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Posts Tagged ‘Medical schools discuss changes’

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The Detroit News (4/4, Bouffard) reports that “eleven medical schools from across the nation will meet at the University of Michigan Monday to brainstorm how to adapt to the new health care environment taking shape under the” ACA. This convention “is part of an American Medical Association (AMA) initiative, ‘Accelerating Change in Medical Education.’” According to AMA president and CEO James Madara, “The basic structure (of medical education) has been pretty static for a century.” Madara added, “Medicine used to be almost (entirely) about acute disease, and now it’s more about chronic disease. We can anticipate a huge chronic disease burden and most of that will be outpatient.”

In the Detroit News article, the author Karen Bouffard  says, “The federal Affordable Care Act is also changing how hospitals and physicians’ practices operate, because it rewards health care providers who improve medical outcomes while trimming costs, and penalizes those who don’t.”

Blogfinger Medical Commentary  by Paul Goldfinger, MD, FACC

In recent years, on Blogfinger, we have been speculating about how the ACA will affect the practice of medicine, but all we heard about were insurance and cost issues.  Some, on Blogfinger, even said that the ACA will have nothing to do with how medicine is practiced, but we were skeptical.  This article is an example that illustrates the fact that the ACA will influence much about how physicians will function in the future. Specifically, as described above, we have medical schools planning major changes in what doctors will learn compared with what has been taught over the last hundred years.

In medical school we learned almost nothing about the everyday care of outpatients with chronic diseases. We learned the equivalent of two languages, but it was mostly memorizing a mountain of information. We rarely got to see the inside of a doctor’s office, and during the clinical years, we saw mostly hospital and emergency room cases. That is changing already in many med schools.

When I arrived at Mt. Sinai Hospital  in New York City for my internal medicine internship, the teaching service was mostly filled with patients having complex and/or rare diseases that I had either never seen before or even heard of:  monoclonal gammopathy, myasthenia gravis, systemic lupus,  porphyria, and sarcoidosis, among others. But that’s what you run into in major teaching/referral institutions.  I don’t think that bothered anyone, because we felt that if we could handle those difficult cases, then we could do anything that  eventually might cross our paths.

By the time I was finished there, five years later, I was an expert in acute medicine, but, as a cardiologist eligible for board exams, I had never taken care of  chronically ill heart patients with common disorders over time.  That all changed when I became a Navy cardiologist in a big hospital with a large outpatient clinic population, where I got to see and follow chronic cases  (mostly retired Navy men) with “bread and butter” conditions such as mild to moderate hypertension, stable coronary disease, diabetes mellitus, and prevention issues such as weight/lipid control.

When I began my private practice in Morris County,  the primary care doctors were often quite weak in terms of what they should have been doing. Later some able internists showed up and improved the situation.  After retiring to Ocean Grove, I discovered that some primary doctors  I ran into in Monmouth County were  suboptimal. It became a challenge to find one who did the job correctly.  So, as the ACA began to roll out, I suspected that  many of the  primary care  doctors would not be able to  meet the demands of the “new medicine” on the horizon and that there would be shortages of effective primary physicians.

Thus the AMA sponsored  convention noted above which aims to restructure medical school education for the future has its eye on the ball.  But in the near future, it will be a challenge for patients to get the chronic care that they will need and which is being proposed and defined under the ACA.

It will be interesting to watch the way the medical profession changes to meet the new demands and challenges.

 

 

 

 

 

 

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