Medical trainees need knowledge and education on health care systems and policy

As medical trainees, we will shape the rapidly changing health care environment in this country. We are fiercely advocating for our disadvantaged patients, debating the price of life-saving medications, and carefully considering how the upcoming elections will shape the health care system in which we both provide and receive care. All the while, we handle our responsibilities and prepare to care for critically ill patients during a seemingly inevitable pandemic. These diverse issues bring to light a huge deficit in medical education — the lack of training on complex health systems.

We (the authors of this piece) met in business school, where we quickly realized how little we knew about the economics, business, and policy of health care. At that point — although we were capable medical students — learning new lessons about organizational culture, health care legislation and the flow of money in medicine represented an entirely new way of thinking. And although these subjects are not rigorously addressed in medical school or residency, they increasingly shape the way health care is delivered in this country. While clinicians should certainly not feel obligated to pursue an additional degree, the practice of medicine suffers when doctors, nurses, and other providers do not share in this crucial non-clinical knowledge.

Recent changes in medical education have created opportunities for reform and expansion of the traditional curriculum. The elimination of score reporting for USMLE Step 1 should free up time and resources, allowing schools to address the many critical and complex problems afflicting the broader U.S. health care system.  Perhaps now, instead of cramming “high-yield” biochemistry for the sake of a few questions on this exam, students might explore topics related to insurance, economics, and social determinant of health. Mastering these issues will inform their entire careers and will allow them to advocate for much-needed change. While many medical schools attempt to teach these topics, we believe that the allotted 5-10 hours of lecture are not sufficient.

For example, the rapidly evolving and not yet fully understood COVID-19 outbreak highlights how important it can be for trainees to have a broad knowledge of the mechanics of care delivery. There is little doubt that COVID-19 will test our hospitals, our government, and our overall economy. As health care providers, we represent the “front lines” against the spread of the disease, and many of us will likely contract the highly contagious virus. These risks are not trivial, and the next 12 months may represent the defining challenge of our medical training. As such, we should feel empowered to demand training that does not teach us merely how to follow infection control protocols, but also how to design them and change patient care for the better.

Lastly, the last decade of primaries and elections have repeatedly demonstrated that health care is top of mind for most Americans. As clinicians, we can be powerful voices of reason in public discourse and use this opportunity to advocate for our most vulnerable patients. Across the country, we have been encouraged by the rise in political activism by some of our colleagues, but many clinicians believe it is their duty to remain outside of the political fray. Instead, much of the health care conversations appear to be dominated by journalists and politicians who, despite their persuasiveness, have never cared for a sick patient.

Ultimately, for clinicians to continue having a critical role in designing medical care, medical education in 2020 needs to emphasize today’s critical issues: public policy, health insurance, drug pricing, and social determinants of health. If we do not take the lead on these problems, patients will be harmed. For example, the upcoming experience with COVID-19 will most certainly underscore the incredible health disparities in this country. As for those with chronic illness and poor access to care, there are certain to be worse clinical outcomes. Just as medical education arms its trainees with the knowledge to take care of complex medical illnesses, it must also arm us with the tools to understand the systems of care which our patients must navigate.

Daniel Arteaga is an internal medicine resident. Isobel Rosenthal is a psychiatry resident in New York. They are founders of the podcast, Well Rounded.

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