The System We’ve Inherited
Posted by Zachary LeonardComment

Zachary LeonardI can truly say logging on to the NCCPA website and seeing I’ve passed the boards was one of the happiest moments of my life. All of the hours spent learning to take great care of patients was worth that feeling.

Like an entire generation of young new MD/DO/PA/NP graduates looking to make a positive impact in this world, I never felt more ready to begin my career. I accepted a dream position working at an Urgent Care in Arizona. This clinic gives me the variety I need to stay entertained, a very supportive staff and the most helpful supervising physician a PA could ever ask for.

However, nothing could have prepared me for the disappointment when I had a major paradigm shift; we’ve inherited a healthcare system broken beyond repair.

Though I expect accusations of pessimism, I realized our American healthcare system is designed to keep you sick and poor. This was not done intentionally, but rather through years of greed, poor regulation and the many variables that add to the skyrocketing cost of care.

My realization began to blossom when a young skateboarder came into the Urgent Care complaining of a broken collarbone. Before I entered the exam room, I saw a pink form creeping out from his chart. He was paying cash for this visit. I walked in the room and was greeted by a college-age gentleman in obvious pain. After hearing his story about a routine day ending in injury, I asked him what made him so sure it was broken. He replied, “I could hear and feel the snap. I’m positive it’s broken.”

When I suggested an x-ray, he began to politely argue the point of it. He asked what difference it was going to make if I’m just going to put a sling on him anyway. Even though I explained why it’s not wise to skip the imaging, I knew without a doubt that his concern was cost. Reluctantly he agreed. The result: displaced clavicle fracture, completely broken in three places.  What followed is what renders us powerless as providers.

I began to educate him about the diagnosis and how my resources were somewhat limited in the clinic. I’m not an orthopedic specialist, but I was confident it warranted a consult. I warned him that a worst-case scenario would be surgery and I would like him to be transferred to the local emergency room for further care.

With a mixed expression of disbelief and hopelessness, he questioned my opinion and asked me to call his father. Within minutes, I was speaking with this boy’s father who was looking for answers. At one point he even asked, “Can’t you just pop it back into place yourself? We don’t have the money for the ER, much less surgery!”

Hearing his desperate attempt to avoid an emergency room visit, I grew angry. What healthcare system makes people feel they need to stay home suffering than seek the care they need? It’s the one we’ve inherited.

New graduates today are at the forefront of tomorrow’s healthcare model. No matter how much training you get or how many hours you study, you can’t do much about a patient who is refusing care. It made me ask myself, “Is this what I’m going to have to deal with the rest of my career?” I would like to think the particular patient in my story eventually made it to the hospital despite leaving against medical advice, but I’m not sure.

My point is not to offer a solution to this healthcare crisis and our imploding system, but to make a prediction that it will inevitably collapse. I don’t think it takes a healthcare provider to see it. With an aging population, comorbidities in epidemic proportions and primary care providers dwindling everyday, this crisis is going to get worse before it gets better.

It’s important all new graduates have this paradigm shift with themselves, because we’re not taught nearly enough in school about life. Healthcare is more than just a field. It is an industry. It stands to reason it is not immune to the same strife as the U.S. banking industry, auto industry or oil industry. Many changes will occur, and we have to be prepared to accept whatever may come and be part of the solution.

I expect all new grads to never lose sight of why they chose this path. Despite the stresses and challenges that come with getting a new job and building a life for yourself, remember the moment you passed your boards and keep your positive outlook a priority for the future.

Zachary Leonard, PA-C, is a 2012 graduate of the King’s College PA program. He is currently practicing full time in urgent care medicine in Arizona and is the recipient of a grant from the Physician Assistant Foundation.

See also: PA Student to PA-Certified: Memories from the Journey by Kimberly Mackey

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