Transcript 2012_SpringBOG_LockwoodPPT

Overview of Medical
Education Today
Charles Lockwood, MD
Dean, The Ohio State University
College of Medicine
• Historical Perspective
• Current State of American
Academic Medical Centers
• National Health Care Realities
• Our College of Medicine
• The Future
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100 years ago – Abraham Flexner
• 2+2 Formula
• Low Tech
• Teacher Centered
• Physician focused
 Science and clinical
practice more integrated.
 High Tech
 Student-Centered
 Team focused
4
Current State of American
Academic Medical Centers
5
American Association
Of Medical Colleges
(AAMC)
• More than131 US Medical
Schools.
• Each is affiliated with large
hospitals and/or medical
centers and most with a
university.
Take a closer look at these
institutions…
AMCs are Major Providers of Healthcare
AAMC Member Teaching Hospitals represent only 6 % of all hospitals.
BUT account for:
40% of all Medicare inpatient days
22% of all Medicaid inpatient days
40 % of all Hospital Charity Care
7
American Association of Medical Colleges
They also account for:
79% of all burn center beds
40 % of neonatal intensive care beds
83% of all Level 1 regional trauma centers
Overall, AAMC-member teaching hospital provide 20% of all
hospital care.
How is that possible? Big institutions (i.e., OSU - 6 Hospitals)
How do Medical Schools Fund their Mission
of Research, Teaching and Clinical Care
Source: LCME Part I-A, Annual Financial Questionnaire, FY2010
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Threats - Funding the Mission
 NIH paylines decreasing
 Tuitions are too high
 State revenues are
decreasing
 Reimbursement for
faculty practice plans
are in jeopardy
 Subsidies from hospitals
are shrinking
WHY?
10
Healthcare: Too Costly
Health Care 24 %
http://www.usgovernmentspending.com/united_states_total_spending_pie_chart
Health Care Spending
2006
2011
2016
2020
National health expenditures
(trillions)
$2.15
$2.71
$3.63
$4.64
National health expenditures as
a percent of GDP
16.1%
17.7%
18.6%
19.8%
National health expenditures per
capita
$7,197
$8,648 $11,099 $13,708
Source: CMS National Health Expenditure Data, 2012
Our Medical Education
System is too complex
13
AAMC
FSMB
Med Schools
MCAT
AHME
ABMS
State Boards
Subject
Exams
College Med School
Cert Exams
In-Training
Exams
CME
14
Recert/MOC
Practice Plans
Residency
ACGME
AHA
(Individual in) Practice
Allopathic Training
LCME
AMA
Specialty
Societies
Specialty
NBME Boards
USMLE
CMSS
Physical Facilities
ACCME
NCQA
JCAHO
Current medical education is inefficient.
Traditional
medical school
education takes
too long, has
significant waste
and redundancy
and does not
consistently
prepare students
for their next step.
15
11 to 21 years!!!
Practice
Residency and Fellowships
Medical School
Premedical
In the face of these realities,
what future should academic
medicine seek to create?
16
Transforming Academic Medicine Will
Require A Different Culture –
System Based Physician
17
Hierarchical
Collaborative
Autonomous
Team-based
Individualistic
Mutually Accountable
Expert-centered
Patient-centered
•
The Ohio State University College of Medicine
ahead of the curve in curricular reform
Rich history of curriculum innovation
In September, we will launch new Lead. Serve.
Inspire Curriculum
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We Offer Unique
Program
Opportunities
Research
Clinical Skills
Education &
Assessment
Center
Technology
Global Health
Immediate access to patients
… Opportunity and innovation
comes at a cost
20
Student Debt is a problem:
 Our average debt for 2011 past year
was $152,028 (not including undergrad
debt)
 All AAMC school average was
$143,185
 Top 20 medical schools have average
indebtedness of $111,590
2011 Scholarships (without a service
commitment)
 Our total scholarship dollars awarded
was $5,804,831
 Top 20 medical schools average was
$11,008,014
A Closer Look
Premedical
Medical School
Residency and
Fellowships
Practice
Ohio State $5,804,831 divided by 719 students= $8073 per student
Top 20 schools provided $11,008,014 divided by an average of 575
students= $19,144 per student
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Summary – Medical Education Today
Opportunities are endless..
• Systems Based Physician
• Team training Integration
• Technology
• Community (Global) Health
• Improved safety and outcomes
but, threats to outstanding medical education exist and
we cannot ignore them.
• Student debt
• US Healthcare Costs
• NIH funding
• Decrease time of training and regulatory complexity of the system
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Questions?
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