Rainu Kaishal MD MPH (Photograph by John Abbott) Rainu Kaishal MD MPH
(Photograph by John Abbott)

As the Affordable Care Act transforms medicine, will higher education respond? Rainu Kaushal is physician-in-chief of health-care policy and research at New York-Presbyterian/Weill Cornell Medical Center, and  chair of the department of health-care policy and research at Weill Cornell Medical College, offers her view:

By Rainu Kaushal, MD, MPH

I still remember the first time I wore my white coat to take a patient’s history as a medical student. After years of studying in a classroom, I was finally able to meet a patient, learn her story, examine her, and connect what I was seeing with what I had studied. And this is how I learned, one patient at a time.

Most doctors in the United States still go through similar training, years of scientific coursework followed by one-on-one work with individual patients. But taking care of one patient at a time is no longer what we need doctors to do.

The health-care reform law signed into law more than five years ago has forced every player in the health-care delivery system to adapt to its new strategic imperatives. That’s no secret.

Providers, insurers, and governments, among others, have sharply changed direction in order to comply with the Affordable Care Act (ACA). They’re experimenting with new health-care delivery and payment models and exploring new opportunities for information technology. All of this action, aimed at providing access to high-quality affordable care to Americans everywhere, has inspired robust debate.

But one sector of our society is still lagging behind. Higher education has yet to transform to meet the needs of health-care reform.

That’s a problem. As health-care changes, so must higher education. Just as the ACA has changed the equation for the practice of medicine and the rules of the game for the health-care professional – and changed that equation both clinically and economically – so must medical and other professional health education in particular.

This issue is far more practical than theoretical. The changes now underway throughout the health-care system are nothing less than radical.

Health care is already shifting away from the traditional model that charges fee for service, where providers are paid more for doing more regardless of the quality of care provided, to a model that measures value delivered to the consumer.

The medical profession is shifting focus from the treatment of individuals to managing the health of populations. New organizations that embody these principles, such as accountable care organizations and patient-centered medical homes, are emerging. Much of this change is fueled by the innovative use of information technology, such as health data analytics and predictive modeling.

Under the circumstances, physicians and other professionals – forced to figure out how to function in this new landscape – often have little choice but to learn on the job, an approach often referred to as building an airplane while flying it.

How do you effectively coordinate care? Manage costs? Optimize all the data at your fingertips? Eliminate variation in quality? Minimize socioeconomic disparities? Keep your hospital or group practice in business?

Higher education should be stepping in to answer those and other questions, and do so sooner rather than later.

For years, certain classic degree programs could handle the job. Master’s degrees could be received in public health, public administration, public policy, and of course in business. Such programs have merit, but focus little on actual health-care delivery itself – and prove to be, under the new reforms, rather blunt instruments.

Compounding the issue here, more hospitals, including those at academic medical centers, have non-physicians serving as CEOs and presidents.

Considering the growth in employment of physicians at these institutions – the number of physicians employed by hospitals grew by 34 percent between 2000 and 2010, according to the American Hospital Association – such management choices may no longer be optimal.

Physicians should have leadership roles in our health-care institutions.

With their practical and nuanced knowledge, physician leaders have the potential to lead health-care organizations during this period of fast change and complexity. Physicians operating under the supervision of other physicians tend to perform differently and many times better. However, physician leaders will ideally supplement their medical knowledge with knowledge about health-care delivery.

Some nationally prominent physicians have already called for doctors to assume a larger role in both the practice and the business of medicine in the 21st century. Among such advocates are Donald Berwick, former administrator of the Centers for Medicare & Medicaid Services; Robert Pearl, CEO of the Permanente Medical Group; and Lisa Bielamowicz, chief medical officer of The Advisory Board Company.

But at the same time, the increasing trend of non-physician CEOs has called for a change in how we train our health-care delivery experts. A study last year by Black Book Rankings determined that two-thirds of hospital CEOs would have little to no health care experience.

The best leadership teams will need to be multi-disciplinary to respond to the rapidly evolving health-care market.

Some schools are already stepping up efforts along these lines. Indeed, schools nationwide now offer more than 70 advanced degree programs in health informatics in particular — such as the University of Illinois at Chicago and the Rochester Institute of Technology  in New York — according to the American Medical Informatics Association.

Weill Cornell Medical College offers master’s degree programs in health informatics and health policy and economics. These programs educate health-care professionals – both with and without medical degrees – about the current policy environment and train them to apply data-driven analytics to develop, implement, and evaluate innovative approaches to health-care delivery.

We recognized the crucial need for new training programs after hearing from hospital CEOs about the scarcity of leaders with background in health-care policy, particularly given the explosion of data and evidence.

The formula proposed here is basic: as health-care changes, so must medical and other professional health education.

Academic medical centers must set a higher standard for such education and accelerate the design of special programs, especially for health-care policy, economics, information technology, and health-care delivery leadership.

Only then can our future practitioners expect to meet the demands for health care that promise to grow faster than any of us ever imagined.

Read more:

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