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CONTACT:
Amy Brodkey, MD
215-831-7949
brodkeya@fast.net
Fredrick McCurdy MD. PhD, MBA
402-559-2263
famccurd@unmc.edu
CHICAGO, ILLINOIS, November 14, 2002 _ A study to be published in the journal Academic Medicine on Friday, November 15, 2002 details the findings of a large survey of key medical student educators on the destructive impact of managed care on the education of future physicians. Faculty members from the disciplines of gynecology-obstetrics, internal medicine, neurology, pediatrics, psychiatry, and surgery perceive that the erosion of faculty support for teaching may have placed the foundation of the nation�s future health care in jeopardy.
The study was conducted by the Alliance for Clinical Education (ACE), a group composed of leaders of seven education organizations representing faculty who direct the core clinical clerkships in medical schools across the country. The clerkships are medical students� first and primary exposure to clinical medicine and the foundation of medical education. By virtue of their role in developing and overseeing clerkships, and their close contact with students and the local educational environment, clerkship directors are in a unique position to observe the effects of managed care on clinical education in medical schools.
The 500 clerkship directors from across the nation who responded to the anonymous survey indicated particular concern about difficulty recruiting faculty to teach and to participate in other educational activities, as well as a decline in the quality of clerkship training sites. The survey also documented widespread diminished enthusiasm for teaching. The greatest negative impact on education was perceived in locations with the highest amount of managed care. Over 88% of the respondents stated that managed care has made health care more like a commodity, and 72% stated it had reduced professionalism in medicine.
Managed care has adversely affected academic medical centers financially, reducing the time and resources available for education and research. Tuition pays for only a fraction of the cost of medical students� education. In addition, managed care companies frequently exclude students from patient care and the opportunity to learn physical examination and diagnostic skills. Many educators expressed concern over a possible decline in professionalism due to training in an environment of increasingly commercial values and reduced quality of care.
�The findings are impressive in part because of their strength and uniformity _ every specialty that was surveyed reported the same problems,� said Amy C. Brodkey, MD, the study�s lead investigator. �Many people think that the spread of for-profit managed care has made it more difficult to get good medical care, but most people don�t realize the impact it has had on the ability of academic medical centers to train future doctors. Our study respondents indicated that it is the current economic pressures associated with for-profit managed care, rather than the management of care itself, that is responsible for the damage. Given the further penetration of managed care into academic medical centers since the time of this study, I would predict that this situation will only get worse.�
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Alliance for Clinical Education (ACE) was formed in 1992 to foster collaboration across medical specialties to promote excellence in the clinical education of medical students. Its mission is to foster collaboration across specialties to promote excellence in clinical education of medical students. Its member organizations include: Association of Directors of Medical Student Education in Psychiatry; Association of Professors of Gynecology and Obstetrics; Association for Surgical Education; Clerkship Directors in Internal Medicine; Consortium of Neurology Clerkship Directors; Council on Medical Student Education in Pediatrics; and Society of Teachers of Family Medicine.
Physicians for a National Health Program has been advocating for health care reform for 15 years with more than 10,000 members across the United States.
PNHP is headquartered in Chicago.
www.pnhp.org