Blog by Bina Valsangkar & Fitzhugh Mullan – June 2017

ACA or Not, American Medical Schools Are Not Ready for Future of Healthcare

June 1, 2017

Bina Valsangkar, MD
Save the Children
The George Washington University

Fitzhugh Mullan, MD
The George Washington University

Republicans and Democrats in Congress continue to battle over repealing the Affordable Care Act (ACA).  Whether ACA is carried out as planned or replaced with something entirely new, our physician workforce is unlikely ready to meet the changing healthcare needs of the nation. Shifts in demographics, the rise of chronic disease, and escalating health care costs are placing new demands on the knowledge and skills of our doctors.  Most American medical schools, however, continue to educate their student doctors in the same ways of decades past.The Association of American Medical Colleges predicts a shortage of 35,600 primary care doctors by 2025. We need more primary care physicians and a more diverse workforce, in cities as well as rural communities and formally designated health professional shortage areas.  We need a workforce that understands the importance of prevention and is judicious in its use of limited financial resources for health.Medical schools are a key part of the supply pipeline that can help meet the changing health demands of the American people, but are they aligned with the nation’s emerging healthcare needs?  Do they even consider themselves part of this essential pipeline?

To answer these questions, our research team looked at the mission statements of all American medical schools and reported the results in an article in Academic Medicine.  We were interested to see if schools were incorporating the imperatives of the evolving health system in their public game plans.
Not surprisingly, American medical schools are very committed to education and research—100% and 86%, respectively, expressed this in some way. Service was also listed in 88% of school mission statements.

Themes in Medical School Mission Statements

But when we looked at what medical schools say about emerging national needs—references to primary care, prevention, increased diversity, the distribution of doctors, and cost-effectiveness—the commitments start to wane.  Only 19% of schools mention primary care in their missions — a level of commitment unlikely to meet the demands of the immediate future. Sixteen percent of schools make some mention of diversity.  With approximately 50% of the U.S. population estimated to be racial or ethnic minorities by 2044 and only 14% of current medical students from these groups, increasing efforts to build a diverse physician workforce will be crucial.  With chronic shortages of physicians in rural areas and disadvantaged communities, it was concerning to find that only 24% of schools mentioned anything in their mission statement about contributing to improved distribution of American physicians.

Numbers indicate percent of schools with the specified themes stated in their mission statements. A total of 170 schools were assessed. The lower right columns represent Prevention (5%) and Cost Control (1%) respectively.

The greater need for preventative services and controlling medical costs were rarely mentioned in the mission statements of medical schools, with 5% and less than 1% of schools making references, respectively.

To be sure, inclusion (or exclusion) of these emerging needs in a written mission statement does not equate to action (or inaction) on the part of any medical school. But empirical evidence shows that the mission statement is a powerful tool of change and is associated with higher organizational performance.

A study by the American Association of Colleges and Universities found that 80% of all colleges and universities were actively making major revisions to their mission statements, goals, and curricula. If these emerging needs are not enough of a priority to appear in a school’s mission statement, will they make it onto the agenda when strategic decisions are made?

Some may feel that issues such as cost control and health workforce distribution should not fall on medical schools’ shoulders—but if tomorrow’s doctors are not trained  to address these needs and serve as advocates for these important issues—who is?  Doctors in the trenches of patient care are among the best positioned to advocate and work for the systemic changes needed to meet our rapidly changing national needs—but this will require special skills and training not necessarily provided by a traditional medical curriculum.

What can the medical community do?

Some medical schools have already stepped up to the challenge. The American Medical Association (AMA) has funded 32 U.S. medical schools to reform their curricula to meet the changing health care needs of the nation through innovative medical education ideas. Projects include enhancing community-engaged training at Morehouse School of Medicine, and training future physician leaders at Brown University. Curricular changes are not limited to the AMA grantees; newly formed medical schools, like Cooper Medical School of Rowan University and the University of California-Riverside, have formulated their mission statements to include civic responsibility, patient advocacy, service to the community, diversity of the physician workforce, and improving the health of underserved populations. These pioneers in medical education, both historic and newly formed, can serve as strong examples for the rest of America’s medical schools.

Dr. Bina Valsangkar is a pediatrician and Adjunct Assistant Professor of Pediatrics at the George Washington University School of Medicine in Washington, DC.

Dr. Fitzhugh Mullan is a pediatrician and Professor of Health Policy and Pediatrics at the George Washington University in Washington, DC.