Jain Wins Debate With Critique of Fee-for-Service

Debate winner Monica Jain, MD, (left) with Bruce Gewertz, MD, chair of the Department of Surgery, (center) and Jain's competitor, Derek Serna-Gallegos, MD

An overflow crowd of more than 300 people filled the seats and stood at the edges of the Harvey Morse Auditorium on June 5 as Derek Serna-Gallegos, MD, and Monica Jain, MD, faced off in the 12th annual Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition.

Jain, who answered the debate question of "Can Fee-for-Service Medicine Survive?" with a firm "no," was declared the winner. 

Jain, who earned her medical degree from Boston University in 2012 and plans to become an endocrine surgeon, cited spiraling medical costs and a lack of accountability by care providers in the fee-for-service model. While the average salary in the U.S. has risen 38 percent in the past decade, medical costs have risen 131 percent, Jain said, citing a study by the Institute of Medicine.

If food costs since 1945 had risen at that same rate, a carton of eggs would now cost $55, a gallon of milk would be priced at $48, and you would have to shell out $134 for a dozen oranges.

"Perhaps Dr. Serna can afford that glass of orange juice," Jain said to general laughter. "But I certainly can't."

Serna, a 2012 graduate of the Keck School of Medicine of USC who plans to become a thoracic surgeon, had many in the audience nodding and murmuring in agreement as he spoke about the sometimes-disastrous intrusion of insurance companies into patient care.

The managed care model gives people with no medical training the right to oversee and overrule physicians, Serna said. His slide illustrating the exponential growth of bureaucracy within insurance companies since 1970, with insurance company executives who earn upward of $130 million per year, or $90,000 per day, drew gasps.

"Medicine's top earners are not the physicians," Serna said.

Both debaters followed tradition as they took good-natured digs at each other during the debate. Jain displayed several slides, prominently displaying Serna in situations that bolstered her argument. Serna later praised her excellent photo-manipulation skills.

Each debate participant fielded questions from the panel of judges. The panel included Thomas M. Priselac, president and CEO of Cedars-Sinai; Bruce Gewertz, MD, chair of the Department of Surgery; David Cossman, MD, medical director of the Cedars-Sinai Vascular Lab; Sid Anand, MD, of the Salick Comprehensive Diabetes Centers; and Rocky Delgadillo, the former city attorney of Los Angeles and now CEO of the Los Angeles County Medical Association.

After congratulating Jain and Serna, moderator Leo Gordon, MD, praised the debaters' passion and scholarship.

"I have great confidence that we are turning this profession over to capable, humane and dedicated hands," he said.

The next Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition will be held June 3, 2016

The debate is named for the late Leon Morgenstern, MD, founding director of Surgery at Cedars-Sinai. Morgenstern chaired the Department of Surgery for 33 years before leaving the post in 1988 to establish the Cedars-Sinai Department of Bioethics.