AAMC Reporter: April 2009

Viewpoint: "Preparing New Doctors for Health Care Reform"

Elliot J. Sussman, M.D., M.B.A., AAMC chair, president and chief executive officer, Lehigh Valley Hospital and Health Network

In 2006, academic medicine heard the call loud and clear. To stem the tide of a future physician shortage, the AAMC recommended a 30 percent increase in enrollment to medical schools by 2015, adding 4,900 medical students to the entering first-year class.

Expanding the physician workforce—along with the supply of nurses, pharmacists, dentists, and other critical medical professionals—is of paramount importance if we are to meet the needs of our nation's growing and aging population.

We also are hearing another call loud and clear. It is coming from our patients, our communities, and our federal and state governments. It is the call to reform our ailing health care system. While recruiting more doctors is a key part of reform, it is unacceptable to educate tomorrow's doctors the same way we have for decades. We need to create new models for medical education.

We need to design curricula that reflect the current realities faced by doctors. We must address issues like quality, safety, efficiency, interprofessional education, and cost management—the very challenges that are at the forefront of the national discussion on health care reform.

How to make this occur has been a topic of discourse in our community. Last October, Jordan J. Cohen, M.D., AAMC president emeritus and a professor of medicine and public health at George Washington University School of Medicine and Health Sciences, led a conference of 35 national leaders in medical education. The conference, sponsored by the Josiah Macy, Jr. Foundation, discussed those contemporary realities not yet reflected in medical education. Among them: the accelerating pace of scientific discovery, more public accountability, the unsustainable rise in health care costs, the well-documented shortfalls in health care quality, the unconscionable racial and ethnic disparities in health care, and the inexorable increase in the burden of chronic illness and disease.

"The overarching theme that coursed through the discussions was the urgent desire to bring medical education into better alignment with societal needs and expectations," Cohen said.

Revolutionizing the medical education curriculum in the ways Cohen's panel discussed is a remarkable undertaking that will require an equally remarkable level of creativity and teamwork. It requires all of us—universities, teaching hospitals, medical schools, professional societies, faculty, doctors, residents, and students—to challenge our long-held assumptions and create a model that empowers tomorrow's physicians to lead the reform our health care system needs.

We at Lehigh Valley Health Network (LVHN) are excited to be part of that creative process. My colleagues and I at LVHN recently announced a unique partnership with the University of South Florida's (USF) College of Medicine. USF is the nation's ninth largest university, and includes colleges of medicine, nursing, public health, pharmacy, as well as schools of biomedical sciences and physical therapy and rehabilitation services housed within USF Health, the university's health and health education center.

Together, USF Health and Lehigh Valley Health Network are developing a proposal to create a new regional campus and a curriculum designed to prepare 50 additional USF medical students for the new paradigm of health care delivery. As new leaders of health care, the curriculum will provide the "tools" to enable the highest-quality patient care as well as manage costs, eliminate medical errors, and address health care disparities. In the near future, we will submit our application for a regional medical campus to the Liaison Committee on Medical Education for its approval.

This model will change the way medical students receive their hands-on education. They will spend their first two years at USF Health in Tampa. Then, they will devote their last two years to clinical training at Lehigh Valley Health Network. We believe that learning inside a large, community-based academic health system will provide a meaningful and rich experience for medical students. For example, our information technology platform will enable optimal clinical care while teaching the precepts of safety and quality for the next generation of physicians.

We hope that the first students will begin this program at USF Health in 2011, transitioning to Lehigh Valley Health Network's campus in 2013. LVHN, with an average of 70 medical students on site at any time over the past five years, has built a substantial educational infrastructure. Still, there is much work to be done prior to the new students' arrival in 2013. Innovative champions like USF Health Senior Vice President and USF College of Medicine Dean Stephen Klasko, M.D., and USF Vice Dean for Educational Affairs Alicia Monroe, M.D., with invaluable support from deans, chairs, clerkship directors, medical school leadership, and faculty from both organizations, will thoughtfully and carefully create a curriculum that addresses the current deficiencies noted by the Macy conference.

As chair of the AAMC, I challenge each of us to continue to develop progressive ideas for meaningful and thoughtful educational reform. Based on the Macy conference report, one thing is clear: the teaching methods and environments of the past have not kept pace with the breakneck speed of change in health care. Producing more doctors is a worthy goal; giving those doctors the proper education to serve our communities effectively is an imperative.

Editor's Note: The opinions expressed by the authors do not necessarily reflect the opinions of the AAMC or its members.