MEDICAL EDUCATION: COMMISSION RECOMMENDS TRAINING OVERHAUL
A commission of medical scholars in California hasThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
"concluded that it is time to train future doctors to fit into
the managed-care system," Los Angeles Times reports. The 28-
member Commission on the Future of Medical Education, which was
appointed last August by University of California President
Richard Atkinson, is scheduled to release the report on UC's
medical school system later this month. If the report is
approved, California will be the only state to have adopted "such
an extensive overhaul of its medical school system." The report
is being "widely seen as the first step toward a modernization of
the academic health system," Times reports. The guidelines are
designed to resolve "the conflict between the way doctors were
taught to practice and the way they are now forced to practice
due to the sweeping changes" made by managed care. Dr. Molly
Coye, former director of the state Department of Health Services
and member of the commission, said, "We are seeing the death of a
cottage industry and the birth of the industrialization of
medicine. ... For the first time we're in a world where demand
will drive employment."
The commission concluded that medical schools will have to
find ways to reduce the numbers of doctors, particularly
specialists, because patient care is increasingly being turned
over to physicians' assistants, nurses and other staff members.
The commission also suggested that more training be conducted in
clinics rather than hospitals, and that medical students become
"culturally competent." One of the most fundamental changes
suggested, Times reports, would be a greater emphasis on business
knowledge and computer skills. According to the commission,
medical training will be based less on "mastery of the biomedical
model." Instead, because doctors will "increasingly seek a
treatment plan from computer databases of detailed 'outcome
data,' statistics based on previous experience," medical students
will be required to use computers as part of their training.
According to commission Chair Dr. Thomas Langfitt, today's
medical students need "a sophisticated understanding of business
management" to work more effectively with other caregivers and
HMOs. Additionally, the commission found that doctors will need
to find ways to meet "consumers' growing demands for attention to
alternative health methods as well as the spiritual,
psychological and nutritional aspects of their health."
STRUCTURE OF MEDICINE
The Commission envisions a new structure of medicine. There
would be two main types of doctors. The large majority would
focus on primary care and prevention, while a smaller group would
"specialize in treating particular diseases or ailments."
Doctors would work more often in clinics and other outpatient
settings, and hospitals would be reserved for the acutely ill.
Changes of this type are already underway in some California
schools. At the University of Southern California, "60% of
today's graduates are going into primary care medicine." Some UC
authorities have claimed that the changes are not necessary
because most medical schools are already heading in that
direction anyway. However, others have said that changes are not
coming quickly enough. There is also skepticism among medical
leaders about whether funding will be available for the proposed
changes, particularly from HMOs (Roan, 6/16).