U.S. health care is changing, and it will continue to change across multiple dimensions: a different mix of patients; more ambulatory, chronic care and less acute, inpatient care; an older population; expanded insurance coverage; a team approach to care; rapid growth of subspecialty care; growing emphasis on cost-effective care; and rapid technological change. These changes demand a corresponding evolution in physician roles and training. However, despite innovation in content and teaching methods, there has been little alteration to the basic structure of medical education since the Flexner Report sparked widespread reform in 1910. Looking to the future, medical education might evolve to include preparation for a team approach to care via practical training for multispecialty collaborative practice and preparing physicians to be leaders of primary care teams that include nonphysician providers; shorter training for some physicians via flexible pathways and “fast tracks” at each phase of training; cost-effective care in clinical practice; increased training in geriatrics; and “on ramps” and “off ramps” along the physician career path for flexible training over a lifetime. Although the challenges facing the health care system are great, meeting changing health care needs must begin at the foundation, in medical education.
Dr. Pershing is chief of ophthalmology, VA Palo Alto Health Care System, Palo Alto, California; affiliate, Stanford Health Policy, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford, California; and clinical instructor, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Stanford, California.
Dr. Fuchs is Henry J. Kaiser, Jr. Professor Emeritus, Departments of Economics and Health Research and Policy, Stanford Institute for Economic Policy Research, Stanford University, Stanford, California.
Funding/Support: Workshop funding was supplied by an unrestricted grant from the Blue Shield of California Foundation. Suzann Pershing is supported by grant number T32-HS000028 from the Agency for Healthcare Research and Quality, and Vic Fuchs is supported by a grant from the Robert Wood Johnson Foundation. The views within this text are solely the responsibility of the authors and do not necessarily represent the views of the NIH, the AHRQ, or the Robert Wood Johnson Foundation.
Other disclosures: None.
Ethical approval: Not applicable.
Disclaimer: The content of this manuscript reflects the personal views of the authors and does not represent consensus or individual statements of workshop participants.
Correspondence should be addressed to Dr. Pershing, 2452 Watson Ct., Palo Alto, CA 94303; e-mail: email@example.com.