"Beyond Flexner" kicks off in Albuquerque
Teaching tomorrow’s doctors to recognize and respond to the myriad social factors that influence health was a recurring theme Monday at the kickoff of a three-day meeting that has brought nearly 400 prominent medical educators, health insurers and policy experts to Albuquerque.
The Beyond Flexner 2015 conference, cohosted by the University of New Mexico Health Sciences Center and The George Washington University, aims to build a national movement to tackle the social determinants of health – “upstream” factors like smoking, obesity, poor diet, lack of exercise and toxic environments – that lead to chronic disease.
Representatives from more than 80 academic health centers and universities, 60 health organizations and a dozen foreign countries turned out for the conference.
In his welcoming remarks, Paul B. Roth, MD, UNM’s Chancellor for Health Sciences, noted that “upstream” factors encompass both environmental and behavioral factors, with some researchers estimating that these account for more than two-thirds of the problems that cause people to access medical care.
“The emerging understanding of the role these factors play in driving morbidity and mortality in our society open the door to creative new interventions that could dramatically transform the health care landscape,” Roth said.
Meanwhile, conference co-organizer Arthur Kaufman, MD, UNM’s Vice Chancellor for Community Health, said he hoped the meeting would lead to the creation of a clearinghouse and new networks to promote the social mission in education.
Keynote speaker Donald Berwick, MD, former administrator for the federal Centers for Medicare and Medicaid Services, said that as the son and father of physicians, he well understood doctors’ traditional “very romantic” self-image, in which they bear “the unitary burden of responsibility” for their patients.
Now, however, “the romantic identity is absolutely insufficient,” Berwick said. “There’s a mismatch between the professional self-definition and an evolving sociological, political, financial and economic context.
For one thing, there is a tremendous amount of waste in what Berwick described as the “health care-industrial complex.” While he ran CMS, the agency that administers the Medicaid and Medicare programs, he oversaw $820 million in spending to provide care for 100 million people, he said.
The U.S. ranks 40th in the world in mortality and longevity measures, even though it spends more per capita than any other country, and more than a third of the $2.8 trillion in U.S. health care spending “is not related at all to anything of value,” Berwick said.
If the U.S. spending for health care ran at the same rate as Switzerland (its closest competitor), it would have saved $15.5 trillion over 30 years, he said. The health care system is in effect “confiscating” funding from roads, schools, parks and other public resources, he added.
A redesigned system of medical education starts by encouraging students to look for simple, low-tech preventive measures that will keep their patients from getting sick in the first place is a first step toward reform.
Educational reforms might include more relevant premedical education requirements during the college years, greater standardization and a national physician licensure system, Berwick said.
Meanwhile, he said, doctors need to pay better attention to what their patients have to say. “We need to change from, ‘What’s the matter with you?’ medicine to, ‘What matters to you?’ medicine, he said. Echoing Gandhi, he added, “Let’s make health education look like the health care system we want.”
Berwick and other speakers drew rave reviews from attendees. “There’s a powerful sense of community at this conference,” said Hana Hinkle, MPH, from the National Center for Rural Health Professions at the University of Illinois. “I’m excited to network with like-minded people and gather experiences from some of these existing integrated programs,”
Ken Rivlin, MD, a pediatric hematologist at Jacobi Medical Center in New York City, said he’s personally seen a lot of disparity in health care. “The concept of a need for change in health education is coming out clearly at this conference,” he said. “It gives me hope that others are trying to improve the social component of medicine. It’s also providing me important tools with which to approach leadership in my institution.
In addition to plenary speeches and more narrowly themed breakout sessions, conference organizers arranged for attendees to visit a number of Albuquerque-area community programs, many run in collaboration with UNM, that address a variety of social needs.
The conference name references Abraham Flexner, an American educator whose landmark 1910 study of medical education led to comprehensive reform of U.S. medical schools, giving rise to the science-based curriculum that has dominated for the past century.
The 20th century model, however, often neglected the social mission of medical education, prompting a “Beyond Flexner” movement, which in 2012 brought together socially accountable medical schools to share ideas on how changes in medical education can help address health inequities.
This year’s conference also seeks to shape new public-private partnerships to help translate this movement into a force for change and includes representatives from major managed care organizations.