Faces of Public Health: Lisel Loy, Bipartisan Policy Center
Late last month, the Bipartisan Policy Center, a think tank based in Washington, D.C., released a new white paper, Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention-Oriented Care, that strongly recommends providing greater training in nutrition and physical activity for medical students and physicians in order to help reduce U.S. obesity rates. The report was jointly published with the American College of Sports Medicine and the Alliance for a Healthier Generation, a nonprofit founded by the American Heart Association and the Clinton Foundation as a response to the growing rate of childhood obesity. The report found that current training for medical professionals and students in nutrition and exercise is inadequate to cope with the nation’s obesity epidemic.
A survey conducted for the new report found that more than 75 percent of physicians felt they had received inadequate training to be able to counsel their patients on changing diet and increasing activity levels. It also found that while some schools have stepped up their performance, fewer than 30 percent of medical schools meet the minimum number of hours of education in nutrition and exercise science recommended by the National Academy of Sciences.
“The health care marketplace needs to place greater value on preventive care,” said Jim Whitehead, Chief Executive Officer and Executive Vice President of the American College of Sports Medicine. “Doing so will provide medical schools with the incentive to train their students accordingly. And it will give medical professionals the leverage they need to address healthy lifestyles with their patients.”
NewPublicHealth recently spoke with Lisel Loy, director of the Nutrition and Physical Activity Initiative at the Bipartisan Policy Center, about the report and about how to improve training for medical professionals on nutrition and exercise.
NPH: What was the idea that propelled you to look into making changing to medical school education?
Loy: Well, the technical launching pad was our June 2012 policy report called Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future. And in that, my four co-chairs recommended a suite of policy changes that would improve health outcomes and lower costs for families, communities, schools and work sites. Within that community context they called out the need to improve training for health professionals—not just physicians but health professionals much more broadly defined than that—in pursuit of the goal of reducing obesity and chronic disease and cutting costs.
So that’s sort of the technical answer to your question. The more philosophical answer is as we as a country shift toward more preventive care, they really saw a gap in the education and training of health professionals in terms of being able to best support improved health outcomes. So that’s how they determined that that belonged in our report as a policy recommendation, and since we put out that report we prioritized a handful of recommendations, one of which had to do with health professional training.
NPH: Have you gotten feedback so far on the white paper?
Loy: We’ve gotten a fair amount of feedback, actually. We disseminated the report to the best of our ability, including a briefing that Hal Wexler, Jim and I did at the IOM...[a]nd there’s a subgroup of that roundtable that I think is quite interested in this issue. So there was a lot of traction in terms of thinking about opportunities to continue this work and sort of try to move the ball down the field, so to speak.
NPH: Who are your partners on the initiative?
Loy: Our partners are the Alliance for a Healthier Generation and the American College of Sports Medicine. Those two organizations and the Bipartisan Policy Center both hosted the forum that we did in the fall that spotlighted some innovations in curriculum reform at different schools around the country, and they are also our co-authors on the report. Our other two important partners are Bill Dietz, at the George Washington University Milken Institute School of Public Health, and Don Bradley, who was the Chief Medical Officer at Blue Cross Blue Shield North Carolina and is now at Duke University. He is an important collaborator also representing the payer’s perspective.
NPH: What’s the feedback that you’re getting that tells you that you might see that you’ll make some inroads on this issue going forward?
Loy: What’s challenging and interesting about this field, as you know, is that it is requiring input from lots of different kinds of stakeholders who don’t always necessarily talk to one another during their course of daily business. So there’s the academic community both writing about and teaching about this issue, and there’s the medical boards and credentialing agencies that are really some of the ultimate decision makers in this arena. I think they are feeling some pressure to engage, but as you can imagine, they’re not necessarily quick to change, and rightly so. And then even on the Hill there are a couple of pieces of legislation regarding this issue. So I think I would say from actual schools to some of the decision makers, to some of the payers who are kind of changing priorities against the landscape of the Affordable Care Act, to Congress, there’s interest from these multiple sets of stakeholders, and so what we’re trying to do is kind of act as a little bit of an integrator or facilitator for some of those conversations and relationships that we think are going to be essential to changing from the status quo to something better.
NPH: Is it still the case that a great deal of medical education is paid for by Medicare and how does that factor into changes to medical school education?
Loy: That is a factor. It’s not one that we took on in this chapter of this work, and I think that is a piece of it, but that’s not the only piece or necessarily even the biggest piece, although I think to delve into that more deeply would require another chapter of work on our part.
NPH: How does this fit into a general sense of making changes to medical school education by making it much more community oriented? How do you fit into initiatives already underway?
Loy: We’ve worked very hard to make sure that we are aware of, aligned with, complementary to and not competing with existing initiatives. And there are several—AMA being one of the most prominent and recent examples of that—and I think there’s plenty of room for multiple players, but it’s obviously a priority of ours to not duplicate efforts. But in terms of how training physicians fits with the broader landscape of the community, connecting clinical care to community-based care is a high priority for us, particularly given our focus on prevention and health promotion. We believe that that connection is essential to achieving the outcomes we’re talking about, which is improved care at lower cost.
And so...one of the pieces of our October conversation focused on that clinical community connection: How to make doctors more aware of resources in the community, how to make doctors more aware of conditions in the communities in which their patients live and really recognizing that doctors can’t do all of this. There’s no suggestion that they should do all of this, but to equip them to provide the best care for their patients. There’s a lot of room for them to collaborate much more closely with community-based resources. At the moment there’s a big gap in what they seem to know or what many of them seem to know about those resources, and we heard that over and over again from medical students and physicians at the conversation we hosted in October.
NPH: Is there anything else you like to say about the report or about what’s up ahead?
Loy: In terms of what’s next, this is a field with multiple players in it, and so...we focus a lot on how we can add value, and I think given our co-chairs we have an opportunity to continue to spotlight the issues through convening and media exposure. But more important, I think, is one of the things we found was that as we see in many areas of prevention, there’s a lot going on that not a lot of people know about, and I don’t mean the general audience, I mean other similarly situated entities. So if school A is innovating, school B, C and D may not know about that. That was one of the things that inspired us to host this convening in the fall, and I think we would like to continue to play the role of promoting the exchange of those promising practices that already exist, even sort of any system change that may come later. So kind of sharing what works and playing a role in sort of promoting that either though hosting a clearing house or something a bit more proactive than that.
Second, I think some of the recommendations we make in the paper talk about changing the current system, and I think that’s going to require some coalition building or some aligning of parties from different silos, if you will. And so trying to kind of play that role of integrator from these very different worlds and sort of prioritizing outcomes and then helping align stakeholders behind those outcomes is the second thing we have to do. And the third you kind of touched on: This does not begin and end just with physicians. We chose to start our focus on physicians, but there are lots of other health professionals—from nurse practitioners to community health workers, to pharmacists—who also receive little in the way of education and training around these issues, so we are considering opportunities to broaden our scope beyond just physicians.