By KIM BELLARD

I saw a report last week – Clinician of the Future 2023 Education Edition, from Elsevier Health – that had some startling findings, and which didn’t seem to garner the kind of coverage I might have expected.  Aside from Elsevier’s press release and an article in The Hill, I didn’t see anything about it.  It’s worth a deeper look.

The key finding is that, although 89% say they are devoted to improving patients’ lives, the majority are planning careers outside patient care.  Most intend to say in healthcare, mind you; they just don’t see themselves staying in direct patient care.

We should be asking ourselves what that tells us.

The report was based on a survey of over 2,000 medical and nursing students, from 91 countries, as well as two roundtable sessions with opinion leaders and faculty in the United States and United Kingdom.  Since I’m in the U.S. and think most about U.S. healthcare, I’ll focus mostly on those respondents, except when they’re not split out or where the U.S. responses are notably different.

Overall, 16% of respondents said they are considering quitting their medical/nursing studies (12% medical, 21% nursing), but the results are much worse in the U.S, especially for medical students – 25% (nursing students are still 21%).  That figure is higher than anywhere else. Globally, a third of those who are considering leaving are planning to leave healthcare overall; it’s closer to 50% in the U.S.

Tate Erlinger, vice president of clinical analytics at Elsevier, noted: “There were several things [that] sort of floated to the top at least that caught my attention. One was sort of the cost, and that’s not limited to the U.S., but the U.S. students are more likely to be worried about the cost of their studies.”  Overall, 68% were worried about the cost of their education, but the figure is 76% among U.S. medical students (and for UK medical students).  

Having debt from their education is a factor, as almost two-thirds of nursing students and just over half of medical students are worried about their future income as clinicians, with U.S. medical students the least worried (47%).

It’s worth noting that 60% are already worried about their mental health, and the future is daunting: 62% see a shortage of doctors within ten years and 64% see a shortage of nurses. Globally, 69% of students (65% medical, 72% nursing) are worried about clinician shortages and the impact it will have on them as clinicians.

Where it gets really interesting is when asked: “I see my current studies as a stepping-stone towards a broader career in healthcare that will not involve directly treating patients.” Fifty-eight percent (58%) agreed (54% medical, 62% nursing). Every region was over 50%. In the U.S., the answer was even higher – 61% overall (63% medical, 60% nursing).

Dr. Sanjay Desai, one of the U.S. roundtable panelists, said: “I know this might evolve as they go through their education, but 6 out of 10 in school, when we hope that they’re most excited about that career, are looking at it with skepticism. That is surprising to me.” 

Me too.

The ratings on the education they are getting are good news/bad news.  Seventy-eight percent (78%) agreed that their school is “adequately preparing me to communicate and engage with a diverse patient population,” and 74% that the curriculum has been adapted to the skills that today’s clinicians need, but, honestly, wouldn’t you hope those percentages would be higher? 

Perhaps this is explained in part by only 51% reporting they have used A.I. in their training and only 43% agreeing their instructors welcome it.  The latter percentage is 49% in the U.S.  Overall, 62% are excited about the use of AI in their education, although only 55% in the U.S. (57% medical, 53% nursing).

Similarly, 62% think the potential for AI to help clinicians excites them, but only 55% in the U.S. (58% medical, 52% nursing).  Seventy percent (70%) think AI will aid in diagnosis, treatment, and patient outcomes, but, again, the U.S. lags: 64%, same for medical and nursing. Still, only 56% (globally and in the U.S.) agree that within 10 years clinical decisions will be made with the assistance of AI tool.

Dr. Desai was emphatic about use of AI: “It’s here and it’s going to stay. There are some who have said that we should slow down until the frameworks and the guardrails for ethics and for appropriate use, etc., are in place, and I think that’s wise. But I think we need to accelerate that, because as technology outpaces our organization of the space, there are risks.” Another U.S. panelist, Dr. Lois Margaret Nora, was more circumspect: “AI can turn out great, and it can turn out really terrible, and understanding the difference, I think, is an issue that is going to be very important in education.”

More broadly, 71% believe the widespread use of digital health technologies will enable the positive transformation of healthcare, although only 66% in the U.S., but 60% fear that will be a “challenging burden on clinicians’’ responsibilities.” For once, U.S. students were less pessimistic: only 52% have the same fear (51% medical, 54% nursing). 

————-

It’s disturbing but not surprising that a quarter of U.S. medical students, and a fifth of nursing students, are considering leaving school.  The lengthy time it takes and the corresponding debts are daunting.  Of more concern is that so many – over 60% for both medical and nursing students – are already planning for a career that doesn’t involve patient care. Are those schools the right place for such students?  Have careers involving direct patient care become that bad? 

It’s also clear that the world is changing more rapidly than medical/nurse schools or their students.  They’re not ready for an AI world, they’re not even fully prepared for a digital health world. These students are going to be the vanguard in deploying the new tools that are coming available, and they’re neither adequately trained nor quite enthusiastic about them.     

