During our first year of medical school, we were fortunate to benefit from a comprehensive and mandatory 40-hour course on health policy. However, our conversations with peers at other medical schools made it clear that this was not a common experience. Given the importance of the subject, particularly in the context of the contentious and continuing debates over health care reform, we were curious to learn more about the current state of health policy education. Although many have brought attention to this field's increasing importance in medical education, surprisingly little is known about how exactly health policy is taught in medical schools.
Policy, health care or otherwise, is quite complex. The problem is that in today's market almost anyone can discuss policy despite the fact that they know nothing. To discuss policy intelligently one must have the knowledge of:
1. The Field: In this case one must know and have experience in the medical field. It helps to be educated in the field and it helps to have some daily or at least periodic exposure at more than the patient level.
2. Financial Competence: This means that one understands in detail what costs are, what drives costs and revenue, how to model these elements to both analyze and predict current and future costs. This is not economics. Frankly economists are clueless here, their methods are of little if any use. One must understand the facts, the financial facts, as if one were running the business.
3. Systems Knowledge: The delivery of any product or service is not done in a vacuum. It is a system with linkages and one must have a systems knowledge and not look at this in isolation.
4. Regulatory Understanding: One cannot approach healthcare without understanding the law, Washington, the states, and a plethora of other political factors. One should have some experience in Washington, or some similar state venue and not just think the law if the law. The sausage factory of the Hill must be understood at a visceral level based upon proximate experience and involvement.
These are just four of the essential prerequisites for starting out on policy. Lacking these the student will just listen and accept. The problem is that policy is always done in an adversarial world with varying world views. The Progressives versus the Conservatives versus the Libertarians versus the Individualists. It is extremely naive to assume that you can "learn" policy devoid of that sense of adversarial involvement. You do not just listen to some biased professor, you must challenge, because in the real world that is what is done. One must ask why, not just what and how.
They conclude:
In order to provide comprehensive care for patients and effectively participate in health care reform, the medical community must be literate in health policy. Medical schools would never grant degrees without guaranteeing proficiency in the basic sciences and clinical skills. Similarly, health policy literacy should no longer be considered an ancillary skill, but rather a core competency of a 21st-century physician.
Is it essential for physicians to understand health care policy? For some yes, for many, they just will never have the predilection to deal with the challenge. It is essential for physicians to participate, but given the practicing physicians already overloaded schedule, this may be just a bit too much.
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