The New England Journal of Medicine (subscription only, but it should be available at your local library) has an article recommending changes in pre-med (college) requirements, medical school curriculum, and the changes the editors see in the future practice of medicine.
The article suggests trading the current premed requirement of calculus for statistics (how will we understand statistics and tolerances if we haven’t learned to find the area under the curve?) and physics for a general ethics course (yeah, right, as though that’s possible in a post-post-modern world? Maybe if we all believe we can do it and are willing to accept the results as neither right nor wrong).
What’s the part that I really objected to is this:
Whether administering a practice, a laboratory, a department, or a hospital, physicians need to know how to account for resources. They need to know how to assess performance and quality, and how to change organizations to improve the delivery of care. It is not sufficient to have a handful of medical students who will become investment bankers, corporate executives, or hospital administrators who earn masters of business administration degrees. Every physician needs to know the essentials of management sciences, including negotiations, leadership, personnel management, accounting, strategic planning, and performance assessment. These can no longer be considered incidental skills, but are integral to optimal functioning of clinicians, researchers, and administrators; and each of them can be taught.
What if I had just wanted to practice medicine, one on one with the patient in the exam room and the hospital bed?
As a matter of fact, none of you would have heard a peep from me if I had simply been able to practice medicine without the charges of “fraud and abuse,” the bundling of services (meaning I wouldn’t get paid for what I did and spent beyond the lowest common denominator) and the ever-changing codes, levels of service and the notes to my patients that their tetanus shot was not “medically necessary.” If the doctor’s office weren’t considered to be the weakest link in the government pyramid scheme where recruitment is backed by guns and prisons. I probably would have marched in a few prolife rallies and read great books on cutting edge technology. I certainly wouldn’t have learned how to format web pages and enrolled in bioethics courses if I could have just practiced medicine without having to learn to out smart what I couldn’t understand or influence: the bureaucracy that is today’s medical policy.