Jan Herzhoff, President of Elsevier Health, summarized the report’s implications: “It’s clear that healthcare across the globe is facing unprecedented pressures, and that the next generation of medical and nursing students are anxious about their future. Whether through the use of technology or engaging learning resources, we must support students with new and innovative approaches to enable them to achieve their potential. However, the issues raised in this report can’t be tackled in isolation; it is essential that the whole healthcare community comes together to ensure a sustainable pipeline of healthcare professionals.”

Let’s get on that, then.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

Episode 60 of “The THCB Gang” was live-streamed on Thursday, July 1st. Matthew Holt (@boltyboy) was joined by policy consultant/author Rosemarie Day (@Rosemarie_Day1); THCB Editor and soon-to-be medical student at Yale, and first time #THCBGang participant Christina Liu (@ChristinayLiu) and–making a rare but welcome appearance –venture investor & soccer mogul Marcus Whitney @marcuswhitney We had a great wide ranging chat about Medicaid, venture capital and the unnecessarily excessive rigors of applying to medical school, and what that means for health equity.

The video is below but if you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

By SYLVIE STACY, MD, MPH

As a physician and writer on the topic of medical careers, I’ve noticed extensive interest in nonclinical career options for physicians. These include jobs in health care administration, management consulting, pharmaceuticals, health care financing, and medical writing, to name a few. This anecdotal evidence is supported by survey data. Of over 17,000 physicians surveyed in the 2016 Survey of America’s Physicians: Practice Patterns and Perspectives, 13.5% indicated that they planned to seek a nonclinical job within the subsequent one to three years, which was an increase from less than 10% in a similar survey fielded in 2012.

The causes of this mounting interest in nonclinical work have not been adequately investigated. Speculated reasons tend to be related to burnout, such as increasing demands placed on physicians in clinical practice, loss of autonomy, barriers created by insurance companies, and administrative burdens. However, attributing interest in nonclinical careers to burnout is misguided and unjustified.

Physicians are needed now – more than ever – to take on nonclinical roles in a variety of industries, sectors, and organizational types. By assuming that physicians interested in such roles are simply burned out and by focusing efforts on trying to retain them in clinical practice, we miss an opportunity promote the medical profession and improve the public’s health.

Supporting medical students and physicians in learning about and pursuing nonclinical career options can assist them in being prepared for their job responsibilities and more effectively using their medical training and experience to assist various types of organizations in carrying out missions as they relate to health and health care.   

A shifting locus of control from physicians to patients

A major reason for the expanding need for medical doctors outside of patient care settings is a shift in health- and disease-related locus of control from providers to patients. Medical information is increasingly available, comprehensive, accurate, and free of charge. Individuals wishing to learn about their own health can do so, often without the help of a doctor. Similarly, large data sets, new technologies, and analytical techniques are taking on a progressively significant part of patient care and consumer health.

Domains of patient care that were historically the responsibility of doctors are now in the hands of not just patients themselves, but also corporations, regulators, policymakers, and others whose efforts will ultimately impact patient actions and outcomes.

Physicians in nonclinical roles ensure that the most appropriate decisions are made from a clinical and scientific perspective, despite that fact that these decisions are being made outside of a traditional patient encounter. Physicians can, for example, provide clinical expertise in the development of a device, confirm that scientific data are interpreted accurately, and effectively communicate medical information to stakeholders.

Medicine is becoming less of an art and more of a science

In addition to technologies changing the way that individuals maintain their health, they are altering the way that clinicians deliver care. Electronic health records, health care analytics platforms, and artificial intelligence algorithms play a role in guiding physicians’ medical decision-making in every type of care setting.

As the role of technologies in clinical care becomes more widespread, involvement by physicians throughout the full lifecycle of these tools to ensure that they are scientifically accurate, medically sound, usable, reliable, and valuable. Medical professionals, more so than others, can ensure alignment with the needs of both clinicians and patients as a product or service is being developed.

Nonclinical work addresses a need for systems-thinking in the medical profession

There is little emphasis within medical education on building proficiency on an organizational and system-wide level – and even less on a societal level. While it is vital that doctors are competent in handling medical situations involving individual patients, they should further be able to contribute their knowledge and skills outside of a clinical setting.

The medical profession is not lacking in medical expertise. What is lacking is education on how to use this expertise in a broader capacity, including in the type of work that is the focus of many nonclinical roles.

Medical students and residents who are interested in using their medical expertise outside of patient care are quite limited in their training options to be prepared for this. Some may have the opportunity to do a rotation in an area such as quality improvement or clinical informatics. A few may take time off from their program to pursue an internship with a consulting firm or federal government agency, though are likely to be challenged by logistics, funding, and scheduling issues.

The options available to practicing physicians to participate in continuing medical education on nonclinical topics have been increasing, with courses on topics such as leadership skills, health care financing, and addressing burnout. Nonetheless, there is a need for additional education, especially programs that teach physicians how to use their skills and expertise in settings where their training didn’t take them: outside of the hospital and clinic.

Currently, burnout leaves doctors thinking that they want to “leave medicine” when, if fact, they would be fulfilled in a career that utilizes their medical and clinical knowledge to a great extent, just in a different way than they’re used to. Though a career pivot might mean that they stop directly treating patients, it is far from “leaving medicine.” This misconception leaves too many physicians feeling stuck, not realizing that they have viable options to explore. Many don’t realize the extent to which their experience and knowledge will come into play in other types of work settings.

