4 Years In Medical School Is Wasting HealthCare Resources

Ezekiel J. Emanuel MD, PhD and Victor R. Fuchs PhD want to speed up the clock in medical school and residency.

If you think 10 to 15 years of training to become a doctor is nuts but decided to go for it regardless, I have some bad news. According to recently published article in JAMA, you where right, it is nuts! More than that, it may be a place to look for cutting unnecessary costs in healthcare. This article calls to question some of the most basic assumptions central to becoming a physician.

The Death of The All Knowing All Powerful Physician

The picture of the lone physician hero fighting off death and disease may seem inspiring but is really just ignorant and impossible in healthcare today. No matter how many of your internal medicine attendings puff up their chest and say "I don't need to get consults" it does not change the fact that we can no longer effectively practice medicine in a vacuum. Learning to work closely with our colleges is something that competition in medical school has suppressed but it is a skill that future physicians need to develop.

The consequence [of trying to train one all knowing doctor] is a broad training regimen... [it] emphasizes the autonomy of the physician rather than team-based care. The new model recognizes that with increasing clinical and scientific complexity, no physician can be a competent triple threat; that few clinicians will also be investigators; that no single clinician can know everything even in his or her own specialty; and that effective care requires collaborative, multidisciplinary teams.*

Less Time In Medical School and Residency Makes Better Doctors

At first this seems like a paradox, but when you consider the time spent learning outdated and extraneous facts or working hard to efficiently take care of more and more useless paper work, it begins to make sense. What if the right of passage was something besides showing how well one can fill out reams of paper work on patients. I guarantee any intern will tell you this takes up most of there waking moments during the first year of training. The current system has evolved to fit this waste and has little reason to correct course because, "that's what interns and medical students are for". However this drives up education costs for new physicians and increasing educational debit also limits the career options for graduating doctors. We are all inherently practical and when faced with a mountain of debt, grabbing a job with the highest pay and benefits will win. Following your desires to work in an undeserved area or taking a risk on a new business venture is a cost that many will not take.

There is substantial waste in the education and training of US physicians. Years of training have been added without evidence that they enhance clinical skills or the quality of care. This waste adds to the financial burden of young physicians and increases health care costs. The average length of medical training could be reduced by about 30% without compromising physician competence or quality of care.*

Read the full article here: Shortening Medical Training By 30%

*Emanuel EJ, Fuchs VR. Shortening Medical Training by 30%. JAMA. 2012;307(11):1143-1144. doi:10.1001/jama.2012.292.

Innovating In Health Care As A Young Physican

Looking to change healthcare with your new idea but don't know where or how to start?

Look no further...

Arlen D. Meyers MD MBA, is the cofounder, and Chief Medical Officer of MedVoy, a medical tourism company. His is also a Professor of Otolaryngology, Dentistry and Engineering at the University of Colorado at Denver. He has authored of a new book called The Life Science Innovation Roadmap: Bioscience Innovation Assessment, Planning, Strategy, Execution, and Implementation and currently serves as CEO and President of the Society of Physician Entrepreneurs at www.sopenet.org

I asked if he could give a quick overview of the change in healthcare that is happening right now and some areas where these changes are creating opportunities for young physician entrepreneurs to make a big impact.

Enter Dr. Meyers

None of us needs to be told that the US healthcare system is undergoing change. Designed for yesteryear and showing signs of dysfunction and age, our system is cracking under the strain of an aging population, escalating costs and poor technological progress.

Things have changed in several important ways:

• Health Insurance Reform and changes to the Reimbursement model
• Decentralized patient–centered care
• Downsizing /right-sizing the healthcare workforce
• Electronic medical records, healthcare information exchanges and data analytics/BI
• Acute to preventive care
• Disconnected to integrated care
• Medical travel: The search for value-based care
• Mobile health
• The emergence of non-US markets for biomedical innovation
• Increasing regulatory scrutiny
• The changing intellectual property landscape
• New healthcare delivery models: telemedicine, concierge medicine, hospitalists
• Physician-industry conflict of interest and transparency requirements

These market shifts can be lumped into four categories, each an opportunity for you to make a difference.

The first is healthcare information technology. The infrastructure emerging has four basic components: electronic medical records, health information exchanges, data analytics and business intelligence and telehealth/telemedicine. They all serve as elements of a rapidly evolving national healthcare information architecture that will be second nature to you and your patients someday. Using the system will be as easy as putting your card in an ATM machine in Nairobi and getting US dollars.

