Laura Finkelstein, a clinical assistant professor of pediatrics, has been teaching at the University of Maryland since 2001. She tries to help students see that even in the most flawed of systems "little victories are real victories." And the doctor wrestles with giving students an honest look at what they'll face in the real world, without turning them away from primary care.
"I talk to them about the art and the science of medicine - and then there's the game of medicine," she says. "How do you make people feel cared for and comforted but also still pay your staff and make the bottom line? It has become a game."
She says she would like to take the time to sit Baltimore teenagers down and talk to them about pregnancy prevention. But, as she puts it, "That time is reimbursed less than if I would take solution and freeze a wart on a child's finger."
She adds, "It's hard to tell someone to take a look at one of the least reimbursed areas in medicine [primary care] and tell them they can get their bills paid because they probably can't."
The average medical student leaves Maryland with $142,000 of debt, says Mandeep Mehra, a professor and head of the cardiology department. "You'd think at a state school it would be reasonable here. This is a huge, huge issue for the students and they worry."
Moreover, if, as many hope, health care reform involves a greater emphasis on preventive care, that only means more work for the already-diminished primary care front lines. And as things stand, hospitals don't have the financial wherewithal to add more postgraduate training positions, Mehra points out.
"How are you going to encourage and recruit doctors to take care of these people?" Finkelstein asks.
Adds Mehra: "Who knows what the future of family medicine will be?"
When Nidhi Goel was a little girl, scalding hot tea splashed onto her leg, badly burning her tender skin. She's 28 now, and can hardly remember the pain - just her parents telling her over and over how lucky she was to have had doctors that treated her so gently and so skillfully to prevent scarring.
"Any time you asked me growing up I would have told you I wanted to be a doctor," says Goel, a fourth-year medical student at Maryland. "I loved my physicians growing up. ... I wanted to be that person."
And, unlike many of her young peers, she still does.