Moving toward improvements in medical education and protecting the medical workforce

The issues described above can be addressed from multiple angles and on different levels, in light of the fact that opportunities for physicians outside of clinical care are growing in number, breadth, and interest to doctors.

Undergraduate medical education must foster and invest in learning environments that prepare physicians to be both clinicians and medical experts. Medical schools and residency programs, where possible, should support and encourage trainees to rotate in nonclinical settings and capacities. Continuing medical education providers should make an effort to include topics in their content that enable physicians to utilize their medical knowledge outside of clinical setting.

If they are trained sufficiently, physicians who experience burnout or frustrations in patient care can transition smoothly to a rewarding nonclinical role. Once there, they can make just as much (or more) of a positive impact on our population’s health than they did while directly treating patients.

Sylvie Stacy, MD, MPH is a preventive medicine specialist and blogs about career fulfillment for medical professionals at Look for Zebras. She recently published the book 50 Nonclinical Careers for Physicians.

BY ANISH KOKA, MD

The hottest medical school in the country right now is the New York University School of Medicine thanks to the gift of a generous benefactor that promises to make medical school free for all current and future medical students.  The news was met with elation from the medical community of physicians that groans frequently about student debt loads routinely north of $200,000 upon matriculation.  Not surprisingly, the technocrat class of public health experts and economists did not share in the jubilation.  The smarter-than-the-rest-of-us empiricists are, after all, trained to think in terms of social justice and net benefits to society.   The needs of medical students are far down the list of priorities when forming this social justice utopia.

Contemporary arguments for social justice in some form or the other trace their roots to the philosopher John Rawls and his 1971 magnum opus – “A Theory of Justice”.  In words that would infuse liberal thought for a generation, Rawls laid out a blueprint for a just society by proposing a thought experiment called “the original position”.  This was a hypothetical scenario where a group of people are asked to form the rules of a society which they will then occupy. The catch is that the people making the decision do so behind a ‘veil of ignorance’ not knowing the disadvantages conferred by any number of attributes (age, sex, gender, intelligence, beauty, etc. ) they may be reincarnated with. Rawls posited that under conditions in which there was a possibility of being born as a disadvantaged member of society, social and economic inequalities would be arranged to be of greatest benefit to the least advantaged members of society.

At first glance, it would seem that the objections to tuition-free medical school rest on a social justice framework that does not seem to comport with gifts to the soon-to-be-wealthy.  After all, the $200,000 investment for medical school pales in comparison to the lifetime earnings of the average physician who is assured at least a six-figure income in seeming perpetuity. But it is not entirely clear that one has to even combat Rawlsian ideals to rebut the social justice do-gooders with strong opinions on how other people should spend their money.  A Rawlsian framework never intended that everyone in society would be able to achieve the same outcome regardless of starting position.  Rawls actually went out of his way to argue that inequalities were justified in society as long as the operating rules served to raise the position of those worst off in society.  A rising tide should lift all boats – the rich may become richer, as long as the poor become richer as well.

In this context, a prize that can be partaken just as easily by rich and poor would seem to be just what would emerge from behind the veil of ignorance.  Unfortunately, in 2018 it is not enough to ensure access to opportunities, everyone must get a prize.  So it has come to pass that all social prescriptions are now evaluated based on their ability to improve racial and socioeconomic diversity. At the moment, about 6% of medical students are black, and 5% are Hispanic. This is a problem, we are told because this is not representative of the nation as a whole. Why one may wonder?  In a field where lives depend on quick thinking, experience, and expertise, it would seem that the least important traits in a physician would be the color of their skin, their gender, or race.

Since we live in a world where nothing escapes quantification, researchers routinely try to find the elusive needle that will tell us once and for all of the overriding importance of diversity.  And so we are treated to the spectacle of esteemed researchers at even more esteemed institutions crunching data to see if patient mortality has anything to do with physician gender.  I confess I would never have embarked on a study even if I had the ability because I think its a dumb question with answers that are wholly irrelevant. Patients taken care of by a male physician may end up seeing a female colleague in the practice for an urgent medical problem or vice versa. The attending in the ICU may be male, but the senior resident could be female, and every 12 hours a different nurse is at the bedside. Who exactly owns the patient? Is there really one gender we can point to that controls the outcome that befalls the patient? Even if it was possible to definitively detect a difference that exists along gender or race, would it not be more valuable to identify the elements that lead to better outcomes and emulate them as a group?

Nuance, however, doesn’t translate to New York Times headlines and these questions did not deter these plucky researchers who used Medicare spending as a proxy to attribute hospitalized patients to physicians by gender. Since each visit by an attending physician with a patient who has Medicare generates a billing claim, hospitalizations were assigned to the gender with more billing.  51% to be exact. To clarify: On any given hospitalization, if you the patient saw a female physician for 51% of the time, your hospitalization was deemed to have been managed by the female gender. A woman’s touch, in this case, resulted in 0.4% lower 30-day mortality – enough for the researchers to posit that a medical system devoid of men would mean 32,000 fewer deaths every year. But before we launch a pogrom for male physicians in service of the greater good, consider that this conclusion derives from a large 1.5 million patient observational study that describes a correlation.

