Since starting medical school a short three months ago, I have been told repeatedly what an exciting time it is for medicine. Implementation of the Affordable Care Act is underway – access to care will expand, demand for doctors will grow, and health care delivery systems will be forced to transform.
Yesterday I went to a talk about how medicine is changing. A major paradigm shift is underway. The old model is of the “lone-ranger” physician who makes decisions about care seemingly in a vacuum and must wrangle his patients’ complex health conditions while simultaneously grappling with all the issues that make them non-compliant with care. Insurance problems, travel plans, and addiction are not typically areas in which physicians have expertise, but these all factor greatly into the treatment outcomes for patients. Fifteen-minute appointments barely suffice to cover the pressing physiologic problems that bring the patient into the office – other significant barriers are brushed aside. As a result, patients experience worse health outcomes – outcomes that are not commensurate with patients’ desire to get better, or their physicians’ knowledge, expertise, and dedication.
Today, I got to be part of a new model of care that focuses on the patient’s specific needs, and provides a support team to better coordinate care and address each issue separately. I was part of UCLA’s Mobile Clinic – a student-run healthcare operation for LA’s homeless in West Hollywood and Santa Monica. Each patient – or “client,” as we call them – is seen by both a medical student and an undergraduate caseworker. The medical student interviews the client about his medical conditions and takes vitals, while the caseworker takes a social history. I was incredibly impressed by my caseworker’s knowledge about the resources available to our clients and her ability to interview one client with severe mental illness and another that was high on crystal methamphetamine. The undergraduate managed the clients’ charts and coordinated the paperwork needed for referrals. Her efforts allowed me to focus on the pressing medical issues, and spend my time talking to our clients, writing up notes, presenting cases to the attending physician, and formulating action plans. The clients received more thoughtful and efficient care, thanks to the team approach.
Entire systems are re-aligning themselves to address patients’ needs in this manner. So-called “patient-centered medical homes” are transforming primary care to improve patient and provider experiences. Part of the change involves placing more responsibility on nurses, physicians’ assistants, pharmacists, and social workers, many of whom have been underutilized until now. In reality, the healthcare alliance workers are more specialized in their respective areas than physicians and are a major asset to patient care when given the opportunity. Fewer prescribing mistakes are made when pharmacists are engaged in treatment plans, patients are more likely to come to follow-up visits if a social worker has reconciled questions about insurance coverage, and physicians can spend their energies on tackling complex clinical presentations. Payers are trying to incentivize efficient use of resources by rewarding doctors for good outcomes, rather than paying them for unnecessary tests and imaging. The entire focus of healthcare has turned from services to results.
While we will continue to face significant challenges such as epidemic obesity, diabetes, hypertension, heart disease, and cancer, we who are students now (or prospective students) get to begin our careers in a system that supports better management of these conditions and improved prevention efforts. We will also get to be part of the systematic change that delivers care to the formerly marginalized or uninsured groups of Americans that will have insurance coverage under the Affordable Care Act.
I could not ask for a more exciting time to be starting down the path to my medical career, and I cannot wait to find out what will happen next.
||Read about why Emily applied to medical school||