Page 4 - COM Outlook - Spring 2013

4 COM Outlook . Spring 2013
— Fred Lippman, R.Ph., Ed.D.
aforementioned issues need to be addressed by our policymakers
to avoid a crisis that includes more than just a physician shortage.
With clinical training sites in a state of flux, you have to wonder
how U.S. medical schools will continue to effectively train future
generations of D.O.s and M.D. as the number of medical schools
continues to increase, especially in Florida where the number has
burgeoned from four to nine over the past two decades.
Due to the proliferation of medical schools throughout Florida
and the southeastern United States, we are also dealing with in-
creased competition for placing our students into the clinical train-
ing sites that currently exist. Fortunately, NSU’s College of Osteo-
pathic Medicine has established, longstanding, and collaborative
partnerships with a vast array of hospitals, medical systems, and
physicians’ offices throughout the state.
Although NSU-COM is well-positioned in terms of dealing with
the clinical training topic, the fact remains that the combination of is-
sues I’ve just discussed has led to a noticeable shift when it comes
to how health care is delivered. For example, in physician shortage
areas that currently exist within the United States, other primary
health care professionals such as physician assistants and nurse
practitioners have stepped in to fill the void.
I believe the days of establishing medical schools and simply
assuming they are going to be successful are over, which is why
I’m so optimistic about the newly created relationship between the
American Osteopathic Association (AOA) and the Accreditation
Council for Graduation Medical Education (ACGME). Through this
historic agreement, which is expected to take place in July 2015,
the AOA and ACGME plan to pursue a single accreditation system
for U.S. graduate medical education programs.
As a result of this integrated approach to graduate medical edu-
cation, I think we’re going to see additional attention being paid to
addressing the clinical rotation issue. Because of this, I am very
optimistic about the future of medical education.
An interesting topic that has been ad-
dressed recently during various health
care panels I participate in has to do with
how we, as a nation, are going to provide
for what has been described by various
publications, institutes, and foundations
as an extreme physician shortage that is
estimated to range anywhere from 25,000 to 40,000 in the near future.
However, beyond the impending physician shortage crisis looms
another critical issue that is already impacting both D.O. and M.D.
schools throughout the United States: the increasing lack of clini-
cal training sites for third- and fourth-year medical school students.
While the creation of new medical schools is a logical step toward
increasing the physician pool, it’s equally as important for elected
policymakers to focus on the education that occurs external of the
so-called bricks-and-mortar structures or electronic classrooms in-
volved in a traditional four-year medical education.
I think it’s unfortunate that policymakers at both the state and
federal level keep talking about the lack of graduate medical educa-
tion positions and the impending physician shortage without recog-
nizing that the most difficult aspect of educating future physicians
involves providing abundant clinical training opportunities during
the final two years of medical school.
Traditionally, clinical training has always existed in hospitals,
as well as at external clinics and physician offices. Unfortunately,
because most of this training occurs in hospital settings, opportuni-
ties to provide third- and fourth-year medical students with this vital
clinical training are diminishing due to a number of factors.
In my opinion, the actual delivery of health care has become
much more efficient over the past few decades thanks to the evo-
lution of minimally invasive procedures and robotic surgeries that
dramatically shorten the length of time patients need to remain
in the hospital to recover. But with fewer people having to stay in
hospitals for a sustained period of time, there becomes less need
for hospital beds.
Consequently, what has resulted is a paradoxical situation
where there is an increasing need for clinical training sites for medi-
cal students combined with a diminishing need for hospital beds,
which has resulted in fewer hospitals being created. In addition, be-
cause patient visits are increasingly being handled on an outpatient
basis, medical students are having reduced interaction with both
patients and physicians at the hospital level.
This is an imperative discussion topic because practicing physi-
cians are the individuals we rely on to serve as mentors to and train-
ers for our students during their final two years of medical school.
These physicians are pivotal to student training because they also
function as our offsite clinical faculty members. Consequently, the
HPD Chancellor’s Communiqué