A large sample size is good for finding small but important effect sizes, but importantly also increases the chances of finding spurious correlations.  And correlations without plausible underlying mechanisms may well lead one to the highly correlated conclusion that marriage rates in Kentucky have something to do with the number of people who drowned after falling out of a fishing boat. So the fact that no one can pinpoint a clear mechanism to explain how the difference between 32,000 patients living or dying boils down to male physicians being involved 49% of the time is a major problem.  So even if one accepts as plausible that the dictates of biology mean women are better healers than men, one that has to accept as feasible that an extra u1% involvement in any given hospitalization is lifesaving.  The Virgin Mary herself would struggle to be this effective.

Exposing the thin evidence for prioritizing diversity over all else would be a full-time job, but unfortunately, this house of cards of evidence is how we get the smartest folks in the room uniformly opposing tuition-free medical school on the grounds it won’t promote diversity.

Apparently, the United Colors of Benetton advertisement that the current crop of United States physicians could star in isn’t diverse enough for the champions of diversity.  Almost 40% of physicians come from the Indian subcontinent and half of all physicians being trained right now are women.  Increasing the percentage of under-represented minorities in medicine will do precious little to quench the massive outcome gap that currently exists between rich and poor zip codes – the roots of which are deep and go well beyond conscriptive social policy that would put a physician to match your color/race and sexual orientation in every neighborhood.

And even so, the problem of implementing policies to engineer the right kind of diversity necessarily contradicts the society that would be formed behind the Rawlsian veil of ignorance.  If going to medical school is akin to winning entry into the top 1%, does punching winning tickets based on race and color rather than merit automatically follow?  There is a fundamental truth that no p-value or 10 million strong study will overturn – your health may one day require an astute ER physician who chooses to push for an admission to the hospital even though the labwork looks ok, an inquisitive internist who puts together a large cardiac silhouette on an X-Ray with low voltage on an ECG to diagnose fluid collecting around the heart, and a diligent cardiologist who will get out of bed at 4 am to to stick a seven inch needle into the fluid cavity around your heart.  And this little vignette is far and away the easy stuff.  The point is that the sarcoma, the leaking abdominal aortic aneurysm, or the ruptured coronary plaque care not about the socioeconomic status of the hands that will be called to heal.

While there are many in society that will do the job, there are relatively few that you want to do the job.  The profession of medicine should wallow in elitism like pigs wallow in mud.  Make medical schools harder to get into, not less.  The goal is Seal Team Six, not some band of nincompoops.  In this context NYU is discharging its responsibilities well – in the minutes it took for the story of the gift to go viral, they went from being middle of the pack to becoming a destination of choice for elite college graduates.

The sad (though understandable) part is that it took a middle of the road school to fire the first shot.  Much higher profile schools – think Harvard, Stanford – always have had the opportunity and ability to do what NYU did, but instead chose the virtuous path of allowing medical students to take on hundreds of thousands of dollars worth of debt.

Hubris lives large in this space. Hubris to think medical student debt makes for a more just society. Hubris to believe a better ratio of underrepresented minorities in medical schools will solve society’s ills.  Hubris to think to know the distribution of specialties medical students should choose.

It turns out the veil of ignorance isn’t a theoretical construct after all.  The overthinking class live behind it, creating fantastical worlds comfortably insulated from reality. A truly just society emerges from rejecting the collectivist principles that spring forth from this merry band of technocrats. The gift to NYU from a private benefactor is a response to an important signal from the physician community. It may not be what the economists want, but it is just what the doctor ordered.

Anish Koka is a Cardiologist in Philadelphia. He can be found trolling on twitter @anish_koka

The competition to get into medical school is fierce.  The Association of American Medical Colleges just announced that this year, nearly 50,000 students applied for just over 20,000 positions at the nation’s 141 MD-granting schools – a record.  But medical schools do not have a monopoly on selectivity.  The average student applies to approximately 15 schools, and many are accepted by more than one.  Students attempting to sort out where to apply and which admission offer to accept face a big challenge, and they often look for guidance to medical school rankings.

Among the organizations that rank medical schools, perhaps the best-known is US News and World Report (USNWR).  It ranks the nation’s most prestigious schools using the assessments of deans and chairs (20%), assessments by residency program directors (20%), research activity (grant dollars received, 30%), student selectivity (difficulty of gaining admission, 20%), and faculty resources (10%).   Based on these methods, the top three schools are Harvard, Stanford, and Johns Hopkins.

Rankings seem important, but do they tell applicants what they really need to know?  I recently sat down with a group of a dozen fourth-year medical students who represent a broad range of undergraduate backgrounds and medical specialty interests.  I posed this question: How important are medical school rankings, and are there any other factors you wish you had paid more attention to when you chose which school to attend?

The students immediately expressed doubts about the value of rankings.  “Many factors, such as research funding, don’t necessarily translate into better medical school teaching,” said one student.  “In fact, some of the most research-focused faculty members seem to see teaching as a nuisance, and don’t do a very good job.“  Said another, “Research activity is a way for schools to compete for spots in their pecking order, but not a sign of how good a doctor they will make you.”

