It’s estimated that within the next ten years there may be a substantial shortfall in the total number of physicians worldwide. In the United States alone it is expected that we will have about 20% fewer physicians than we need.
Such projections are hardly new. In 1960 there was a similar prediction and despite recent increases in the number of medical graduates and a great increase in the number of internationally-trained medical professionals, we still have fewer physicians per 100,000 population than we did in 1960. (We have fewer physicians per 100K population than we did in 1900 but that’s a story I’ve told before.) The practice of importing ITMPs by the United States, Canada, the United Kingdom, France, and Germany from Asia, Latin America, and Africa actually exacerbates the shortage in those places.
A startup has devised an innovative approach to medical education with an eye on addressing the problem. Tech Crunch reports:
Lenihan’s thesis is twofold. The first is that medical schools are looking at the wrong signals to determine who they accept. And once accepted, university resources are misallocated by focusing on having professors lecturing to students instead of providing more interactive and practical examples of lessons in the classroom.
Lenihan first began changing admissions guidelines and teaching practices at Touro. He expanded the number of students admitted to the medical school and told teachers to start recording their lectures and distributing them before class.
In the classroom students were quizzed and assessed on their ability to understand and retain the material. It allowed teachers to identify areas where students were falling behind and begin tailoring the lessons to meet individual students’ needs. This new teaching paradigm also let educators determine who would be best pursuing a different path in their studies of medicine. Underperforming students could be referred to nursing school or technical fields where they could still become health care professionals (even if working as a doctor was beyond their ability).
With the success these education innovations had at Touro (admissions were up, students were being accepted into top residency programs, and in-class performance was up across the board), Lenihan began looking for a way to expand on his innovations.
It will be interesting to see how the medical profession and establishment react to their methods, flying in the face, as it does, of the strategy that has been used in medical education in this country for well over a century. Since 1910 the guiding vision has been “fewer better doctors” with “better” defined as more selective and better equipt to be medical researchers.
On the one hand physicians presently practicing are understandably committed to the old strategies and may be concerned about threats to their livelihoods. On the other hand the younger cohorts may well be more amenable not only to new strategies for selecting and training physicians but to telemedicine and other strategies for putting medical resources where they’re most needed.
Running off to do stuff, but this gave me a good chuckle.
” the younger cohorts may well be more amenable not only to new strategies for selecting and training physicians but to telemedicine and other strategies for putting medical resources where they’re most needed.”
The younger cohorts don’t want to go where they are needed and are pretty committed to the status quo. It is how they got into med school. Will expand later.
Steve
Wishful thinking on my part I guess. Historically, the practice of medicine has been very conservative, resistant to change, and jealous of its prerogatives.
Attorneys are very nearly as bad but if attorneys were as resistant to change as physicians even the simplest contract would be custom-written by a lawyer with a quill pen.
There are a number of things that I think we can change pretty easily. Others not so much. Physicians generally accept tech changes pretty well, with older docs more resistant. IT changes are better accepted among the younger docs. More seem happy to just be employees, so they fairly happily accept the changes with the big networks and PE groups taking over everything. Strangely enough it is us older docs trying the hardest to put them in a position where they have a say about how they practice.
I dont, unfortunately, think it likely we see big changes in criteria for getting into med school. People know how the system works, and it mostly benefits those who are better off financially. Those in med school have siblings behind them and they can guide them through to do the right stuff. The thing is that no matter what you do, you would still need a strong core of people with the skills that the current system is supposed to provide, and to be fair, mostly does. What you need to do is add in more people with other skills sets and strengths.
As far as actual teaching goes, there has been more experimentation with that than you think. The Touro method is not that different, I think, than what some other schools are trying, but maybe better organized and more consistent. But, and this is a big one, just having students watch lectures on a computer vs sitting in a classroom doesn’t create more docs. You still need to find them clinical experiences. Even more importantly, and why this article is not very important, the real shortage is in training spots for residents. I am responsible for a number of ICUs and a lot of ORs. I am sure there are better ways to train people. More use of simulators has possibilities. However, I just don’t see how you get around having real practical experience before you let new docs out to work on people by themselves.
As an aside, I just hired a doc who spent the last 3 years working in Puerto Rico. What I expect him to tell me is that this Tiber group has figured out a way to make money doing this, and it won’t really provide more physicians.
Steve
It seems to me you don’t need doctors as much as you used to, an experienced PA or nurse can take care of a lot of routine stuff. At this point, I think doctors should probably all be specialists which would let others handle routine care.
Andy, are you documenting your travels publicly somewhere? You are such a keen commenter, I think your observations would be well worth reading.
Another thing that could be brought to bear is modernization of building design. Once air-conditioning became a “thing,” buidlings were sealed shut to prevent the escape of cool air for efficiency’s sake. With new types of glass available for windows, designs can be re-opened, so homes and commercial structures needed depend energy-gobbling HVAC units every day of the year.
Homes, for instance, in th ’30s and ’40s were built with cross-ventilation in mind. Open windows combined with ceiling fand made homes livable, even comfortable when heat was not at its peak.
Windows are also attractive features on buildings.
See:
http://www.efficientwindows.org/gtypes_2lowe.php
Whoops, wrong thread. Oh, well. I’m southern. We have addled brains.
Janis,
Thank you for the kind words!
We don’t have a public travel blog – we mainly use Facebook for sharing.