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Viewpoint: Profound Lessons for Tomorrow’s Doctors

AAMC Reporter: June 2013

By Michael F. Collins, M.D., Chancellor, University of Massachusetts Medical School

When two explosions shattered the ecstasy of the finish line at the Boston Marathon on April 15, the heroic actions of those who provided care at the scene and in the hospitals demonstrated the best of academic medicine. Their collective commitment and response provide a powerful message to the next generation of caregivers-in-training and, at the same time, should serve as a teaching moment for policymakers, elected officials, and the public at large.

The fact that Boston’s heroic first responders almost instinctively stepped forward to lead and perform is no surprise to those of us in academic medicine. Emergency preparedness and response have been integrated into medical training to a degree unimaginable before the terror attacks of Sept. 11. Likewise, cities and towns have begun to realize that preparation for mass casualty events is as much a part of government as protecting the water supply and maintaining good roads.

Like the patriots we celebrate on Marathon Monday, our society draws on a rich history of communal cooperation dating back to bucket brigades and barn-raising. The tremendous concentration of voluntary health care resources assembled at the marathon finish line undoubtedly played a key role as so many well-prepared health care professionals responded instantly.

The response was so impressive and effective, in fact, that the reasons just cited—good disaster drills, good neighbors, good government, and good luck—run the risk of masking the real reason that so few died. For that, we have to thank the investments made over many decades in our medical schools and teaching hospitals, which are now threatened, even as the shock that occurred at the finish line reminds us of the critical nature and vital success of those investments.

How those of us in the health care professions and those who teach our successors respond to these external challenges will say much to the next generation of caregivers about what sort of profession we will occupy and whether, should the unimaginable happen again, we will have the tools and resources necessary to respond effectively.

This is the values construct that has until recently stood firm: Medical schools and teaching hospitals are supported in their broad mission to educate and train caregivers, care for the ill and injured, and conduct research that improves the ability to do those things. These are high expectations. Ours is a high calling.

Our educational programs; residency and fellowship training; and institution-, city-, and region-wide disaster drills all have at their heart the symbiosis of education, research, patient care, and community service. A generation ago, the field of emergency medicine was just beginning to emerge as a medical specialty; on Marathon Monday, those treating the injured were applying techniques learned recently on the battlefields of Afghanistan, emblematic of the commitment to lifelong learning and the sharing of best practices that are the hallmarks of academic medicine.

We know that research advances medicine and ongoing clinical training saves lives. The approach that our first-year students learn during basic life-support training—to check for an airway, for breathing, for circulation—was enacted on Boylston Street over and over, indicative of medical personnel’s pact with the society that supports their training. It was no accident that so many capable health care professionals—those present at the scene and those waiting in the emergency and operating rooms—saved so many lives. The area’s academic medical centers, which have received tremendous support and have been enabled to fuse the fundamental mission of providing clinical care with a commitment to medical training and research, were prepared to fulfill their public responsibility to promote and protect the health and well-being of all those who may be entrusted to their care. We watched with pride as our colleagues rose to meet challenges they could not have imagined.

Where is our values construct today? Look no further than sequestration cuts, which are the antithesis of the thoughtful and committed investments we have made over generations in academic medicine. Look at how we struggle to make financing for graduate medical education work in a 21st-century world that lacks the conviction and commitment to those who will be tomorrow’s clinicians. Yes, academic medical centers have a role to play in the cost containment discussion, but we are not having a discussion, are we? We are being “tiered” into a corner by forces that question the vital value of academic medicine in America.

This year, our students enter medical school in a vastly changed environment from the one that has helped create and sustain our great academic medical centers. Arguments over health care reform and payer systems conceal the real threat: that we will turn away from a professional commitment to the public good and make medicine a purely transactional arrangement. We already see this in the challenges we face to create an environment that professionally and financially supports primary care physicians, particularly at a moment when the need for them is profound. The environment affecting primary care—unworkable practice conditions, unmanageable debt burdens, lower reimbursement, and difficulty recruiting colleagues—now threatens our academic medical centers as well. Can we make a commitment to today’s students that the infrastructure and the environment that represent generations of wise investment in training and research will be there to support them tomorrow?

As the aftermath of the Boston Marathon proved, even when calamity strikes and their own safety is uncertain, doctors, their nurse colleagues, and all on the caregiving team reach out to their patients. We go to our patients in their moments of greatest need. This speaks volumes about what it means to be a caregiver and the covenant we make with our patients.

On Marathon Monday, and on each and every day in our institutions, we reap the benefits of our nation’s longstanding commitment to academic medicine. Through their service to others, our colleagues in Boston made us proud. If we redouble our commitment, the future will be bright for the patients we serve, the students we educate, and the research we conduct. The stakes are evident. Our resolve must remain so.

June 2013 Home

Michael F. Collins, M.D.

Michael F. Collins, M.D.