Another student criticized selectivity.  “In some cases, selective schools often foster a competitive environment that pits students against one another.”  The students felt that the difficulty of getting into the school is less important than what the school does for students once they get there.  Said another student, “Ranking schools by selectivity reminds me of Groucho Marx’s old line that he wouldn’t want to join any organization that would accept him as a member.”

What factors should applicants pay more attention to in selecting the best school?  To begin with, the students said that most medical schools are more similar than different.  Said one, “Students from every school take identical medical licensing exams and apply to the same residency programs, so all of them naturally end up studying the same subjects.  The issue isn’t so much what they teach or even how they teach it, but whether the students there are thriving.”

When it comes to specific factors that applicants should pay closest attention to, the students came up with four, none of which lends itself easily to quantitative scoring.  Research dollars and grade point averages are easy to calculate and rank, but in the students’ view, other less measurable factors are actually more important in becoming the best possible doctor.  “The key,” one said, “is to talk to the students at the school, because no one knows it better than they do.”

The students’ first recommendation: Pay close attention to whether the school helps its students develop their interests and abilities.  For example, do students have the opportunity to take elective courses, to pursue creative research and service projects, and to make distinctive contributions to the school and the community?  Said one student, “Too often, medical schools merely homogenize students, rather than drawing out the best of their unique capabilities.”

To play this role, the faculty and administration of a medical school need to show real interest in students.  “How can you tell?” I asked.  The students responded with questions to pose: “Do they know their students by name?”  “When you ask them about students they are most proud of, do they talk about test scores or do they tell their stories?”  Warned one student, “If your visit leaves you feeling as though they treat students like numbers, the school gets a failing grade.”

The students’ second recommendation: Look for institutions where students are well-informed and engaged in the life of the school.  At the best schools, they say, students share a sense of ownership with the administration and faculty.  “When you speak with them,” said one student, “they talk in terms of ‘my school’ and “our school.’  Students are actively involved in key activities, such as recruiting new students and faculty.”

The students cautioned against placing too much stock in printed and web-based promotional materials.  “Just because there is a position for a student on a committee, don’t think it necessarily means anything,” said one student.  “What looks good on paper does not always translate into practice.  To find out what is really going on, you need to talk to the right people, ask good questions, and really listen.”

The students’ third recommendation is to make sure that the institution stands for something.  What do people think their school aspires to?  If the best they can offer is that it aims to be “top 10” in something, then its vision probably isn’t very meaningful.  On the other hand, if students tell compelling stories about the difference the school is making in their lives, in the community, and in the profession, “then it is probably on to something.”

As one student expressed it, “At good schools, students say little about than the tests they need to study for or the forms they need to fill out.  Instead of focusing on the hoops they need to jump through, they talk about how their studies are making them better doctors.”  Said another, “Ask yourself this: How often do students highlight a meaningful relationship they have developed with a faculty member, and the difference it is making in their professional development?”

The students’ final recommendation is more of a warning than anything else.  Simply put, do students feel trusted by the school?  One student described it this way.  “I know of a school that treats its students almost like inmates.  If a student falls ill, they need to get a doctor’s note to prove that they were really sick.  If a relative dies, they need to spend so much time filling out forms to get their absence excused that some end up just skipping the funeral.  It’s like first grade.”

“Let’s face it,” said another student, “medical students are paying hundreds of thousands of dollars to be there.  In a few years, they are going to be working with patients to make life-and-death decisions.  If a medical school’s faculty and administration don’t trust their students, where is the encouragement to develop into trustworthy professionals?  A really good school places less emphasis on defining misconduct than on developing students’ internal compass.”

The students admit that, compared to looking up a school’s rung on the rankings ladder, assessing such attributes takes more effort.  Said on student, “It means keeping your eyes and ears open and making a concerted effort to talk to students.”  But the payoff is big: “It not only helps applicants pick the best schools – it also shows schools what factors applicants take most seriously.”  In the course of identifying the best schools, applicants can encourage all schools to become better.

     Each year, over 20,000 US students begin medical school.  They routinely pay $50,000 or more per year for the privilege, and the average medical student graduates with a debt of over $170,000.  That’s a lot of money.  But for some who pursue careers in medicine, the financial cost has been considerably greater.  Melissa Chen, 35, a final-year radiology resident at the University of Texas San Antonio, calculates that her choice of a medical career has cost her over $2.6 million in lost wages, benefits, and added educational costs.  And yet in her mind, the sacrifice has definitely been worth it.

               Chen’s story explains why.  Her father is a doctor and her mother a pharmacist.  She was always a good student.  So a career in medicine would have been a natural.  But her father encouraged her to explore a variety of career options, and her mother had always been very interested in business and the stock market.  So Chen chose to attend one of the nation’s top business schools.  When she arrived, she quickly realized that many of the students had a clear plan: to get their degree and go to New York to pursue a lucrative career on Wall Street.

