The Medical Education Landscape is Changing and Leaders Must Change With ItJeffrey A. Schroetlin | Consultant in the Academic Medicine and Health Sciences Practice, Witt/Kieffer
Major health systems across the United States are exploring their options in the medical education space in unprecedented ways. From partnering with medical schools to purchasing existing schools to simply launching stand-alone medical schools, health systems are changing the face of the medical education market. In this interview, Jeffrey Schroetlin reflects on some of the roots of this trend and shares his thoughts on the work leaders of these new medical schools will have to do to ensure they’re competitive and able to serve students.
The EvoLLLution (Evo): Why are increasing numbers of health systems buying or launching their own medical schools, rather than relying on the medical schools already operating at colleges and universities across the United States?
Jeffrey A. Schroetlin (JS): In one word, control. There remains a great need to train more physicians in the United States—to replace the large number of baby boomer physicians exiting the workforce, and to keep up with population growth and higher utilization of healthcare services.
Health systems see this as an opportunity to address that need at a local level, to train and retain new physicians in hard-to-fill specialties, and to gain prestige in a competitive market.
Because it is such a daunting task to create a new school, very few health systems are able to start them completely on their own. Universities bring the academic support structures and expertise, which are, after all, what they do best. Many systems are choosing to partner with major universities to build or adapt undergraduate medical education, but are also looking to more directly control the graduate medical education environment. Others see real value in creating or taking over new medical schools, believing they can create a new model of educating and training physicians that will better fit the needs of a changed healthcare delivery model—that is, one that prioritizes value-based care. In addition, we’re seeing an unprecedented period of mergers and acquisitions amongst healthcare systems in the U.S., so it also makes sense that some health systems see it in their best interest to acquire medical schools as well.
Evo: What are the key responsibilities of a leader tasked with establishing a new medical school?
JS: Creating a medical school is extraordinarily complex, and expensive. New schools must go through a multi-tiered accreditation process through the Liaison Committee on Medical Education (LCME). Most new schools have also embraced a model of early exposure to clinical experiences for students, requiring close partnerships with clinical sites from the get-go. Experienced physician educators, basic science faculty and medical education staff must be hired. A tremendous amount of work will be put in by leaders well before an institution is ready to start enrolling students.
All of this preparation requires an inaugural dean who, above all else, can build a very strong team, who can keep everyone rowing in the same direction, and who can establish partnerships across a broad set of constituents. In many ways, a new medical school dean must be a salesperson and a visionary, convincing others to give their time, money, expertise and resources for a pay-off that will be years in the future. Leaders who are drawn to these types of positions must be risk-takers and naturally comfortable in a nascent environment. They could be creating the next Johns Hopkins, or the whole enterprise may never ultimately launch.
Evo: With so many schools currently competing for medical enrollments, what does it take to ensure a new medical school—likely lacking in prestige or brand—will stand out from the crowd to prospective applicants?
JS: Any new medical school can be assured of plenty of applicants. All schools, new or not, receive thousands of applications for very few slots. However, any new school will want to matriculate students who will ultimately be able to make it through the long and challenging process to becoming a licensed physician. Medical schools are currently producing more graduates than there are residency spots for, and the problem is getting worse each year. Last year, over 500 U.S. medical students were unable to obtain residency positions. New medical schools must be very focused on making sure their graduates can match into residency. That means they must be focused on attracting high-quality students, and quickly establishing a reputation for excellent training. Health systems who partner closely with medical schools must have medical staffs who embrace education, and support volunteer faculty who wish to teach without hurting their own busy practices. For health systems that have started their own schools, we have also seen a strong commitment to creating new residency positions, ideally to help place the best of their own students.
Medical school graduates are also increasingly worried about debt. The average medical student graduates nearly $200,000 in the hole, and the load is often heavier at new schools with little or no scholarship funds. With little or no endowments for scholarship funds, new medical schools must be able to offer an innovative curriculum, or clinical opportunities that are unique and more student-focused than perhaps there are at more established schools.
Evo: From a more tactical perspective, what are some of the on-the-ground processes that must be developed for a medical school to get up and running
JS: Since LCME accreditation is the primary focus of any new school, bringing in administrators and consultants with strong accreditation experience is required. Where we see many new schools struggle is in focusing too much on the first two years of medical education, which is more didactic, and putting off the clinical third and fourth years, where students will be embedded with the school’s clinical partners. Often relationships fray with clinical partners during the initial stages of a new school’s development. Costs are more than expected, and the resources, space and accommodations to meet the next LCME accreditation step often stress clinical practices and providers who may not have realized what they signed up for.
It is important for medical school leaders to have the right experts in place to create the early educational experience, while continuing to keep their partners and the community informed and in close cooperation.