Wednesday, May 3, 2017

Free medical schools? | Arlen Meyers, MD, MBA |

Is it time to re-think the current model of medical school financing ?

The average undergraduate student debt has risen to $30,000. The average medical student debt is about $170,000. Minorities are underrepresented, many deem the selection process as flawed and the debt burden has an impact on specialty selection and geographic maldistribution, the ability to buy a house and start a family and many other downstream effects. The effects are magnified when one indebted medical student marries another medical student, particularly if they get divorced.

While many are advocating for medical student education reform, changing the business model is lower on the list. Meanwhile, all of this is happening in the face of headwinds created by a lack of basic research funding, meager legislative budgets for state supported schools and decreasing reimbursement for academic clinical services. Many are looking to philanthropreneurship or innovation centers to fill the gaps.

Philanthropy already fills some of the vacuum for private medical schools. Scholarship, and grants are made possible by wealthy individuals who are alumni leaving a legacy gift to their alma-mater.  However, this is a relatively small fraction of an incoming class.  Military or public health funding is available for those willing to devote 4 or 5 years to military service. The amount can extend also to post-graduate residency time.

At one time, small cities, otherwise lacking medical care would select a deserving student for a grant, with the promise of returning to their home to practice medicine.

In the UK some years in the past  college was free. Since that time things have changed and students were demonstrating in the streets and the liberal establishment was pushing back against charging students to attend universities.

A recent analysis of the effects of charging tuition in the UK has analyzed the results. There are lessons to be learned that might apply to the medical school funding business model. The authors conclude that "rather than looking to emulate the English model of the 1990s, the U.S. might instead consider emulating some key features of the modern English system that have helped moderate the impact of rising tuition, such as deferring all tuition fees until after graduation, increasing students’ ability to cover living expenses, and automatically enrolling all graduates in an income-contingent loan repayment system that minimizes both paperwork hassle and the risk of default. No model is without its challenges. But the English experience suggests that making college completely free is hardly the only path to increasing quantity, quality, and equity in higher education. Indeed, the story we tell here shows how a free system can sometimes work against these goals."

Medical education needs a makeover. Here are some principles of medical education reform:

1. Whatever we recommend should be aligned with the vision and mission of the institution. 2. Teaching hospitals are but a part of a community of care and their roles are being redefined not just in the areas of clinical care, but research and education as well . 3. The goal is to create graduates who can serve the needs of the community by improving population health, reducing per capita costs and improving the patient and provider experience.  4. Education and research are step children to clinical care. Just follow the money.   5. Education is different than training.  6. Management is different from leadership, entrepreneurship and innovation.  7. Terms like innovation, value and disruption are used often, with great passion, misinterpretation and misunderstanding.  8. Those that don't walk the talk can only come back to the well so many times.  9. Teaching is not easy or free, only considered by those who pay the bills to be so. 10. What, who, when,and how we teach and measure outcomes is insufficient, costly and badly in need of innovation.  11. Education needs to be responsive to the forces driving the 4th Industrial Revolution .  12. Students should be selected based on their Steampathie (thanks Thomas Friedman) .  13. The business model needs to change to conform to the realities of the environment . 14. We need to address student demands for non-clinical career development, like entrepreneurship, and alternative work-life arrangements other than full-time employment .  15. Learning objectives and curriculum should be driven, in part, by market based determinants including digital health, value based care, interprofessional learning, team based care and cultural competence.
New York has just established "free universities" . Maybe we can learn some things from our friends across the pond when it comes to medical school financing and loan repayment models. Or, we can just sell the assets to private equity. 
Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs

Free medical schools? | Arlen Meyers, MD, MBA | Pulse | LinkedIn
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