Medical education has always carried an enormous responsibility: deciding what a future physician needs to know.
For generations, the answer seemed relatively straightforward. Give medical students a rigorous foundation in anatomy, physiology, biochemistry, pathology, pharmacology, microbiology, and other basic sciences. Build clinical knowledge upon that foundation. Then provide supervised clinical experience until the student becomes capable of practicing medicine. That model has served medicine extraordinarily well.
But the world in which today’s medical students will practice is changing at a speed that earlier generations of physicians could scarcely have imagined. Medical knowledge is expanding rapidly. Artificial intelligence can retrieve and synthesize information within seconds. Health care delivery has become organizationally and financially complex. Physicians increasingly work in large systems and multidisciplinary teams. Health care affordability has become a major societal challenge. Burnout and professional dissatisfaction have become serious concerns.
The question, therefore, is not whether we should weaken the scientific foundation of medical education. We should not. The more important question is this: How should we use the limited educational time of future physicians most intelligently?
Understanding versus memorizing
Every physician needs to understand human biology. But understanding biology is not necessarily the same as memorizing every biological detail.
Generations of medical students have spent enormous amounts of time memorizing biochemical pathways, anatomical relationships, rare physical findings, and other highly specific information. Kayser-Fleischer rings in Wilson disease became memorable examination material. Students struggled to reproduce the Krebs cycle and countless other biochemical pathways from memory.
There is educational value in understanding these concepts. But there is an important distinction between understanding how cellular metabolism works and remembering every intermediate molecule, years later.
Similarly, anatomy is indispensable to medicine. But the anatomical knowledge required by a neurosurgeon or orthopedic surgeon is different in depth from that routinely required by a psychiatrist, internist, or primary-care physician.
Medical education should preserve a strong common scientific foundation while becoming more thoughtful about how much specialized detail every future physician must permanently carry in memory. The human brain is no longer the only information-storage system available to today’s physician.
The more useful educational objective may increasingly be: Know the principles. Understand biology. Recognize what matters. Know where reliable information resides. And know how to use it intelligently.
AI changes the educational equation
Artificial intelligence makes this discussion increasingly urgent. The physician of the future will have access to computational tools capable of retrieving drug interactions, reviewing medical literature, assisting with differential diagnoses, summarizing records, interpreting trends, and performing tasks that previously depended heavily upon human memory.
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This does not make physicians less important. It may make judgment more important. Future doctors will need to understand when AI is useful, when it is wrong, when its output is incomplete, how bias can enter an algorithm, how patient privacy must be protected, and why responsibility cannot simply be transferred from clinician to machine.
Medical schools therefore face a new educational obligation: Students must become competent not merely in medical knowledge but in responsible collaboration with technology. The objective should not be to create physicians who compete with machines at memorization. It should be to educate physicians who can do what machines cannot reliably do alone: understand context, integrate uncertainty, communicate with human beings, exercise ethical judgment, recognize when something does not fit, and accept responsibility for consequential decisions.
The financially illiterate physician
There is another striking gap in traditional medical education. We educate physicians extensively about disease but often send them into professional life knowing remarkably little about the business environment in which medicine is practiced.
Many physicians graduate without meaningful education in contract negotiation, employment agreements, partnership structures, insurance, billing, health care economics, organizational management, or even the basic principles of reading a business contract. Yet shortly after completing training, they may be asked to sign agreements involving hundreds of thousands or even millions of dollars over their professional careers.
A highly educated physician can therefore be scientifically sophisticated and commercially naive at the same time. Earlier generations of physicians sometimes became easy targets for unfavorable contracts, poorly understood managed-care arrangements, questionable business proposals, and aggressive salesmanship.
Teaching basic financial literacy, negotiation, contract interpretation, and health care economics is not beneath medical education. It is part of preparing physicians for the environment in which they will actually practice.
The physician should understand the cost of care
Financial literacy in medicine should extend beyond employment contracts and personal business decisions. Physicians are also major participants in the economic machinery of health care. Every day, we order laboratory tests, imaging studies, medications, consultations, procedures, hospital admissions, medical equipment, and follow-up care. Each decision may be clinically reasonable, but it also carries a cost: to the patient, the insurer, the health care organization, and ultimately society.
