Transformation in U.S. Health Care: Be Part of the Change

Omar Khan, M.D. '03
Omar Khan, M.D. ’03

It has nearly always been a good time to become a doctor, but now is an exception – only since I think it’s a particularly awesome time.

I remember all the things I thought weren’t all that great when I was a student or intern.  But, between putting out fires and being on call, I was impressed by two things: One, that much of the system of medicine is at odds with the common sense laws of every other business. Two, that so many of my mentors and teachers at the University of Vermont – the College of Medicine and the Medical Center – were patient, smart, balanced individuals and made me want to be like them.  Still do.

That said, I think things are better in medicine.  Sure it seems a time of upheaval in the health system, but I think it’s a good upheaval.  Just consider the improvements since just a few years ago.  Unnecessary lab tests? Less, thanks to Choosing Wisely.   Attendings yelling at you? Not so much anymore (we’re paying attention to this).  Crazy long (and unhealthy) work hours?  An 80 to 88-hour work week is still quite a bit but it’s better.   Worried about what insurance a patient has (or doesn’t have)?  The Affordable Care Act has dropped uninsured rates to historic lows.  Burned out docs? Finally someone is paying attention in new efforts to address this.   Find medicine too solitary?  It’s now a team sport and you have help.

There is still much to be done in all the areas above, but we have gone from explaining away the faults and flaws in U.S. medicine to actually doing something about it.  I’ll go so far as to say we live in a time where idealism meets necessity.  All the stuff you know is intuitively the right thing to do? We’re starting to do it.  When you really sort of suspected that just billing patients ‘fee for service’ had all sorts of bad incentives built into it?  We’re recognizing it.  When you look around, it’s easy to see we are actively evolving away from a system where doctors get paid by virtue of what encounter they had, to a system where we get rewarded for the right outcome for the patient.  (The technical term for that would be a “win-win”).

Just a few years ago, doing the right thing was not always the financially smart thing.  Spending extra time and effort to discharge patients from the emergency department, or calling them up to discuss lab results, or even spending extra time with a bereaved family, made us no extra revenue.  I even recall being berated by a senior resident about how I didn’t want to admit every ER call and set up outpatient services instead.  But we think this is the right thing to do, and thanks to some innovative thinking, we have ways to measure that – through patient experience scores and outcome metrics, among others.

Today’s medical students enter a world full of possibility.  It will be informed by the best evidence, not just from medicine but from public health, anthropology, and the social sciences. Our models will be informed by best practices from across the globe.  This evolving medical model – available now at a primary care practice near you! – will allow you to do the right thing, get rewarded for doing the most difficult work, and go into the specialty you dreamed of, not the one you felt you had to for your student loans.

The difficult part might be believing that it’s happening.  (My college psych prof named it Learned Helplessness).  After all, to someone who graduated from medical school 10, or five, or even two years ago, it may seem too good to be true – too fanciful, just another new fad.  It’s not, and therein lies the challenge and the fun part: You get to believe in it, and design this with us.  As residents, you will see lots of changes, so ask questions. Ask to be part of them. Volunteer to be on committees.  And if not enough change is happening, ask why not, and create it.   Need ideas, or someone to share them with?  My email is always open. Find me at: okhan12@icloud.com

-Omar Khan, M.D.’03, is chair of the primary care & community medicine service line, medical director of preventive medicine, and director of the global health residency track at Delaware’s Christiana Care, one of the country’s largest health systems.  He is associate professor of family medicine at UVM and blames his medical education in Vermont for his crazy ideas.

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