Preparing Physicians to Lead Reform
ROOTS publications explore issues with respect to healthcare quality and value. The study produced by ROOTS is underwritten by the Pittsburgh Regional Health Initiative (PRHI) and the Jewish Healthcare Foundation (JHF).
The genesis of the Pittsburgh Regional Health Initiative publication of ROOTS on “reforming medical education” is the 1999 Institute of Medicine publication, To Err Is Human or Crossing the Quality Chasm. The current state of the healthcare system in the United States is unhealthy. Of every $1, we currently put $.40 towards preventable complications, unnecessary treatments, inefficiencies and errors. $.60 of every dollar are for services that add value. The Institute of Medicine confirms wasteful spending as recently as 2012. Recent projections estimate that between 2009 and 2019, average annual healthcare spending growth is anticipated to exceed the growth in the overall economy; yet there is little evidence that this will improve healthcare. According to the latest Institute of Medicine report in 2012, estimates of waste approach $750 billion. Waste exceeds the 2009 budget for the Department of Defense by more than $100 billion.
Ranking of 7 nations’ healthcare systems on quality of care and outcomes consistently puts the United States last, even though we spend twice as much as any of the other comparator nations. The United States is on the bottom of the list with respect to improvements in mortality between 1997 and 2007.
One of the major problems with respect to the delivery of healthcare in the United States is medical education. The 2007 study by the Council on Graduate Medical Education stated that “programs are not uniformly educating residents/fellows with all the required skills to enable them to meet the array of future healthcare needs of their patients, nor the future needs of the population.” Team-based care is often set aside as a result of an ego-driven profession where the emphasis is on marketing to increase profits. We see this in direct advertising, patients, billboards, television, and in the print media. Competition for everything from cancer care to male urinary incontinence is overwhelming. New techniques, avant garde cures and sophisticated medicines are marketed like new iPhones. New approaches in medical education will address six core competencies:
- Patient care;
- Medical knowledge;
- Practice-based learning and improvement;
- Interpersonal and communication skills;
These are very general propositions that will need to be developed seriously if there is going to be any change in medical education. ROOTS describes competency milestones, which includes understanding medical errors by virtue of root-cause analysis.
ROOTS notes that the challenge remaining is how to move from the current system, “rooted in decades of volume-based and error-prone practices” to newly-defined goals that reward and encourage patient-centered, high-quality care. ROOTS believes that a solution can be found in the education and development of the workforce, namely physicians. Whether generalities are translated into reality remains to be seen.
If we have learned anything, however, it is that removal of civil responsibility has accompanied the downward spiral in healthcare in the United States. Everyone, at every job, must be accountable not only from an improvement point of view, but also to remunerate patients where harm has been caused by substandard care.
Rieders, Travis, Dohrmann, Mowrey, Humphrey & Waters
161 West Third Street
Williamsport, PA 17701
(570) 323-8711 (telephone)
(570) 323-4192 (facsimile)
Cliff Rieders, who practices law in Williamsport, is Past President of the Pennsylvania Trial Lawyers Association and a member of the Pennsylvania Patient Safety Authority. None of the opinions expressed necessarily represent the views of these organizations.