Yet physicians may complete years of medical education without developing even a practical understanding of what many of the tests and treatments they order actually cost. That educational gap matters.
A physician does not need to become a health care economist. But future doctors should understand basic concepts such as drug pricing, insurance design, deductibles, copayments, prior authorization, generic and therapeutic alternatives, the relative costs of common diagnostic studies, and the financial consequences of unnecessary testing and low-value care. Most importantly, they should learn to ask a question that belongs alongside clinical effectiveness and safety: What will this decision cost the patient?
For some patients, an expensive medication is not merely an economic inconvenience. It may determine whether the prescription is filled at all. A diagnostic test with a large deductible may compete with rent, groceries, or other family obligations. A medically reasonable recommendation that a patient cannot afford may have little practical value.
Cost-conscious medicine should not mean withholding necessary care or allowing finances to override sound clinical judgment. It means recognizing that affordability itself can influence whether good medical care actually reaches the patient. Medical students should therefore learn the principles of clinical stewardship: how to distinguish necessary care from habitual care, how to recognize low-value testing, how to consider less expensive therapeutically appropriate alternatives, and how to discuss costs respectfully with patients.
There is also a larger societal responsibility. Health care resources are finite. When thousands or millions of individual clinical decisions are multiplied across a health care system, small differences in practice can become enormous differences in expenditure. Physicians cannot solve the affordability crisis alone, but it is difficult to imagine solving it without physicians.
Health care affordability should therefore become part of medical education, not as an accounting exercise, but as an element of responsible clinical practice. A future physician should leave medical school knowing not only what can be done for a patient, but also when it should be done, what value it provides, and what burden it may impose.
Medicine also requires human skills
Physicians rarely practice alone anymore. Modern health care depends upon nurses, pharmacists, therapists, medical assistants, advanced-practice clinicians, administrators, technicians, social workers, and many others. Yet teamwork is frequently learned informally rather than systematically.
How does a physician lead without becoming authoritarian? How does one disagree respectfully with a colleague? How should conflict be resolved? How does one negotiate? How does a young physician maintain appropriate professional boundaries with patients, colleagues, employees, and employers? How should difficult feedback be given and received?
These are not peripheral “soft skills.” They directly affect professional relationships, patient safety, organizational performance, and physician well-being. They deserve a legitimate place in medical education.
We should also teach physicians how to remain healthy
Perhaps one of the great ironies of medical education is that we teach future physicians how to protect the health of others while devoting comparatively little structured attention to teaching them how to protect their own. The habits established during medical school and residency can persist for decades.
Sleep deprivation, irregular meals, prolonged sitting, insufficient exercise, chronic psychological stress, professional overcommitment, and neglect of family and social relationships can gradually become normalized. Physicians should learn early that professional dedication and personal health are not opposing values.
Medical education should include practical instruction in sleep, movement, nutrition, stress regulation, maintaining relationships, professional boundaries, time management, and balancing professional ambition with family and personal life. Self-care should not be presented merely as an antidote to burnout after damage has occurred. It should be taught as a professional competency.
A physician who is physically exhausted, emotionally depleted, financially distressed, or chronically disconnected from family does not become a better physician through sacrifice alone. Medicine should certainly continue to teach service and professional responsibility, but it should also teach sustainability.
A medical career may last four decades. Medical education should help prepare physicians not merely to enter that career, but to remain healthy enough to sustain it.
A curriculum built around enduring competencies
Perhaps medical education needs to think less exclusively in terms of subjects and more in terms of enduring competencies. Future physicians will still need strong foundations in anatomy, physiology, pathology, pharmacology, biochemistry, microbiology, and clinical medicine.
But alongside those foundations, they will increasingly need five broader capabilities:
- Scientific literacy: Understand biological principles deeply enough to reason rather than merely memorize. Know what information must be retained, what can appropriately be retrieved, and how to distinguish reliable scientific evidence from misinformation.