The second category are those changes and models designed to deliver care more efficiently and effectively than the present face-to-face model, where the patient has to come into an office or hosptial to see the doctor for minor check ups or follow up visits. Examples include on-site clinics located in businesses, disease management facilities, intermediate care clinics and pharmacy based offices.

The third group attempts to make billing and collection better, faster and cheaper. Processes like identity verification and authorization, real time benefits verification, dependent validation and benefits comparisons are designed to make sure the right person is getting paid the right amount for the right reasons.

Finally, the ground is shifting under the biomedical innovation infrastructure. Changes in regulatory rules concerning manufacturing, marketing, FDA approval, and intellectual property are but a few of the manifestations. There are huge opportunities to create positive change for the way doctors treat disease.

If entrepreneurship and innovation sound interesting to you, start learning about it now. (in medical school, residency, or even college as a premed) This is not something you will get during your medical training and there are lots of resources to help young physicians learn the world of bio innovation.

________________________________________________________________

A big thanks to Dr. Meyers, and if you want to learn more...

Join the Society of Physician Entrepreneurs, it's free and there are a ton of great resources to help doctors learn to be entrepreneur. Check out SoPE Here

Check out Dr. Meyer's new book The Life Science Innovation Roadmap: Bioscience Innovation Assessment, Planning, Strategy, Execution, and Implementation.

US Healthcare Spending vs. The World

This chart presented without editorial comment, there's really not much more to say.....

source

Endurance Training During Medical Training

9 tips for any medical student thinking about doing a marathon, triathlon, or even Tough Mudder?

A guest post by Brad Harris, a Medical Student and Ultramarathoner currently attending Loma Linda University School of Medicine.

People always ask me how I find time to train for 50 mile races while juggling a full schedule as a medical student? It's not a difficult as it sounds but it does take some work and planning.

Here is what I've learned....

Make it fun.

The most important thing is to incorporate activities you enjoy doing into your workouts. Find something that you just can't wait to get home to do then use that for motivation.  Remember, training doesn't have to be boring. Maybe you have a frozen yogurt craving. Instead of driving, run down to the local FroYo establishment, indulge, and run back home. Just make sure to make it something you look forward to. Enjoying your workouts is a mindset.

Find your pain cave, and crawl inside.

The pain cave is an uncomfortable place to be. It's a mental state that makes you feel fatigued and want to quit. Sometimes medical school pushes you into the pain cave. Find your personal pain cave and get comfortable with feeling uncomfortable. It is through stressing our bodies that we become stronger.

EXPLORE!

Grab a map, be prepared for the conditions, and go see what's around the next corner. Never stop exploring. Where does that trail go that's behind your house? How do you get to the top of that mountain? What's it like to run through the middle of skyscrapers in the big city? During my time in SoCal I've really enjoyed finding new trails in the local mountains, its actually become a hobby of mine. Don't be afraid to wander and explore new places from time to time.

Give each workout a purpose.

I, like most people, get bored simply going out and pounding the pavement for 3 miles every morning in order to check off the exercise box on the to-do list. Build variation into your workouts. Warm up and just run hills one day. Find a running track and do repeats of 2-8 minutes of sprinting with a 2 min recovery after each. Find an elliptical trainer or treadmill at the gym and set it to a random setting while you review notes or flash cards. Seek out new workouts to push yourself and keep it exciting.

Add minutes or even hours to your day.

Wasting time on the internet is something that we all do. By limiting time on the internet with a program like StayFocused, you'll be surprised how much more free time you have for exercising. Plan out your internet usage before getting on your computer and set a time for each task. You will be surprised what you can accomplish with an extra 30 minutes in a day?

Listen to review sessions while exercising.

A few of my classmates would audio record every lecture during the first two years of med school. I know some med schools do it for each class, either way, this is a great way to maximise study time.  Goljan audio review was my running companion for most of 2nd year. This is a great way to avoid feeling guilty about exercising when the pressure is building before exams.

Rest.

Lay low every once in a while. Take mental breaks, both from studying and training periodically. I have found that taking one day off a week from studying (I know they may sound like nonsense to some, especially those with gunnorrhea) did wonders for my focus and provided opportunities to maintain sanity and balance during times of stress. The body also needs rest. Don't be afraid of taking time off from exercise to let your body recuperate.

Plan long workouts on the weekends.

If you are looking to run a 10k, half marathon, or marathon - plan your long runs for the weekends or off days when you'll have more time. If you don't plan them, they won't happen! Also, try to make them an adventure, not just a slog. Proper planning and mindset will both make a huge difference.

Exercise after tests.

