Clinical Training Must Be Coupled with Policy, Management to Improve Care

By Sachin Jain, MD

As outgoing Johns Hopkins Dean Ed Miller and I argued in a letter in this month’s edition of Academic Medicine, formal coursework and knowledge about the health care system should be a requirement for undergraduate students considering careers in medicine. It just makes sense. No one should enter a career path like medicine without at least a basic understanding of the system of care; its financing model; and the social and political issues forces that influence the profession.

But it shouldn’t stop with revised premedical requirements. Medical schools and residencies should be doing more, too. We need to move beyond the status quo—the occasional special lecture, the ill-attended course, and the token boards question—to make policy and management more mainstream. This is not a new argument, but it is a new era. With the implementation of health care reform underway; the transition to electronic models of storing and transmitting health information; and an increasing professional focus on resource utilization and management, clinical training more than ever must take on a population-health orientation—and prepare students for clinical and managerial success. Without a significant change in our profession’s focus, our best efforts to improve care will fall short.

Clinical medicine, policy, and management don’t stand in isolation of each other in the real world. Accordingly, they should not be taught in isolation of each other in medical education. This was a key premise of www.ImproveHealthCare.org, a group Kiran Kakarala and I started in 2002 with the support of the Commonwealth Fund that continues to produce cases studies that bring clinical problem-solving together with policy and managerial questions. Medical schools and residencies must take an approach to integrating the teaching of these issues that allows them to stand together. When it accomplishes this synthesis, students and trainees will cease to see these issues as an after-thought (as they currently do)—and more as a critical part of their training as physicians.

Clinical practice is changing fast—and medical education needs to catch up. Thoughtfully incorporating training in the management science and policy is no longer “a nice to have,” but is instead a must-have.

—Sachin H. Jain, MD, is a physician at the Brigham and Women’s Hospital in Boston, MA. Formerly senior adviser to Donald M. Berwick, Administrator of the Centers for Medicare and Medicaid Services (CMS), Jain was involved in the launch of the Center for Medicare and Medicaid Innovation that was chartered by Section 3021 of the Patient Protection and Affordable Care Act, briefly serving as its first Acting Deputy Director for Policy and Programs. He received his undergraduate degree in government from Harvard College; his medical degree from Harvard Medical School; and his master’s degree in business administration from the Harvard Business School. He can be reached at shjain@gmail.com.