One potential solution to fixing the healthcare problem is to restructure the way physicians are trained by utilizing the large number of volunteer faculty available at all medical schools. In an article I wrote about using volunteer clinical faculty at medical schools to help train psychiatry residents to meet the needs of college students requiring mental health services. Medical schools often have hundreds of volunteer faculty in each of their departments that go unutilized or underutilized. The article provides an example of using volunteer clinical faculty in a department of psychiatry to meet mental health needs at a minimal cost. The patients as well as the residents found it to be a valuable experience.
More importantly, this program does not have to be limited to mental health. It
can be applied to a variety of different primary settings very inexpensively. In effect, it is a reversal of the recommendations of the original Flexner Report of 1910 and returning physician training to a model similar to apprenticeship programs used in the US from the late 18th to the early 20th century, but also adding online support for additional training. Residents are not subject to the restrictions of insurance, Medicare or Medicaid since they are prohibiting from participating with those payment systems. As the number of attending physicians participating in such a training program grow, the number of residents that can be trained without cost to the residency training programs increases to the point that it becomes self-perpetuating.
For patients on public assistance or Medicare, one option would be to issue
Health Savings or Flexible Spending Account cards instead of their Medicare or Medicaid cards for the purposes of paying for outpatient services. This can help to reduce the cost of outpatient services, which makes up the vast majority of the medical care provided in the United States. A separate solution will need to be provided to reduce the costs of higher level of intensity care primarily provided by hospitals. In more rural areas, hospitals seeking to add staff can help house residents in training and create incentives for them to remain in the area upon completion.
Four years ago, I had the great fortune of being able to work with a fourth year
resident from Georgetown University Hospital. Since then I have worked with additional residents with similar results. Another major advantage with the program is that it can be introduced on a limited basis and be slowly released until it is clear whether it works on a larger scale.
Lastly, the paper points out some of the original components of the Flexner Report, and that there is more to the report than meets the eye.
I also invite you to consider reading Arrowsmith, a novel by Sinclair Lewis, published in 1925. Nearly 100 years later it still accurately captures the world of health care and all the forces that can either enhance or corrupt it.
Click the Image to read a selection.