The New Doctors
In my last piece, I wrote about possible challenges facing the next, much larger generation of physicians. Now, I’ll discuss some of the ways I think we can prepare them better for the uncertainty and volatility of the American healthcare system, in part by suggesting a set of broad reforms to medical education that better maintain a sense of idealism coupled with generating other technical skills concurrently during traditional medical education.
Mandate that every medical student AND resident take at least one year during that phase of their training to pursue another skill set in line with their interests to improve health systems: Many medical students already engage in this practice, doing research, obtaining an MPH, or even working overseas or domestically with healthcare consulting companies, nonprofits, or at biotechnology or pharmaceutical companies. Many residencies, especially surgical ones, also have years dedicated for residents to do research and, in some cases, pursue other endeavors as an integrated part of their residency curriculum. Today, many physicians obtain these skill sets or engage in this work at the end of their career, when they have more limited options to pursue their passions given the demands of family, longstanding obligations to a geographic region, or for other reasons. By accelerating the process and making it an expected part of medical education, yes, we demand even more of medical students and residents - but we also allow them to develop a perspective and skillset they can use sooner in their careers to help affect systemic change.
Change our paradigm of the full-time career physician: I spoke in my last piece about the risk of high turnover in medicine, and I continue to believe it is a real risk we are facing. The nature of medicine as a profession is changing, and we must consider that the full-time lifetime physician may no longer be an emotionally or physically sustainable career. Many will disagree that physicians feel this way. I doubt that all of them do, but at least some do or we would not be facing the current crisis in our profession. And in an era where we’ll need every physician we can get, if changing our paradigm encourages physicians to embrace their role for longer, sustaining the cycle of generational passing off of clinical experience, why not at least try it?
Embrace rather than get in noxious debates about the roles that other healthcare providers may be able to play in care provision: Numerous states are deep in debates about the scope of practice for mid-level providers (nurse practitioners and physician assistants, primarily). Instead of debating whether they should be able to practice at an expanded scale, we should embrace that the shortage we are facing is tremendous, and a solution does exist. More time should be spent trying to develop a solution, trialing it, and revising as necessary to achieve a workable medium over time.
Develop more established pipelines for physicians into roles of leadership within healthcare systems commensurate with the nature of non-clinical training they have pursued: A physician should not get a job just because he or she is a physician. But if he or she has a comparable level of knowledge and skills compared to someone without clinical knowledge and experience, that ought to be considered and incorporated into the process for selecting individuals into positions of leadership within healthcare. To be sure, even with the time off proposed above, a level of business and strategic acumen will be missing for many physicians seeking out health systems-wide positions. In exchange for knowledge that no other professional can offer in understanding how we might improve outcomes and processes within our healthcare system, however, we should work harder to establish ways that physicians can transition into roles complementary with clinical work. This won’t be easy. It will require proactivity on the part of trainees and their residency programs to establish pipelines and networks to accommodate diverse interests. It also won’t be a pursuit made in vain.
This selection of reforms affects medical schools, residency programs, teaching hospitals, academic and non-academic medical centers, and moves into both political and private sector realms for collaboration. It is not an overnight undertaking, or a years long one. It is a paradigm shift within our profession and a call to action that we embrace more urgently what is changing in our field, advocate for solutions to make medicine a more sustainable and enjoyable pursuit for the next generation of providers, and fill an enormous gap of future providers that will leave millions of patients ill and unattended to if something is not done.
Share your thoughts on how to improve the state of medical training in the comment section.
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