Reforms in Health Care Start With Education

General.

Health care needs are on the rise in our country. Although the population as a whole is getting older, demand is up in every age demographic. We need more physicians. Costs are rising. The two most visited disciplines – primary care and general practice– are trying to integrate new technology and efficiencies into an archaic system, and there are real challenges.  When looking for ways to facilitate the improvement of the system, it seems evident that logical place to start is with the education of the coming generation of health care professionals.

According to an article written by Forbes contributor Nicole Fisher, the following represent the seven areas our medical school system which will require reform if we are serious about fixing our problems.

1. Incentivize Geriatric Care – Those who specialize in geriatric care are generally paid less than their counterparts, resulting in a serious deficit of geriatric physicians. Given that the baby boomers and those over 65 years old represent the fastest growing age group in the country, this is alarming. It is estimated that up to 30,000 physicians who specialize in geriatrics are needed to handle the population, however there are currently only 7,500 practicing. Medical schools have failed to properly prepare for this coming perfect storm of baby boomer healthcare; in fact, only 8 of the country’s 145 academic medical centers have a full geriatrics program.
2. Elevate the Role of Primary Care Physician – Medical schools in the U.S. are known to encourage students to choose a specialty early on in their career. The medical profession incentivizes medical schools and students to behave this way. Even though primary care represents the bulk of the needed care, specialists have more prestige and make more money.  Until pay structures and incentives line up with the most needed discipline, we will continue to see students moving into high-paid subspecialties, leaving the bulk of the population without enough care.
3. Integrate Non-MD’s into Care – A successful healthcare landscape is based on team dynamics that promote cost-effective outcomes. Teamwork means that training physicians have to be educated on using and integrating physician assistants and nurse practitioners into the care. Although they are not substitutes for medical doctors, they are increasingly needed yet not underutilized. Starting in medical school, providers should learn to harness the abilities of their peers, as well as practice implementing dynamics which will benefit the entire healthcare system.
4. Incorporate Technology and Business Acumen – Curriculums in many U.S. medical schools have not been updated for decades.  While there are some examples of programs incorporating business skills, entrepreneurship and technological education, there is a recognized gap in teaching new physicians these skills.  In 2014, the Institutes of Medicine (IOM) reported that to generate more successful medical practitioners, graduate medical education needed to incorporate innovation. With business and creative thinking skills incorporated into the curriculum, providers will be better prepared to infuse new ideas into an aging field.
5. 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, but with only 30 waivers per state, there is still far little supply for the demand. As foreign-born practitioners choose general practice and primary care more often than their U.S.-born colleagues, it is paramount that we maximize their potential. Also, as the U.S. continues to diversify, a multi-cultural care team should be a top business priority.
6. Break Down Language and Culture Barriers – Estimates tell us that only 4% of physicians in the country speak Spanish, although 55 million people – 17% of the population – is Hispanic. By 2060, projections are that 30% of the country will be Hispanic. Access to personal care – and establishing a trusting relationship – rely on effective communication. Overall, all minorities take advantage of the health system less often than their white peers. Providers will need to better reflect the population (racially, ethnically and religiously) for better healthcare services.
7. Incentivize Rural Physicians – With an increasing migration of professionals to urban and metropolitan areas, physician shortages in rural areas are growing. The fact that the rural communities do not have the population to support specialty practices or medical schools means that many services are not being provided effectively. With the trends towards specialties and away from primary care, and little to attract new doctors to rural areas, shortages are going to increase. Although there are loan forgiveness programs for those who work in rural areas, they are not enough of an incentive; all of these issues must be addressed if rural areas are to be serviced.