Do we need a crisis management team?

(HT for this post to Amir Ghaferi, who shared a comment about teaching awards being incompatible with tenure in a clinical department earlier in the week. I assured him, and assure you, that they are not.)

I’m the first person to admit that we’re headed into a crisis in medical education, and it’s coming from a variety of sources.

  • This coming year’s statistics indicate that we will graduate more medical students than there are residency slots in the U.S.; while medical schools have heeded the call to expand to face a looming physician shortage, expansion of residency slots has not kept pace, largely because of how residency is funded.
  • The distribution of funds for residency slots has been tied to Medicare, and the 1997 Balanced Budget Act basically froze the number of residency slots.  There are interesting geographic maldistributions that are historical holdovers from I-don’t-know-what, as evidenced by New York state having just over 6% of the country’s population but receiving 20% of US funds for residency training.
  • The mission of academic health science centers has changed tremendously.  Teaching hospitals were historically just that- teaching hospitals.  No longer.  Most teaching hospitals are now part of an academic-industrial complex in pursuit of NIH funding, corporate and foundation sponsorship, and faculty are held to the fire of meeting economic benchmarks using the ubiquitous, “No mission, no margin.”  While education is still part of the mission of the academic center, it is just that…a part.  And while historical acknowledgement exists of the “academic triple threat” (remarkable clinician, feted educator, extramurally funded researcher), I’ve seen greater than one obituary to these individuals being a historical footnote in academic medicine.

For a slightly longer weekend longer read, I recommend this discussion of Ken Ludmerer’s new book on the demise of GME.  It’s worthwhile to set the stage if you don’t have an existing relationship with medical training, and it’s meaningful if you do.  While it airs many of our systemic failures in the training of young physicians, these closing lines give me hope:

“If we can restore protected time for good teaching and good patient care, they will flourish. ”

Indeed, they will, and both go hand-in-hand.