By SAI BALA, JD
The United States medical education system is heralded as one among the top in the world for medical training. Given the strict standards of education, multiple licensing boards, and continuous oversight by governing bodies, getting a placement to train in the US is extremely competitive. In 2017 alone, nearly 7000+ non-US citizens (commonly referred to as “foreign medical graduates”) applied to compete with 24,000+ US citizens for American residency spots to pursue specialty training. The reasons for this competitiveness are simple. The vast majority of medical institutions in the US boast a comprehensive curriculum that entails basic sciences, clinical principles, practical and hands-on didactics, and enriched exposure to the clinical aspects of patient care. This training produces astute clinicians that are capable of resolving the most complex diagnoses while providing comprehensive patient care.
However, it is high time to recognize that being a shrewd clinician is no longer a sufficient product for the demands of the healthcare market today. That is to say, the scope of medicine today for a physician has gone far beyond resolving complex medical problems, but demands a higher understanding of multidisciplinary skillsets, most important of which are finance and legal theory. In these aspects, the US medical education system direly underprepares physicians, and thus, requires a thorough reevaluation.
The art of medicine, as much as it was originally developed to be purely about the betterment of patient health, has become yet another siloed service industry. Simply put, patients are customers, and physicians are increasingly held accountable for the financial metrics and revenue their work produces. Compensation models are increasingly favoring productivity based payment methods, such as the relative value unit (RVU) system, and are moving away from the traditional, salaried physician. This has resulted in increased pressure on physicians to become more efficient with their workload and patient docket, while managing the often turbulent and contradictory interests of insurance, patients, and hospital administration.
Furthermore, from a personal finance standpoint, the average medical student comes out with nearly $200,000 in financial debt by the end of their formal training. This figure often doesn’t account for accrued interest, loan fees, or lost years of income. With some of the highest education debt in the world, physicians are woefully underprepared in navigating the complexities of loan repayments and general financial management. Most physicians end up relying heavily on tax planners, financial advisors, and personal bankers for advice on how best to manage loan payments, invest their earnings, and accrue enough funds for retirement.
Yet another grievance is the lack of education given to training physicians in the fundamentals of the law. The prevalence of medical malpractice cases continues to be a daunting aspect of practicing medicine for many physicians, as most doctors will be involved in a case at some point during their career, whether or not actively or on the sidelines. The unfortunate reality is that most physicians are not well versed in the realities of tort law, negligence, or the legal theory behind the very “standard of care” they are held up to in practice, until they are often forced to learn in pre-trial preparations. As medical malpractice is estimated to cost the healthcare system nearly $50+ billion a year, and nearly 1 in 3 physicians will get sued over the course of their career, medical institutions must undoubtedly inculcate at least the basic fundamentals of legal theory into their education in order to prepare future physicians.
On a more practical aspect, medical residents are often confronted with complex employment contracts while pursuing full time employment opportunities during their final year of specialty training. These contracts often contain non-compete clauses, non-disclosure and confidentiality agreements, termination protocols, and information regarding complex compensation models based on salary and revenue generated. Unfortunately, due to sheer lack of expertise in the area, most budding physicians either seek professional legal help when signing their contracts in order to navigate through the legal complexities, or worse, sign the contracts blindly.
Fortunately, the solution to this lack of education does not have to be complicated. Most medical schools today have numerous elective blocks during the final year. These elective months are dedicated to the sole purpose of allowing students to delve deeper into personal healthcare interests and unique aspects of medicine that they may not have had an opportunity to explore during the first 3 years. One simple solution to provide a more comprehensive education is to use some of this block time to provide an intensive “crash course” on financial and legal fundamentals. Though students may not appreciate it at the time, they will be better able to navigate their first paychecks and the first time there is liability attached to their name, both of which occur during residency training. Alternatively, medical schools could strive to incorporate more of this curriculum into their first few years of basic training. While the volume of study is already high, this vital training should not be neglected, and should be given as much attention as it is in the “real world” of medical practice.
Only by quelling these fundamental education-gaps can the United States medical system truly continue to be at the cutting edge of training well-rounded, capable physicians. Without doing so, physicians will be continue to be woefully underprepared for what the modern US healthcare system demands.
Sai Bala, J.D., has a background in strategy consulting, and is currently an M.D. candidate. His work and scholarship focuses on the intersections of clinical medicine, policy, and innovation.
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