“I loved my classes there,” Chen says.  “It was fun to see how what you were learning every day would apply in the real world.  Determining how well a particular business or the economy as a whole is performing was fun.  We felt like scientists.  You could collect the data, run the equations, and come out with an exact number.  It answered huge questions, like ‘Are we in a recession?’  And it was amazing how smart my fellow students were.  Many of them came from affluent backgrounds and already knew so much about business.  At times, it could be intimidating.”

So Chen took her business degree to New York, where she had secured a great job with one of the largest investment banks in the world.  Perhaps because she was from Texas, she had been slated to start with their oil and gas division, where she would help energy companies with mergers and acquisitions and the financing of businesses with equity and debt issuances.  Her first day on the job proved unforgettable, not so much because of her new office, the employees she met, or the nature of her responsibilities, but because of the date itself: September 11, 2001.

Chen’s office was located about a block from the World Trade Center.  As soon has she arrived, she phoned her mother to share her excitement, but she realized immediately that her mother sounded quite worried.  Within seconds, Chen says, “She told me to get out of the building right away.”  As Chen left, she could feel the heat from the burning first tower, and before she could get more than a block away, it collapsed.  “There was a loud rumbling noise,” Chen says.  “It was like a bomb exploding.  I started running as fast as I could, but I was in high heels, and I was certain I was going to get stampeded and die.”

“When I finally got far enough away that people were no longer running,” Chen says, “I stopped to catch my breath and turned around.  The building was gone.  The rest of the day and all that night, I was with a colleague who was worried that his father had been in the World Trade Center.  He kept phoning and phoning, but could get no answer.  Finally, we learned that his father had been in the building when it collapsed.  It was devastating.  From that moment on, I began to view life differently.  I realized how quickly everything you love can disappear.”

When work at the firm resumed, Chen threw herself into it.  She worked hard and enjoyed considerable success, helping to put together business deals worth huge sums of money.  At first the hours seemed almost overwhelming, but she soon realized that people treated working late into the night as a badge of pride.  People would brag, “Man, I haven’t even been home in two days!”  After a bit more than a year on the job, Chen was slated for promotion, but her 9/11 experience led her to take a closer look at the people above her on the corporate ladder.

“People were very successful, but they also seemed deeply unhappy,” Chen says.  “They would tell me things like, ‘This job is horrible’ or ‘My life really sucks.’  So I would say, ‘Then why don’t you quit and do something else?’  And they would look at me with incomprehension and say, ‘Everyone knows this is what I have to do to get to the next level.’  But it was beginning to dawn on me that no matter how high up the ladder you ascended, everyone still seemed to keep saying, ‘I hate my job, but this is what I have to do to move up.’”

“After a while, it seemed pretty absurd” Chen continues.  “Here they were, some of the best-educated and most highly compensated people in the world, people who could do almost anything they set their sights on, and they were just miserable, getting all stressed out over some marketing project for a bank.  I couldn’t help but compare it to phone conversations with my dad.  I would ask him about work, and sometimes he would talk about the stress he felt, but at least when he was stressed it was because the life of one of his patients was on the line.”

“I began to realize that much of what had attracted me to investment banking in the first place wasn’t as real as I thought.  People were all uptight over money.  But to me, having been there when the twin towers collapsed, it just didn’t seem so meaningful.  At meetings and parties, they would smile and be so nice to people, but it was all about ‘networking.’  My co-analysts acted so sweet toward those who could advance their careers.  And then they would smile thinking about how fun it would be to tell the higher ups to just take this job and stick it.”

“For me,” she continues, “the turning point came one night when I was working late.  I phoned home.  ‘Dad,’ I asked, ‘Do you ever regret being a doctor?’  ‘No,’ he said.  ‘There are some rough times, but I have never stopped believing in what I do, and that makes me happy.’  The next day, I told the people in the office that I was going to go to medical school.  They said, ‘Are you crazy?  You could move up in this company.’  I think my boss felt almost betrayed.  ‘We were grooming you to advance,’ he said.  ‘Are you sure you don’t want to reconsider?’”

“But I didn’t,” Chen continues.  “So I enrolled in a post-baccalaureate program to complete my premedical requirements and then started medical school back in my hometown of San Antonio.  It has taken two years of additional premedical studies, four years of medical school, and five years of residency, for a total of 11 years.”  Given the huge sacrifice in time and money, was it worth it?  Chen answers without hesitation, “Yes it was.  Sometimes I felt impatient, and sometimes I felt a bit out of place, because most of my classmates came straight from college.  But from the first day, I knew it was better.”

When Chen speaks about her life in medicine, the weary tone that marks her reminiscences of life in investment banking gives way to enthusiasm.  “Though I work as hard as I did before, it does not feel like a drag, because I can see directly how it is helping patients.  It is a feeling that I never really had in business.  Even after closing a big deal, I would often ask myself, ‘Are we really doing the right thing for our clients?’  In medicine, you have the privilege of knowing that you are truly working for your patient, always trying to do the best thing for them.”

Chen tells numerous stories of patients whose lives she has touched, many of whom have touched her life.  One night when she was on call in the hospital, a middle-aged man came in with constipation and abdominal pain.  A CT scan was ordered, and when Chen read it, she recognized subtle signs of a colon cancer.  The patient went to surgery that night.  Said the emergency department doctor, “Your reading of the CT scan totally changed the way I managed that patient.  I was going to give him an enema and send him home, but thanks to you, he is now getting treated for his cancer.”

