The AMA does not define the term in its press release on the announcement, but it said schools should “include information on fee-for-service, managed care and other payment structures.”
The policy was adopted by the AMA’s House of Delegates at its meeting in mid-November. The AMA says it has spent several years trying “to integrate health systems science” into the curriculum and it should be a “third pillar” in addition to basic and clinical science.
“Medical students and residents with a deeper understanding of cost, financing, and medical economics will be better equipped to provide more cost-effective care that will have a positive impact for patients and the health care system as a whole,” stated Barbara McAneny, M.D., spokesperson and past president of the AMA.
Concerned About Bias
Teaching medical students about the highly regulated profession they are about to enter can be a positive step, says Beth Haynes, M.D., a board member of the Benjamin Rush Institute, a nonprofit organization that helps students learn more about free-market medicine.
“My concern is that medical schools will fail to be balanced in their presentation of economic theories,” said Haynes. “Schools may emphasize [the late economist John Maynard] Keynes and other supporters of significant government intervention while ignoring free-market, limited-government theories like [those of Milton] Friedman and [Ludwig] von Mises.”
Economics can be a touchy subject in medical school, says Chad Savage, M.D., owner of the Michigan-based direct primary care practice YourChoice Direct Care and a policy advisor to The Heartland Institute, which publishes Health Care News.
“There is an implicit understanding in medical schools that it is for some reason taboo that physicians should discuss or have any expectation of compensation,” said Savage. “It is somehow unseemly to expect compensation, and this engenders the belief that the only way to partake of medical care is via governmental transaction.”
Hoping for Balance
The AMA says it has published a study tool and developed several teaching models so medical educators can provide a better understanding of health care economics.
The AMA’s announcement is welcome news to third-year medical student Anthony Fappiano.
“I happen to love economics, so this is a topic I would have loved to learn about more, especially in school,” said Fappiano, who attends the University of New England College of Osteopathic Medicine.
Fappiano says he hopes the presentation will be balanced, but a recent conference he attended was not encouraging.
“It was a panel with a lobbyist for some single-payer company and two physicians who supported single-payer systems,” said Fappiano. “Not exactly a broad set of opinions.”
Calls for Consumer Emphasis
Fappiano says he would like to learn more about consumer-driven care models.
“I think it would be important to emphasize the ways that we as upcoming doctors can lower costs for patients more effectively,” said Fappiano. “We need to stress the importance of inexpensive treatments like lifestyle changes, hands-on medicine like physical therapy and osteopathic manipulation, and generic drugs, rather than jumping to topline drugs or surgery. This is rarely emphasized in medical school, and the board exams reinforce the idea that expensive tests are a necessity, when that is not always the case.”
Fappiano says he learned about direct primary care from a faculty member who had such a practice, which does not accept insurance or government payments.
“It gives the patient more flexibility and unlimited access to their physician,” said Fappiano. “It is lower-cost than most insurance, and the quality of care is the same or better.”
The AMA has a strong influence on the nation’s medical schools, and policy announcements can be an indication of where the organization stands on political issues. In June 2019, the AMA announced it wants medical schools to introduce climate change into the curriculum, and an amendment to stop formally opposing single-payer health care was defeated by three votes.
AnneMarie Schieber ([email protected]) is managing editor of Health Care News.
AnneMarie Schieber is a research fellow at The Heartland Institute and managing editor of Health Care News, Heartland’s monthly newspaper for health care reform.
