Overview of Medical Education Today

Charles Lockwood, MDDean, The Ohio State University College of Medicine

• Historical Perspective

• Current State of American Academic Medical Centers

• National Health Care Realities

• Our College of Medicine

• The Future

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100 years ago – Abraham Flexner• 2+2 Formula• Low Tech• Teacher Centered• Physician focused

Science and clinical practice more integrated.

High Tech

Student-Centered

Team focused

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Current State of American Academic Medical Centers

American Association Of Medical Colleges (AAMC)

• More than131 US Medical Schools.• Each is affiliated with large

hospitals and/or medical centers and most with a university.

Take a closer look at these institutions…

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AMCs are Major Providers of HealthcareAAMC Member Teaching Hospitals represent only 6 % of all hospitals.

BUT account for: 40% of all Medicare inpatient days22% of all Medicaid inpatient days40 % of all Hospital Charity Care

American Association of Medical Colleges

They also account for: 79% of all burn center beds40 % of neonatal intensive care beds83% of all Level 1 regional trauma centers

Overall, AAMC-member teaching hospital provide 20% of all hospital care.

How is that possible? Big institutions (i.e., OSU - 6 Hospitals)

How do Medical Schools Fund their Missionof Research, Teaching and Clinical Care

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Source: LCME Part I-A, Annual Financial Questionnaire, FY2010

Threats - Funding the Mission

NIH paylines decreasing Tuitions are too high State revenues are

decreasing Reimbursement for

faculty practice plans are in jeopardy

Subsidies from hospitals are shrinking

WHY?

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Healthcare: Too Costly

http://www.usgovernmentspending.com/united_states_total_spending_pie_chart

Health Care 24 %

Health Care Spending

  2006 2011 2016 2020

National health expenditures (trillions)

$2.15 $2.71 $3.63 $4.64

National health expenditures as a percent of GDP

16.1% 17.7% 18.6% 19.8%

National health expenditures per capita

$7,197 $8,648 $11,099 $13,708

Source: CMS National Health Expenditure Data, 2012

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Our Medical Education System is too complex

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College

AAMC FSMB CMSSAHME

Allopathic Training

NCQAACGMELCME

ACCME

(Individual in) Practice

Practice Plans

Physical Facilities

NBME

Specialty Societies

In-Training Exams

Med Schools

Recert/MOCMCAT CME

Subject Exams

Cert ExamsUSMLE

AHAABMS

State Boards

Residency

Specialty Boards

JCAHO

AMA

Med School

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Current medical education is inefficient.

Premedical

Medical School

Residency and Fellowships

Practice

11 to 21 years!!!

Traditional medical school education takes too long, has significant waste and redundancy and does not consistently prepare students for their next step.

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In the face of these realities, what future should academic

medicine seek to create?

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Transforming Academic Medicine Will Require A Different Culture –

System Based Physician

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The Ohio State University College of Medicine ahead of the curve in curricular reform

Rich history of curriculum innovation

In September, we will launch new Lead. Serve. Inspire Curriculum

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Research

We Offer Unique Program Opportunities

Clinical SkillsEducation &AssessmentCenter

Global Health

Technology

Immediate access to patients

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… Opportunity and innovation comes at a cost

Student Debt is a problem:

Our average debt for 2011 past year was $152,028 (not including undergrad debt)

All AAMC school average was $143,185

Top 20 medical schools have average indebtedness of $111,590 

2011 Scholarships (without a service commitment)

Our total scholarship dollars awarded was $5,804,831

Top 20 medical schools average was $11,008,014

:

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A Closer Look

Premedical Medical School

Residency and Fellowships

Practice

Ohio State $5,804,831 divided by 719 students= $8073 per student

Top 20 schools provided $11,008,014 divided by an average of 575 students= $19,144 per student

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Summary – Medical Education Today

Opportunities are endless..

• Systems Based Physician• Team training Integration• Technology • Community (Global) Health• Improved safety and outcomes

but, threats to outstanding medical education exist and we cannot ignore them.

• Student debt• US Healthcare Costs• NIH funding • Decrease time of training and regulatory complexity of the system

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Questions?