An object with a large mass moving at high-speed (such as a Navy ship) requires a lot of effort to turn as shown here. Health care consumes almost 20% of the economy, has a lot of momentum, and changing the direction is going to take a lot of energy. The Affordable Care Act includes several provisions that will move healthcare, discussed here.  Many practices are experimenting with changes in care delivery and mechanisms of payment, documented by the Patient Centered Primary Care Collaborative here. The American Academy of Family Medicine has posted resources on practice change for established practices and residency training sites here. We are graduating 16000 physicians every year, though, that may not be exposed to any of this. The AAMC has identified 12 medical schools (out of approximately 120) who are trying to expose students to different types of care delivery, discussed here, but we are not trying to influence medical students in an organized fashion.  Because of the 8 to 12 years needed from admission to practice, turning this ship will require new educational materials, new faculty skilled in different types of care delivery, and new methods of educating physicians-to-be.

The American Academy of Family Physic ians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association have put together a list of educational skills that they feel should be adopted by medical schools and used to teach American physicians-to-be, found here. Th reason for this, as identified by Perry Pugno of the AAFP is

“Training for PCMH practice has been embraced by the graduate medical education community, but at the medical school level, the response has been less — hence, the development of these principles to guide development at the medical school level of training,” said Pugno.

The reason these were developed is to help turn the health care ship around

It’s important for medical schools to recognize the need to invest in the future to provide these educational opportunities, Pugno said.

“We know that the current model of health care isn’t financially sustainable,” said Pugno. “We need at least some medical schools and their academic medical centers to show leadership and make some difficult choices — and change how they do business. In the short term, it will cost, but the dividends will come in the future.”

Maybe not “All Engines Reverse” but perhaps moving off “All Ahead Full.”

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