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Medical Futures


By Grace-Marie Turner, Galen Institute 

I accept virtually every invitation I receive to speak to students studying to enter the health field—whether in medical school or in policy or public health.

Earlier this month, I spoke virtually to a group of medical students as part of a summer lecture series hosted by a major university. It would be an understatement to say they don’t accept the idea of a market-based system that would provide physician autonomy and patient choice.  

They see their futures as part of a single-payer, government-run health system.  If any of the students disagreed, they did not speak up.

But then…

I had a chance to sit down with two medical students attending a different major university who give me hope because they seek the patient-physician autonomy we have fought to foster for nearly three decades at the Galen Institute.  

These two said most of their fellow students also want a government-run system and disparage any discussion of alternatives.   

Interesting fact:  One told me they have so far had nine hours of classes in how to use the proper pronouns with patients and colleagues, compared to only one hour of study on lung cancer.

Then we learn this:  Primary care providers say field is ‘crumbling’. A new study documents the unhappy plight of too many primary care physicians today.

Three years after COVID hit, primary care providers remain overwhelmed, burned out and pessimistic about the future, with many seeking alternative forms of employment.  

“This is, perhaps, not surprising given that physician payment in the Medicare program declined greatly between 2001 and 2023 after adjusting for inflation in practice costs and that a large majority of physicians describe the burden associated with prior authorization as high or extremely high,” the American Medical Association report noted.

Staffing shortages means doctors have to do more administrative tasks, tasks which are ballooning. Not surprisingly, the AMA finds that the percentage of physicians working in private practices across the U.S. continues to decline as hospitals, private equity firms and payers acquire physician practices.

The way to solve the primary care shortage is to create a different platform for physician practice.  Dr. Lee Gross and his colleagues are pioneers in advancing an alternative practice model called Direct Primary Care—a model that puts doctors and patients in charge of medical decisions.

DPC physicians are paid through direct monthly or annual membership payments from their patients. This model reduces overhead costs and allows doctors and patients to work together in structuring care arrangements.  Most patients find that DPC is less expensive than traditional coverage, even with the major medical insurance they also purchase.

I also have spoken to gatherings of these doctors—the happiest, most optimistic doctors I know.  More on this to come…


And to follow up on our report from last week, Sen. Bernie Sanders proposed and added to a bill reported out by the Health, Education, Labor, and Pensions committee he chairs a measure to give “prizes” for pharmaceutical development.

It provides a $3 million grant to study “alternative models for directly funding, or stimulating investment in, biomedical research and development that delink R&D costs from the prices of drugs.”  

In effect, Sen. Sanders want to replace patents and competition with a “prize” the government would give to companies that succeed in developing a new drug.  

The House version of pandemic preparedness bill does not include a similar amendment, and hopefully it will drop this destructive provision. 

The Sisyphean battles continue…


Grace-Marie Turner runs the Galen Institute, a public policy research organization that she founded in 1995 to promote an informed debate over free-market ideas for health reform.