Dr. James Madara, executive vice president and CEO of the American Medical Association, says momentum is building for reimagining medical education, as evidenced by the nearly 40 schools that are part of the association’s Accelerating Change in Medical Education. The AMA is now setting its sights on residency programs. Project Japan’s editorial board met with Madara to talk about the need to revamp how doctors are trained. The following is an edited transcript.
MH: What policy are you working on in regard to medical education?
Madara: There have been opinions on what’s wrong with the current educational structure for more than a decade. Everyone’s in agreement but no one was doing anything about it. So we decided we would try to do experiments with a group of medical schools. We hoped we’d get four, five or six schools. We put out a request for proposals under which we were going to financially support this work. Eighty-five percent of the 140 (allopathic) schools responded. We selected 11 initially and gave $14 million toward the development. Now there are 37 schools in the consortium.
In the last half of the century, we’ve gone from largely an episodic disease burden to a chronic disease burden in the U.S. But if you look at the way medical school is structured, the intensity of the clinical exposure is still largely on the inpatient side. The outpatient side is like a strobe light. Given the new ways that we do analytics, we had to create a third science in medical schools. There’s clinical science, basic science, and the third science we introduced was health system science. So team-based care, coordination of care, analytics, information technology, all these things have not been embedded in established curricula.
We were also weak in having our students understand the economic underpinnings of healthcare and how policy affected healthcare. If we’re going to produce physicians who can act and contribute to solving the problem, how can you do that without knowing the economic wiring of the healthcare system or how policy works?
The Accreditation Council for Graduate Medical Education approached us to see if we had an interest in expanding this into the residency program. We put out a request for proposals to get about six or seven, or maybe eight integrated areas where we could work on this transition from a competency-based medical school to a competency-based measured residency. We had the same reaction—over 200 responses for the RFP—which means everyone recognizes the problem we have.
MH: What’s the makeup of the participating hospitals and what are you looking for?
Madara: About all, except maybe three or four of our consortium schools responded, but mostly from teaching hospitals almost by definition, but not necessarily the core academic medical centers. Some outside of that as well.
We’ll be announcing schools in June. We’re looking for innovation and transformative (work). We should pick problems that are big enough that it doesn’t matter what healthcare system we have in 10 years. It doesn’t matter if we’re single-payer, if we’re pluralistic, if we’re all-private, it just doesn’t matter. But you cannot imagine a healthcare system of any type where physicians don’t have to be retrained for the 21st century, where you don’t need better data and data liquidity, where you don’t have to take the physician hours and actually have those focused on patients rather than computers.
We’re also creating a medical education hub. The early form of that has been launched. The idea there is to take all the assets of the AMA in the first instance, and whether they be JAMA or non-JAMA related, they’re related to education. Put that in a form that’s attractive in this current digital age, which also means mobile, and be able in an Amazon-like way to start wrapping around physicians the type of education that they need.
MH: Is one of the goals of your efforts in medical education to increase the physician workforce?
Madara: The Association of American Medical Colleges has estimated that there will be a substantial shortage of physicians in the next 10 years relative to what’s needed. We have the same calculation, though it is done largely on the premise of how things exist today. We know for example that for every hour face to face with a patient today, a physician spends two hours in data entry and administration. We need to think of a different way of looking at that workforce.
Six years ago, we did a collaborative study with the RAND Corp. It was multimarket, with a lot of different kinds of physician practices defining what was satisfying and what was dissatisfying for physicians. Hands down the top satisfier was face time with patients. Nothing else came close.
So when we think about the workforce, we think about the numbers of people we need, the types of fields they’ll have to be in, but also how we use the current workforce. What we’re doing currently is crazy.
MH: What role does entrepreneurship have in the medical school of the future?
Madara: It has to be at least connected. Fifty percent of medical schools—at least this was the case two or three years ago—did not allow their medical students to touch their electronic health records in their institutions. That’s one of the reasons why we co-created an EHR in our consortium. It wasn’t parroting any of the existing vendors, but it was showing what was possible in the general pathways.
If you went to an institution, and you were unable to talk to the EHR and you were to ask, “Well, I don’t see how we do population health on this platform,” and the answer was, “Well, you can’t do population health,” you know that’s wrong.
Another broad disconnect that I saw personally when I was at the University of Chicago is, we had two degrees: MDs with MBAs. I began to ask all of our students who were graduating, “So you’re MD MBA, you’re interested in business and economics as part of your career in medicine, right?” They said yes. “Can you tell me the name of the CFO of the health system of the university?” “No.” The degree wasn’t specified in any way that differentiated it from other MBAs. In medical school, the way we run the healthcare processes and the way we connect to communities, we have to recognize it’s all a big system.