Physician Training Needs to be Modernized

It is easy to forget how quickly the U.S. healthcare system can change. In 2008, 9 percent of physicians used EHRs. Now,

of all physicians do.

More change is coming. In less than three years, CMS’ goal is to have half of all Medicare payments under value-based agreements. As the healthcare system continues to evolve and new technologies continue to emerge, physician training programs that support the latest innovations, data science, and a truly connected ecosystem will become increasingly critical to improve population health outcomes.

When Docs are Untrained in Data Analytics

Demand is growing for clinically trained data scientists and data science trained clinicians; however, the amount of available information continues to strain our capacity to judge value. Physicians are having to swim in a sea of data while only a fraction are trained to deal with, or have time to act upon, the information with confidence. As more health insights are added to the sea of data, it becomes increasingly difficult to judge the value of information or to rely on these insights to support the transition to a value-based environment. 

It is also important to consider that traditional medical training focuses on an understanding of human anatomy, physiology, pathology, pharmacology, and other perspectives on the health of a typical individual. To effect change within the population health perspective, physicians and other clinicians not only need to understand statistics, but must also be fully “number literate” (i.e., numerate) and understand data and analytics.

Through training platforms such as the University of Wisconsin School of Medicine and Public Health’s preventive medicine residency program, physicians can get exposed to various areas of an individual’s care that they would not have otherwise received. This approach to care delivery promotes education and awareness across various sectors of the healthcare industry and provides physicians with the opportunity to be more mindful of everything going on around them. For example, preventive medicine residents have the opportunity to work closely with public health professionals to study social determinants of health and bring that knowledge back to the clinic. Most purely clinical residencies are not able to offer that kind of training and perspective-broadening to their trainees. A physician-in-training who is given the time and opportunity to see and think of disease from a population level and promote a broader perspective to an individual’s symptoms or other conditions, will be better equipped to manage teams responsible for the health of an entire population.

As a member of the residency advisory committee for the University of Wisconsin School of Medicine and Public Health’s preventive medicine residency, I am privileged to meet some of the brightest and most diversely skilled young physicians trying to tackle the most difficult medical issues. One challenge the residency faculty faces is allocating scarce training time and dollars. How much classroom time is appropriate? How many clinical rotations are feasible? How should the training be focused: toward community health efforts or broader health policy work? 

Integrating Existing Technology Utilized by Care Teams to Drive Adoption

The Robert Wood Johnson Foundation, in partnership with the University of Wisconsin, is among various organizations that can help modernize physician training programs. The Robert Wood Johnson Foundation develops an annual health ranking (www.countyhealthrankings.org), derived from U.S. counties nationwide, to determine high-level indicators and health risks across the country. Although it is a well-known resource at the public health and county government level, it is still relatively unknown at the individual clinician level. Having this tool more readily available by incorporating it into existing technology utilized by physicians and care teams would help drive its adoption.

Consider a patient with a condition that causes abdominal pain and vomiting, mimicking a number of other serious conditions. Before visiting their primary-care physician, the patient had undergone dozens of radiological tests, hundreds of lab tests, and a number of emergency room visits and hospital stays. Fortunately, the primary-care physician of the patient worked in a clinic that was an early adopter of EHRs and was able to pull together most of their previous labs and radiology results and rule out some of the diagnoses that had been suggested by various hospital visits. Subsequently, the patient visited an ER with which the primary-care physician’s EHR was not connected. The primary-care physician was fortunate enough to have come across a specialist who had a registry of patients with his or her condition. The patient then hand delivered the results of their ER stay and a brochure describing the registry. After the primary-care physician successfully enrolled him or her in the registry, the patient was then seen on a regular basis by the specialist running the registry.

Imagine how much more quickly this patient would have been accurately diagnosed, how many tests he or she could have avoided, and how much better his or her healthcare experience would have been had all of the hospitals, ERs, clinics, and labs been connected to share vital information. Imagine if the local specialist managing the relevant disease registry had been connected to the EHR and allowed the primary-care physician to make a referral earlier in his or her healthcare course. With fully connected systems and physicians trained in data science and information technology, this patient and others would receive better care and have a better experience.

Data literacy and grounding in healthcare analytics are vital tools of a clinician’s 21^st century medicine bag. According to the publication, Health Professions Education:  A Bridge to Quality, the IOM suggested five core competencies for healthcare professionals: provide patient-centered care, work in interdisciplinary teams, employ evidence-based practice, apply quality improvement, and utilize informatics. Additionally, as Brooke Salzman, physician and author, noted in the publication, Population Health:  Creating a Culture of Wellness, “flaws in health professions education both reflect and contribute to failures in our current healthcare delivery system.”

Even as our health information technology (HIT) systems mature and provide access to richer, more reliable information, if our education and training systems are not producing professionals trained in IOM’s five competencies, our recent HIT investments will not give us the promised return. Physician training programs should include targeted, relevant data training in medical school, residency, and as a part of a continuing medical education.

About Thomas J. Van Gilder, MD, JD, MPH

Chief Medical Officer and Vice President of Informatics and Analytics, Transcend Insights

Dr. Thomas J. Van Gilder, MD, JD, MPH, chief medical officer and vice president of informatics and analytics at Transcend Insights, is a board-certified physician in internal medicine, general preventive medicine and public health. Dr. Van Gilder obtained his master’s degree in public health from the Harvard School of Public Health.