Category Archives: Medical students and residents
What’s on the minds of this year’s medical school graduates? Among top concerns for the country’s future physicians are uncertainty about health care reform, practice choices, and debt repayment, according to the 2013 Medical School Graduation Questionnaire administered by the Association of American Medical Colleges (AAMC). Overall, most medical students say they are satisfied with their education.
The 2013 graduates in the new survey report an average premedical education debt of $11,849, which is about eleven percent more than students reported in 2012. This ends a four-year trend in which the average premedical debt had been decreasing. In addition, the 2013 graduates report an average medical education debt of $135,084—an increase of two percent from 2012 graduates. Nearly two in five graduates this year (38.1%) say they plan to enter a loan-forgiveness program.
Fewer than 2 percent of 2013 graduates say they plan to go into full-time solo practice. Twenty percent have their sights set on a group practice of three or more. Nine percent expect to pursue hospital work.
With a primary care provider shortage looming, medical schools are trying a new approach to get physicians into the workforce quickly: condensing medical education from four years to three.
Mercer University (Georgia), Texas Tech University, and New York University offer three-year primary care programs, and will soon be joined by programs in Tennessee, Indiana, University of Wisconsin, East Carolina, and Kentucky, MedPage Today and Fierce Healthcare report.
Most of the schools are shortening or eliminating fourth-year clinical rotations to consolidate their programs, leaving the first three years—which often focus on medical science—untouched.
"We chose to do it on the clinical end rather than [the] basic science end because, as long as Step 1 is [and] as important as it is, our students need to be fully prepared for it,” Betsy Jones, EdD, vice chair of research in Texas Tech's Department of Family Medicine, told MedPage Today. “We didn't make any changes to the curriculum that would threaten our students' ability to do well on [the United States Medical Licensing Examination]. The changes are really at the fourth year level."
A three-year program also saves medical students tuition money, and allows them to earn money in the workforce sooner than in a conventional four-year program, according to Fierce Healthcare.
There have been some unusual cooks in the kitchen at the Johnson & Wales University culinary institute in Providence, R.I., lately: medical students.
Doctors-in-training from Tulane University have been cooking alongside Johnson & Wales students for several weeks, NPR reports, to learn about nutrition. This unique program, which debuted this year and was organized by Tulane’s Goldring Center for Culinary Medicine, aims to change the way medical students think about food and, ultimately, how they will talk to future patients about nutrition and healthy eating.
Many health problems and diseases—like obesity and diabetes—could be prevented by lifestyle changes such as better eating habits.
"We basically learn how to take care of patients when things go wrong,” Neha Solanki, a fourth-year Tulane medical student, told NPR. “I think that we need to learn how to be able to make nutritious meals and to discuss diet in an educated manner."
In addition to the collaboration with Johnson & Wales, Tulane’s Goldring Center for Culinary Medicine has built relationships in its own community. Medical students help with an “edible schoolyard” program at local schools, and host hands-on cooking and nutrition education classes for community members at the nation’s first teaching kitchen affiliated with a medical school.
The Accreditation Council for Graduate Medical Education’s decision to limit the working hours of medical residents has not increased patient mortality rates, but it has decreased the time residents spend on direct patient care, according to two studies published in the August issue of the Journal of General Internal Medicine.
Researchers from the University of Pennsylvania studied 13.7 million Medicare patients admitted to hospitals between 2000 and 2008. In the first three years after the Accreditation Council enacted an 80-hour work week for residents in 2003, the researchers found no significant changes in patient mortality within 30 days of admission.
“We can reassure the public that patients did not appear to be harmed by the initial duty hour reform of 2003,” senior study author Jeffrey Silber, MD, PhD, told American Medical News. “We have published many papers prior to this looking at other outcomes [including prolonged length of stay following 2003 duty hour reform], and we have found similar results.”
A second change in resident hours came in 2011, when the Accreditation Council limited residents’ maximum shift length to 16 hours, down from 30. Researchers at Johns Hopkins University and the University of Maryland found that this change contributed to a reduction in the amount of time residents spent on direct patient care. Studies conducted in 1989 and 1993 found an average of 18 to 22 percent of residents’ time was spent on direct patient care; the new study finds residents only spent 12 percent of their time on direct patient care—or about eight minutes per patient, per day—in 2012.
Residents spent most of their time (64 percent) on indirect patient care tasks, such as talking with other health professionals, reviewing charts, and handoffs, the study concluded. Lead author Lauren Block, MD, MPH, told American Medical News that while residents aren’t spending as much time eating and sleeping at hospitals, “that time is not being made up spending time with patients, because they spend that time instead working at their computer stations.”
Richard Rieselbach, MD, is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program and a professor emeritus and health policy consultant for the University of Wisconsin Medical Foundation.
In the last decade, the nation’s community health centers (CHCs) have doubled their capacity. They now provide care for more than 22 million underserved children and adults in every state. But they’re going to need to do it again. By 2019, some 40 million patients will be in need of care.
The United States does not have enough primary care providers to serve these new patients, and our public investment in health professions education—graduate medical education (GME)—is failing to produce the pipeline we need. Medical students are choosing specialties over primary care at an alarming rate, and a policy vacuum keeps the GME program from being held accountable.
