The country is at a crossroads with unmet healthcare needs. Demand is increasing across age groups, the population as a whole is aging, costs are going up and physician shortages exist in a significant part of the nation. We see the biggest gaps in primary care and general practice–where a majority of patients seek care–all while we struggle to integrate new technology and efficiencies into the decades-old system. Further, practicing physicians do not necessarily reflect the racial, ethnic and religious makeup of their patients. When looking for ways to improve our broken system, the way we educate the next generation of doctors, and what we prioritize for our medical school cohorts, is a fundamental place to begin. Below are seven areas our medical school system needs to be reformed for real change to take place: Incentivize Geriatric Care Those who specialize in geriatric care are few and far between, primarily because they are paid less than their counterparts (Medicare reimbursements are generally lower). This is in spite of Baby Boomers having the greatest need in the United States and those over 65 being the fastest-growing age group in the country. Specifically, the estimated medical need for geriatricians is around 25,000 by 2030, but currently, there are just over 7,500 practicing in the U.S. The over-65 population grows by about 10,000 people every day, and has more comorbidities and worse health than the rest of the nation. This means more complications, more care, longer appointments and more costs. Although the Silver Tsunami is at our doorstep, medical schools have failed to train our younger practitioners to properly meet this cohort’s need. In fact, an astonishingly low eight of the country’s 145 academic medical centers have a full geriatrics program. Stop Forcing First-Years Into Specialties Medical schools in the U.S. encourage students to choose a specialty early. The medical profession as a whole does the same, incentivizing medical schools and students to behave this way. Despite primary care being the backbone of the healthcare system, specialists tend to make more money. They also tend to have more prestige. Therefore, U.S.-born medical students tend to choose more specialized fields than foreign-born counterparts. Until pay structures and incentives align with the most care needed, we will continue to see students rushing into high-paid subspecialties and specialties like dermatology. Utilize Non-MDs In Training And Practice While licensure and regulations are very contentious subjects in the medical field, the future is based on team dynamics that promote cost-effective outcomes. Teamwork means that training physicians have to be taught how to utilize and integrate alternative providers into their way of thinking. This begins in school. Although physician assistants, nurse practitioners and the like are not substitutes for medical doctors, they are exceptionally important complements that are not employed enough. Beginning as early as medical school, it is advantageous for providers to learn to harness the skills of their peers, as well as practice working in dynamics that reflect the broader health system. Incorporate Technology, Biotech And Business Curriculums in many schools around the nation have not changed in decades. While there are a few exceptions of programs incorporating business skills, entrepreneurship and technological education, there is a notable gap in training new physicians on new technologies. In fact, there is such a gap that in 2014, theInstitutes of Medicine (IOM) reported that for more successful medical practitioners, graduate medical education needed to incorporate innovation. We’ve seen example after example of how much physicians struggle to incorporate new technologies into their practices, as well as become entrepreneurs themselves. With business and creative thinking skills worked into the medical curriculum, providers will be better equipped to improve their work practices and introduce creative ideas into a decades-old field. In this May 11, 2016 photo, University of Massachusetts Medical School medical student Melanie Dubois, standing, speaks with an actor-patient coping with addiction during a simulation at the medical school in Worcester, Mass. Immigration Reform The Conrad 30 J-1 Waiver Program allows foreign-born graduates from U.S. medical schools to remain in the United States post-residency if they practice in a Health Professional Shortage Area (HPSA) for no fewer than three years. However, with just 30 waivers allotted per state, the number of these physicians still falls far short of demand. When foreign-born practitioners go into general practice and primary care more frequently than their U.S.-born counterparts, it is imperative that we not limit their potential and reach. Further, they are able to bring new knowledge and culturally competent care practices into our health system. As the nation continues to diversify, a multi-cultural care team will be a top business priority. Teach Culturally Competent Care Currently, it is estimated that only 4% of physicians in the country speak Spanish. This is compared to the U.S. population, which is estimated to be 17% Hispanic–numbering 55 million people. According to Pew Research Center 2014 census data, this estimate is expected to increase to 119 million people–almost 30% of the population–by 2060. At the core of this communication issue is trust in the system and access to care that reflects personal preferences. Minorities of all kinds utilize the health system less than their white peers, and having providers that reflect the U.S. population (racially, ethnically and religiously) is imperative for better outcomes. Improve Incentives To Work In Rural Areas The United States has seen a significant migration in the last few decades to metropolitan areas. This is particularly true for those with college and graduate degrees. Therefore, the physician shortages are growing more rapidly in less populated areas. Additionally, there is not a large enough population in rural areas to sustain specialty practices, open more medical schools or provide many services that are needed. Add in difficulties with keeping young medical professionals due to lack of opportunities, and the shortages are going to continue escalating. Although there are loan forgiveness programs for those who work in rural areas, they are not enough. More incentives and better access to telemedicine and technology are needed. Source
