Add Healthcare Policy to Medical School Curriculum, Doctors Say

Medical student and resident education has to include instruction on how healthcare systems function -- especially with the advent of complicated national healthcare reforms, University of Michigan physicians said.

Two U-M physicians and a U-M Medical School graduate called for a national curriculum in health policy for medical students and residents, in an article in the New England Journal of Medicine. “Without education in health policy and the healthcare system, physicians are missing critical tools in their professional toolbox,” said co-author Matthew M. Davis, MD, associate professor at U-M in Pediatrics and Communicable Diseases, Internal Medicine and Public Policy.

Davis said his previous research has found that fewer than half of graduating medical students in the U.S. said they received adequate training in understanding healthcare systems and the economics of practicing medicine.

“As a resident, I routinely care for patients who cannot afford their medications or don’t have access to regular medical care,” said Mitesh S. Patel, MD, a 2009 U-M Medical School graduate and lead author of the article. “These issues have a major impact on the delivery and cost of healthcare. However, they are rarely discussed in educational lectures or during teaching rounds.”

Physicians who don't understand the healthcare system or health insurance policies disserve their patients, said Monica Lypson, MD, assistant dean of Graduate Medical Education at U-M and a co-author on the article. “The healthcare system is complicated, but it’s no more complicated than the other things we expect medical students and residents to learn,” Lypson said. “Regardless of partisan persuasion or political beliefs, physician trainees and medical doctors in general should have the knowledge needed to engage in meaningful discussions regarding health policy.”

The U-M Medical School has added an elective course in healthcare policy, which Davis teaches. “It is enrolled to the maximum,” he said. “The students were hungry to learn more. We have to find the best ways to teach medical students to be the best navigators of the healthcare system for their patients.”

The three authors want a common national curriculum -- with content tailored regionally and locally. They recommend pilot projects as a precursor to a standardized national curriculum and propose a focus on four concentrations: healthcare systems, healthcare quality, value and equity, and health politics and law.

The new curriculum should not jeopardize other topics, but that policy discussions should be integrated with clinical instruction and permeate the educational training. The authors want a multidisciplinary faculty to conduct the health policy training, including experts in health economics, sociology, business, and psychology.  

Lypson said patients expect physicians to be knowledgeable about healthcare reforms, health insurance, health policy, and the impact of these forces on their care. “We don't expect them to learn to practice medicine simply by saying, “Go take care of patients now,’” she said. “That doesn't work for clinical knowledge, and it doesn't work for policy knowledge, either.”