“Without education in health policy and the healthcare system, physicians are missing critical tools in their professional toolbox,” said Matthew M. Davis, MD, MAPP, associate professor at U-M in Pediatrics and Communicable Diseases, Internal Medicine and Public Policy and a co-author of the NEJM article.
In previous research, Davis found that less than half of graduating medical students in the United States say they received adequate training in understanding healthcare systems and the economics of practicing medicine.
“As a resident, I routinely care for patients who cannot afford their medications or don’t have access to regular medical care,” said Mitesh S. Patel, MD, MBA, a 2009 U-M Medical School graduate and lead author of the article.
“These issues have a major impact on the delivery and cost of healthcare. However, they are rarely discussed in educational lectures or during teaching rounds,” added Patel, who is currently a second year internal medicine resident at the University of Pennsylvania School of Medicine.
Physicians who don’t understand the healthcare system or health insurance policies do a real disservice to their patients, according to Monica Lypson, MD, MHPE, assistant dean of Graduate Medical Education at U-M and a co-author on the article.
“The health care system is complicated, but it’s no more complicated than the other things we expect medical students and residents to learn,” she said. “Regardless of partisan persuasion or political beliefs, physician trainees and medical doctors in general should have the knowledge needed to engage in meaningful discussions regarding health policy.”
At U-M, the Medical School has added an elective course in health care policy, which Davis teaches. “It is enrolled to the maximum,” Davis said. “The students were hungry to learn more. We have to find the best ways to teach medical students to be the best navigators of the healthcare system for their patients.”
In the article, authors call for a common national curriculum—with content tailored to regional and local needs. The authors recommend early pilot projects as a precursor to a standardized national curriculum and propose a focus on four concentrations: health care systems, healthcare quality, value and equity, and health politics and law.
The authors also called for implementing the new curriculum without jeopardizing other topics. Davis said policy discussions can and should be integrated with clinical instruction and permeate the educational training. They advocate for a multidisciplinary faculty to conduct the health policy training, including experts in health economics, sociology, business, and psychology.
Lypson added that patients are demanding this kind of knowledge from their physicians. “We don’t expect them to learn to practice medicine simply by saying, ‘Go take care of patients now’,” Lypson said. “That doesn’t work for clinical knowledge, and it doesn’t work for policy knowledge, either.”
