Carrying On the Timeless Mission of Medicine

It’s easy to think of the times we live in as unprecedented—for each of us, it is. Yet, as we all know, history repeats itself, and our experiences are usually not quite as unprecedented as we think. You might vaguely recall the name Galen as the eponym for the great cerebral vein; he discovered it during his many vivisections. Galen, in addition to being one of the pioneers of sports medicine (he was the physician to Roman gladiators and reduced their mortality rate greatly),¹ became the physician to Commodus. Commodus, as you may remember, was the basis for the antagonist of the movie “Gladiator,” and I’m guessing that, as boss, psychological safety was not high on his list of priorities. To add to Galen’s plate, Rome was struck by the Antonine Plague (likely a form of smallpox) while he was the emperor’s physician, and in fact, it became known as the Plague of Galen because of his association with it. (By the way, if I can retire without the onset of the Plague of Weijen, I’ve succeeded in my career.) During this challenging time, Galen was paraphrased as saying, “It is easy to be a physician in peace, but the true test comes when the whole city is besieged by war or famine, when resources are scarce, and the physician must be both healer and innovator.”²

Fast forward to modern times, and the medical community in the U.S. is grappling with rapid-fire changes in our systems of funding, training, and prevention that have raised concerns about whether we can maintain our ability to care for our patients. Highest on the minds of many physicians are the potential cuts to Medicaid funding in the most recent budget passed by the House, which is awaiting a vote in the Senate at this writing. According to the Congressional Budget Office, the bill would reduce federal Medicaid spending by approximately $723 billion over the next decade, an 11% drop in funding over that time.³ These cuts would affect all states, but those in the South, which have the highest percentages of their populations covered by Medicaid, would suffer the most.⁴ TennCare, the state Medicaid plan for Tennessee, would stand to lose approximately $1 billion, forcing Vanderbilt University Medical Center to cut $250 million from its upcoming annual budget.⁵ As a result, many states would be forced to drop coverage for numerous Medicaid recipients, leading to higher levels of uncompensated care, increased emergency department burdens, and ultimately, sicker patients requiring more intensive and costly care.⁶

Concurrently, the U.S. Department of State has temporarily halted scheduling of new J-1 visa interviews, affecting exchange visitor categories, which include resident physicians. This could lead to delays in many incoming residents from international medical schools being able to start their residency programs, and further tax hospitals administratively.⁷ Attending faculty physicians may have to pick up the work that cannot be covered due to delayed resident physicians, disproportionately in rural and underserved hospitals’ residency programs. In addition, the recently announced plans to revoke Chinese student visas would further delay international medical graduates (IMGs) from China who matched into U.S. residency programs. While IMGs from China are a relatively small percentage of the overall IMG population in U.S. residency programs, they represent a larger percentage of residents in certain specialties, such as internal medicine, family medicine, and neurology, which form the labor backbone of many hospitals.⁸ In addition, the chilling effect of these sudden edicts from the State Department will likely dissuade IMGs from considering U.S. residency programs. As 37% of internal medicine and 21% of pediatric residents are IMGs, any drop in the IMG interest in U.S. residency programs could prove to be devastating to the ability of these programs to fill their spaces.⁹

Finally, our ability to protect our patients—and ourselves—from emerging zoonotic diseases like avian flu has been compromised by the recent cancellation by Secretary of Health and Human Services Robert F. Kennedy Jr. of funding for Moderna to develop an mRNA-based bird flu vaccine. While non-mRNA vaccines for H5N1 are available, having redundancy in our ability to control the outbreak of emerging infectious diseases is a cornerstone of epidemic control. During the COVID-19 pandemic, more than 90% of all COVID-19 vaccine doses were mRNA-based.¹⁰ The ability to scale up production is possible for mRNA vaccines due to the lack of need to grow large quantities of virus in eggs, cell cultures, or bioreactors.¹¹ As we know, it’s only a question of when, not if, the next pandemic will descend upon the U.S. and the rest of the world, and controlling it with rapidly scalable vaccine production and coordinated outbreak responses will be critical. But with the recent firing of the entire Advisory Committee on Immunization Practices, followed by the direct appointment of eight members by Secretary Kennedy, relying on the federal government for objective and unbiased recommendations seems unlikely. ¹² (Read SHM’s Statement on Firing of Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention.) 

