After the world watched a health care CEO get murdered on the street, the views of the public became intriguing. Although there are more current health care concerns on our minds, the murder of the United Health Care CEO should and will continue to be reviewed and examined. The U.S. health care system is broken, and the right individuals need to learn how to fix it early in their education, or we will continue with a broken, expensive health care system that serves executives and not the people for whom it is intended.
The evolution of health care in the United States began with a holistic approach in the 1700s, progressed to an apprenticeship model in the 1800s, became structured in the 1900s due to the Flexner Report, and little has changed since then. Most medical schools continue to teach the two pillars of medical education: basic sciences and clinical sciences, with little regard to the third pillar of medical education: health systems science (HSS). Medical HSS experts understand the importance of teaching a systems approach to health care, but there is a struggle as to where to place the content and how much information undergraduate medical students need. They need it now, and they need it early so they can frame and understand health care as a system, not just caring for one patient at a time.
HSS consists of looking at health care as a system that includes “improving quality, outcomes, and costs of health care delivery for patients and populations within systems of medical care.” This includes looking at collaboration among health care professionals, the ethics of care, patient safety, social determinants of health, population health, public health, value-based care, quality and performance improvement, technology, artificial intelligence, and other concepts. These concepts and approaches to medicine are often siloed to fit into undergraduate medical education haphazardly, not because they are not valued, but because in four years of undergraduate medical education, there is a limited amount of time. Now is the time to rethink what is important to care for the U.S. population and health care system. Is biochemistry and basic sciences more, less, or equally important as preparing our medical students to work within our broken care system?
Evidence: A landmark article, “Health Systems Science: The ‘Broccoli’ of Undergraduate Medical Education,” highlighted the importance of undergraduate students getting HSS curriculum early in their medical education. The reasoning is that students do not know it is good for them but need to understand HSS to be the changemakers of the future. Do we really need to “hide the broccoli,” or should we be embracing the broccoli, loving the broccoli, and explicitly connecting the students to the importance of having this broccoli to guard health care professionals against “burnout,” which is really “moral injury”?
Change is hard. As a passionate HSS medical educator, I understand the difficulty of creating and implementing HSS into undergraduate medical education. Each medical school needs to work within the boundaries of its academic calendar, limited hours, excessive testing, and preparing students for the “boards” that have a limited amount of HSS content tested. If we do not acknowledge the importance of HSS, we will not be able to have physician leaders in the future who can work on our broken system. This means that we need deep and consistent change across all schools.
We cannot reform and improve the U.S. health care system without reforming the way undergraduate medical education is taught. Highlighting board scores and traditional basic sciences is short-sighted. Now is the time for medical educators to act and insist on reform and perhaps an overhaul of medical education, as it occurred over 100 years ago in the Flexner Report. We need the Broccoli Report with new recipes to include HSS, whether hidden in a brownie recipe or more appropriately highlighted as part of a stir-fry to be served and consumed by the future leaders of the U.S. health care system. These leaders should include physicians and health care advocates, not just bean counters. Killing a health care CEO is not the answer, but maybe education and advocacy is.
Janet Lieto is a medical educator.
