Dr. Joseph Heyman
Alright I admit it, that was a rather provocative title. The truth is that at the end of a recent interview with Dr. Joseph Heyman, the chair of the board of trustees of the AMA, I was in fact chided for having left full time clinical practice. Dr. Heyman was rather avuncular in his tone when he stated,
You are robbing patients of the opportunity to have a good clinician like you involved in their care. I guess it reflects badly on our profession that the best and brightest are making alternative career choices – practicing clinical medicine is becoming unbearable.
No amount of protest on my part (about my volunteer work at Walter Reed) would convince Dr. Heyman that I hadn’t abandoned my profession to some degree. And it touched a chord with me too – because taking care of patients is very gratifying for me in many ways. It was with a heavy heart that I chose to become a medical journalist instead.
And so back to the interview with Dr. Heyman. We had an interesting discussion about the concept of medical tourism:
You may listen to our conversation here, or read my summary below.
Dr. Val: Is medical tourism about people coming to the U.S. for care, or about patients leaving the U.S. to get more affordable care elsewhere?
Dr. Heyman: Historically, medical tourism has been about patients coming to the United States to get high quality care. Nowadays, people are realizing that there are wonderful places overseas where they can seek treatment. If they don’t have a very exotic illness, or require a highly specialized procedure, they can get appropriate care overseas. Hip replacements are a good example of a standard procedure that can be performed without too much difficulty. It wouldn’t be as much of a draw for patients who need hip replacements to come to the U.S.
Dr. Val: How common is medical tourism in the United States? How many Americans are seeking care outside the country?
Dr. Heyman: It’s not very common. Probably less than 1% of Americans purposefully seek treatment outside the U.S.
Dr. Val: Do you think that medical tourism is good for the U.S. economy?
Dr. Heyman: When people travel to the U.S. for care, it’s good for our hospitals’ bottom lines. Some American hospital systems actively promote medical tourism.
Dr. Val: But are we saving on health insurance costs by having lower cost procedures overseas, or are we eroding our own economy?
Dr. Heyman: I think that most people who are going overseas for elective procedures are going because they have an HSA or they are uninsured. Soon health insurance plans will begin to incentivize patients to undergo procedures overseas to lower costs, but that movement hasn’t begun yet. Overall I don’t know if medical tourism is good for our economy or not – while saving money on procedures is a good thing, we’re certainly taking work away from our providers at home.
Dr. Val: How can the U.S. justify an influx of medical tourists when we don’t even have enough primary care physicians to handle our own needs?
Dr. Heyman: I think that’s very problematic. Sometimes it’s harder for a poor patient to find care for a melanoma than it is for a wealthy person to get a botox injection. We have a crazy system here – we need to find a way to insure everybody and make the healthcare system much more rational.
Dr. Val: What does the AMA website report on medical tourism tell us about what’s going on overseas?
Dr. Heyman: It describes the incentives that patients have to go abroad for care. There are very qualified doctors in very beautiful hospitals overseas, many of whom are U.S.-trained. Also there’s the added benefit of having surgery at a vacation destination. However, most Americans are not comfortable taking the added risk, especially since they don’t understand what it takes to become accredited by the International Joint Commission.
Dr. Val: What are some of the health concerns that the AMA has regarding patients who engage in medical tourism?
Dr. Heyman: First of all we think that medical tourism should be voluntary. No one should be forced into going overseas to save a health plan money. On the other hand we think that patients should have choices, and we welcome their ability to make choices about their care. However, the AMA is concerned about 1) patients who don’t have plans in place for follow up care once they get home 2) patients trying to combine a vacation with medical care, and putting themselves at risk by shortening their recovery period 3) a long plane ride too soon after surgery can predispose patients to pulmonary emboli 4) the patient’s ability to receive full disclosure about the risks associated with their elective surgery, and the credentials of their physician 5) patients’ legal recourse in the case of medical errors or unanticipated consequences.
Dr. Val: What’s the most important thing for Americans to know about medical tourism?
Dr. Heyman: People should know that they can get terrific care overseas. But if you’re going to do it, you should understand all the ramifications of doing so – including the credentials of the place where you’re going and the people who are going to be taking care of you. You must make plans for the possibility that something could go wrong both while you’re there or when you return home. With advanced planning and full disclosure, I think that medical tourism is a reasonable option for elective procedures for some people.