The ACA Is Changing How Students Become Doctors

From the Medical College Admissions Test to post-graduate residencies, the way U.S. doctors are taught is changing in the wake of health care reform.

Surveys have shown that medical students and younger doctors largely approve of the ACA. For instance, The Physicians Foundation last year found that nearly one-third of doctors ages 45 or younger and one-quarter of doctors 46 and older gave the health reform law an “A” or “B” grade. Meanwhile, another survey conducted around the time the ACA was passed found that the majority of medical students supported the law, even though just about half said they understood it.

Changes Starting Before Medical School

Future doctors are seeing some changes before they even enter medical school.

In April, sections on neuroscience, psychology and sociology were added to the Medical College Admissions Test. A section on humanities and social sciences also has been added.

The changes are the first major revision to the MCAT in more than two decades. In a letter explaining the changes, Association of American Medical Colleges President and CEO Darrell Kirch wrote, “The health care system of tomorrow will require a different kind of physician.” Further, experts at AAMC — which administers the test — wrote in a Journal of the American Medical Association article that “tomorrow’s physicians need broader skills and knowledge than in the past.”

Medical students Allan Joseph and Karan Chhabra recently wrote in Forbes that the “revision sends an important message.” According to Joseph and Chhabra — students at Brown University’s Warren Alpert Medical School and Rutgers’ Robert Wood Johnson Medical School, respectively — “The current premedical curriculum only adds to the prevailing attitude that success in the ‘hard sciences’ (biology, chemistry, organic chemistry and physics) is all that determines success in medicine and that the social determinants of health are ‘soft’ in comparison.” But social sciences are “critical,” the two argue, adding that modern hospitals require “empathetic communication, tech savvy and the ability to respond to a rapidly changing body of knowledge.”

Medical Schools, Residencies Re-Evaluating Focus

In response to the ACA and other reform efforts, some medical schools are increasing their focus on population health and patient-centered care.

Janis Orlowski, chief health care officer at AAMC, told California Healthline, “We are seeing the need for medical students and physicians in general to have information about treating populations as opposed to just treating an individual patient.

“What are the parameters that would improve the health of a larger swath of people — that’s something medical schools are beginning to incorporate into their curriculums.”

Meanwhile, AAMC is re-evaluating the requirements for graduate medical education to ensure they prepare new doctors for the changing health care landscape in the U.S. Orlowski said, “It’s time for us to relook at our curriculum and relook at the competencies that a graduating physician should have.”

AAMC’s Optimizing Graduate Medical Education initiative attempts to do just that.

The initiative was launched because of the many “changing forces” in today’s health care landscape — including requirements and goals of the ACA, Orlowski said.

According to the initiative, “Recent and emerging trends … are demanding rapid and simultaneous changes in medical education and health care delivery.

“Achieving these goals requires physicians who are well equipped to focus on issues such as systems thinking, population health, health equity, continuous improvement and interprofessional collaboration. Education and training programs are adapting to meet these needs, but they need support from the broader systems in which they operate.”

Residency Opportunities Aren’t Keeping Up With Demand

Medical school enrollment has climbed rapidly, with enrollment on target to increase nearly 30% by 2019, according to a survey. However, residency slots for new doctors have not kept pace.

“The problem we have right now is we’re not seeing an increase in the number of residency slots under the ACA,” Orlowski said.

About 87% of U.S. medical schools deans say they are concerned about the availability of clinical training sites, while 71% say they are concerned that medical school enrollment will outpace residency slots.

Congress in 1997 froze funding for medical residencies. But a bill (HR 2124) introduced last week would amend the Social Security Act to provide funding for more residency slots.

The ACA has made graduate medical education more important than ever — more physicians are needed to treat the increasing number of residents who have gained coverage under the law. In fact, AAMC predicts a shortage of up to 90,000 doctors by 2025 because of the aging population, an increase in individuals living with chronic diseases and other factors. AAMC said the physician supply also will grow, but not fast enough.

Medical Schools, Teaching Programs ‘Embrace’ Changes

From taking the MCAT to treating patients, the way that future doctors are selected and trained is shifting in the wake of ACA implementation.

Orlowski said that the refocus on population health reminds her that many public health programs used to be part of medical schools. She said that what we’re seeing now is “the reintegration of public health concepts into the medical curriculum.”

She added that officials at teaching hospitals and teaching programs are eager to “embrace the changes that are going on.”

Around the Nation

Coercing reform? Kansas and Texas have thrown their support behind a lawsuit filed by Florida Gov. Rick Scott (R) alleging that the federal government is illegally attempting to force states to expand their Medicaid programs by not renewing funding measures for uncompensated care programs.

Predicting SCOTUS ruling. Modern Healthcare‘s Power Panel Survey finds that CEOs in the health care industry largely predict that the Supreme Court will uphold the ACA’s subsidies to help U.S. residents purchase federal exchange coverage.

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