Today's newly minted doctors face a completely different practice environment Here at Thomas Jefferson University, we are looking forward to the May commencement ceremonies that will launch new careers in the healthcare industry. Recently, I was invited to address the 4th year class of medical students at our Sidney Kimmel Medical School on the topic of "How Your Practice World is Changing," as part of their Gateway to Internship 2017 Program. As I mulled over my presentation, I reflected on my own transition from medical student to real-world practitioner a few decades ago, and was immediately struck by the radically different landscape that will confront our newly minted physicians. The information I shared with them does not appear in the typical medical school curriculum, but it is vital to their insights into their profession in the 21st century. For example, I explained how two reports from the National Academy of Medicine (formerly the Institute of Medicine) -- "To Err is Human" (1999) and "Crossing the Quality Chasm" (2001) -- uncovered appalling inefficiencies and substandard quality of care in the U.S. healthcare system, giving rise to a national quality and safety imperative, and precipitating fundamental changes in the way physician practices are monitored and evaluated by payers and patients. I told them that, in addition to being prepared in the science base of medicine to care for individual patients, they must acquire the skills necessary to improve care and safety: e.g., working effectively in teams; collecting, analyzing and displaying data on the outcomes of care; working collaboratively with managers and patients; and learning from mistakes. I described the ongoing shift from fee-for-service reimbursement to value-based payment and population health models, and reviewed the underlying concepts of payment reform and described them -- i.e., payments that are tied to evidence and outcomes rather than per unit of service, reimbursement for coordination of care in a medical home, accountability for results and management of care across settings, and bundled payments for physician and hospital services by episode or condition. Transparency and accountability will be major themes as we move forward -- basically, "No outcome, no income." This will require fundamental changes in culture – such as practicing based on evidence, reducing unexplained clinical variation, reducing adherence to the notion of professional autonomy, continuously measuring and closing the feedback loop, and engaging with patients across the continuum of care. How will this year's class of medical school graduates fare in real-world practice? My guess is that, working together, these tech-savvy, innovative graduates will move the culture change needle much further than their predecessors. Source
