Transforming Primary Care Begins in the Classroom

How can the doctors of the future make better choices for the patients? The answer to this question begins in the classroom, with education underpinning the primary care transformation. Given the ongoing shift from the fee-for-service to a value-based approach, the importance of teaching residents and students about transforming primary care has never been more relevant. However, to achieve this, four fundamental changes must be made.

Prioritizing prevention and social determinants of health

The first shift in focus is prioritizing of prevention and social determinants of health. But what do we mean by this? Currently, most medical schools and residencies emphasize intervention instead of prevention, a concept promoted in value-based care. Prevention is an umbrella term incorporating chronic disease management and coaching for behavioral changes. The vast majority of doctors seeking to improve the quality and efficiency of the care they provide believe that this shift in the industry is necessary.

“If we want residents to think differently, we need instructors to coach them differently” – Christopher Chen, ChenMed CEO

Yet, it is evident that to reap the full benefits of a value-based care model, medical schools need to change the education structure. Effective value-based care requires knowledge of and sensitivity to the social determinants of health – all the factors outside of clinical care that profoundly influence whether and how patients can follow a care plan. This knowledge will enable medical students and residents to devise the simplest, safest, most effective, and least expensive care plan for their patients.

Providing hands-on clinical training in value-based care

Although the concept of value-based care is covered in medical education, there are few opportunities presented to students and residents to apply this knowledge in practice. Providing hands-on clinical training in value-based care, similar to the training for specialties like surgery and intensive care, will demonstrate the importance of transforming primary care and provide examples of what this shift looks like in practice.

“Medical students and residents should have a chance to develop a relationship over time with a manageable panel of patients” – Dan McCarter, National Director of Primary Care Advancement

Providing hands-on clinical training in this sector will enable students to understand the cost of all the individual items that make up a routine visit. This is especially true with diagnostic testing. Students will learn to weigh those costs against the probability those items will bring about positive patient outcomes beyond opening the eyes of students and residents. These alterations to the curriculum are instigated in schools like Dell and supported by campaigns like Choosing Wisely. The goal is to encourage clinicians to avoid unnecessary tests, treatments, and procedures. Teaching students and residents the importance of this early on will have a knock-on effect on the future of primary care.

Introducing trainees to the business and economics of medicine

This change ties in with providing hands-on clinical training in value-based care and educating students and residents on the business model of healthcare. After all, medicine and the healthcare industry is first-and-foremost a business. At ChenMed, we invite primary care physicians that join our practices to learn how managed care works, how value-based care works, and how outcomes that are good for the patient are also good for the doctor.

Physicians must be able to integrate different aspects of business and medicine to build a successful practice. This education should be the responsibility of medical schools and provided early on. However, students and residents don’t get much exposure to the business aspects and medicine; if they do, it is rarely a hands-on learning experience. Therefore, it is suggested that medical schools offer rotations focusing on parts of the business side of medicine, including specialties, hospitals, outpatient, and value-based care. This immersion will give our future physicians a window into the real world of medicine.

Familiarizing students and residents with metrics and data

The last proposed change to advance the primary care revolution is familiarizing students and residents with the metrics and data used to assess their patients’ care. This incentivizes accountability and prioritizes prevention and social determinants of health. Although this change may be uncomfortable for residents, it does not have to be a punitive structure. Instead, educating students on these metrics can be highly informative, providing them with constant feedback on which areas they are excelling in, and which areas may need some work. 

Instigating the changes described here will promote giant leaps in the right direction where value-based care is concerned, and it is evident that each of these changes are interlinked. However, we must focus on closing the medical education gap and recognize that small changes in the industry will have little impact if we do not shift the fundamental structure of education. The current healthcare system is a prime example of the impact that inaction on medical education has on good health for those that need it most.

To learn more about the importance of medical education, listen to this episode of Faisel & Friends: A Primary Care Podcast. For more discussions about primary care issues in America, head to your favorite podcast platform and subscribe, so you never miss an episode.