AMA Plays Leadership Role in Solving Medical Education Issues

In a speech presented last year at the University of Pittsburgh Medical Center, Donald J. Palmisano, M.D., J.D., immediate past president of the American Medical Association, warned of the daunting problems threatening medical education today. But Palmisano also reassured his audience, explaining the leadership role that the AMA has assumed, and challenged them to join what he considers a fight for the future of medicine.

Palmisano believes that without a strong, healthy system of quality medical education, the American health care system cannot survive. Medical education is the foundation of medical care – but the nation’s medical education systems face complex problems that are resulting in physician shortages and other negative consequences. The AMA is intervening on many levels to reverse the trends and transform the situation into one that benefits the medical students, the medical profession and ultimately, the entire health care industry. Working through affiliated organizations, including the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME) and the National Board of Medical Examiners (NBME), the AMA is playing a vital advisory and advocacy role.

The problems confronting medical education include the overwhelming debt accrued by medical students, the decreasing numbers of minority students, the problem of safe and reasonable work hours for resident physicians and the medical liability insurance crisis.

“High debt is a deterrent to enrolling in medical school,” says Palmisano, “and that debt has been steadily rising. The median debt for med school graduates is five times higher today than it was just twenty years ago. While 1984 graduates left school with $22,000 – 26,000 of debt, today’s graduates of public schools will owe $100,000 and graduates of private schools will owe $135,000.” The debt is staggering and loan repayment is expected to begin simultaneously with one’s residency – hardly an opportune time to manage such a financial burden. One of the dangers of this is that medical school could become an option only for the affluent.

According to Palmisano, “The problem of medical debt tends to be more of a problem for minority students, and we need diversity in the profession. We need physicians who can provide culturally relevant care. Medical student debt influences choice of specialty, driving students away from the lower paying specialties and endangering care in underserved communities.” Medical school enrollments have not kept pace with America’s growing and graying population and the AMA has called for a 16% increase in medical school enrollments, emphasizing minority and foreign students, to meet the need.

The AMA has acted to ease the financial burdens facing medical school graduates, lobbying for tax relief, loan forgiveness, delayed repayment plans, scholarship programs and tuition reimbursement programs, at the federal and state levels.

Another concern is resident work hours. Safety and training needs must be balanced, giving resident physicians reasonable work hours and working conditions while making certain that patient care and medical training are not compromised. New guidelines, developed with the ACGME and the AMA’s House of Delegates, the organization’s policy-making body, went into effect in 2003 and the AMA is monitoring their effectiveness as well as compliance with them in the nation’s teaching hospitals.

While medical school debt, recruitment of minorities and resident work hours are all significant issues that impact heavily on the medical profession, the issue that takes priority is the medical liability insurance crisis. The problem has reached crisis proportions in twenty states and Palmisano says that it is clearly a national problem and one that the AMA must solve.

Skyrocketing medical liability insurance costs and “runaway juries” have driven doctors away from those specialties that are more at risk for lawsuits, particularly obstetrics, orthopaedics and neurosurgery. Premiums are so high in some states that young doctors leave the state after completing their residencies, setting up their practices in states where liability insurance is more affordable. This exodus has created a growing shortage of physicians in certain states and specialties, even closing down obstetric practices, maternity departments and trauma centers and limiting patient access to care.

The nation’s medical liability system is broken, says Palmisano, a peripheral vascular surgeon, and the American people and a majority of our Congressmen recognize that and support reform. Opponents of liability reform like to say that litigation reduces errors, making doctors more careful and making patient care safer. But Palmisano argues that that is simply not the case: errors arise from poorly defined systems, not from careless doctors. Patient safety is an important issue, but it is a separate issue and one that is also being addressed by the AMA. Reduction of medical errors will come about through the National Patient Safety Foundation, which the AMA helped to create, and will depend upon identifying the flaws in the systems that allow mistakes to occur. A key component of enhancing patient safety is for Congress to pass the Patient Safety and Quality Improvement Act that allows confidential voluntary reporting with review by experts, feedback to change the flawed system and sharing the lessons learned with all. This bill passed the House and Senate but time ran out to get it out of conference committee in the last Congress.

The AMA is the nation’s premier medical organization, providing a clear, strong and authoritative voice for the medical profession and medical students and representing the interests of physicians and patients in Washington. Despite the many problems that beset medical education, the practice of medicine and the health care industry in general, Palmisano is confident that the AMA is leading the way to a future of essential renewal and transformation. He encourages physicians and medical students to become members, furthering strengthening the organization through numbers and solidarity, adding their voices and allowing the AMA to speak on their behalf as they tackle the issues and create a better future for medicine.