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First year med students attending a pharmacology lecture at Case Western Reserve University.
A group of first year Case medical students. They talked about how changes in health care have, or have not, impacted the career choices they are making.

The duties facing today's doctors have changed along with the nation's health care delivery system. In reaction, medical schools have adjusted their curricula. Future doctors are now learning more about public heath, and legal and business issues... In part three of our series, "What You Don't Know Can Hurt You," we find out how medical students are reacting to the changes.....

WKSU's Kevin Niedermier reports:

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Morgan: I don't think I'll ever experience the way that things once were those golden years.

Morgan Richards is a first year med student at Case Western Reserve University....

Morgan: The medicine for me is gonna be, is gonna have lawsuits, is gonna have difficulties with insurance and that's sort of gonna be something not that I have to get used to but something that maybe I can help improve or would be a factor that will always be there.

Most new med students, are being taught how to traverse the of insurance maze...and the about the pitfalls of malpractice suits ....

At The Northeastern Ohio Universities Colleges of Medicine, fourth year student Tiffany Zellman has seen how treatment procedures have changed in reaction to malpractice threats....

Zellman: I have definitely seen certain decisions being made, and you know, the emergency room, or we'll keep patients in the hospital longer than we might have in the past and run more tests than um maybe necessary just because if you miss something you are afraid that the family is gonna come back and sue you. You never want to miss cancer or anything like that, so know you might order the actual CAT scan and do things like that, so yeah, I think lawsuits and other legal stuff of medicine has definitely played a part in how we practice. Unfortunately.

Zellman now plans to be an internal medicine doctor...but may decide later to go into a higher paying specialty. Second year NEOUCOM student Brian Man-nillo says he believes he's on the path to a stable, rewarding career in medicine...but conversations with some veteran physicians have added a bit of caution....

Minnillo: Some were bitter here, some said it's change a lot, you know I was a little apprehensive getting into it, you know, make sure you really wanna know go into it before you make that commitment, 'cuz it is a long call. Um, some of them talked about insurance um issues, you know malpractice issues, um but just insurance in general, problems with that. Not not knowing where the field is going. Um so I was apprehensive but I still just kind of said it will work, you know in my mind thought its gonna work its way out, I'll deal with it when I get there type of thing.

Minnillo is un-decided on whether he will become a primary care doctor or go into a specialty..... Primary care doctors are in short supply, and about half of NEOUCOM's graduates go into that field. But it's still a tough sell for many students with one-hundred or more thousand dollar loans to pay off.

Minillo: Until the the salary is higher in those areas they are most likely not gonna stimulate, you know, no matter how much you force people out to see these things, a lot of it is driven by the golden dollar, but, you know, I think it has affected me, 'cause you know you have these loans, I mean, yeah, you know, over hundreds of thousands, you know, mid hundred thousand, hundred and fifty thousand dollars of debt, you know, you are worried about the malpractice insurance. I don't know, I think some people it doesn't bother them, others it does. In the end you have a decent job that you are gonna be stable for a while, um I think its just student dependent, you know, but it could play a role. In mine I don't think it specifically has yet.

Dr. Dan Wolpaw is clinical curriculum coordinator at the Case Medical School.....

Wolpaw: Being a primary care physician, I think there are some very interesting and rewarding ways to make a living as a primary care physician. Um and there are a variety of models out there, but I think that students often see individuals who are working a lot and not getting a lot of positive feedback from our society or making relatively speaking a lot of money in our medical care system. And there are physicians who don't work as hard, have interesting jobs and, um and make a lot of money. And that impacts how people make career decisions.

First year Case Med student Anna Lee J Bowlen says she's fortunate to be able to pursue a career as a primary care doctor and says warnings that she's making a financial mistake don't really bother her.

Bowlen: No, its its something that people always tell me as soon as I tell them I am interested in family medicine. Um but I've sort of luckily and fortunately grown up in an environment where cost wasn't an issue in the sense that if you wanna do something, family will help you do it and I think its all relative. People say it doesn't pay as much but its all relative. I think I'll be comfortable and I'll be happy and be able to do what I love, which is more important.

Regadless of what they choose...Public health and preventative medicine have also become a bigger part of medical training as health care costs rises and millions of Americans remain un-insured. Cuyahoga County Health Commissioner Terry Allen's department has a working relationship with students at the medical school....

T. Allen: We can expose them to a whole range of things. They can understand the challenges that some of their patients may face. We can get them out on some home visits and they see a family coming in and they are finding out that the child is not controlling their asthma well. Well, they may get out to a home visit, see that the family has challenges with just getting the children too to the practice. It may be multiple bus routes. They may be just dealing with pressures of jobs. And the challenges that, that surround that, with the welfare to work conditions, particularly with children in families in poverty. And then they may see that the family is just trying to put food on the table, and roof over their head. And they begin to understand, that a lot of these other issues have to be addressed before the family can begin to think about asthma. It's a bit farther down the list. And so, I think that's just one instance where some practical experience can help them I think in their practice to be better advocates for their patients and understand, I think, better ways to have an impact on their conditions.

First year Case medical student Allen Chanda, has a masters in public health, and has spent time in emergency rooms, where many uninsured go for primary care.....

Chanda: Its inspired me to do more community work because, you know, my eyes are getting opened. I am seeing where the issues are, am seeing where the patterns are, and this is my public health coming into play. Um, and wanting to set something up, and, you know, being in a dual degree program, as I told you, I am receiving the tools to be able to assess, to be able to, you know, develop um outreach projects, to be able to, you know, to look at data, to see trends and so on.

High hopes mixed with concerns about the future are hallmarks of most medical students.....as NEOUCOM student Tiffany Zellman points out....

Zellman: So yeah, you question all the time, but then, when you go into a patient's room and you are doing what you love to do every day, it makes it worth it. So...

I'm Kevin Niedermier....89-7 WKSU....

Listener Comments:

well,guess as med stds we have a whole lot of choices to make concerning the specialty to delve into.for me i believe that the specialty i have satisfaction in ...i will venture into...thinking of primary health care though

Posted by: stephanie nigeria (nigeria) on December 3, 2008 11:48AM
well your right lead can kill you

Posted by: Anonymous on February 4, 2008 4:50PM

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What You Don't Know Can Hurt You is presented with support from the Area Agency on Aging, the Center for Community Solutions and the Greater Akron Chamber of Commerce.