- Clinical and human judgment: Integrate evidence, uncertainty, patient preferences, communication, ethics, clinical experience, and compassion into decisions affecting individual human beings.
- Technological literacy: Use AI, digital tools, and emerging technologies intelligently while understanding their limitations, biases, privacy implications, and appropriate boundaries.
- Professional, organizational, and economic literacy: Understand health care systems, teamwork, leadership, negotiation, employment and partnership contracts, insurance structures, health care economics, and the economic consequences of clinical decisions. Physicians should understand not only whether an intervention can work, but whether it represents responsible use of health care resources and whether the patient can realistically afford it.
- Personal sustainability: Develop the skills necessary to protect one’s own physical, emotional, family, social, and professional health across a career that may span decades.
None of these requires abandoning traditional medical education. It requires rebalancing it.
What deserves space in the physician’s brain?
The amount of information available to medicine will continue to expand. The number of hours available to educate a medical student will not. That reality forces medical educators to make choices. We must distinguish among information that must be memorized, principles that must be understood, skills that must be repeatedly practiced, judgment that must be developed through experience, and information that can safely and rapidly be retrieved when needed.
Every addition to a curriculum also has an opportunity cost. An hour spent requiring memorization of information that can reliably be retrieved is an hour that cannot be spent developing communication, clinical reasoning, AI literacy, leadership, cost awareness, negotiation skills, teamwork, or personal health practices.
This does not mean making medical education easier. In some ways, the education I am describing may be more demanding.
Memorization can be tested with an examination. Judgment is harder to teach. Communication is harder to assess. Leadership requires practice. Cost-conscious clinical reasoning requires understanding both medicine and health care systems. Responsible use of AI requires intellectual humility, the ability to recognize when either the machine or the physician may be wrong. These are sophisticated skills. They deserve educational time.
Preparing physicians for the world they will inherit
Medical education should not become less scientific. It should become more intelligently scientific.
The physician of tomorrow will not be defined by how much information can be stored in one human brain. Technology has fundamentally changed that equation. The physician of tomorrow will be defined by something more important: the ability to understand biology, think critically, exercise sound clinical judgment, use technology wisely, communicate humanely, understand the economic consequences of medical decisions, work effectively with others, navigate an increasingly complex health care system, and remain healthy enough to sustain a lifetime of caring for patients.
The scientific foundations of medicine remain indispensable. But medical education must periodically ask whether its curriculum reflects the world its graduates are about to enter.
We should educate future physicians for the world in which they will actually practice, not merely the world in which we learned medicine.
Narinder Singh Parhar is a physician with more than three decades of experience in internal medicine, hospital medicine, and intensive care medicine. Over the course of his career, he cared for a broad spectrum of medically complex and critically ill patients while developing a growing interest in health care systems improvement, prevention, biomechanics, and population health.
Dr. Parhar previously served as an associate clinical professor affiliated with the University of California, Davis, and on the executive board of Sutter Independent Physicians IPA in California. His professional experience spans outpatient medicine, inpatient care, intensive care medicine, and health care leadership, including past affiliations with Sutter Health and Sutter Roseville in California.
Throughout his career, he became increasingly concerned about several structural challenges within the current health care model, including affordability, accessibility, polypharmacy, health care fragmentation, microbial resistance, physician burnout, and the progressive underemphasis of prevention and functional preservation. These observations led him to develop the Health Enhancement Organization (HEO) Framework, a prevention-oriented and biomechanics-aware health care enhancement model designed to complement scientific medicine through earlier biological support, movement preservation, patient empowerment, and health care team well-being.
Dr. Parhar’s current work focuses on health care course correction, scalable prevention strategies, biomechanics education, healthier aging, and improving long-term population health resilience in practical, affordable, and biologically grounded ways. He is the founder of Jeeva Health Systems, and his research includes “Impact of a Novel Plant-Based Treatment Option in Improving Pulmonary Function Markers,” published in Alternative and Integrative Medicine.
