Medical School Challenges
Arlen Meyers, MD, MBA
President and CEO, Society of Physician Entrepreneurs, another lousy golfer, terrible cook, friction fixer
Despite the noise and groaning,?medical school applications continue to grow, ?driven by many factors.?However, the medical school education model dates back to the Flexner report issued in 1910. . Many are trying to address the challenges of?how to train the biomedical research and practice workforce to win the 4th industrial revolution, ?but progress has been slow.?Here were the challenges facing medical schools in 2015. ?Things have not radically changed.
Now that Corona has decimated state budgets. higher ed and public medical schools are, once again, on the chopping block.?Analysis of the financing of medical education is a complex task. ?It involves an examination of numerous sources of funds that flow into and among the various educational settings, funds that are used to finance the diverse functions and responsibilities of the organizations that participate in medical education. Sources of funds include federal and state governments, families or individuals that pay tuition, insurance companies that pay for patient care, and philanthropy.
I have been receiving emails from my university leadership informing me of cuts to make up for the unexpected loss of funds, including a hiring freeze, eliminated temporary and contingent positions including non-tenure-track instructors and deferred capital projects.
Medical educators. particularly those in public medical schools will continue to face several basic problems in the coming years. Many have been exacerbated by the "invisible enemy".
DEMONSTRATING THE VALUE OF MEDICAL EDUCATION AND TRAINING
?According to a new AAMC?study,?76% of students graduate with debt. And while that percentage has decreased in the last few years, those who do borrow for medical school face big loans: the median debt was $192,000 in 2018. At private schools, 21% of students have a debt of $300,000 or more. The average four-year cost for public school students is $243,902. For private school students, the cost is $322,767. Many medical students in debt marry other medical students in debt. Do the math and the implications of career and family planning, housing and specialty choice.
In a 2018 survey of 3,571 resident physicians, career choice regret was reported by 502 or 14.1% of the respondents, according to a?study ?in JAMA. However, there were wide ranges of prevalence by clinical specialty.
For instance, 32.7% of those training in pathology and 20.6% of those training in anesthesiology said they regretted their career choice. That compared with 7.4% of those training in plastic surgery and 8.9% of those in family medicine who said if they were able to revisit their choice, they would not choose to become a physician again.
When it came to choice of their actual specialty, 253 of 3,570 resident physicians (7.1%) indicated they would “definitely not” or “probably not” choose the same specialty if given the change to revisit their choice.
ACCOMMODATING THE MARKET DEMAND FOR NON-CLINICAL CAREER OPPORTUNITIES
Medical students are forgoing residencies, practitioners are abbreviating their clinical careers, side gigs, and hustles are hot and many want to create patient value other than seeing 20 a day for their entire career.?Physician entrepreneurship ?is finally getting its rightful due, yet few medical schools offer education and training in it, let alone the business of medicine.?There are few entrepreneurial medical schools ?and, arguably,?there is a sick care innovation bubble.
18. How to manage a gig economy portfolio
19. Understanding the tax and liability consequences of various compensation schemes
20. Risk management
Translating discoveries and inventions from ideas that eventually get to patients, however, will take more than data science.?It takes a team of scientists, clinicians, data scientists, investors, and entrepreneurs.
We should also offer medical students other knowledge, skills, behaviors and competencies to work with or for Amazon or Apple.?The urgent need for doctors, nurses, pharmacists and home health workers isn’t just coming from hospitals. ?Instead, a variety of industries are?looking to hire people ?to navigate today’s most pressing challenges: from how to keep their employees healthy to how to prevent the next pandemic. Tech companies, like Amazon, are also bringing on people with health care skills as they aim to make the industry more efficient and convenient.
DECLINING REVENUES FROM RESEARCH GRANTS, CLINICAL EARNINGS AND STATE SUPPORT
Major consolidation and the expansion of academic integrated delivery networks mean the rich get richer and the poor get poorer. NIH funding uncertainty is pervasive.?Some states have withdrawn funding from their public medical schools. ?Reforms in clinical practice reimbursement will lead to decreasing revenues. Many schools are reaching out to create partnerships with industry?with ethical and professional conduct threats. ?More are relying on?philanthropreneurs to put their names on buildings. ?Many have repacked their technology transfer offices and rebranded them as innovation centers.
DEFINING NEW MARKET NEEDS DERIVED LEARNING OBJECTIVES AND CURRICULUM REFORM AND RESKILLING THROUGH THE DEVELOPMENT AND DEPLOYMENT OF MEDEDTECH INNOVATION
Amazon.com ?Inc.?AMZN?0.54%? is the latest example of a large employer committing to help its workers gain new skills. The online retailer said Thursday it plans to spend $700 million over about six years to retrain a third of its U.S. workforce as automation, machine learning and other technology upends the way many of its employees do their jobs.
TEACHING TO THE TEST TO COMPLY WITH ACCREDITATION REQUIREMENTS WHILE, AT THE SAME TIME, INTEGRATING NEW SUBJECT MATTER THAT IS NOT ON THE TEST
"Finding time to teach all this new stuff" is an outmoded mindset and should be replaced with one that integrates new subjects, like data science, literacy and dexterity into existing basic and clinical courses and rotations.
FINDING THE FACULTY WHO CAN TEACH NEW THINGS
Training the trainers will require collaboration with outside subject matter experts, innovative approaches to faculty development, promotion and tenure and reward systems.
FIXING THE "INDUSTRY IS DIRTY" MINDSET
Graduate school programs focused on publications, grants and research are outdated. Undergraduate and Master's level data scientists , as well as their faculty, see much greener fields in industry and are questioning the value of a PhD.
