A major health maintenance organization says it wants to start its own medical school. Will this change the culture of medical education for the better? The need is definitely there, as young doctors increasingly report burnout from the medieval training practices they experience. Whether the HMO’s approach is the cure, though, remains to be seen.
Kaiser Permanente, an organization many know for its huge, nationwide footprint in delivering HMO-style care, has raised eyebrows in Southern California by pledging to open its own medical school to provide more and more diverse physicians who also are more adept at adopting the latest technologies and practicing a more evidence-based kind of medicine. Kaiser hopes to launch its first class in 2019, although it has yet to finalize exactly where students would be schooled and at what cost, the Los Angeles Times reports.
The paper says that the medical school is part of the ambitions of Kaiser’s CEO, who sees his company’s approach to coordinated care as beneficial to what ails the huge, expensive U.S. health system. But critics worry that Kaiser’s cost-consciousness will unduly influence doctors who study in the HMO’s medical school, lessening the quality of future patients’ care.
It’s neither cheap nor quick to start a medical school, as Californians know. They’ve watched for a decade as the University of California at Riverside labored to launch the state’s newest such institution. It’s one of 15 nationwide created in response to a 2006 call by the Association of American Medical Colleges to increase medical school enrollment by 30 percent because physician shortages already were cropping up, were expected to worsen, and might affect Americans’ access to healthcare. These new institutions seeking accreditation and licensure and those that have been planned since, experts say, face an array of challenges. It will be difficult to ensure that tomorrow’s doctors not only are plentiful, diverse in ethnicity, gender, and sexual orientation, but also that they can cope smartly with the seismic change in technology and economics affecting the practice of medicine.
As for existing medical schools, the news there, at least from the students’ point of view, is grim. As National Public Radio has reported, students, asked to draw comics about their experiences, portrayed their workplaces as “dank dungeons, represented supervising physicians as fiendish, foul-mouthed monsters, and themselves as sleep-deprived zombies walking through barren post-apocalyptic landscapes.” This dark view of medical education was captured in a study published in the Journal of the American Medical Association.
Conditions also don’t improve much for practitioners, according to a recent Washington Post report. It cited new research, published in the Mayo Clinic Proceedings, finding that more than 6,000 responding physicians, just in the last three years (2011-2014), showed increasing signs of professional burnout and depression; more than half of respondents said they felt “emotionally exhausted and ineffective,” and that their work increasingly was less meaningful.
KevinMD.com, an online site that allows physicians to air their many concerns, recently posted a startling and timely interview with Pamela Wible, a doctor and blogger on the topic of ideal practice, with Christine Sinsky, another doctor and the AMA’s vice president for professional satisfaction. Wible said her profession loses the equivalent number of doctors each year to suicide as might make up the entire enrollment of one medical school; it is, she said, a little discussed issue that hundreds of doctors feel both so isolated and overwhelmed that they kill themselves, leaving more than 1 millions Americans annually in search of new caregivers.
I’ve written for years about just the issue of how everyone, including federal regulators, have tried to address the terrible hours that interns and residents are expected to put in during their training. This often leaves them numb and weary — and not the optimal caregivers for patients in increasingly complex, demanding hospital settings.
The remedies for physician anxiety, depression, burnout, and dissatisfaction are too many to detail here. The issue is huge for all of us who put our lives and well-being in unhappy practitioners’ hands. I will say that physicians themselves might improve their lot if they gave up the misguided view of themselves as godlike clinicians garbed in white, incapable of error, and above the rest of the many, including their own health care colleagues. The perpetuation of such rigid, hierarchical attitudes makes it tough for real human beings to improve not just their own well-being but also to provide the careful, compassionate care that we patients rightly expect.