Maybe you missed some of the gimme questions that everybody else in the class said were easy on your most recent exam. Getting out and exercising after a stressful test is a great way to clear the mind as well as isolate yourself from frantically looking up every question you think you missed. Exercising will allow you to burn off some frustration and rejuvenate your mind to allow for more efficient studying.

Train with friends.

Some of the best conversations come during long training runs. Invest time forging bonds with new friends and reconnecting with old ones. They will keep you motivated and push you as well. Also having someone that is counting on you to show up for a run is great for accountability.

Hope these tips help! My endurance training has truly made a big difference in my medical school experience and I believe it will make me a better doctor as well. If you have any other great tips for training leave me a comment and let me know.

Medical Student and Ultramarathoner: An Interview with Brad Harris

Anyone thinking about a marathon during medical school? This guy eats them for breakfast!

Brad Harris is a 3rd, soon-to-be, 4th year medical student at Loma Linda University. When he is not rocking the wards he's probably in the mountains, pushing his lactate threshold to the limit.

Tell me about your last race?

My last race was the Old Goat 50 miler on March 24. It was a trail race on 75% singletrack trails in the beautiful coastal Santa Ana Mountains. It was a tough course with 13,000 feet of climbing. Ninety-five percent of the course was either going up or down. The physical side of running an ultra race proved to be much easier to train for than the mental side. At some points in the race all I wanted to do was stop and stretch, just so I could have a good excuse to stop running. By the end it became a battle to find motivation to finish. Overall, it was great experience and a good challenge mentally. I finished with a smile on my face.

What did you feel like after finishing a first 50 mile run?

HUNGRY! I subscribe to the theory that your body tells you what it needs through cravings so that meant that I ate nachos, chili, pancakes, gatorade, chocolate milk, salty potato chips, and grilled cheese all within the first 10 hours after the race. And it was all guilt-free eating. Of course, crossing the finish line was a lifelong goal for me and brought a tremendous feeling of accomplishment, but stuffing my face sure brought a lot of satisfaction as well.

When did you get into running?

My high school biology teacher got me into long distance running in 9th grade. I have since transitioned to more trail running. After moving to Southern California for medical school, I found the local mountain trails lots of fun to play in. Running has become a way of life now.

Ok, I know you like pain, was that what inspired you do pursue medicine?

One of the biggest reasons I first decided to go into medicine was to give back to my community. I've been very fortunate to get medical help when I've needed it most. I've been shown compassion and experienced how it feels to receive it. I look forward to being able to this on to others both locally and globally. Another thing that appealed to me about medicine was the opportunity to be a part of a community that constantly strives for excellence and works to improve peoples' quality of life. In addition, I really enjoy the mental stimulation that medicine provides. It's a challenging career that will always be evolving, changing, and making you think. As I started medical school, I became very interested in wilderness medicine and specifically high altitude medicine. I love the mountains so its a pretty natural fit for me. I look forward to incorporating as much medicine as I can into the things I love to do in the outdoors and giving back to the community.

One of my favorite quotes kind of says it all...

What we have done for ourselves alone dies with us; what we have done for others and the world remains and is immortal.

- Albert Pike

What types of races have you done in medical school?

While in medical school, I've done 2 big races (2010 Boston Marathon & 2012 Old Goat 50 miler), a few smaller races, and am constantly coming up with entertaining endurance challenges with friends on the weekends to challenge ourselves. My goal throughout med school has been to get out into the wilderness at least once a week to run, rock climb, or backcountry ski. Its a great way to clear the mind and a good motivation to be efficient with studying.

How do you keep up with medical school and have time to train at such a high level?

I try to maintain a focused yet flexible training schedule with a lot of variation, but some times school doesn't comply with my training schedule. Check out my guest post on Endurance Training During Medical Training.

Has your running life opened any doors in you medical career?

I've made great friends and met all kinds of interesting people that are in the medical field at races and while out training, but the most direct way that running has opened doors is that it provides an easy icebreaker to start up conversations with residents, attendings, and patients on a day-to-day basis. Its fun for me to find out what other people like about running and create a common bond. I've found that the shoes that people wear in the hospital tend to be a great conversation starter.

So what’s next for your running career?

My most important goals are to continue to stay healthy, push myself, and meet fun, interesting people through running. In addition to these goals, I keep a google doc chocked full of future adventures. It's a dynamic list that helps keep me focused and  keeps me dreaming. I highly recommend this type of adventure list to anybody that enjoys the outdoors.

A few running adventures on my short list for the next couple years include:

1. 100 mile trail race,
2. Running up Mt. Whitney,
3. Running the West Coast Trail in BC Canada
4. Running the Rim to Rim to Rim of the Grand Canyon.

How has staying connected to this passion helped you in medical school?

