In June, the United States Supreme Court began to deliberate over whether medical residents qualify as graduate students to receive a federal payroll tax exemption. In the grand scheme of the Great Health Care Debate, whether residents receive a tax break may seem like a minor issue, but the result of Mayo v. U.S. holds significance for the next generation of health care providers and consequences for the primary care provider shortage.
As a medical student, I have found that journey to become a doctor is measured far more by numbers than it should be. The minds of premedical students are bloated with exam scores, grade point averages, medical school rankings, and community service hours. Still, we press on because of that one patient encounter that taught us that the greatest gift of being human is to manifest care to fellow humans and we just cannot get enough. As a result, every hopeful doctor’s medical school admissions essay contains one prevailing theme: the desire to be helpful in the world. We reconcile that the road towards doing good is paved by doing well.
When we finally enroll in medical school, the adding and subtracting is far from over. We still obsessively count the numbers on the library clock as they tick tock closer to exam time, but the burden of the numbers grows heavier and this time these numbers have dollar signs in front of them. The American Medical News reports that average debt for medical students graduating in 2008 was $155,000, a whopping 53% increase from 1998. After medical school graduation, resident stipends currently average about $45,000. This amount not only represents the starting salaries our college roommates made out of college half a decade prior, but also is eaten up by medical school loan repayments.
As the former student chapter president of the American Medical Women’s Association at my medical school, I can testify that a popular life-work balance topic is the concern that we might have trouble financially supporting a family during our child-bearing years. The consequence of this fear is that we doctors-in-training feel pressed towards higher-paying specialties and away from primary care, even when it represents the doctoring that many students came to medical school to deliver in the first place. It is heartbreaking that we students feel like we cannot afford to provide primary care at a time in our country’s history when it is needed so acutely.
According to a brief filed by then-Solicitor General Elena Kagan, medical residents putting in the usual 40 hours or more of work per week should be considered employees and not students. This statement utterly misrepresents the reality of the average 70-80 hour workweek that a medical resident faces. As the amicus brief filed by the Mayo Foundation and the University of Minnesota explains, residents’ work is designed to be educational, not vocational. The Supreme Court needs to understand that when I toss my cap at my medical school graduation, school will have just begun. The human body is tremendously complex, and the foundation of the medical profession is to provide the highest standard of care available, which requires an extraordinarily high level and amount of training and instruction.
Oral arguments begin in November.