Medical schools need to answer what business they are in

Is Coach Prime back in his prime? The black sky emptied as about 50,000 rain-soaked University of Colorado football fans exhaled in improbable joy at Folsom Field. This was after the Hail Mary pass caught as time expired, after the game-clinching fumble that squirted out of the end zone in overtime.

Students poured onto the field. In the dry cocoon of the press box, cynicism washed away. I laughed. That’s when the reporter came closest to answering the question that he had come to ask:

"What is the point of college football these days?" Is it no more than the NFL Minor League?

Many are asking the same question about higher education (hedge funds that happen to admit students) and medical schools.

Harvard Business School professor and the father of modern marketing, Theodore Levitt, asks a powerful question that every business leader, sales representative and marketing manager must answer: What business are you in?

The answer to this question will determine the future of your company. At this critical moment when the needs of your customers are changing, this question needs to be answered correctly.

Should medical schools only be in the business of providing graduates with the knowledge, skills, attitudes, and competencies to get a residency, or should their purpose be something more than preparing graduates for a lifetime of only clinical care?

It’s easy for organizations to get stuck in strategy myopia — prioritizing the urgent, the proven, and the easily measured — particularly in a moment of intense change. To avoid this, successful leaders follow five principles. First, they refuse false proxies, recognizing that new projects to solve future problems are always less efficient than the status quo.? Second, they focus on their customers’ needs, rather than what they currently produce. Third, they know you can’t compromise your way to an elegant strategy, and they make sure the right people are in the room. Fourth, they recognize that solving a big problem requires starting with a small solution. And fifth, they focus on interesting questions, rather than correct answers.

Medical schools need to rethink what business they are in because:

1. The premed persona has changed
2. Medical students are pursuing more non-clinical career opportunities
3. Medical students want exit ramps
4. Medical school curriculum reform initiatives have not been responsive to rapid technological and economic forces
5. Money, technology and talent go where they are treated best.
6. Meeting the needs of stakeholders, primarily students, is a competitive recruitment advantage
7. We need more entrepreneurial academic medical centers
8. Not teaching the business of medicine borders on negligence and, at worse, educational malpractice and is driving a non-value adding MD/MBA frenzy
9. Given the multiple systemic self-inflicted bottlenecks in the physician workforce pipeline, we are setting up a significant number of talented people for very expensive and emotionally wrenching failure to practice medicine including graduates who don't match and international medical graduates and clinicians who face formidable obstacles if they want to practice medicine in the US.
10. If you do not learn how to practice the business of medicine, you have no business practicing medicine
11. The majority of residents and clinicians want to do more than see patients for their entire career.
12. We need to address the inconvenient truths about the leaks in the workforce pipeline by not just plugging them but also providing dropouts with career options that allow them to get ideas to patients and help fix the siloed, sick, US sick care system of systems machine.
13. Practicing medicine is getting harder, the demands of physician employers have changed, and physician satisfaction has plummeted.
14. Students are not prepared to innovate, find their first job out of residency, build financial independence, or cope with the dark underbelly of medicine, including bullycide. Sending them to the front with blanks in their weapons is irresponsible.
15. We are not addressing the need of women, first generation to medical school, and underrepresented cohorts of students. Recently, DEI has come under fire and is being renamed MEI. It’s known as MEI, short for merit, excellence and intelligence. As described by Scale AI Chief Executive Alexandr Wang, who helped popularize the term, MEI means hiring the best candidates for open roles without considering demographics. Here are some ways medical educators can be held accountable for doing it.

The cost of attending medical school has greatly outpaced inflation over the last two decades, according to an Oct. 2 report by CHG Healthcare.?

According to the report, physicians are entering residency with more debt and taking longer to pay it off. Over the last 22 years, medical school costs have increased 91% after adjusting for inflation. Overall, 74% of physicians report having current or past medical school debt. In 2024, 32% of physicians reported having over $250,000 of medical debt.?

The medical education industry has lost touch with its customers and stakeholders. When that happens, we know how the movie ends. It’s been proven time and again that when organizations are unable or unwilling to adapt to disruption, technological advancements, and evolving customer demands, they simply cannot survive in the long term.

Uncertain times abound, and as a result many of us are enduring a prolonged separation from our normal ways of being and doing. We are having liminal experiences, in other words — experiences that represent a break from the familiar but that don’t fully replace it. The protracted uncertainty that comes with living in liminal times can cause leaders and employees alike to feel unsettled or anxious, but these authors of this article remind us that we have more agency during these times than we might realize. They offer guidance on how to not only survive such periods but also embrace them as a time for reflection and learning

When will the medical school bubble pop?

Is your medical school selling to private equity?

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack