Recently, Medscape Editor-in-Chief Eric J. Topol, MD, interviewed prolific author Malcolm Gladwell, who contended, “The world of health care does a very bad job of storytelling about itself. It represents itself to the public very poorly. The gap between the reality of medicine and the way the public thinks about medicine is growing, not shrinking … What is so striking when you talk to ordinary, front-line doctors is how frustrated and unhappy they are in the present day with the way that their workloads have shifted, how their status in society has changed, and the way that [changes have been] pushed on them so that their own interests are last.”
Since the beginning of my medical education, I have seen a knowledge gap amongst our colleagues — medical students, fellow residents, new physicians — regarding the health care system in the United States. This obvious gap spurred me along with a group of fellow students to start a conversation with providers at all levels of training across the country. From these discussions, a consistent theme emerged: Nationally, our current medical education model fails to address the fundamental tenets of the U.S. health care system, health care policy, and business management. Despite the recent major shift in health care policy, medical schools have proved universally inept at equipping future doctors with the knowledge and tools they need to influence policy in their professional field and to thrive in their careers. In today’s milieu, schools remain deficient in health care policy teaching. As a result of this curricular deficiency, students graduate ill-equipped to face challenges arising later in their medical careers. Even students at medical schools with a dedicated health care policy course lack a sound understanding of the United States system (and the ways in which doctors make their voices heard) due primarily to variations in course length, structure, and content.
At its crux, the problem is twofold. First, the majority of trainees and professionals in the medical field lack a fundamental knowledge of the U.S. health care system, business, and policy. Second, the medical community is not prepared to tackle the future of health care or address and inspire policy change on a grand scale.
In contrast to many other professions, medicine remains unique in that the majority of our training is devoted to perfecting one aspect (i.e. patient care) of the role, often leaving the skills needed to be a successful professional in today’s business and political environments underdeveloped. Current health care policy remains in flux. Now more than ever, physicians need a centralized resource that is accessible and reliable to keep up with the changes.
The ubiquitous tide of complaints arising from within the medical community — from medical students to attendings — demonstrates the need for a fundamental change in our medical education system. A quick Google search yields a sundry list of issues that doctors across the nation have with the current state of health care. Furthermore, as students, we have witnessed firsthand physicians who feel as though their voices are unheard when it comes to promoting meaningful change. Essentially, as a direct result of the current structure of medical education in the United States, future and current doctors are ill-equipped to address the many issues plaguing our health care system. This negatively impacts both physicians and medical students and also has catastrophic consequences for their patients.
The deficit of knowledge in these areas within the medical community translates into a loss of control over our own profession. While physicians and medical students have interest groups to help mobilize and promote legislation to varying degrees, their efforts are stifled by limited health policy education and information. Despite the presence of an extremely knowledgeable minority, the responsibility of dictating the structure of U.S. health care falls on people outside of the medical community such as special interest groups, politicians, pharmaceutical corporations and insurance companies.
Countless examples of the negative outcomes that follow when physicians lack a comprehensive understanding of the business and economic dimensions of their profession reveal dangerous consequences. For instance, frustrated physicians are leaving the medical community at a time when the shortage of physicians becomes greater every day. Primary care physicians and other specialists are turning to alternative business models such as refusing insurance and converting their practices to prepaid services, which inadvertently creates inequality in patient care and targets economically disadvantaged patients. Medical students are making career decisions due to misinformation and misunderstanding of the financial aspects of medicine, including the omnipresent notion that repayment of exorbitant loans requires subspecialization.
Many argue that doctors ought not to be concerned with policy and business, but rather should focus on patient care, research and clinical knowledge. Although patient care is paramount, failing to understand the health care system does not have isolated effects. Ultimately patients also suffer, as their physicians are unable to properly advocate for them. It is only logical that physicians, who have dedicated a large portion of their lives to medicine, are able to brainstorm novel ways to improve our system. However, if the same providers do not understand the system, and more importantly how to promote change, their ideas will be functionally useless.
Given these problems, it is clear that a radical change must commence, which leaves us with questions. What kind of change do we need? More importantly, how can we begin to effect such a sweeping reform?
One promising and innovative approach involves the development of a novel curriculum aimed at educating medical students, residents and attending physicians on the key tenets of the U.S. health care system affecting policy and business. The curriculum would ideally be an interactive, multidisciplinary course that is utilized longitudinally through all four years of medical school and beyond. It would be structured in a manner that does not leave healthcare policy by the neglected in medical education. The curriculum would produce physicians confident in navigating the challenges in health care.
While not every physician or medical student has an interest in the economics or legalities of health care, many students would like to have a voice in the field but are untrained to do so. However, it is increasingly difficult to find the time to learn beyond diseases and their treatments. An appropriate compromise could be to offer this novel curriculum on an elective basis. This follows the precedent set by many schools around the nation that offer optional electives (medical humanities, etc.) for interested students to pursue.
If health care professionals are not able to tackle problems in their own profession due to a lack of knowledge, then the future of health care will be steered by unknown — and perhaps unqualified — entities. We contend that physicians are best suited to lead this change. In doing so, physicians will be able to advocate for policies that simultaneously improve their own career satisfaction and, most importantly, benefit patient care. A novel medical school curriculum is necessary and should provide health care system, business and policy education in a succinct and direct manner accessible through multiple modalities. Through early integration in our training, we can have a better foundation to mount an attack on health care economy and policy issues. By developing an understanding of our own health care system, we position future physicians to have a stronger voice in shaping their careers and patient care. An emphasis on U.S. health care policy in medical education equips physicians with not only the understanding but also the tools needed to inspire change that benefits patients, physicians and our national health as a whole.