Josh Lesko, MD

Josh Lesko is a flight surgeon based in San Diego, California, writing about health policy, organized medicine, and whatever else comes across his news desk.

What the Government Shutdown Means to You

It turns out that as medical students, the amount of time we sacrifice to the gods that are basic sciences and clinical rotations is so great that the world of current events can pass us by. But one event that I can’t in good conscience let you ignore is the government shutdown. It’s easy to turn your textbooks into an impenetrable Fort Kickass, but the implications of this quandary reach even into the hallowed halls we construct to insulate ourselves from the outside world. First, a little background. Our country every year must pass a budget that guides our spending. Realistically, it’s like giving an 18-month-old a paint-by-numbers and expecting a masterpiece, but it gives us a place to start. A federal budget is typically proposed by the President and then Congress takes this recommendation, passes a law, and then sends a final version back to the White House for approval. And then unicorns go dancing across the rainbows of Bubblegum Canyon. Since 1997, shockingly, this happy little agreement has failed to materialize. Because of the Antideficiency Act, in the absence of a budget, all government activities must stop (turns out it’s illegal to spend government money without it being allocated, who knew?).  To avoid this, Congress relies on the well-loved stop-gap approach, in this iteration known as a “Continuing Resolution,” that provides structure for the funds and allows...

Your Future, Our Fight: #SaveGME

Is it worth it? If you’re a med student, at some point between daily reading, studying for the next test, preparing for Boards, or relearning the pertinent physical findings for a Shelf, you have asked yourself this question. Well, have I got an answer for you.  It turns out that there’s a chance that after four years of medical school, X number of “years of opportunity” before that, college, and whenever you first heard the calling, you might not even have a residency…So relax! Now before you faint, a little background.  Part of Medicare’s mission, as established in 1965, is to help fund Graduate Medical Education (GME) costs.  This support comes in two flavors: Direct GME and Indirect GME.  The Direct program uses $3.5 billion each year to pay residents, compensate physician teachers, etc.  The Indirect program pays $6 billion to hospitals to offset the higher costs associated with being a teaching institution.  That’s a grand total of roughly $9 billion every year.  Still with me? Along comes the (recent) present and, amidst a confluence of politics including a desire to not look like that classmate who’ll always “get you next time”, the Budget Control Act established automatic 2% cuts across the board for every government program.  Medicare, and by extension, GME, is one of these programs. In addition to this, President Obama’s 2014 budget plans to cut $11...

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