Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Does A Good Doctor Treat A Patient's Economic Aches and Pains?

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Doctors are relatively uninformed about health care systems, outcomes research or health care economics, specifically the costs of care and cost-benefit.  Is that a critical knowledge gap?

58,294 U.S. medical graduates completed the Association of American Medical Colleges (AAMC) annual, 2003-2007 Medical School Graduation Questionnaire.  The data were used to compare medical school curricula that varied in the intensity of teaching about health care systems. 

Results: Medical students reported that had:

  • 90-92% appropriate training in Clinical Decision Making
  • 80% to 82% appropriate training in Clinical Care
  • 40% to 50% appropriate training in the Practice of Medicine

"Students from the school with a higher-intensity curriculum in health care systems reported higher satisfaction than students from the school with a lower-intensity curriculum for training in four of five practice of medicine components: medical economics, health care systems, managed care, and practice management. Importantly, the high commitment to education in health care systems in the higher-intensity curriculum did not lead to lower perceived levels of adequate training in other domains of instruction." 

Patel MS, Lypson ML, Davis MM. "Medical Student Perceptions of Education in Health Care Systems." Academic Medicine, Sept. 2009;84(9):1301-1306  

Dr. Chen, writing in the NY Times ("When the Patient Can’t Afford the Care." Feb. 4, 2010), says not only is it "possible to learn about the economic and social aspects of health care while immersed in the details of biology, physiology and pharmacology".... [But] it is "impossible to become a good clinician without doing so." 

Dr. Chen then quotes Dr. John E. Prescott, the chief academic officer for the Association of American Medical Colleges (AAMC) who adds that: "These are incredibly important topics.... Physicians knowing about the system and the environment in which they work, allows them to be better doctors. And that in turn allows them to take better care of their patients."