For generations, America’s medical schools have largely been bastions of prestige, challenge, opportunity and idealism.
Getting in to med school was one of the elite goals of modern academia, and the question upon graduation was often how best to establish the high-profile life traditionally associated with the field.
But medical schools are facing an unprecedented landscape: turmoil, uncertainty, change, realism. Once set apart from many pressures of the world and encouraged to break boundaries, medical schools are being forced to operate in a world of limits.
The government is cutting research funds. Managed care is pressuring doctors to cut costs, leading to changes in medical education and treatment. Fewer jobs exist for specialists, the highest-earning physicians. Fewer minorities are entering the profession.
Recently, the government expanded nationwide a program to temporarily pay hospitals to train fewer doctors.
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On Wednesday, a six-member federal task force meeting in Chicago held the first of two national forums on that and other changes roiling medical training, research and practice. A second forum, sponsored by the U.S. Department of Health and Human Services, is scheduled for Tuesday in Houston.
More than two dozen administrators from medical, nursing, dental, public-health and related schools from around the country offered suggestions on the shape that change should take. By the end of September, the task force is expected to develop recommendations that will be used to mold federal policy for years to come.
Panel members stressed there will be changes–probably significant ones. The task force is not “an archeological expedition” to preserve the old order of academic medical centers, said Dr. John Eisenberg, acting assistant secretary for health in the Department of Health and Human Services.
Chicago–with its world-renowned medical centers that make historic discoveries and generate big bucks as well as its large number of poor and uninsured people–represents a microcosm of changes and pressures on the national scene, said U.S. Rep. Danny Davis (D-Ill.).
“Health care is a unique science–errors in judgment often have immediate life-or-death consequences,” said Davis, whose district contains several academic medical centers. He was the only politician to speak at the forum.
Although many said some of the changes are good, stimulating efficiencies and new ways of attacking problems, the health centers are struggling to fund the cornerstones of their missions: education, research and health care for the underserved.
“Traditionally, academic health centers have defrayed the additional costs associated with their social mandates by charging higher fees to patients and insurers,” said Dr. Daniel Winship, dean of the Stritch School of Medicine at Loyola University Medical Center in Maywood. “Private and public payers, however, are less willing in this price-sensitive environment to offer such implicit support.”
One result has been an attempt by the federal government to decrease the number of doctors being trained, but deciding how many medical students to train and how many specialists in which area is very tricky.
“The difficulty is we don’t know how much to do and necessarily in what areas,” said Dr. Robert Vanecko, associate dean for graduate medical education at Northwestern University Medical School. “All of a sudden, a breakthrough in new technology may necessitate a need in a specialty where we’ve cut way back.”
Given the pressures of managed care and the decrease in federal support, there are likely to be stronger ties between the medical schools and the private sector, some administrators said.
“You’ve got to look for other sources of revenue,” said Dr. Harry Jacobson, vice chancellor for health affairs at the Vanderbilt University Medical Center in Nashville. “I think there’s going to be a greater emphasis on technology transfer, spinoff companies and the commercialization of discoveries.”
Such permutations and possibilities are what continue to draw young people to medicine.
Josh Kouri, a third-year student at the University of Michigan Medical School, said that while he is concerned that cost pressures could lower the quality of patient care, he remains confident in his career choice. “I’m optimistic,” he said. “I’m excited about moving on and being able to take care of patients.”
Even after enduring decades of changes, pressures and bumps, some medical school deans say they continue to feel that same excitement about their profession.
“It’s still the greatest profession in the world,” said Dr. Gerald Moss, dean of the medical college at the University of Illinois at Chicago, the nation’s largest. “The intellectual challenges are limitless, there’s an opportunity to make a contribution to the good of society–none of that has changed.
“I wish that I were starting over again.”