A new medical school to teach new medicine?

Interesting piece at Forbes by David Shaywitz on Dell Medical School. It’s brand new, and it seeks to change the way we think about training docs. They see traditional medical education as flawed:

How can you expect a medical school to train physicians to think innovatively about reducing waste, or pursue serious research on waste reduction, the new Dell Medical team asks, when the results of this waste are responsible for such a large share of medical school revenue?  One leader at Dell Medical described this as “the ultimate conflict of interest.”

As if this wasn’t enough, I also detected an undercurrent of concern from Dell Medical leaders that much of the research agenda at traditional academic medical centers tends to be driven by reductionist basic scientists, keen to defend and if possible, augment their territory.  Their approach, Dell Medical executives seemed to suggest, are often not informed by the sorts of broader questions you would ask if you were truly focused on improving the health of the population in front of you.  The implication is that the direction and emphasis of traditional academic medical research is driven more by the political power wielded by scientists rather than by any concerted effort to discern and respond to the actual health needs of a community, which may require less focus on molecular description, and on more on prevention and care delivery.

I’m sympathetic to these arguments. In fact, I’ve made many of them before. I never understood why I needed to spend so much time in biochemistry and histology, and so little time understanding how the actual health care system works. More:

In the minds of the Dell Medical leaders, the most important goal of a medical school – and certainly of theirs — should be measurably enhancing the health of a community, an especially relevant issue in Austin where the medical school was explicitly paid for by local residents who clearly wanted it there.

The focus on the health of the community also results in a very different sort of model, as they see it; rather than paying for medical education by the waste generated by clinical care, they aspire to train, as far as I can tell, “populationists,” doctors who are focused on efficiencies of care, and who can find ways to remove costs, and add quality to the system.  The theory is that this will lead to measurable improvements in community health, and that payors – whether insurance companies or large employers who own their employees’ risk – will ultimately foot the medical education bill, motivated by the savings these waste management docs (WMDs?) have delivered.

There is concern that this could tip too far in the opposite direction, though. I can’t help but wonder – as I have in the past – whether something vital may get lost by the doctor who is raised from the start on the principle of parsimony.

I’ve made that argument in the past, too.

Moreover, you don’t need to start over to achieve this type of move:


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