On a short study break, a classmate and I were discussing how the public health and health policy courses we took in graduate school influence our view of the healthcare system as medical students. It was the most productive form of procrastination (nerding out about public health and health policy) but it was also supremely frustrating to talk about all the problems in the healthcare system. The ACA was such a monumental step forward and now it seems like we’ve taken many steps back–only 34 states have expanded Medicaid, states are implementing work requirements for Medicaid, and Congressional Republicans have tried to repeal the ACA dozens of times with no real replacement or effort to fix the provisions that aren’t working well.
A survey published earlier this year reported that 40% of Americans skipped a recommended medical treatment and that 44% did not go to the doctor for an illness or injury because of cost. The survey also revealed that 30% of individuals had to choose between paying for medical care or basic necessities like food. These statistics reveal fundamental flaws in our $3.3 trillion healthcare system–most Americans do not believe they are receiving good value for their healthcare dollars and forgo important visits, tests, or treatments or they simply cannot afford the cost to begin with, value notwithstanding.
There are bright minds across the U.S. working on solutions to the affordability and value crises of our healthcare system–and medical students should be involved now to ensure they have the vocabulary and context to participate in the future. Doctors interact (directly or indirectly) with health policy issues every day–medications must be checked against formularies, certain tests might not be covered by an insurance plan, or the specialist you want to refer to does not accept your patient’s insurance.
Very few students enter medical school with a Master of Public Health and most enter without a working knowledge of how health policy is crafted at a governmental level. While we all hopefully know the three branches of government and their functions, the development and implementation of health policy is vast and complex. If we are expected to contribute to the U.S. health care system as students, researchers, educators, and innovators, shouldn’t we be given, at a minimum, a basic working knowledge of that system? Yes, some of the rules and regulations might be different by the time we start practicing and our speciality might impact what policies influence our daily practice more, but every single one of us, not just dual MD-MPH students, should know how federal, state, and local governments craft health policy; the basics of major health care programs; and the importance of social determinants of health.
I’m hopeful that innovative changes like the Clinical Public Health curriculum at George Washington University (my MPH alma mater) or Penn State’s Science of Health Systems course will soon become the norm in medical schools around the country. To assist in this endeavor, the American Medical Association supports member schools in the Accelerating Change in Medical Education consortium. In addition to supporting the Penn State curriculum change, the AMA consortium also features efforts to integrate health systems science and health policy from Eastern Virginia Medical School, the University of Michigan, and Brown University.
Every medical student should be exposed to public health and health policy just as we are instructed in communication, empathy, and diagnostic skills. But until that time comes, we’ll be here as often as we can, giving you the health policy basics and then some!