By Rahul Rekhi
Since its inception more than a century ago, modern medical education has undergone a series of quiet revolutions. Yet this comprehensive expansion in one critical area masks a relative neglect of another: Medical curricula today largely omit training on health policy.
The result? Even as today’s medical students graduate with a deep scientific fluency, they leave all but illiterate when it comes to the health care system.
I can bear witness to this firsthand. The curriculum of Stanford Medical School, where I am a deferred first-year student, does not incorporate a single required course on health policy or the health care system across four years and 249 credits of training.
And this oversight comes with consequences. To illustrate, recent research in JAMA Internal Medicine found that fewer than half of medical students nationwide understand even the basic components of the Affordable Care Act.
On a systemic level, this illiteracy directly impedes our ability to institute meaningful health policy reforms that tackle such thorny issues as quality-based physician payments, comparative effectiveness guidelines or end-of-life care. Without willing and capable physician leaders to guide, implement and sustain such major shifts for the decades to come, reform efforts almost certainly will founder.
Consequently, efforts to rein in health care costs and improve patient outcomes must begin by modernizing medical curricula to incorporate health policy training.
For example, a national mandate that fundamental knowledge of health systems be a prerequisite for medical licensing would encourage medical schools to incorporate course work on basic principles of health policy and economics. This teaching, moreover, should be nonpartisan and nonideological, focusing instead on the nuts and bolts of health systems – akin to what law or business school students learn about policymaking and institutional governance.
Furthermore, the advent of so-called massive open online courses, or MOOCs, means that financial concerns – the costs of expanding medical curricula to encompass health care policy – may be unwarranted. Online health policy courses, such as the one taught by physician/policymaker Ezekiel Emanuel at the University of Pennsylvania, could serve as a functional stand-in when a university lacks a department or set of instructors dedicated to health policy.
Whatever the medium, it is imperative that we install health policy as an integral part of the national medical curricula, lest we continue to churn out a generation of students who are ill-equipped to make sense of the challenges and changes to come.
Rahul Rekhi served as special assistant to the Maryland secretary of health in 2013. He wrote this for the Los Angeles Times.