Sometimes it is not making a life-saving diagnosis but simply building a relationship with a patient that makes all the difference.  Chen was treating a young woman with Down syndrome and a hyperactive thyroid gland.  Instead of just administering the treatment and leaving, Chen stayed with the patient, listening to her as she described her favorite toys.  “I didn’t understand everything she said, but she was just so animated and enthusiastic.  Before I left, she had hugged me many times.  I tell you, that girl really made my week!”

I asked Chen how she feels about the growing role of business in medicine today.  “With all the talk of productivity and declining payments, I sometimes have to remind myself that I am not doing this for the money,” she says.  “Unlike business people, doctors are not here to enrich the shareholders of a company.  Sure, some business practices could make medicine more efficient, and we should take advantage of those.  But these things must be very carefully applied, and we should always remember that our primary mission is to serve our patients.”

Chen has learned that perpetual anticipation is no attitude with which to go through life.  Her colleagues in business would always say, “Sure, life is tough, but this is the price we have to pay to advance to the top and make the really big bucks.”  But even at the top, Chen says, “The day when they could stop and enjoy it never seemed to come.”  Chen has applied this same lesson to marriage and parenthood, having taken time off to have two babies during her residency training.  “I have learned that if I really want to have a good life and make a difference, I need to live now.  I can’t keep putting it off into the future.”

If there has been a turning point in Chen’s professional life, it came on 9/11.   It was the experience of running at full-tilt away from the collapsing World Trade Center, knowing that at any moment the smoke and heat could engulf her, and fearing that she was about to be crushed under the ruble of the towers and the feet of the stampeding crowd.  Compared to that, the costs of pursuing a medical career – even $2.6 million – pales by comparison.  Looking at life from this point of view, she never gets too discouraged.  “Every day,” she says with a smile, “I just feel so grateful for the chance I have to make a difference for my patients.”

The corpse, laid out on a gurney and covered with a white sheet, was wheeled onto the stage by two women in long, white lab coats. A middle aged man with a bow tie welcomed us, the incoming class of the spring semester, to Uppsala University and the Biomedicine Center, where we would spend the next two years in “pre-clinicals”, until we knew enough to start our three and a half clinical years at the Academy Hospital.

The Biomedicine Center was almost brand new, a glass and concrete labyrinth with a large sculpture depicting Watson and Crick’s DNA molecule by the front entrance. The vast complex lay near S-1, the Uppsala military regiment. The brick buildings diagonally across the street were very familiar to me as the place where I had met the biggest failure in all my twenty years only months before.

As I sat in the large lecture hall with the corpse on the stage, I glanced over at L., my buddy from the Swedish military’s elite division, the Interpreter School, where we had also sat next to each other on the first day, when the Captain in charge told us:

“Soldiers, you may all have been the smartest kids in your school, but it’s different here. Most of you won’t make it, and will be culled over the next two months. The Interpreter School accepts eighty recruits and graduates twenty to twenty-five. If you don’t have what it takes, don’t waste our time or yours!”

L. and I had both thought that learning Russian would be a neat way to spend our compulsory year and a half in the military, but just barely more than a month after that harsh introduction, we were both on our way back to our respective home towns to figure out what to do until we would be able to start medical school. Our military service was put on hold until we could return as medics.

The man with the bow tie went on to introduce our guest professor, on loan from the University of Bavaria. As we all knew, the Germans have been the greatest anatomists since the last century, and all of us had already been to the University book store to purchase Haeffel’s “Topografishe Anatomie”, which would be our constant companion for the next five months.

“Hopefully, most of you took several years of German in High School,” the man continued, “but those of you who chose French instead and only took one year of German are encouraged to take advantage of our German night classes, every weekday from 8 to 9 pm in Hall B next door.”

With that, he gestured to the Bavarian guest professor, who bowed and began speaking as the first slide was projected behind him. He had the most peculiar accent, and spoke in a slow drawl. I strained to get a handle on what he was saying. L. cocked his head and as I turned toward him, I saw many heads shaking.

With every new slide, the German speaker seemed to increase the tempo of his speech and as the slides behind him changed faster and faster, more and more heads were shaking in the lecture hall. Soon, all of us had given up trying to understand as the staccato voice from the stage pounded the syllables faster than a sports commentator and the rapidly changing slides became more and more filled with details. Heads were shaking, many people were talking, some stirred and rose from their seats and turned toward the exit doors.

Then, suddenly, everything turned dark, the speaker stopped talking and all the chatter in the lecture hall ceased. We sat in darkness and silence for maybe a minute. Then, a faint tune from a small flute rose from the dark stage and dim lights began to illuminate the two women with in white lab coats. One was playing the flute, the other picked up a clarinet and began to play.

As the lights continued to brighten, the sheet suddenly flew off the corpse, who sat up, pulled a trumpet to his mouth and belted out a tune like something from a Mardi Gras parade.

The stage filled with upperclassmen and the “German” professor took a bow as they all applauded in his direction.

