Does the ACGME serve the needs of tomorrow’s physicians?

“A new roadmap for improving residents’ professional skills was released Tuesday by the Accreditation Council for Graduate Medical Education (ACGME)” begins the press release.

As I dove into this announcement a bit further, I discovered the origins of this initiative outlined in this executive summary published by the ACGME on the “CLER Program:”

The Accreditation Council for Graduate Medical Education (ACGME) recognizes the public’s need for a physician workforce capable of meeting the challenges of a rapidly evolving health care environment.

The ACGME has responded to this need by implementing the Clinical Learning Environment Review (CLER) program as a part of its Next Accreditation System. The CLER program is designed to provide US teaching hospitals, medical centers, health systems, and other clinical settings affiliated with ACGME-accredited institutions with periodic feedback that addresses the following six areas: patient safety; health care quality; care transitions; supervision; duty hours and fatigue management and mitigation; and professionalism.

The feedback provided by the CLER program is designed to improve how clinical sites engage resident and fellow physicians in learning to provide safe, high quality patient care.

While the “public” certainly wants responsible physicians with good clinical skills, shouldn’t the ACGME be asking what their training physicians need to get achieve their goals?  To adopt a program that emphasizes the “public’s needs” above those of training physicians,  political, academic and corporate agendas supersede those of the very people who need to learn.  It is missed on no one that hospital funding is now closely tied to “meaningful” completion of electronic data entry fields and “quality” and “performance” measures.

The ACGME, seemingly in concert with the American Hospital Association, appears to be focusing on creating a subservient and compliant physician workforce that will work lockstep in our new highly regulatory medical environment rather focusing on what is needed to create a better, sustainable physician workforce.

No where in the ACGME’s new “CLER program” is medical educational debt, perhaps one of the biggest concerns of today’s physicians, addressed.  Instead of focusing on this critical issue, the ACGME focuses on placating the many corporate entities involved in health care delivery.  After all, insurers, hospitals, and even the medical education complex needs submissive physicians that toe the line.

The ACGME has also systematically allowed medical education to devolve into nothing more than  recitation of the latest published guidelines for medical residents, thanks, in part, to the thousands of these published by various professional organizations and promoted by the US government.   Why do these pathways exist?  Well, in part to provide the best care possible in ideal circumstances, but also to assure that if these guidelines are followed, everyone in the health care complex makes money.  Critical outside-the-box clinical decision making, a skill sorely needed in tomorrow’s evolving pre-canned medical world, is being sidelined.

If the ACGME is serious about having a viable, functional, and engaged physician workforce in the future, they’d better stop serving the public and start serving the real needs of tomorrow’s physician workforce.  Giving lip-service to a program that ignores doctors in favor of the public isn’t going to get patients where they’ll need doctors to be in the years ahead.

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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