EXECUTIVE INTERVIEW: SUSAN SKOCHELAK

Meet the new doctor…not the same as the old doctor

Healthcare delivery is rapidly changing, and the way in which young doctors are educated is not keeping pace. But the American Medical Association – through its “Accelerating Change in Medical Education” initiative – intends to address that gap. As a result, the doctors with whom tomorrow’s supply chain executives will interact in the hospital and non-acute-care setting are more likely to have a deeper understanding of the financial impact of their decisions, not to mention a greater adeptness at providing team-based, patient-centered care in multiple settings.

At press time, the AMA was evaluating a number of proposals from medical schools intended to transform the way future physicians are trained. The association was expected to award a total of $10 million to eight to 10 schools this summer. Goals include:

  • Develop new methods for teaching and assessing key competencies for medical students.
  • Create more flexible, individualized learning plans.
  • Promote exemplary methods to achieve patient safety; performance improvement; and patient-centered, team-based care.
  • Improve understanding of the healthcare system and healthcare financing.
  • Enhance development of professionalism throughout the medical education learning environment.

The gap
“The training provided to physicians, in terms of medical quality and care, is excellent,” says Susan Skochelak, M.D., the AMA’s group vice president for medical education. “But the way we’ve trained physicians historically is different than the way the healthcare system has evolved.”

That’s true for a number of reasons, she says. First, young physicians tend to be trained as individuals. “We know we need to work in teams,” says Skochelak. Second, physicians tend to be trained in the hospital setting, despite much care being delivered in the outpatient setting today. Third, today’s medical students are more likely than those in the past to have prior work experience – such as biomedical engineering or physical therapy – and hence, have different educational needs than those fresh out of college. And fourth, new developments in healthcare make it imperative that physicians be good stewards of resources, that is, they understand the business of healthcare and the fiscal implications of their decisions.

“Physicians constantly make medical decisions that affect healthcare spending,” says Skochelak. They order tests, write prescriptions, perform procedures. “Without understanding the impact of their decisions on the overall financial and resource utilization of healthcare, we’re leaving things up to chance rather than making sure we’re training our young physicians to think about the evidence behind the decisions they make.” Physicians should be trained, for example, on when it’s appropriate to prescribe a generic drug vs. a brand-name one, so long as it is just as effective for the patient. “There has been very little focus on resource management and fiscal stewardship,” she says.

Learning how to learn
AMA intends to bring a “broader voice” to medical education, says Skochelak. That includes healthcare system executives as well as innovators in educational methods, all of whom are represented on the association’s national advisory panel for education. The latter can help students become lifelong learners, according to AMA.

“We don’t stop our training after medical school,” says Skochelak, noting that it’s not uncommon for physicians to practice medicine 30 or 40 years after finishing their formal training. AMA recognized the need for lifelong learning long ago, when it required physicians to receive ongoing continuing medical education.

But traditional methods of education – lectures, memorization, multiple-choice tests, etc. – don’t necessarily prepare students to be life-long learners. “With the burgeoning amount of information available to all of us, we need to be able to assess and manage information, and to assess how much we know and where our knowledge gaps are,” says Skochelak. Tomorrow’s doctors need to be able to discern useful, quality information from useless information.

And CME needs to change as well. “It used to be, you could go to a meeting and listen to lectures,” she says. But today’s physicians need to be continually challenged: “How are you managing your practice?” “How are your patients doing?” “Can you improve the quality of the care you’re providing?”

“Learning how to learn can also be applied to the way we practice medicine,” continues Skochelak. “What do I need to learn now about managing the diabetic patient that I didn’t know before?”

Team-based care
Medical education needs to come into alignment with the changing needs of patients, communities and the healthcare environment, the AMA believes. Skochelak reinforces the point:

  • Patients’ needs are changing. The United States is facing a growing burden associated with chronic disease, and many of those diseases are caused – or exacerbated – by people’s lifestyle choices. “What that means for medical education is, physicians need to be trained in lifestyle management and motivating behavioral change. There’s a whole new science in that area.”
  • Communities’ needs are changing. Physicians need to be more proactive in promoting population health. For example, rather than waiting for patients to come in for a vaccination, physicians may need to reach out into the community to explain the benefits of vaccination.
  • The healthcare environment is changing. “If we don’t teach students about healthcare financing and the systems of care, it will cost us in the future – as it is costing us now,” says Skochelak.

