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The Link Between Healthcare Reform and Post-Graduate Medical Training

Posted Jul 02 2009 6:32pm

Politicians and pundits have been stressing over the years the need for more primary care physicians. It's clear that this group of professionals fills a very important niche in our healthcare system, providing office care and coordinating referrals to medical specialists when necessary. By the way, such coordination is critical for the well-being of patients and inadequately, or not at all, compensated. It's time to launch a serious dialogue about the link between healthcare reform and post-graduate medical eduction with particular emphasis on the training of primary care physicians. A recent article is a good place to start (see: What Medical Education Has to Do With Health Reform ). Below is an excerpt from the article with boldface emphasis mine:

Medicare spends $9 billion a year paying for the medical residencies where doctors get their clinical training. That training needs to change as part of the nation’s big health-reform push, argued a report...from MedPAC [Medical Payment Advisory Commission], the commission that advises Congress on Medicare. The report looked broadly at health-system reform, touching on a number of issues we’ve been hearing a lot about lately — the way Medicare pays doctors for volume rather than quality, for example, and how private insurers in the Medicare Advantage program are paid more than traditional Medicare programs. But we haven’t heard so much about how medical education fits in.... Specifically, the report cited “the relative lack of formal training and experience in multidisciplinary teamwork, cost awareness in clinical decision making, comprehensive health information technology, and patient care in ambulatory settings.” More generally, the report noted, medical residencies are largely based in hospitals. That gives doctors great training in treating acutely ill, hospitalized patients, but doesn’t do so much to teach them to treat patients in outpatient clinic, where primary care docs do much of their work — and where key targets for reform, such as better management of chronically ill patients, will occur. MedPAC said it will look at ways to shift the funding for medical residencies to more closely link doctor training to long-term health-reform goals.

At the present time, most residents are trained in academic medical centers or in community hospitals that have a relationship with an academic medical center. The sickest and most complicated patients gravitate to, directly or by referral, hospitals such as these. This patient flow occurs with good reason because these facilities frequently tend to offer the best care. Medical residents at academic medical centers can opt for training that emphasizes outpatient care rather than critical care. However, I suspect that the experience of most may be lacking in particular areas such as those emphasized in the article quoted above: multidisciplinary teamwork, cost awareness in clinical decision making, and the requirements of running a small business such as an office practice. I am not sure that our teaching hospitals can provide the physician training that is required for a reform agenda. It's a topic that badly needs additional discussion.

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