An initiative was launched in 2011 that I think holds great promise: the Teaching Health Center Graduate Medical Education initiative. This five-year, $230 million program was funded by the Affordable Care Act and created to increase the number of primary care graduates trained in community settings.
My colleagues and I have proposed a modified and expanded version of this initiative, called “CHAMP” Teaching Health Centers (CHAMP THCs). Our teaching model would pair CHCs with academic medical centers to develop a THC track that would encourage students to graduate in primary care and practice in urban and rural underserved areas.
Human Capital News Roundup: The cost of overtriaging, ‘medical students’ disease,’ the demographics of new Medicaid enrollees, and more.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
People who will be newly eligible for Medicaid after expansion under the Affordable Care Act will be younger and healthier than those currently enrolled in the program, according to a study by RWJF Clinical Scholars alumna Tammy Chang, MD, MPH, and program site co-director Matthew Davis, MD, MAPP. The researchers found that the new Medicaid enrollees will also be less likely to be obese or to suffer from depression, although more of them will be smokers and drinkers. Among the outlets to report on the findings: Reuters, Kaiser Health News, NBC News, NPR’s Shots blog, and Medpage Today.
Medpage Today reports on a study led by RWJF Physician Faculty Scholars alumnus Craig Newgard, MD, MPH, finding that nearly one-third of patients sent to major trauma centers by first responders did not need that level of care and could have been sent elsewhere for diagnosis and treatment. This “overtriaging" raises per-patient health care costs by as much as 40 percent, the study finds. Read more about it.
While in Australia for a conference on reforming health care systems to meet the challenges of aging populations, RWJF Harold Amos Medical Faculty Development Program alumna Alicia Arbaje, MD, MPH, sat down for two interviews—one with The Australian Financial Review on how stereotypes about aging are changing, and one with Australian Broadcasting Corporation Radio about transitional care and reducing readmissions among older adults after they leave hospitals. Read a post Arbaje wrote for the RWJF Human Capital Blog about navigating care across settings and the role of caregivers.
The news media has recently covered some innovative programs that are influencing the choices and attitudes of the next generation of doctors.
American Medical News reports on the Buddy Program, which pairs first-year medical students with early-stage Alzheimer’s patients and their caregivers. The program empowers patients, and also serves as a valuable learning tool for the students, heightening “their sensitivity and empathy toward people with the disease.” The program was developed at the Northwestern University Alzheimer’s Disease Center in Chicago; Boston University, Dartmouth College, and Washington University have replicated it.
NPR reports on a program at the University of Missouri School of Medicine that is encouraging more young doctors to pursue primary care in rural areas. During the summers, the school has been sending medical students to work alongside country doctors. While school officials caution they can’t be sure about the reasons, they have discovered that students who took part in the summer program were more likely to become primary care doctors who practice family medicine. Some 46 percent of participants are choosing to work in the country after completing their medical training.
The U.S. Department of Health & Human Services (HSS) last week announced that it will support twice as many primary care residencies during the 2013-2014 academic year as it supported last year, thanks to $12 million in funding from the Affordable Care Act. The new funds will support more than 300 residents at community-based Teaching Health Center programs across the country.
“Teaching Health Centers help attract students who are committed to serving communities of need and prepare them to practice in these communities,” HHS Secretary Kathleen Sebelius said in a news release. “Students exposed to training opportunities in health center settings are more likely to stay in these communities and continue to contribute to the care of their residents.”
Residents will be trained in family and internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and general and pediatric dentistry.
First-year surgical interns are getting less experience performing or assisting with surgeries as a result of the 16-hour workday cap enacted in July 2011 by the Accreditation Council for Graduate Medical Education, according to a study in JAMA Surgery.
In a review of 10 West Coast general surgery residency programs, researchers found 2011-2012 interns recorded a 25.8 percent decrease in total operative cases as compared with the preceding four years before the cap was enacted. There was also a 31.8 percent decrease in cases performed primary by the interns, under faculty supervision, and a 46.3 percent decrease in cases in which the interns assisted a faculty member.
“The decline in operative case volume in our present study is in some respects surprising given that the new duty-hour changes did not mandate a reduction in an overall 80-hour work week for interns,” the researchers write. “Thus, interns were presumably working the same number of total hours.” The program directors surveyed in the study reported that their predominant solution to the 16-hour rule was to expand the “night-float” system, meaning interns are increasingly working overnight when there are fewer intern-level, elective surgeries taking place.
Graduate Medical Education Funding Is Not Helping Solve Primary Care, Rural Provider Shortages, Study Finds
From 2006 to 2008, 158 of the country’s 759 residency sponsoring institutions and teaching sites did not produce any primary care graduates, according to a study published online last week by Academic Medicine. Less than one-quarter of medical school graduates entered primary care during those years.
The study also found that physician shortages in rural and underserved areas persist; only 4.8 percent of 2006-2008 graduates practice in rural areas. Nearly 200 institutions produced no rural physicians, more than half produced no Health Service Corps graduates, and 283 produced no physicians practicing at Federally Qualified Health Centers or Rural Health Clinics.
Graduate medical education (GME) distribution is uneven, the researchers found, and provides more support to subspecialty programs than to primary care programs. The top 20 primary care producing institutions (where 41 percent of graduates were in primary care) received $292 million in total Medicare GME payments, while the bottom 20 (where only 6.4 percent of graduates were in primary care) received $842 million in these funds.