Preparing the New Generation of Doctors

I read this stupid article in the NEJM Catalyst, whatever that is, called “Preparing a New Generation of Physicians for a New Kind of Health Care”.   It’s one of those “we predict the future” and “have all the answers” kind of thing that is easy to get published because it is edgy.  Here are some of their observations:

  • Today’s physicians differ markedly from those who came out of medical school 30 years ago. (That is me and no sh%t).
  • These generational changes in the physician workforce have implications for medical schools and policymakers. Health care’s new payment models, such as population-based risk-sharing, episodic payments, and care bundles, require physicians to change how they deliver care. These models reward teamwork, care coordination, and leveraging data to improve quality and lower costs. (There is no proof this is beneficial or works but who needs evidence in an evidence-based profession?).
  • Medical schools have both a responsibility and an opportunity to prepare their students for success under new value-based payment models. (Great idea. Let’s change curriculums to follow the newest fad which changes every two years or so).
  • For example, under the Medicare Access and CHIP Reauthorization Act (MACRA), most physicians who see Medicare patients now have a portion of their payments tied to quality measures and cost considerations. This new paradigm emphasizes a different set of priorities, including team-based care, addressing patients’ social determinants of health, reducing extensive utilization of expensive tests and procedures, and developing relationships with a wider variety of providers. (Brilliant. By the time the medical schools figure out their syllabus this crap will be gone).
  • Medical schools will need to look beyond undergraduate GPA and MCAT scores and identify candidates who will work most effectively in a team-based environment, who will be able to best address social determinants of health, develop novel care coordination programs, and thrive in an increasingly complicated care delivery system.(I just vomited in my mouth a little).

I have some ideas on preparing the next generation of doctors. How about they:

  • Learn how to look at someone in the eye.
  • Stop staring at the computer.
  • Learn how to do a real physical exam.
  • Have social skills.
  • Stop staring at their phones.
  • Stop complaining about work hours.
  • Care about people.
  • Dress professionally.

Any more recommendations from you guys?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  12 comments for “Preparing the New Generation of Doctors

  1. Kurt
    March 17, 2018 at 2:09 pm

    Stay the “F” out of primary care medicine. Until patients are held accountable for their lousy
    health behaviors we will be whipped to death with golden carrots that are held so far away they’re
    impossible to grab and the administrators insist, “We’re leaving money on the table.”
    Every primary care doc I know in their late 40’s and by all means their 50’s can’t wait to get out
    and retire or do something else. I know one doc that married another younger doc and announced they’ll be gone at 55 and have their spouses health insurance. Lucky stiff.

  2. Brad Banko
    March 16, 2018 at 9:10 pm

    Be your OWN hamster. Not somebody else’s.

  3. March 14, 2018 at 6:49 am

    Both authors from this paper are from Leavitt Partners. These consultants aren’t hired for patients’ benefit, they’re hired to make money by “getting ahead of the curve.” Healthcare these days is all about the money:

  4. Richard B. Willner
    March 14, 2018 at 12:16 am

    One Residency Director whom I spoke with told me that “100 out of 100” newly graduated physicians wanted a salary position rather than to strike out on his/her own. Gosh. No chance to be his/her own boss. Seems to me to be another Big Change over 30 years. But on the other hand, with 20,000 new Nurse Practitioners graduating every year, and practicing independently in 1/2 of the states, who knows how the future will turn out. All I do know is that the 900,000 physicians must start to organize rather rapidly and with their numbers and clout, take back their leadership in Medicine. Time is not on our side.

    Richard Willner
    The Center for Peer Review Justice

  5. Perry
    March 13, 2018 at 10:56 am

    Sadly, the newer physicians seem to be drinking the Kool-aid provided them in their little med school nursery, evidenced a recent article in KevinMD, a med student proclaiming they need classes on population medicine and providing “quality” care, etc, etc. The next week in KevinMD there was an article by a med student bemoaning scutwork. These kids need to learn to buck up and start thinking for themselves.

    • Sir Hakum of Hugo
      March 13, 2018 at 11:16 am

      They will never be equipped to be independent practitioners. In fact, the entrepreneurial spirit with be discouraged. They will depend unknowingly on the few remaining achievers to survive.

      Perpetual servitude and dependency and group-think galore.

      Now where did I put my copy of Atlas Shrugged…..

  6. RSW
    March 13, 2018 at 10:42 am

    I would be terrified to develop a serious illness and depend on one of these corporate cogs for my medical care.

  7. Thomas Guastavino
    March 13, 2018 at 10:30 am

    Medicines first phase was the “golden age” where physicians had all the responsibility and power but others paid the bills. Patients did well, physicians did well, payers not so well. So, in the second phase pressure was put on physicians to control their “bad” behavior but physicians still had the responsibility. There were questionable gains in savings, patients did not do as well and physicians did poorly. Now as we are faced with having to admit that this second phase was a failure, there are vain attempts to keep it going but failure is inevitable. The next phase of medicine will be the payers accepting the consequences of denial of care. I suspect physicians could live with this, payers will do well, but patients will be shocked.

  8. Sir Hakum of Hugo
    March 13, 2018 at 9:47 am

    Agreed, but I am afraid that the ship has long sailed for the vast majority of physicians. It is difficulty to pursue lofty goals and stand up for principles when we are shackled with more chains than Jacob Marley.

    It was the trap that was laid, and ensnared the majority of our profession shall be (credit be to the brave pioneers of DPC). I feel sorrow when I think of how the current generation of junior physicians will never have the time to ask an open ended question (such queries rarely fit into an EMR checklist). They will never have time to sit back and think for a moment about the patient, never experiencing a eureka-like moment when the patient’s seemingly unrelated constellation of symptoms yield a unifying diagnosis. They will never walk into the room and know ninety percent of the patient’s medical and family history without opening a chart.

    After twenty years, upon reflection, knowing how much more impersonal and computer dependent primary care has become, I would have chosen a lesser yet fairer fate, perhaps an air traffic controller or an animal control officer.

    Then again, selling alcohol infused popsicles on a warm and delightful beach sounds enticing as well. Great Press-Gainey-like scores, all cash, and no after hours on call duty.

  9. Steve O'
    March 13, 2018 at 8:42 am

    I am always wary when a large powerful institute or entity, such as the NEJM machine, celebrates the New Diversity. Very often, when a profession changes from predominantly men to one similar to the community, it is because someone in control has harvested “the pink discount” for their workers. That means that the salary and prestige goes down.
    It irritates feminists to no end, rightfully so. But they get mad at the profession and say – “Your salary and prestige shouldn’t go down!” We agree. Get mad at the people harvesting the discount.
    The clinic is the factory floor of the new medicine, and it’s getting well-populated by diversity as it sinks into a rote job controlled by the guideline writers at the big universities and insurance companies. They are unsuprisingly uninterested in diversity at that level.

    • Sir Hakum of Hugo
      March 13, 2018 at 10:05 am

      How can one miss one’s “lost freedom” if one was designed to be a lowly serf from the beginning?

      Oh if I could only aspire to be one of those high falutin’ physician-administrators to escape the drudgery of my everyday professional life… the great philosopher John Lovitz once said….”yeah, yeah, that’s the ticket !”

  10. March 13, 2018 at 8:06 am

    The next generation of doctors need to learn to make their voices heard and stop being left out or leaving themselves out of policy changes that endanger their patients, destroy their work environment, and limit their ability to take the best care of their patients. They need to become comfortable with advocacy, participate in legislative efforts and pursue health care system leadership positions. It’s time for doctors to take back their profession.

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