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Letters to the Editor

A Critical Need for Progress in Implementing Education in Health Care Delivery Science

Weeks, Kristin S.; Swanson, Morgan B.; Reed, Alan MD, MBA

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doi: 10.1097/ACM.0000000000003780
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To the Editor:

Health care spending is nearly 17% of the U.S. gross domestic product. Consequently, from presidential debates to corporate meetings, health care delivery models are taking center stage. 1 Excellent health care delivery has the vast potential to improve patient outcomes, reduce health inequities, optimize health care workplace opportunities and processes, and expand health care access. Physicians are necessary stakeholders in these discussions, yet most do not receive formal training in health care delivery science.

Historically, basic business and management skills have been missing from the medical school curriculum. Spurred by robust local efforts of institutions and trainees, some medical schools have tried to incorporate a health care economics curriculum or cocurricular programs, such as tracks or pathways. However, despite institutional enthusiasm and aggressive personal initiative, programs have struggled to find time for topic areas or to establish rigorous, well-defined learning objectives. A shift from isolated, decentralized institutional efforts to nationwide, successful changes requires establishing a definition and universally accepted core competencies for education in health care delivery science.

Recognizing this imminent need, the American Medical Association (AMA) recently called for inclusion of basic health care delivery science content related to the structures and finances of the health care system in medical school and residency curricula. 2,3 The AMA’s recommendations provide impetus for change. They highlight a major shortcoming—the lack of a standardized definition and core competencies of health care delivery science. The AMA has provided a starting point for a definition by mentioning models of practice, cost-effective use of diagnostic and treatment services, risk management, quality assurance, and payment mechanisms. Collectively, we need to build on this to equip future physicians with the necessary skills to lead change.

Trainees are taught new pathologies and interventions, so they are not overawed by continually expanding medical knowledge. Through the same lens, the competencies developed in health care delivery science must advance beyond cultivating knowledge and a practical understanding of the subject matter alone. Medical students and trainees should be taught proficiencies that allow them to continue to successfully accrue, process, investigate, and develop new health care economic models and practices throughout their careers. A defined, robust competency toolkit could empower systemic health care change.

The AMA’s call for increased educational efforts in health care economics recognizes a critical knowledge gap in medical education. To succeed, this initiative requires diligent interdisciplinary efforts to collectively develop the “what” of health care delivery science training.

References

1. Centers for Medicare & Medicaid Services.. National health expenditure data: NHE fact sheet. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet. Updated March 24, 2020. Accessed September 23, 2020.
2. American Medical Association. Creating a community of innovation: The work of the AMA accelerating change in medical education consortium. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/about-ama/ace-monograph-interactive_0.pdf. Published 2017 Accessed September 23, 2020.
3. American Medical Association. AMA to ensure future physicians receive health care economics training. https://www.ama-assn.org/press-center/press-releases/ama-ensure-future-physicians-receive-health-care-economics-training. Updated November 19, 2019. Accessed September 23, 2020.
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