Fall 2013

Medical Practice Unpacked

Harris BermanMoney drives a great deal of the national conversation about medicine these days. But it was not always so. I can well remember the complete absence of financial talk from my professors and among my peers when I graduated from medical school in 1964. Back then, no one would ever talk about money, almost like certain families you may know where the subject never comes up. The whole presumption 50 years ago was that we doctors would learn what we needed to know on the job.

Since the advent of Medicare in 1965 and the arrival of a host of new health-care delivery systems and insurance models in the 1970s, ’80s and ’90s, the world of the practicing physician is much more complicated now. In fact, one of the comments I hear most frequently as dean is that we here at the medical school should be doing a better job of teaching our students about all the financial realities that lie just beyond our gates. It’s a fair suggestion, but let me ask you: When do you suppose the best time to do that teaching might be?

I believe that medical school is too early in the scheme of things for students to be learning about the complexities of practice. Our medical-care models in this country are constantly in flux. I would argue that by the time our students finish their residency training, whatever prevailing model we taught them about may well have changed.

For the past 15 years, your medical school, in partnership with Tufts Health Plan, has sponsored the Tufts Health Care Institute (THCI). Together, we have been offering a minirotation called “Practicing Medicine in a Changing Health-Care Environment” for residents in their last year of training to address this content gap in the standard medical curriculum. Our intensive four-day program is held each August and is open to senior and chief resident applicants from around the northeastern United States at just the right point, I think, before they plunge into their medical careers.

The Tufts minirotation is a great program in which I’m privileged to participate by speaking at the opening session on the evolution of the U.S. health-care system, based in part on my personal experience in the field. The general goal of the minirotation, as Rosalie Phillips, the THCI director, has expressed it, is to help participants understand the context in which they will go on to become effective practitioners.

The size and feel of the minirotation are intimate. Enrollment is limited to about 25 people. Everything is handled seminar-style, with plenty of discussion filling the air during every segment. This year’s program lineup broke into four parts. On Monday, the theme was “The Organization and Financing of the U.S. Health-Care System.” (This is the day on which I spoke.) Tuesday focused on “Quality Matters,” with individual speakers addressing issues arising from such topics as the public reporting of physician performance and the growing role of medical informatics in contemporary practice.

Wednesday tackled the complexities of cost, access, care management and all the new models of care that are emerging. Thursday was devoted to health reform and what new forms, requirements and opportunities the future practice of medicine might assume. On each day, expert speakers—many of whom are full or adjunct Tufts faculty—would offer well-informed commentary in digestible presentations lasting between an hour and an hour-and-a-half. The four days were packed with provocative material explored among peers.

Regardless of the particulars of your own experience, I’m sure you can well appreciate the value of timely, concentrated dialogue like this for a young resident poised to embark on his or her medical career. Rosalie tells me that she routinely hears expressions of heartfelt gratitude from participants at her program’s conclusion. They often say something along the lines of, “We don’t get this anywhere else. This is the best education we’ve ever had on the health-care system.”

I like to think we are doing something really worthwhile with this program. And of course, our patients, both current and future, will be the ones who benefit most.

Harris A. Berman, M.D., is the dean of Tufts University School of Medicine.

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