Last week NPR covered a story highlighting how medical education is morphing in order to adapt to the unmet demand for primary care physicians driven (at least in part) by the increased access to primary care that will be ushered in under the ACA. It may be surprising to some to learn that many of the most prestigious medical schools like Johns Hopkins and Harvard do not have a primary care program; however, as reported by NPR, medical schools may soon rethink this hole in their curriculum in the face of changing demands upon the health care system and its accompanying incentives for young physicians to enter primary care. Mount Sinai School of Medicine is leading the way in this regard by launching a new department of family medicine in June.
Intuitively, changing the medical education system to produce more primary care physicians will further goals of the ACA by increasing access to primary care, and therefore improving overall public health and diminishing cost by decreasing emergency room care for conditions that could have been treated less expensively or avoided altogether by increasing access to preventative services. These are the arguments we’ve heard repeatedly by the champions of the ACA and by the Obama administration, particularly through its vision for the Prevention and Public Health Fund which was intended to bolster the pipeline of primary care physicians before being gutted earlier this year.
However, if the focus on primary care does result in an increased number of PCPs, there may also be an of-yet undervalued or under-emphasized benefit. Increasing the time students think about primary care issues may lead to more humane physicians who are better-versed in medical ethics and professionalism and thus provide a higher quality of care. Jack Coulehan and Peter Williams have described how programs focused on primary care place greater emphasis on professional values such as empathy whereas other programs may place a premium on technical skill.
The competing values inherent in these skill sets is captured in the common question: “Would you rather have a surgeon with good hands or with good bedside manner?” More appropriate to the current trends in health care reform may be: “Would you rather have a PCP with good hands or with a good bedside manner?” As is often the case in many “would you rather” hypotheticals, we’d probably like both. Assuming that if forced to choose many would prefer a PCP with a good bedside manner, it seems tantamount that alongside launching new programs medical schools need to carefully consider how to best-train physicians within the programs to best meet the demand. In the culture of prestigious hyper-specialization (captured by the fact that top medical schools do not have family medicine programs) it appears that as a whole, a cultural shift in medical education is in order to accompany the shift in health policy.
It may or may not be the case that medical students and residents that focus on primary care actually receive superior training or knowledge that results in superior skills. Nonetheless, the new emphasis and institutional support for primary care within the ACA provides an important moment of reflection and opportunity for medical schools and organizations like the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education to critically consider its curriculum and culture. By creating an environment that values bedside manner as it does technical prowess, medical schools may be able to help achieve some of the goals of the ACA.