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!