The Change Imperative

By Atul Grover, MD

At the 2013 AAMC Annual Meeting in Philadelphia, I was inspired to hear how members at our medical schools and teaching hospitals are coming up with innovative strategies for improving the health care system, while at the same time they are struggling to stay out of the crosshairs of progress-stifling federal budget cuts.

What strikes me most is seeing how our AAMC institutions are assuming leadership in transforming health care–and doing it with determination and foresight. The impact of the change imperative is already visible. There are promising initiatives underway around the country with the potential to revolutionize medical education, care delivery, and research.

For example, medical schools are using new methods to recruit students from their communities as early as middle school to address the looming doctor shortage. Admissions committees are applying holistic review evaluations to ensure the workforce is well suited to care for an increasingly diverse patient population.

On the training front, the University of Texas is leading an initiative to structure medical education around competencies instead of the standard time-based progression. Through the Transformation in Medical Education (TIME) initiative, enrolled college students may graduate with a B.A./M.D. degree in approximately six years. Some may still take the traditional number of years to graduate, but others will enter the workforce sooner based on their competencies.

Another nod to the future: As health care delivery is evolving toward team-based care, new graduates are likely to learn in interprofessional teams, partnering with other professions, such as nursing, pharmacy, public health, and physician assistant programs. In the 2011-2012 academic year, 76 percent of medical schools had an interprofessional education requirement.

In the area of research, AAMC-member institutions are focusing more on accountability in the age of sequestration. We’re seeing the development of measures to better evaluate and target medical and basic science studies that meet society’s demands for new clinical treatments and cures.

AAMC members also have stepped up to the plate in implementing care delivery and reimbursement models through active participation in accountable care organizations and bundled payments. This includes new steps to bridge the current gap between inpatient care and the all-important follow-up care once the patient leaves the hospital.

Change is imperative. But so is a realistic approach to the development and implementation of health care innovation. As AAMC President and CEO Darrell G. Kirch, M.D., urged in a letter to Congress, the budget conference committee should replace sequestration and create a balanced approach to deficit reduction that supports, not thwarts, improvement.

If sequestration continues, we are shooting ourselves in the foot–we are reducing the number of trainees who could treat the injury; preventing research that could have led to a better, quicker, more painless treatment; and stifling the development of new care delivery and reimbursement models that could have made the care more accessible, efficient, and reasonably priced.

groverAtul Grover, MD, is Chief Public Policy Officer at the Association of American Medical Colleges.

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