Rarely does a state have the opportunity to change the course of medical education and, by extension, the health of its populace and its economic future. Yet, the recent decision by The University of Texas Board of Regents has done just that by supporting the development of a medical school in South Texas and a medical school for Central Texas. This decision to move forward with two medical schools has far reaching implications and could not be timelier. Why? Because, as we are all painfully aware, our health care system is on life support.
If Texas were a person, it would be in the emergency room, and the ER is one of the costliest health care settings in our system. As a nation, we spend more per capita on health care than any other nation on the planet. We are spending more than $7,500 per person. Health care spending is now 18.2 percent of our gross national product. This is an enormous amount of money.
How is it possible then that we have an infant mortality rate (IMR) of 5.98? This indicates that the number of deaths of infants under one year old per 1,000 live births is nearly six in the U.S. How can 48 countries have a better IMR than us? How is it possible then that we are experiencing a primary care and behavioral health care workforce crisis in Texas and across the U.S. that has the potential to collapse certain sectors of our society? How is it possible then that we have been unable to eliminate health care disparities?
Part of the answer to these questions lies in the fact that we have created a medical school infrastructure that is creating specialists. What we need are generalists in primary care. That does not mean that we don’t need specialists. Of course we do, but we need the ratio of new doctors being created to be in favor of generalists and to far exceed the number of specialists we are creating.
The Board of Regents has pledged a minimum of $25 million a year from the permanent university fund for the new school of medicine for Central Texas. However, the funds are contingent on a continuing stream of $35 million a year in medical school support from the local community. That means that we, the community, will have skin in the game.
As such, it is imperative that we all ensure that these two new medical schools are not developed for the status quo, but instead are exemplars of the medical schools of the future. They must prepare providers with a greater variety of skills in addition to their clinical skills. The provider of tomorrow needs to have leadership skills, team building skills, cultural and linguistic competency skills, and policy skills. The knowledge base must include public health and finance, not just clinical knowledge. Clinical knowledge alone is insufficient preparation for the complexities of today’s health care system, let alone the complexities of tomorrow.
Is this a tall order? Absolutely. Can it be done? Absolutely. It can be accomplished through interdisciplinary, intra-disciplinary and trans-disciplinary curriculum models. This means avoiding the teaching silos that we have historically created. The students and faculty of the clinical professions must collaborate, comingle and intermingle with each other and with the students and faculty of academic institutions such as UT-Austin and UT-Pan American. This is equally applicable to the research units within these institutions. Cross fertilization enhances creativity, translation of research and, ultimately, applicability.
It is also imperative that the clinical and practice settings enhance the curriculum, skills and models being taught. The entire spectrum of education from the undergraduate experience to residency experience needs to be synergistic, complimentary and additive in nature. This is currently not the case at the majority of our medical schools.
These two new medical schools have the potential to set the bar high and help accomplish what so far has eluded us: a diverse healthcare workforce that is dedicated to the elimination of health disparities that are affecting so many of our communities; and a holistic, recovery-oriented, culturally and linguistically competent integrated healthcare delivery system. The challenge for us all is to create something Texas can be proud of: the medical school of the future. The stakes are high, but the investment will pay off as an economic engine and, in the process, improve our health. A healthy Texas is a strong economically competitive Texas for decades to come.