By David Thill
The medical landscape changes as doctors leave their offices and enter the communities they serve.
Editor’s note: Sensing a gap between how physicians are educated and the future needs of the U.S. healthcare system, the American Medical Association in 2013 launched its “Accelerating Change in Medical Education” initiative. The association awarded grants to 11 medical schools to fund selected innovations in medical education, and then expanded the program in 2015 to an additional 21 schools. Here’s a look at one program shaping tomorrow’s physicians – and Repertoire readers’ customers of tomorrow.
“We don’t just want to have the best science and technology; I want to have the healthiest country,” says Pedro “Joe” Greer, Jr., M.D., associate dean of community engagement and chair of the Department of Medicine, Family Medicine and Community Health at Florida International University’s (FIU) Herbert Wertheim College of Medicine in Miami, Fla. Community and population health are the focus of the curriculum at Wertheim, which, in 2015, joined 31 other medical schools across the nation in the American Medical Association’s “Accelerating Change in Medical Education” consortium.
A community-based approach
FIU’s College of Medicine was instituted in 2006 when founding dean John Rock, M.D., MSPH, realized the disconnect between academic health centers and their communities while he was providing disaster management leadership during Hurricane Katrina as chancellor and professor of obstetrics and gynecology, pediatrics and public health at Louisiana State University. “He wanted a community-based medical school,” says Greer. Since then, the Wertheim College of Medicine has worked to bring medical care directly to underserved and uninsured households in a way that focuses on the causes of ailments just as much as it focuses on the ailments themselves.
In addition to the traditional clinical side of their education, first-year students learn about the ethical foundations of medicine. From there, they learn about longitudinal care and the social determinants of health – factors such as patients’ access to transportation, their education, their income, and the neighborhoods in which they live.
The value of serving the community is central to the program. Midway through their first year, students are paired with a family – many of these families are below the poverty level, and all of them are uninsured – and they spend the next three and a half years serving that family as part of an interdisciplinary team.
“You can’t, as a doctor, say that the problem is transportation and not do anything about it.” By working with other professionals – including social workers, educators, lawyers, and public health specialists – medical students begin to address all the factors that affect the patient’s health. “The outreach worker is just as important as the doctor,” says Greer. The doctor makes the diagnosis, and the outreach worker takes care of the issues needed to treat the patient.
“Before, it was your genetic code that determined how long you live. Now, it’s zip code” that determines it, he says. The patient’s household is where they experience most of the stressors that affect their well-being, so Greer and the rest of the FIU faculty believe it is important to address those issues in the place they arise: the home.
More than just the blood pressure
“No longer can we doctors be in isolation,” says Greer. “We have to fulfill our social contract with the country,” which means truly engaging people’s whole health, and providing value-based care that meets patients’ basic needs, including convenience. “Instead of everybody coming to the mountain, maybe the mountain’s got to spread out.”
Greer emphasizes that he sees many doctors taking this initiative, but the medical field as a whole has to move even more toward addressing patients where they are at, taking into account everything they experience. The general attitude, he explains, is, “if blood pressure is normal, we have succeeded.” But there is more to the patient than their blood pressure. “We need to look at their entire life.”
The healthier a society is, the wealthier it is, he says. And “health” includes more than just physical health.
David Thill is a contributing editor for Repertoire.