Less than half of graduating U.S. medical students say they received adequate training in understanding healthcare systems and the economics of practicing medicine, according to a study conducted by the University of Michigan Medical School.
The national survey of more than 58,000 medical students from 2003-2007 showed an overwhelming majority were confident about their clinical training. But when it came to understanding health economics, the healthcare system, managed care, managing a practice or medical record-keeping, 40 percent to 50 percent of students reported feeling inadequately prepared.
The findings were published this month in Academic Medicine.
"Our patients expect us to understand the system," said Matthew M. Davis, MD, associate professor of pediatrics and internal medicine in the Child Health Evaluation and Research Unit at the University of Michigan Medical School. "If we don't, that can result in poor patient care. And if we don't expect doctors to understand the healthcare system, who is going to?"
Davis co-authored the research with Monica L. Lypson, MD, assistant dean of graduate medical education at the U-M Medical School, and Mitesh S. Patel, MD, a U-M medical school graduate now at the University of Pennsylvania.
Davis said researchers wanted to assess what medical students are learning about healthcare systems, especially as the nation struggles with healthcare reform. It's important, he said, that physicians can contribute to the national dialogue.
The study looked at graduates nationwide from 2003 to 2007 and also compared two top-ranked medical schools in more detail. One of those schools had a higher intensity curriculum in healthcare systems.
Students who had the higher intensity curriculum were three times more likely to report that they had appropriate training in healthcare systems. The time devoted to healthcare systems training, however, did not lead to lower perceptions about their clinical or other training.
"So, a higher intensity curriculum in healthcare systems could hold the potential to overcome medical students' perceptions of inadequate training in the practice of medicine," Davis said. "Those students in the higher-intensity curriculum were not less confident about other things ... in other words, instead of a tradeoff, there is a payoff."
Davis said he hopes the survey will prompt medical schools to stress the importance not only of physicians' ability to heal, but also to help guide their patients through a complex healthcare system.