The biggest way running has helped me in medical school is it has allowed a time for me to clear my head and remember that life is much bigger than the current landry list of stressors I may be facing in my life.

Do What You Love Guide: Tips On Keeping Dreams Alive During Medical Training

"Reality is merely an illusion, albeit a very persistent one."- Albert Einstein

From the outside looking in, becoming a medical student is not unlike scoring one of Willie Wanka's golden tickets. Most people see you as someone who is on the fast track to living a life of your dreams. They hear you are going to be a doctor and already picture you healthy and happy, with a condo at the beach. Sadly, the burnout rates and frustration amount physicians are on the rise, especially in primary care, and this trend does not seem to be changing any time soon.

Medicine is a culture with very rigid structure. Each type of physician is supposed to fit into a predetermined personality, way of practice, and even work schedule. There is a certain amount of brainwashing that is built into the system and it can be difficult to dream big and chart your own path in this sort of environment.

We are well into the graduation season and this means there will soon be many med students embarking on a new journey as residents, and many college grads preparing to hit the books as medical students. I thought this would be a good time for some tips on Doing What You Love.  For that we turn to someone who has helped many people follow there dreams...

Enter Leo Babauta, the founder of ZenHabits.

I wrote the first words of ZenHabits more than five years ago, I had no idea those few keystrokes would change my life.

I thought I was doing nothing more than reflecting on the changes that had been happening in my life, sharing a bit about what I learned with a handful of friends. I thought those tinkling of computer keys would fade into the void, as most of my thoughts had before that.

I never imagined that a year later, I would have 26,000 people reading my blog (and eventually a quarter million subscribers), that I’d finally be out of debt, that I’d have my first book publishing contract, that I’d happily hand in my resignation for my day job. All of that was out of the realm of possibility.

That’s the amazing realization here: that we rule out the possibility of great change, because it doesn’t seem realistic. For nearly two decades I focused on going to college, and working at a day job that I sometimes enjoyed but often dreaded, because that’s what we expect should happen. Starting my own business, pursuing my dreams, doing something I loved? Crazy talk.

Crazy talk is what I’m going to give you today, in hopes that perhaps one of you will expand your possibilities. It is possible — I did it, all while working a full-time job, doing free-lance writing on the side, and having a wife and six kids. I did it, even if I never dared to dream it for the first three decades of my life.

I am not someone who likes to give career advice, or teach people to be entrepreneurs. So I’m not going to do that here. I’ll just tell you this: it’s possible. And I’ll share what I’ve learned, in small snippets of goodness, about doing what you love.

If you don’t think it’s possible, do a small easy test.

Don’t think you can start a big/impossible idea? Start small. Take one small step in the direction of your dream. You don’t even need to tell anyone about it. It costs nothing, risks nothing, takes almost no time. But you will learn you can do that one little thing, and if you pass that test, you now know your theory of impossibility was wrong.

Expand your tests.

If you pass the first test, do another small one. Then another. Keep going and notice your confidence grow. Your skills grow along with the confidence. It’s amazingly simple. Iterate and re-iterate as long as you are having fun.

If you don’t know exactly what you love, don’t worry.

There’s no need to figure that out right away. Try something that someone else is doing, and see if you think it’s fun. The real fun part, btw, comes when you start to get good at it, so perhaps stick with it for awhile and enjoy the learning, then enjoy being good at it. If that first try doesn’t work, try something else. You don’t have to commit to one thing for your entire life. You can do a dozen a year if you want, for a decade. You’ll probably find something by then.

Find inspiration.

Think about what will inspire you 10 years from now. Who else is doing what you love doing? Who is excited about it most? Follow them. Learn about them. See what path they took. Watch closely how they execute, what they do right. Learn from the best.

Reach out to a mentor.

Of the people who inspire you the most, try to make contact with a few of them. If they never respond, try a few more. See if you can buy them lunch or coffee. Don’t pitch them on anything. Just ask for their help, and say you’d love for them to mentor you in a way that won’t take up much of their time. Don’t demand a lot of time, but go to them when you’re having trouble making big decisions.

Choose one passion at random.

Some people have many interests and don’t know where to start. Pick one or two randomly if they’re all about equal, and just get started. Don’t let choice paralyze you. Get started, because in the end it won’t matter if you started with the wrong passion — you’ll learn something valuable no matter what. Read more.

Get good at it.

You get good at something with practice. Allow your friends and family to be your first audience, readers, customers. Then take on a few others at a low cost, or increase your audience slowly. But always have an audience or customers if possible — you’ll get good much faster this way, with feedback and accountability. Read about it. Watch videos. Take a class. Join a group of others learning. Find people to partner with. Before long, you’ll be good at it.

