In a recent grand rounds on the future of medicine, the buzzwords were “collaboration” and “managing of the health of populations.” The same day, a group of ten residents were presented with their patient data about cancer screening rates. In both venues, the call to “population health” elicited sighs of exasperation. It’s just another checkbox we are being asked to click off. How can we be assessed on that as well?

In the last five years in medicine, the initiatives to teach quality improvement (QI) have gained money, resident interest, and distinct educational pathways. Most of QI research has focused on inpatient initiatives, partly by virtue of the amount of resident time devoted to inpatient rotations. Consequently, the notion of ambulatory QI and management of populations (cancer screening, immunization, diabetic panels) feels foreign and even invasive to residents.

Why is inpatient QI perceived as more exciting, and what can we do about it? I offer three models.

1. Treatment is more satisfying than prevention. Take two common quality initiatives: initiating a new protocol for treating sepsis and developing a new system for tracking colonoscopies. At the end of the day in the ICU, watching a very sick septic patient improve is extremely gratifying; tracking an increase in colonoscopies less so.

2. The hospital is a neater laboratory than the world. When we looked at our resident data in the clinic, we talked about barriers to patient care: no-show appointments, non-English speaking patients, and lack of translated patient education materials. The social world of patients is messy and requires a non-medical gaze to respond to cultural, socioeconomic, and educational diversity. A medical gaze goes further in the hospital, where most data can be captured and manipulated in the EHR.

3. Inpatient data is more complex and dynamic than ambulatory data. For better or worse, the modern EHR contains a near labyrinthine repository to analyze. In the inpatient setting, there is a near constant flow of new information to decode and analyze. In contrast, the common metrics for ambulatory improvement as few (screening rates, number of visits). Not only this, but the salient variables that impact patient health are harder to put into numbers (i.e., a patients’ readiness to change, their trust of the medical establishment, their ability to pay for next months medications).

What can we do about it?

First, we need to reframe the importance of preventative measures so they are more powerful. If a hospital initiative to treat sepsis concludes “we saved 100 lives this year from sepsis” we need to use the language for preventative care: “In their career, a primary care doctor will save ten lives from colon cancer — will this be you?”

Second, we need to teach medical students and residents how to approach medical problems with a non-medical gaze. This is easier said than done, but requires building upon existing skills and capacities of residents (i.e., as economics majors, multilingual speakers, volunteers, etc.).

Last, we need to develop a scientific curiosity about how to screen and measure social determinants of health. Maybe no-show rates are correlated with fewer interactions with medical office staff, or age, or severity of illness. We currently do not have the informational infrastructure to ask these types of questions. With these changes, we the words “population health” might not exasperate us, but lead to a renewed sense of purpose and scientific curiosity.

Tom Peteet is a board-certified internal medicine physician, educator, and writer. For nearly a decade, he has practiced at Commonwealth Care Alliance, focusing on home-based care for patients with complex disabilities. He also cares for patients in long-term care facilities and works with InstED, a mobile health program that brings acute care into patients’ homes.

As an adjunct professor at Massachusetts College of Pharmacy and Health Sciences, he directs a year-long pharmacology course for physician assistant students. At Boston University, he has taught more than ten courses through its prison education program and is developing courses in neuroscience and medical anthropology.

His scholarship spans medical ethics, medical education, and health equity, including work on the treatment rights of incarcerated patients, the role of theory and the humanities in medical training, and the intersection of quality improvement and equity in residency. His writing has appeared in the AMA Journal of Ethics, Medical Teacher, and the Journal of Family Medicine, and he authored a 2025 textbook chapter on renal disorders in Pathophysiology in Focus.

His writing explores health care ethics, medical education, and the overlooked paradoxes of human physiology. He writes Against Medical Advice, a Substack on the hidden science of medicine, and is working on a nonfiction book about the strange science of blood pressure. More of his work is available on his personal website.