Nor will tomorrow’s physicians deliver the kind of care needed by operating solely on their own. “Team-based care is where we’re going,” says Skochelak. The healthcare delivery system is complex, with many players involved. Proper care calls for coordination of care – and communication – among all the different parts. And in the midst of it all, someone needs to act as an advocate for the patient. “The physician’s role is really being an orchestra conductor, that is, being the person who helps bring that team together and making sure all the resources that the patient needs are coordinated and current.

“The gap in today’s education is, we don’t effectively train physicians on the best way to work in teams, how to communicate, and how to put the patient in the center of it all.”

And the need to learn how to coordinate patient-centered, team-based care is just as urgent for specialists as for general practitioners, she emphasizes. “The concept of team care applies across all [disciplines],” she says, drawing upon cancer care and childhood neurological-disease care as examples.

In the next five years, the AMA intends to accomplish the following:

  • Establish partnerships with select medical schools and healthcare systems to develop innovations supporting new, flexible and outcomes-based education across the continuum.
  • Convene a consortium of medical schools and additional partners to collaboratively evaluate successes and lessons learned.
  • Widely promote dissemination and adoption of successful innovations.

At the same time, the AMA will continue its work to shape graduate medical education by working closely with the Accreditation Council for Graduate Medical Education and residency committees on GME standards as well as supporting federal and state-level advocacy that addresses GME and workforce issues. The AMA also intends to facilitate electronic access to AMA and Journal of the American Medical Association continuing medical education while developing and disseminating additional learning tools that support students, residents and practicing physicians.


Sidebar:
Doctors look into uncertain future

Physicians have looked into the future, and they’re not sure they like what they see.

Based on the results of the Deloitte 2013 Survey of U.S. Physicians, most U.S. physicians are concerned about the future of their profession and consider many changes in the market to be a threat. Six hundred and 13 physicians completed the survey, which was composed by the Deloitte Center for Health Solutions.

Most of those surveyed believe that:

  • The performance of the U.S. healthcare system is suboptimal, but the Affordable Care Act is a good start to addressing issues of access and cost.
  • The future of the medical profession may be in jeopardy as it loses clinical autonomy and compensation.
  • Satisfaction with the profession is driven by
  • patient relationships.
  • Medical liability (malpractice) reform is a
  • major concern to physicians.
  • Health insurance exchanges are unlikely to be ready for enrollment by the 2013 deadline.
  • Physicians are likely to increasingly compete with mid-level professionals in primary care.
  • Medicaid and Medicare reimbursements may be problematic, prompting many physicians to limit or close their practices to these enrollees.
  • Physician-hospital integration will increase.
  • Integrating comparative effectiveness research into clinical practice may require detailed communication of study methods and tailored results, increased access to clinical decision-support tools in electronic health records, and financial incentives for adoption.
  • Clinical decision-support information technologies that reduce unnecessary services and increase clinician adherence to evidence-based practices are of interest to physicians.
  • Adoption of electronic health records by physicians will increase.
  • Connectivity with consumers (patients) using online or mobile technologies and personal health records is expected to become increasingly important to physicians.
  • Incentives to address consumers’ unhealthy lifestyles should be carefully designed to avoid unintended consequences of non-adherence by the most vulnerable consumer (patient) populations.

Among the key findings:

  • Nearly seven in 10 physicians are satisfied with practicing medicine. Of all those surveyed, primary care providers are the least satisfied compared with their specialist colleagues. Satisfaction with the profession is higher in the younger age groups (25-39) and among those with fewer years of experience (10 years or less).
  • Physicians report that accountable care organizations will be successful to some extent in improving quality of care and reducing costs.
  • Larger practices (large medical groups, health systems, hospitals and health insurance plans) will secure superior third-party payer contracts and offer the greatest financial success potential, whereas solo practices are perceived to offer greater clinical autonomy.
  • Half (51 percent) of all physicians think that physician incomes will fall dramatically in the next one to three years. Significantly more solo physicians (68 percent) are likely to believe that their incomes will fall than those in practices of two-to-nine physicians (51 percent) or 10+ physicians (44 percent).
  • Nearly half (49 percent) of all physicians think that capitation will replace fee-for-service payments in the next one to three years.
  • Few (26 percent) physicians believe that the Sustainable Growth Rate (SGR) mechanism will be repealed in the next one to three years.
  • Although most physicians have not consolidated or considered it, three in ten (31 percent) report having done so in the past one to two years. Twenty-nine percent of physicians who consolidated in the past one to two years did so in order to gain or retain income security, while 21 percent did so to leverage negotiation power with payers.
  • About two-thirds of all physicians believe that physicians and hospitals will become more integrated in the next one to three years.

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