Help others.

One of the best ways to get good at something is to help others learn. Making someone’s life better with your new skill is also an amazing way to get satisfaction out of what you do, to love what you do. Help as many people as you can in any way possible — it will pay off.

Find your voice.

Eventually, as you master your skill, you will learn that you are different than the thousands of others doing it. You will find your uniqueness. It’s not necessarily there at first, because you might not have the technical skills to express yourself. But eventually, find that voice. Find the thing that sets you apart, that helps you to stand out from the crowd. Then emphasize that. Read more.

It’s the doing and loving that matters.

Many people focus on growing, or hitting goals, or making money, but they forget what matters. What matters most is loving what you do. If you love it, and you’re doing it, you’ve already succeeded. Don’t worry so much about achieving certain levels of success — people push themselves so hard to reach those things that they forget to enjoy what they’re doing, and in the process they lose the reason they’re doing it in the first place.

Dream bigger.

Once you’ve overcome the initial fear and started to become good at something you love, dream bigger. The first stage is small steps, but don’t stop there. You can change lives. You can change the world. Doing so will change you.

Fixing Patients In A Broken Healthcare System

"Status Quo, you know that is Latin for "the mess we're in."" -Ronald Reagan

As I glanced at the chart of my next patient I felt my heart sink. It was littered with warning phrases; words like progressing, recurrence, and worst of all, suspicious. Most of the time these charts are filled with unintelligible scribble recorded in a half-hearted SOAP format. A few lab results, a differential diagnosis or two, followed by the solution to the patient's ailment. However, as a medical student, you learn to develop an eye for the warning phrases. Once they begin to pop up you know that a doctor is trying to communicate that this patient’s findings are giving them a bad feeling. It seems that once you have been in the game for some time you develop a visceral reaction when you see certain patients. It transcends the lab tests, the imaging studies, even the all hallowed physical exam. There is some thy of "gut factor" experienced physicians develop, and evidently my patient had triggered a few on her way to see me.

“Do you people even care if I live or die!?” My patient blurted out as I entered the room, she looked tired, exasperated, and scared. Her question left me reeling, but only for a split second. I knew that this was one of those questions that required a swift and definite answer. You have a similar time frame when your wife or girlfriend inquires about her outfit and if it makes her look fat. Of course in that case the only response is an immediate and decisive “are you kidding, no....” Thought the implications of this encounter where much more serious. I did my best to deliver an answer dripping with as much empathy and reassurance as I could heap on, but I knew in my heart that I could not deliver the full truth to my patient.

Of course it’s ludicrous to think that any doctor would ever have total indifference toward the lives of their patients, however, we are the face of a system that, by some measure, truly does not care. This patient had recently lost her job and the “perks” of health insurance that came with it. I knew that eventually she would be able to get the care she needed but I could not have confidence in the timeliness of this remedy. This is understandably disconcerting for someone with a mass relentlessly growing (and possibley spreading) inside your body, with no regard for the timing of an overloaded clinic schedule.

The simple reality is that we work in a world of limited resources and at some point there must be people who will bear the brunt of this limitation. As it stands now the nature of selection favors those who have the means to pay for options. In some ways, this may always be the case but I do feel that we can do alot to make the system better. The political rhetoric surrounding health care at the moment is in many ways missing the boat because no matter how many people you give access to health care we still come back to this issue of limited resources. Sure you can give everyone health insurance but it won’t mean anything if it takes 5 years for an appointment to get your colonoscopy done so the doctors can rule out colon cancer. All you have done is substituted one form of selection for another.

I do not know what will become of my patient. I want to truly believe she will get all the appointments in all the free clinics that she needs in a timely manner so that she can go on and live a meaningful life. Though by the end of our visit, after calling various clinics, and coordinating lab tests that must be complete before surgery,  I have begun to develop an imperceptible feeling in the pit of my stomach. I cannot seem to shake it off as I go back into the exam room. I try my best to hide it and leave my patient with a bit of hope as we part ways.

As I go forward in my medical training I not only see the challenges of developing my own clinical skills as a doctor but I also see that future physicians will be taking over a health care system that is, at best, overburdened and, at worst, dysfunctional to the point of breaking. It is for this reason that our health care system is in need of a different type of doctor or at least a greater variety of them. Attributes like creativity, vision, outside-the-box thinking, and risk taking are likely not the ones that got you a spot in medical school or residency. However those character traits are the ones that must be cultivated in the next generation of physicians as we move forward in finding better ways to care for our patients.