Managed Care Devastating Medical Education

Anonymous questionnaires were mailed to 808 clerkship directors in the departments of six specialties at 125 U.S medical schools between October 1997 and March 1998.

Among other questions, respondents were asked whether they had observed changes in 19 different aspects of medical students’ education, whether these changes were beneficial or detrimental, and whether they believed the changes were due to managed care and/or other factors. Results were analyzed to determine perceptions of the overall magnitude and source of change, the perceived positive versus negative effect of managed care, and whether those outcomes were statistically associated with the perceived degree of managed care market penetration.

Five hundred questionnaires were returned. The most common response was that managed care had an adverse effect on the following areas: (1) full-time and voluntary faculty teaching, (2) faculty availability for educational administration, (3) directors’ clinical responsibilities, and (4) quality of professional life.

The most common response was “no change” in the following areas: (1) faculty enthusiasm for teaching, (2) directors’ administrative and educational duties, and (3) clerkship training sites. But the second most common response in those areas was that managed care had a negative effect.

Brodkey acknowledged that the time since the survey was performed may date the responses, but she suggested that, if anything, the effect of managed care on academic medicine and the perceptions of those effects have only gotten worse in the intervening years due to the further penetration of MC into academic medical centers.

Regardless of the validity of the perceptions, she and her fellow authors believe the perceptions themselves are likely to have a detrimental effect on education.

“Medical educators must have sufficient time and resources to develop, direct, and assess the outcomes of their programs,” Brodkey stated in the Academic Medicine report. “Experience and amount of time spent teaching, enjoyment of teaching, degree of perceived support, and career satisfaction of educators have been found to predict excellent clinical teaching.”

The report noted that the erosion of clinical revenues at academic medical centers—which is most pronounced in areas of the highest managed-care penetration—has reduced the ability of directors to “cross-subsidize” research, teaching, and patient care. Brodkey said that the solution lies in dedicated funding for medical education.

“The position of the Alliance for Clinical Education is that we need an independent funding stream that is specifically for medical student education,” she said.

More generally, she said the problems encountered by academic medical centers are reflective of the ripening problems with the nation’s health care system and for-profit managed care.

“I think we need to take a look at a national health insurance plan,” Brodkey told Psychiatric News. “Too much money is being drained out of the health care system to stockholders.”