The historical concept of graduate medical education residency
training (GME) must be placed into a modern context, and new
realities need to be conveyed, learned, and taught. Along with that, we
should examine how GME contributes to the future physician workforce
and how it can play a role in providing solutions for healthcare in the
United States.
GME remains an integral component of a physician’s education, but
the traditional emphasis on hospital-based disease management is in
need of fairly dramatic change. We need to modernize our approach
to GME. It must still include an understanding of evidence-based
disease management, but it must also include a renewed focus on health
outcomes, quality, safety, and cost of care. The healthcare workforce of
the future needs to be equipped to care for patients in an ambulatory
setting, and as part of a healthcare team. As healthcare becomes more
population based, we will need to move away from our traditional siloed
approach. Healthcare workers will increasingly focus on the health and
wellness of patients in the communities where they live.
This is a major challenge for academic health centers. Even today,
residents or graduate trainees are integral to the healthcare workforce of
hospitals. For many decades, residents have been the “go-to” providers of
care, particularly in hospital settings. As a result, hospitals have become
dependent on their residents to provide care, particularly in acute care.
Because funding for GME is largely from Medicare, teaching hospitals
have also become economically dependent on the current GME funding
model. Hospitals will need to recalibrate the role of trainees and how
they are funded, and emphasize their role as learners, rather than just as
service providers. This is a substantial change, and it will require a new
paradigm for how patients are cared for in the hospital setting and how
academic health centers pay for these services.
We also should take a more holistic view around what our future
physicians need to know, and equip them for the care they will need to
provide. Physicians will still care for patients with disease, but it will
be less hospital-based, and more focused on maintaining health and
managing patients with chronic disease. This is of particular concern as
we confront the needs of an aging population. The demographic realities
have led some to conclude that we will have a shortage of physicians
in the future, and while there is little doubt that we will need more
physicians, the mechanisms and assessments that have been performed
have been based on the historical role of doctors, rather than the role
they will play in the future. The healthcare workforce of the future will
use technology in ways that will significantly alter and modify the way
physicians engage with patients and should engage other professionals
(including nurses, social workers, pharmacists, etc.) in new team-based
models of care delivery.
Philip A. Pizzo, MD
Former Dean,
School of Medicine David and Susan Heckerman
Professor of Pediatrics, Microbiology and Immunology
Founding Director,
The Stanford Distinguished Careers Institute Stanford University