We must prepare the next generation of physicians for the uncertainty and volatility of the American health care system, in part by suggesting broad reforms to medical education that better maintain a sense of idealism while generating technical skills.
First, we should mandate that every medical student and resident spend at least one year during training to pursue another skill set aligned with their interests to improve health systems. Many medical students already engage in this practice, doing research, obtaining a master's in public health, or even working overseas or domestically with health care consulting companies, nonprofits, or biotechnology or pharmaceutical companies. Many residencies, especially surgical ones, also provide residents with dedicated time to pursue research and other endeavors as an integrated part of their residency curriculum.
Today, many physicians obtain these skills or engage in this work at the end of their careers, but accelerating the process and making it a part of medical education would allow students to develop a perspective and skills they can use earlier in their careers to help effect systemic change.
We also have to change the paradigm of the full-time career physician. I believe this is a risk we are facing, as I said in my last piece about the high turnover in medicine. (EMN. Oct 16, 2019; http://bit.ly/2VFqZTS.) The nature of medicine as a profession is changing, and we must consider that being a full-time physician for our whole career may no longer be emotionally or physically sustainable. Many will disagree that physicians feel this way. I doubt all of them do, but at least some do or we would not be facing the current crisis. Why not try changing the paradigm to encourage physicians to embrace their role longer, sustaining the cycle of one generation passing clinical experience to the next, especially in an era in which we will need every physician we can get?
We must also embrace the roles other health care providers may be able to play in providing care rather than get in noxious debates. Numerous states are deep in discussions about the scope of practice for advanced practice providers. (The Telegram. Dec. 27, 2017; http://bit.ly/2qmqq60.) Instead of weighing whether they should be able to practice on an expanded scale, we should embrace them as a solution to the tremendous shortage we are facing. More time should be spent trying to develop a solution, testing it, and revising it to achieve a workable medium over time.
Medicine should also develop more established pipelines for physicians into roles of leadership within health care systems commensurate with the nature of non-clinical training they have pursued. A physician should not get a job just because he is a physician, but if he has comparable knowledge and skills compared with someone without clinical knowledge and experience, that ought to be considered and incorporated into the process of selecting individuals for positions of leadership within health care.
To be sure, a level of business and strategic acumen could be missing for many physicians seeking system-wide positions. In exchange for knowledge that no other professional can offer in understanding how we might improve outcomes and processes within our health care system, we should work harder to establish ways that physicians can transition into roles complementary with clinical work. This won't be easy. It will require a proactive effort by trainees and their residency programs to establish pipelines and networks to accommodate diverse interests. It also won't be a pursuit made in vain.
These reforms affect medical schools, residency programs, teaching hospitals, and academic and non-academic medical centers, and move us into the political and private sector realms for collaboration. It is not an overnight undertaking nor a short one. It is a paradigm shift within our profession and a call to action that we should embrace more urgently what is changing in our field, advocate for solutions to make medicine a more sustainable and enjoyable pursuit for the next generation of providers, and fill an enormous gap of future providers that will leave millions of patients ill and unattended if something is not done.