Why medical school may be failing today’s doctors

Little has changed at the nation’s medical schools, but now some clinicians are questioning the makeup of traditional medical school curriculum and even what qualities make for a great doctor. At the same time, the U.S. health care system is undergoing a number of changes that influence how doctors today and in the future will practice medicine. 

“We have stuffed all this information into the minds of our young doctors and trainees that is really not exactly what they need to know,” Dr. Marty Makary, a surgeon at Johns Hopkins Hospital, told me this summer. “What they need to learn are good communication skills, how to deal with uncertainty, how to tell a patient you don't know, how to assess something when there's not a randomized controlled trial, knowing your limits when you call the senior doc in to give you advice, the business of medicine, health care literacy.”

Makary isn’t the only doctor (or expert) who feels this way. They are concerned about how physicians are trained when it comes to leadership training, nutrition and opioids. MD/MBA programs are flourishing. And some medical schools are starting to take into account non-traditional medical skills like empathy and emotional intelligence.   

An analysis published last month in The Lancet Planetary Health found that “nutrition is insufficiently incorporated into medical education, regardless of country, setting, or year of medical education.” Also in September, a new report from Harvard University’s Food Law and Policy Clinic urges medical schools to incorporate more nutrition training for doctors. “We have to get beyond the disease care model that we doctors get trained in where the only therapeutic tools taught are drugs and surgery,” Dr. Frank Lipman, a practitioner of functional medicine, told Well + Good. 

At Thomas Jefferson University’s Sidney Kimmel Medical School, would-be medical students are scored on their empathy, in addition to their academic prowess. Leaders there believe that doctors with higher empathy scores tend to have better patient outcomes. That's something that also resonates with Dr. Eric Topol, a cardiologist at Scripps Health, artificial intelligence expert, and a regular in #TheCheckup.

“Do we really need the brainiacs, the ones with the highest MCAT scores and the best grade point averages?” he said in an interview earlier this year. “Or or do we really need people who are the ones with the most emotional intelligence?”

Physicians, what’s your take on these ideas? Did medical school adequately prepare you for your career? What skills or knowledge do you wish you would have gained? Share your thoughts in the comments.

News I’m Watching

MARKETS | Is an IPO on tap for One Medical? According to CNBC, the direct primary care startup with its own electronic health record is reportedly preparing to go public next year. In a direct primary care model, patients pay an annual fee to join a medical practice. The reported IPO plans indicate two trends to watch. A number of health technology firms like Health Catalyst and Livongo have gone public this year, and physicians and patients are intrigued by direct primary care, which aims to improve access for patients and allow doctors to spend quality time caring for patients. 

Editor’s Pick: “By any measure One Medical is overvalued...A $1.5 billion valuation on the last funding round with 70 clinics: the numbers don't make sense. What's the EBITDA or revenue multiple here that supports this? Seems unlikely in an outpatient retail clinic chain model.” - Dr. Brian Miller, MedStar Georgetown University Hospital

MONEY | The price tag for health care waste? $760 billion a year. Up to 25% of U.S. health care spending is wasteful, according to The New York Times reports, citing research from JAMA. Administrative costs are the main culprit, with overpricing, inefficient care and fraud also prominent. Administrative costs include billing and reporting to health insurance companies,. Health care accounts for 18% of the U.S. economy; researchers argue that even marginal savings could reap monumental benefits. [By Lauren Lee and Zach Roston]

Editor’s Pick: “Health care is, by definition, a market failure...That's the elephant in the room. If we don't address prices, the rest quite frankly doesn't much matter. Value-based care has an icicles' chance in hell to bring prices of health care products and services to affordable levels.” - Jan Malek, Cannery Row Advisors

WORKFORCE | No Rx needed in California for HIV prevention drugs. California passed a law that allows pharmacists to dispense HIV prevention medications to patients without a prescription, according to the Los Angeles Times. It is the first state to do so. Gilead Sciences is the only drugmaker so far to market a HIV drug Truvada for pre-exposure prophylaxis and post-exposure prophylaxis. Pharmacists in California can also dispense emergency contraceptives, birth control, naloxone and smoking cessation drugs without a prescription.

Editor’s Pick: “We need more expansion of pharmacist services like this.” - Christelle Biame, pharmacist, Encompass Health

*Comments have been edited. 

Physicians, what’s your take on these ideas? Did medical school adequately prepare you for your career? What skills or knowledge do you wish you would have gained? Share your thoughts in the comments.