The sweeping changes being wrought at the University of California's medical centers represent, in the view of many experts, only one part of the response UC needs to make to the shift currently underway in the U.S. health-care industry. What is needed in addition is a complete rethinking of medical education at UC, since, according to some critics, the University currently is training physicians for a working world that no longer exists.
As it turns out, the University is likely to get such a top-to-bottom reassessment of medical education soon. The Office of the President has appointed a blue-ribbon Commission on the Future of Medical Education, which seems to be on a fast-track to recommending major changes in UC medical training. Meanwhile, the Academic Senate has formed a Health Sciences Education Committee that will address similar issues.
The 27-member Commission on the Future of Medical Education (CFME), put together in August at the request of President Atkinson, is composed of a broad spectrum of health-sciences experts, mostly from outside the University. One measure of CFME's importance is that its director, UC San Francisco neurosurgeon Charles Wilson, stipulated as a condition of taking the job that he be allowed to report directly to Atkinson. CFME's members include such figures as Kenneth Kizer, the under secretary for health in the U.S. Department of Veterans Affairs; Ralph Snyderman, the chancellor for health affairs at Duke University; and David Lawrence, the CEO of Kaiser Foundation Health Plans.
The commission has an ambitious goal: To deliver by next June a report that specifies what physician workforce California should have; the competencies these physicians should possess; and the training that should be utilized to provide them with their skills. To come to an understanding of the issues, CFME has commissioned 21 white-papers from experts nationwide on subjects ranging from models of medical education to demographic change in California.
Though CFME will be making recommendations on the state's medical education needs, the panel has no representation from any California medical schools outside UC. Wilson says this "is a matter of when they will be involved and to what extent." He notes that representatives from other medical schools will attend a CFME workshop next April, prior to the release of the panel's report.
CFME is also open to criticism on grounds that it does not have a single representative on it from the UC Academic Senate, and and almost no representation from the UC faculty. With the exception of UCLA physician Charles Lewis (and a single student) all CFME's UC members are administrators. "We believed that our deliberations would be going on in parallel with those of the Academic Senate," says Wilson, who is expected to work closely with the Senate's Health Sciences Education Committee.
Though CFME has yet to formulate any recommendations, certain types of changes can be predicted for UC. Wilson agrees with those who say UC is training too many specialists, as opposed to primary care physicians. Then there is the matter of the funding of medical education. "Medical education . . . needs to be treated by the legislature as a public good," Wilson says. "The commission will have a very clear recommendation for the Office of the President, which will then reach the Legislature, on how medical education ought to be funded."