Perspectives on U.S. Healthcare Policy | Policy in the Classroom



Upon walking into a class at the University of Illinois College of Medicine at Peoria (UICOMP), you will usually find me and my classmates debating the next step in managing a patient’s case.

But at other times, you may see the medical students discussing the impacts of the Affordable Care Act, healthcare executives from OSF Saint Francis Medical Center and UnityPoint Health explaining their experiences with medical leadership, and physicians describing how their payment systems influence the laboratory tests they order for you, the patient. These topics, taught as part of a sequence termed “Medical Colloquia,” are part of the new overhaul of the College of Medicine’s curriculum. We are taught the “non-science” aspects of our medical education, topics that range from U.S. healthcare systems, to transgender medicine, to the patient centered medical home.

While these aspects of medicine are clearly important to physicians today, such topics were not part of medical education until recently. Prior to the 1980s, medical schools mainly taught physicians to treat the disease, rather than the person. The focus was on identifying symptoms, ordering diagnostic laboratory tests and prescribing a treatment. This philosophy changed in the ‘80s as physicians started recognizing that health was a combination of both the disease and the patient’s environment. Also recognized as factors impacting people’s health: the finances available to patients; the patient’s home, work and social environment; and the patient’s personal background.

Change in medical curricula to incorporate these aspects was slow to take place, until in 2010, when the Medicare Payment Advisory Commission, a board of healthcare delivery experts that advises Medicare on the complexity of spending its $670 billion budget, voted on several reforms to graduate medical education. One such reform (that was unanimously agreed upon) was allocating $3.5 billion to reward medical schools that successfully included in their curriculum an education on value in healthcare. This value would include a healthcare systems education, including understanding how coordinated care works between healthcare professionals and other professions, how a hospital compensates physicians and may therefore impact the quantity and quality of diagnostic tests ordered, and how we physicians can work differently between uninsured patients and wealthier, privately insured ones.

For some schools, these modifications have resulted in quite noticeable changes. In the top 20 medical schools as ranked in 2016, each one of them had an affiliated health policy department. Yet, for many other schools, this investment has not had the desired impact. According to a 2011 survey of 93 out of the 160 medical schools conferring MD and DO degrees, the average amount of instruction in health policy over four years of medical education was approximately 14 hours. Over half of the deans responding to this survey believed their school had “too little” health policy education. Moreover, many schools have health policy tracks that medical students can join to supplement the regular curriculum.

But the problem is that the average course load of medical school – with clinical rotations in our third year reaching up to 80 hours per week – leaves little time for those not already interested in pursuing additional coursework. UICOMP does an excellent job of incorporating medical policy issues into Medical Colloquia; I have had well over 20 hours of education in my first year alone. We could certainly be exploring further issues, but for a curriculum newly instituted this year, I think we are on the right track.

Yet, with the majority of schools still not emphasizing healthcare policy, medical schools must change their tune if they want to continue to graduate successful physicians in the United States. Healthcare policy tremendously impacts both the patient and physician. For the patient, the impact is felt from our broad, private and publicly funded healthcare system to the individual insurance policies that control which physicians they can see and medications they can afford. For the physician, the impact is felt from the hospital payment systems that reward them for ordering an abundance of tests or a minimal amount to save the hospital money, to the rewards from Medicare for performing certain tasks like checking every patient for hypertension.

As healthcare costs rise, technology improves, and different policymakers enter and exit office. Healthcare policy will change in response.

I am lucky to be in a school that readily emphasizes to its students the importance of learning about this environment in which we will someday practice. If we can continue to stay ahead of this constantly changing curve, then hopefully, we will be the kind of sensitive and caring physicians that we all strive to be.

David Gao is a first-year medical student at the University of Illinois College of Medicine at Peoria.

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