We need to stop graduating knowledge technicians. ?Recruiting?the traditional triple threat to lead departments is a dead model. ?Domain expertise needs to be supplemented with communication, creativity, collaboration, and complex problem solving to address the social determinants of health and?other wicked problems. ?Here are the?principles of medical education reform. ?Free tuition won't solve the problems.
?The Institute for the Future for the University of Phoenix Research Institute ?outlines ‘trans disciplinarity’ as one of the ‘Ten Skills for the Future Workforce’ alongside the following: Sense-making, social intelligence, novel, and adaptive thinking, cross-cultural competency, computational thinking, new-media literacy, design mindset, cognitive load management, and virtual collaboration
Here's how to create a culture of digital transformation. ?We need to teach doctors and patients how to win the 4th industrial revolution ?and will?include data literacy. ?It should all start?before anyone even starts thinking about being a doctor.
Your children can expect to change jobs?and professions?multiple times in their lifetimes, ?which means their career path will no longer follow a simple “learn-to-work’’ trajectory, as?Heather E. McGowan , co-author of “The Adaptation Advantage,” likes to say, but rather a path of “work-learn-work-learn-work-learn.”
FIXING THE TOXIC CULTURE OF MEDICAL EDUCATION AND TRAINING AND THE LACK OF DIVERSITY
How many more times do we need to read about?physician burnout, stress, mental health ?issues and suicide? When will we fix how we recruit applicants and faculty?to create a more diverse and inclusive talent pipeline?
Medical school graduates are now more racially diverse than before, but they’re still not representative of the general population, according to?new research .
Higher education feeds the medical school pipeline and has its own problems ?that need to be fixed.
CREATING A NEW BUSINESS MODEL
As higher ed goes, so will medical schools. ?It will become?part of the hybrid economy, ?instead of one for the children of the 1%. This school year marks a major inflection point for America’s colleges and universities.?Which institutions will seize the moment to transform, and which ones will be left behind?
Driven by a combination of rapid development of technology and medical science, market demand, government policy, and financial pressures, the evolution toward?new business models ?(for example, next-gen managed care, the simultaneous fragmentation of sites of care, integration of care around the patient, consolidation of care delivery institutions, technology-enabled healthcare services businesses)?is already underway.
The conventional wisdom seems to be that we will be facing a doctor shortage due to the 10,000 boomers turning 65 each day, disparities in geographic distribution and inappropriate specialist/generalist ratios.? Add that to the bottle neck in graduate medical education funding and the pundits would have you believe you'll need to go the black market to find a doctor in the future.
The US sick-care system of systems, masquerading as a healthcare system, is sick and badly in need of medical attention. The Coronapocalypse has magnified the flaws.
The 4th Industrial Revolution is a mental model created by the leaders of the Joint Economic Forum and describes how physical, digital and biologic technologies have collided and the?resulting challenges and opportunities that presents.
Suppose we were to apply the lean startup methodology to new medical schools or those that that want to or must pivot? That means identifying customer segments, doing customer discovery, needs assessment and gap analysis, defining a value proposition, building a business model canvas with hypotheses that need to be validated and pivoting when necessary.
DECLINES IN COLLEGE ENROLLMENT AND LOWER BIRTH RATES
Years from now, universities may join the ranks of abandoned malls and factories, their deserted campuses monuments to bygone times. That’s because higher education is speeding toward an “enrollment cliff” in 2026,?Vox reports , and a birth rate that’s been declining since the Great Recession means class sizes will dwindle over the next two decades. Demographers expect elite colleges to endure, but regional universities, community colleges and rural schools are at risk of disappearing — an outcome that would deepen existing divides along class, demographic, and geographic lines.
There are many parts to the contemporary economic bubble diagram and medical schools could be one of them is they don't address these problems. ?Maybe?private equity is the solution.
Arlen Meyers, MD, MBA is the President and CEO of the?Society of Physician Entrepreneurs ?on Twitter@SoPEOfficial and Co-editor of?Digital Health Entrepreneurship
Basic Health Access
1 年Lies abound. Can you really claim that internal medicine is primary care training with less than 1000 a year entering and staying in primary care for less than 30,000 as a primary care workforce (down from 150,000 early 1980s).
Basic Health Access
1 年They cannot fix half enough primary care for half of the nation 1. because the financial design is fixed at 250 billion 2. because the payments are too low where most Americans have half enough 3. because RBRVS shifts workforce to higher paid better supported procedural, technical, subspecialty, and hospital areas where the financial design supports more and better delivery team members - the opposite of what is dealt to primary care, mental health, women's health, basic surgical, and especially geriatrics 4. because AAMC, academics, hospitals and big health all fight a shift or 100 billion more to primary care to reach 350 billion and sufficient for all Americans 5. because they profit from training more MD DO NP and PA from tuition and slave labor If they say that they are for health equity, this is inconsistent with "well we want more or primary care spending, but not if it costs us in our most important work
Basic Health Access
1 年They cannot do diversity, because too many highest SES are admitted.
Keynote Speaker, Cybersecurity Luminary, Evangelist, Thought Leader, and Board Member
1 年Good article. Well worth the read.
Primary Care Physician | Researcher | Entrepreneur
1 年Interesting, what do you think a medical school’s place is in training soon to be physicians in research? Do you think medical schools should give in-depth research training to physicians or do you think that’s more the domain of PhD training and medical schools should just give basic research experience and focus on developing clinical skills of physicians?