Beyond the Affordable Care Act: Training the Next Generation of Health Care Providers for the Post-Reform Era
As students settle back into school and the nation finishes its Labor Day celebration, the Robert Wood Johnson Foundation (RWJF) Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Elizabeth Wiley, MD, JD, MPH, the national president of the American Medical Student Association and a recent graduate of George Washington University School of Medicine.
Ensuring the health professions workforce is prepared for the challenges to come demands a multifaceted approach. With the Supreme Court’s decision this summer to uphold the Affordable Care Act (ACA), it is more important than ever that our health professions workforce be prepared for health care reform implementation. The statistics detailing the growing demand for health professionals have been well-documented. The Association of American Medical Colleges (AAMC) estimates that there will be a shortage of 124,000 – 159,000 physicians by 2025. But, for medical education, increasing the number of medical graduates alone is likely to be insufficient. Rather, expansions in production could support a higher functioning workforce if accompanied by additional reforms. Five areas identified by the American Medical Student Association for reform include:
• “Flipping the pyramid” and recalibrating specialty distribution: It is critical that we change the culture of medical education to better value primary care. Under the ACA, there is investment in meaningful opportunities for primary care training through programs like teaching health centers. Changing the specialty-driven culture of many medical schools, however, will also require addressing the primary care-specialty reimbursement rate gap.
• Reforming curricula to reflect systemic changes: Preparing students to work in the health care system of the future requires better integration of interprofessional team-based care and the patient-centered medical home, health policy and advocacy training and expertise use with patient-centered outcomes research. It may also be worthwhile to seriously consider shortening medical school as part of a transition to competency-based education.
• Managing conflicts of interest: Under the Physician Payment Sunshine Act provisions of the ACA, there is growing momentum around disclosure of relationships with industry. All too often, however, this transparency is compromised in the context of medical education. Lecturers click through disclosure slides, trainees observe industry-driven (rather than evidence-based) prescribing practices and curricula fail to prepare students to appropriately interact with industry. In addition to strengthening policies in educational environments, faculty should model appropriate behavior for trainees.
• Addressing student debt: According to the AAMC, the average medical student debt is now more than $160,000 at graduation with 87 percent of medical graduates reporting some level of indebtedness. With the elimination of subsidized Stafford loans for graduate and professional students, average debt is expected to rise, making medical school increasingly out of reach for many students.
• Revising admission criteria and continue expanding the pipeline: While medical school undoubtedly shapes individual professionals, who medical schools admit has a significant effect on who medical schools graduate. For example, students with a demonstrated record of service through programs like Teach for America, Americorps and the Peace Corps have already demonstrated a commitment and propensity to serve the country’s needs. Rather than focusing exclusively on numeric attributes, a more holistic review process that balances standardized test performance with other desirable characteristics is likely to create a more robust workforce. In addition, the Supreme Court has granted cert to Fisher v. University of Texas, a reverse discrimination case designed to challenge once again the constitutionality of affirmative action, this fall. Should the Court more restrictively limit its holding in Grutter v. Bollinger, which upheld the University of Michigan Law School’s use of race in holistic review, it would be to the detriment of our health professions workforce. It is also important to expand efforts to expose students early to careers in the health professions regardless of socioeconomic status.