What Physicians Want: Emphasizing Value-Based Care in Medical Education

The latest Deloitte Survey of U.S. Physicians found that doctors seeking to improve quality and efficiency in health care believe a shift is necessary – away from the traditional focus on acute care and treatment and toward an emphasis on prevention and overall well-being. But these physicians also say that to fully reap the benefits of a value-based care paradigm, medical schools need to improve instruction in three critical areas: the business and economics of medicine, prevention and sustaining well-being, and development of teamwork skills. 

In this post, I’ll identify how these three areas lie at the heart of the ChenMed model of high-touch value-based care. I’ll also provide recommendations for how medical schools and preceptors can better guide their residents toward best practices that will serve them in a value-based care career.

Introducing residents to the business and economics of medicine

All of our ChenMed practices include physician and business leaders. We invite primary care physicians who 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. We host a series of trainings that give physicians insight into these issues and educate them about what value-based care means for the future of Medicare, how it impacts hospital systems, and how it can change health care as we know it. It’s crucial for us to have physicians who can integrate different aspects of business and medicine to build a successful practice.

Residents, though, don’t get much exposure to the business aspect of medicine. If they do, it’s usually something like a lecture, not a hands-on learning experience. And that’s not enough. Understanding the business and economics of medicine requires being immersed in it, even if it’s just for a short period of time. Medical schools can and should offer a rotation focused on aspects of the medical business. There could be categories – specialty, hospital, outpatient, or value-based care – from which residents could choose. The schools would make connections to provide these educational opportunities to residents, giving them a window into the real world of medicine.

Here in Broward County, I’ve reached out to medical schools and invited residents to shadow our physicians for a month. During their time with us, we would have a business of medicine discussion during which we show them how the value-based care model works financially. These are important experiences to incorporate into medical education, particularly in the third year of residency, just before residents are ready to go out into practice.

Prioritizing prevention and social determinants of health in physician education

Physicians can influence a patient’s wellness in two primary ways. First, there is high-risk disease detection, management, and treatment. This is what medical schools have taught for generations. The second are the many things that influence a patient’s ability to stay well. A patient’s ability to follow a physician’s instructions depends on many factors that have nothing to do with the instructions themselves, such as income, access to support systems, language ability, and past experiences with the health care system. At ChenMed, “wellness” encompasses the totality of a patient’s life. It isn’t simply identifying or treating diseases – which is important – but also having the skills to build strong doctor-patient relationships.

The current model of medical education is focused on solving immediate problems, not addressing any underlying determinants of health. If we want residents to think differently, we need instructors to coach them differently. For example: Say a resident working in a clinic tells her preceptor a patient isn’t taking his heart medication. Instead of doubling down on the instruction, the preceptor might ask: What other barriers are preventing this patient from taking their medicine? What would you advise this patient if you had any resource available to you? This exercise encourages the resident to dig deeper.

We also need to incentivize accountability for residents and apply metrics to assess their patient care. Do they know how often their patients are going to the hospital after a clinic visit? How often their patients are prescribed medications, but not filling them? How many of their diabetic patients have achieved their goal A1C? This doesn’t have to be a punitive structure but rather an informative one that can clearly show residents, “here are the skills you’re excelling in, and here’s where you need work.”

Preparing training physicians to be productive teammates – and future leaders

Teamwork is essential to making a primary care career sustainable and preventing burnout. Physicians historically have worked long hours and forsaken personal lives because that’s what their training tells them is normal. We’ve only recently started seeing restrictions for residents on night calls, and the idea of physician wellness is just now being prioritized by primary care practices.

Our ChenMed practices operate using efficient systems, which allow physicians to balance their personal lives and work through teamwork. Our physicians focus on automating, delegating, and eliminating some of the tasks that, frankly, they don’t need to be doing. For example, a nurse case manager can investigate how a patient’s home life is affecting their care plan, and a medical assistant can help a physician ensure that high-risk patients aren’t missing their appointments.

Traditional medical education—in both structure and substance—doesn’t elevate the importance of teamwork. Residencies have authoritative, hierarchical structures in which first-years do this, and second-years do that. Even as third-years, residents often see a patient in the clinic, then come out and talk to their preceptor about what they missed.

To avoid producing rigid, inflexible physicians, faculty and preceptors need to model teamwork from the top down and focus on opportunities to work in parallel with residents. Doing so will equip residents with the “soft skills” they need to influence colleagues and patients alike to follow their guidance without seeming like they’re telling them what to do all the time. This experience can be infused at every level of residency, and it will help medical students develop the skills they need to be better team members and leaders in their practices.

A glimpse of medicine’s future?

Improving medical education to emphasize these three areas – the business of medicine, prioritizing prevention, and effective teamwork – won’t just produce better doctors. It’ll prepare them to thrive in what, according to the Deloitte report, is a forthcoming a shift in our nation’s health care model.

“Value-based care is no longer something organizations can choose to do as a pilot or an alternative to fee-for-service. Rather, it is a critical part of any health care organization’s short- and long-term strategy,” the report’s authors write. Preparing physicians for this next iteration of the American health care system – to become “stewards of physical, financial, and population health” – will put physicians on a path toward more rewarding and sustainable careers. And that benefits the end user – the patient – just as much as the physician.

Learn more about value-based careers at ChenMed.