Let’s create a more just healthcare system and start in how we train future physicians

The COVID-19 pandemic has laid bare a sad truth in America: health outcomes are too often based on race, ethnicity and zip code, a track record that places us behind our global peers, one that needs our collective attention for once and all.

A recent analysis published in the New York Times based on CDC data concluded that Latino and African-American people in the U.S. are three times as likely to become infected with the virus as whites and are nearly twice as likely to die from it than whites. These unacceptable gaps take on even more urgency as the nation mourns the loss of Congressman John Lewis who championed equality in all realms of life.

To eliminate these inequalities, our nation faces a daunting agenda that includes reducing poverty, expanding access to convenient and affordable healthcare and much more. In our industry, as we work to close these gaps by integrating better population health strategies, we must also start at the beginning – in how we train future physicians.

We must create a physician work force that understands there’s so much more to a patient than what’s in a medical chart. Understanding the social determinants of health – nutrition, living conditions, financial issues, transportation – must be foundational to medical education. We must create a robust system, one that is fully integrated with our health networks and communities if we want to eliminate these shameful shortcomings that marginalize the health of too many people.

At the Hackensack Meridian School of Medicine, we are doing exactly this: our Human Dimension course pairs students with residents in underserved communities for the entirety of their education to understand all the factors that contribute to health and well-being including housing, finances, nutrition, transportation, education and family dynamics.

The result has been profound: one team helped a woman who has diabetes lose 14 pounds through nutrition lessons, enabling her to take less medication. Even a language barrier didn’t get in the way: students used Google translator to communicate the woman’s native Spanish into English and vice-versa. Another team helped a man who uses a wheelchair and has multiple health issues find better housing at a lower cost. Another pair helped a senior citizen learn how to use a computer to conduct essential telehealth visits during the COVID-19 crisis. Our students don’t just see patients – they recognize the community they come from to get a fuller picture of health.

A number of schools across the country are investing in better preparing physicians for a new state of healthcare, mindful of the need to improve outcomes, to better manage chronic illness and to ultimately lower the cost of care.

 Dell Medical School at the University of Texas at Austin has redesigned the third-year experience known as a “growth year” in which students take a deeper look at issues that will ultimately impact their practice including population health or business administration. Geisinger Commonwealth School of Medicine requires students to complete 100 hours of community service before they graduate. 

The American Medical Association is also supportive of these changes through its Accelerating Change in Medical Education Initiative. Launched in 2013, it now includes 37 medical schools working together to transform physician training.

Clearly, health inequalities cannot be solved by medicine alone. But we must all do our part. Many health networks, ours included, are integrating systemwide population health strategies to provide more coordinated care, better outcomes and better value. Simply put, we’re doing more than delivering high quality care: some of us are providing healthy meals in communities that are in food deserts; others are investing in housing to create more stability and ultimately better health. 

At the same time, we are teaching our physicians a new way. They must understand there’s no way a single mother of three has the time to return for a follow-up visit so they should arrange telehealth. They are taking the time to find a day program for a stressed parent of an autistic child so there is a needed break from demanding care. They are taking time to get to know their communities and understand barriers to good health and working to find solutions to eliminate them.

Recently, I visited the campus of our medical school, which has just welcomed its third class. Our classes are being taught virtually, but a video was prepared to celebrate the school’s progress. The students are inspiring, energizing and determined to humanize healthcare. 

One young woman said it best: “Working with my patients on a weekly basis really ignites my passion for medicine and reminds me why I am working so hard.”

Robert C. Garrett is CEO of Hackensack Meridian Health, New Jersey’s largest health network with 17 hospitals and more than 500 patient care locations.


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