Most leaders in health care today know that physicians are the significant
driver of the quality and costs associated with medical care. Because
today payment reform is being driven by the value equation, the traditional
roles providers have played in the past must be transformed. These transformations
are requiring changes in practice style and focus, which many of the older
physicians are finding difficult, supporting the adage that it is difficult
to “teach old dogs new tricks”. And although these more senior
physicians have been educated in medical schools focusing almost solely
on high quality clinical delivery, medical errors are now the third leading
cause of death in the US. And now, these same physicians are also being
challenged to add to their practices a focus on population health and
wellness. This awareness leads to a major question we now face: Can these
senior physicians make the changes necessary to drive higher quality,
service oriented, affordable costs, and appropriately accessible health
care delivery model that will assure success going forward? And even if
they can, will the changes be made fast enough and will they be sustainable?
Perhaps, while we are seeking these answers, we should be focusing simultaneously
on another approach – teaching young medical students as early as
possible about the delivery strategies and processes that will not only
make them more successful, but also give their patients better clinical
outcomes. It has been proven that new tricks will always be learned more
quickly by “young,new dogs”. It only makes sense, then, that
if physicians are going to have to comprehend and embrace new ways of
practicing they must now focus, not only on acute care but, also chronic
care, wellness, population health management, and costs. The best approach
would be for them to learn about all of this during their four years in
medical school.
Fortunately, the faculty of some medical schools are adding to their curriculum
some courses which will provide these new learnings which must be integrated
into the clinical delivery processes. Although the numbers of schools
doing such at this time are small, they are the getting attention of the
press and the medical profession. Hopefully, the improvement of care rendered
by their graduates will begin to prove that these educational changes
are making a difference in medical outcomes and wellness for the populations
that are serving.
One recent example is outlined in an article entitled “The Medical
School Teaches Health Policy Along with the Pills”, by Julian Rover.
It describes how George Washington University Medical School is requiring
their students in their first year to work in teams to explore policies
and procedures that could address public health issues and improve chronic
illnesses. Two examples detailed included unique recommendations for dealing
with childhood asthma and HIV/AIDS. Each team was required to present
their solutions not only to internal audiences, but also external agencies
and policy makers who could potentially fund and support their improvement
recommendations. It only seems reasonable that these students, having
experienced these educational opportunities early in their careers, would
have a better chance of embracing population health and chronic disease
management as a key part of their professional care delivery.
Could this same approach be used to study and seek solutions to an array
of other issues contributing to the alarming number of poor medical outcomes?
These might include:
- Overuse of medical treatments and studies
- Misuse of medical treatments and studies
- High cost of pharmaceuticals
- Variable costs and outcomes within medical staffs and across different
geographical locations
- Price variations in medical supplies
- Lack of teamwork between physicians and nurses
- Lack of willingness to work with nurse practitioners and physician assistants
- Payment reform moving from fee-for-service to pay-for performance
This is only a representative list of the issues which must be addressed
in an integrated fashion by physicians working with other health care
leaders if the value equation is going to be achieved. It is abundantly
clear that the transformation strategies that must be implemented to make
this happen are occurring much too slowly, and, in fact, meeting much
resistance by some physicians who are unwilling to embrace change. While
we have to continue working to “teach these old dogs new tricks”,
we will make faster and more sustainable positive changes by working as
early as possible with the “new dogs”, these young physicians
who have the future of healthcare in America in their hands!