As a hospitalist, hospital administrator, or medical educator, the confluence of these changes may feel like an insurmountable challenge to your ability to deliver care and education. But while Galen faced the overwhelming pressures of plague, war, and a difficult work environment, he also recognized the key to serving our patients—innovating, adapting, and continuing to focus on our patients and educating the next generation of clinicians. By coming together as hospitalists, educators, and advocates, we carry on the timeless mission of medicine: to protect life, champion equity, and find new paths even when the road seems uncertain. While the road ahead may be unclear, as another great physician, Paul Farmer, once said, “… an area of moral clarity is: you’re in front of someone who’s suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.”¹³ This moral clarity extended to his advocacy for changing systems to improve care, “since we had created the current inequitable health care delivery system, only we could change it.”¹⁴ While the future of the U.S. healthcare environment will be unpredictable in the near future, as hospitalists, we must continue to follow in the steps of Galen and Paul Farmer—innovating, advocating, educating, but most importantly, focusing on improving the health of each of our patients.

Dr. Chang, the physician editor of The Hospitalist, is a pediatric and adult hospitalist at Baystate Medical Center and Baystate Children’s Hospital, an associate professor of pediatrics at the University of Massachusetts Medical School Baystate, and chief of pediatric hospital medicine and vice-chair for clinical affairs at Baystate Children’s Hospital, all in Springfield, Mass.

References

1. Shoja MM, et al. The Roman Empire legacy of Galen (129-200 AD). Childs Nerv Syst. 2015;31(1):1-5. doi: 10.1007/s00381-014-2467-7.
2. Littman RJ, Littman ML. Galen and the Antonine plague. Am J Philol. 1973;94:243-55. PMID: 11616517.
3. Euhus R, et al. Allocating CBO’s estimates of federal Medicaid spending reductions and enrollment loss across the states. KFF website. https://www.kff.org/medicaid/issue-brief/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-and-enrollment-loss-across-the-states/. Published June 4, 2025. Accessed June 6, 2025.
4. Whitener, K. Federal Medicaid cuts would harm state GDP, credit ratings, jobs and health systems. 2025. Georgetown University McCourt School of Public Policy Center for Children and Families website. https://ccf.georgetown.edu/2025/05/02/federal-medicaid-cuts-would-harm-state-gdp-credit-ratings-jobs-and-health-systems/. Published May 2, 2025. Accessed June 6, 2025.
5. Sweeney C. Vanderbilt University Medical Center will cut at least $250M as federal government slashes health spending. WPLN News website. https://wpln.org/post/vanderbilt-university-medical-center-will-cut-at-least-250m-as-federal-government-slashes-health-spending/. Published March 30, 2025. Accessed June 6, 2025.
6. Haught R, et al. Federal cuts to Medicaid could end Medicaid expansion and affect hospitals in nearly every state. The Commonwealth Fund website. https://www.commonwealthfund.org/publications/issue-briefs/2025/may/federal-cuts-medicaid-could-end-medicaid-expansion-affect-hospitals. Published May 22, 2025. Accessed June 6, 2025.
7. Jeyaretnam, M. Why the Trump administration is pausing new student visa interviews at embassies across the world. Time website https://time.com/7289060/us-student-visa-interviews-paused-embassies-trump-social-media-vetting/. Updated: May 28, 2025 11:30 AM ET. Accessed June 6, 2025.
8. Duvivier RJ, et al. The contribution of Chinese-educated physicians to health care in the United States. PLoS One. 2019;14(4):e0214378. doi: 10.1371/journal.pone.0214378.
9. Report on residents executive summary. AAMC website. https://www.aamc.org/data-reports/students-residents/data/report-residents/2021/executive-summary. Published 2021. Accessed June 6, 2025.
10. El Kalach R, et al. Federal retail pharmacy program contributions to bivalent mRNA COVID-19 vaccinations across sociodemographic characteristics —United States, September 1, 2022–September 30, 2023. Morb Mortal Wkly Rep. 2024;73(13) :286-290. doi.org/10.15585/mmwr.mm7313a2.
11. ‌ Pardi N, et al. mRNA vaccines — a new era in vaccinology.Nat Rev Drug Discov. 2018;17(4):261-279. doi: 10.1038/nrd.2017.243.
12. DeGroot, L. (2025).Kennedy’s vaccine panel contains skeptics, nonspecialists – Roll Call. [online] Roll Call. Available at: https://rollcall.com/2025/06/11/kennedys-vaccine-panel-contains-skeptics-nonspecialists/ [Accessed 12 Jun. 2025].
13. Prsytowsky, J. Reflections on my hero, Paul Farmer. Santa Barbara Independent website. https://www.independent.com/2022/02/24/reflections-on-my-hero-paul-farmer/. Published February 24, 2022. Accessed June 6, 2025.
14. Rosenbaum, L. Unclouded judgment — global health and the moral clarity of Paul Farmer.N Engl J Med. 2022;386:1470-1474. doi.org/10.1056/nejmms2203232.