by Ryan Gamlin
US Health care is in desperate need of leadership from within. And while there is certainly a notable and growing group of physician leaders (think of the Donald Berwicks, Eric Topols, and Bob Watchers of the world), doctors leading systemic change beyond the realm of clinical medicine is a relatively recent phenomenon.
Health policy remains principally the domain of policy analysts, health and hospital administration is comprised largely of non-clinicians, and the design of our care delivery systems is often inefficient for patients and providers. Yet with an intimate understanding of the delivery of inpatient care (where the bulk of health care dollars are spent), training in the analysis and solution of complex problems, and a vested interest in the efficient provision and administration of care, there is no group better suited — yet paradoxically under-equipped — to drive many of these efforts than hospitalists.
The underlying problem is, in part, a persistent deficit of physician leadership training. Historically, doctors have acquired the skills and tools of organizational and systemic leadership on the job, often in the environment of academic medicine, where promotion is not based on an ability to do the next job, but success in the prior one. This model created our physician leadership gap: too few, and too late. In contrast, as a former management consultant, I saw firsthand how highly resilient and successful institutions create early pipelines to identify and train promising future leaders.
The good news is that some residency programs are beginning to recognize the need to “train ahead” with core health care leadership skills like change management, quality improvement, financial analysis, and management theory, and have created pathways designed specifically to equip graduates with these tools. (Examples include Johns Hopkins’ QI and patient Safety Internal Medicine Training Track, University of Colorado’s Medical Leaders Internal Medicine Program, and the Brigham and Women’s Internal Medicine McArthur Program for Medicine Leadership. It bears noting that all of these programs are associated with Internal Medicine training!)
These programs are laudable, but beg the question: how early in training can (and should) we begin to equip physicians with the skills necessary to take on the challenges facing the U.S. health care system, both macro and micro? And how do we attract the best medical students to these programs and roles?
Austin’s Dell Medical school, currently accepting its inaugural class of medical students, believes that physician leadership training begins during medical school, dedicating nine months of their four year curriculum to an “Innovation, Leadership and Discovery Block”, when students can choose to immerse themselves in care redesign. Students graduating from Dell will have the advantage of longitudinal training in rigorous analysis, execution, and leadership of systemic change. And other programs, such as the University of Colorado’s Young Hospitalist Academy Health Innovations Scholars Program (proud disclosure: I am an alumnus), offer focused training to students selected from medical schools across the country on how to lead innovative transformations in hospitals and the broader health care system.
These programs and others like them play an important role in training the next generation of physician leaders, but some in medical education balk at the notion that medical school (or even residency) is the right time to be learning these skills. “Learn to take care of the sick first” is a quote I’ve heard, verbatim. And as a second year medical student, I can confirm that the modern medical school curriculum is full to overflowing. The pace of scientific advancement continues unabated, and ever faster; there is always more to learn to be a great clinician.
The purpose of medical education is to build the skills to diagnose and treat illness, but the system is sick, too. Delaying these lessons, to assume that doctors will “learn it when they need it” perpetuates the same failings of the current system and relegates too many in the next generation of doctors to continue following. I, for one, would rather see us lead.