Then, from a side door, a tall man with a very straight back, white riding pants, tall black riding boots and a whip appeared. Everyone fell silent as he began to address the students in the lecture hall.

“I’d like to introduce myself. I am professor A. of the Department of Anatomy. I just came back from riding in the fields beyond here. I want to welcome you all.”

L. and I looked at each other and shrugged – was this part of the joke?

Professor A. continued:

“So, you made it to medical school. And if you really want to, all of you will make it out of here with a diploma. Just work hard, enjoy Uppsala, and don’t worry about the German classes – all lectures will be in Swedish!”

He was right, all of us who wanted to made it all the way through. My friend L. chose to leave medical school for a life as a writer, but he often writes with great insight about doctors.

I remember that first day as if it were last week, but it will be forty years in a couple of months. It was the beginning of a journey of learning I can’t imagine ever reaching a final destination. In 1974 there was no HIV; we had only Hepatitis A, B and non A-non B; Sweden didn’t have a single CT scanner; mammography screening was just beginning; Tagamet, Prozac, “statin” cholesterol drugs and clot-busters weren’t invented; low-dose aspirin wasn’t known to reduce heart attack risk, and so on.

In spite of all that has changed in medicine since I started, the way I learned at Uppsala how to evaluate scientific information, to elicit a disease history, to examine patients, and to approach them as individuals, not “cases” – that has not had to change in forty years of doing the only work I could ever imagine doing.

Hans Duvefelt, MD is a Swedish-born family physician in a small town in rural Maine.

Someone has been listening to me.  Or rather, to me and a growing number of voices that are questioning the requirements for admission to medical school.  I have argued in a past blog that you won’t get more good primary care doctors, who practice a lot of humanities in addition to the science, if the only people you admit to medical school are scientists.  Two medical schools and the American Association of Medical Colleges are beginning to agree.

Pauline Chen gives a good overview of what’s happening in this area here.  Essentially, Boston University and the medical school at Mt. Sinai have made pretty radical efforts to apply either more than the traditional evaluation points to their admissions process, or different ones altogether.  Mt. Sinai, in particular, has an extraordinary an early-acceptance program for college sophomores and juniors in which they can get into medical school without the MCATs, and without a few of the standard pre-med science and math requirements. In return, the accepted students have to continue to major in an humanities-related field and maintain an adequate GPA.  They also have to undergo intensive science enrichment courses prior to matriculation.  BU hasn’t gone quite that far, but they have included many more “holistic” data points into their admissions decisions, a process that is extremely labor intensive for the schools’ admissions staff.

Both schools have great ideas that are showing some promising results.  I see a couple potential problems:

1. Mt. Sinai seems to be sort of cramming in all the old science requirements in off-hours, allowing students to pursue wider studies in college. I would rather see a larger decrease in the science and math requirements.  Basic chemistry and biology are probably necessary, but no one has ever explained to me why you need physics.  Or calculus.  You don’t need most of this stuff in medical school.  All you need in medical school is the ability to put your head down and push through the memorization.  You don’t need math, you just need patience.  The thing is, the only way to get rid of the math and science is to get rid of the MCAT, because believe you me you can’t get through that behemoth with an english major.  Then, even if you do that, you eventually run into Step 1, the first of the three-part exam you take in medical school to pass medical school.  The Mt Sinai kids might need more “enrichment” courses to get through that.  If those hoops are eliminated, you might find some great doctors underneath those mountainous requirements.

2. Asking sophomores to commit to medical school means you’re asking 19 and 20 year olds to decide what they want to be when they grow up. I couldn’t even decide what to wear on any given day when I was 19.  The path of medical school and residency is so long and so arduous that it’s a tough commitment to make at any age, let alone 2 years out of high school.  Kids should be having fun and learning a wide range of great new things in college, and even after.   It’s the perfect time in their lives to do this.  The best thing would be to at least consider the application of ANY college student who wants to apply, even if he doesn’t have the science and math.  You’d be more likely to end up with an happy, well-rounded individual.

My proposals aren’t going to come true, of course.  We hold onto the doctor-scientist identity very strongly.  But these schools and the AAMC are making a start and I bet they’re making some great doctors too.

Shirie Leng, MD is a practicing anesthesiologist at Beth Israel Deaconess Medical Center in Boston. She blogs regularly at medicine for real, where this post originally appeared.

1. You Will Have to Move a Lot

I went to medical school in Cleveland and did myj pathology residency in San Francisco at UCSF.  I was on the medical school faculty at UCSF, Iowa, Allegheny University of the Health Sciences, and Michigan State.

Since leaving academic medicine, I have worked at a bio-tech start up in Cambridge, an educational and research institute in Grand Rapids, a $2 billion integrated delivery system in Iowa, and an evidence-based medicine consortium in Minneapolis.

In my experience physician executive positions do not always last a long time because the environment changes, my career aspirations changed, and getting the job done sometimes means alienating enough people to get in the way of long job tenure.

2. You Will Have to Reinvent Yourself Over and Over Again

My main professional roles have included: medical school pathology course master, surgical pathologist, division head, vice chair of academic department, chair of academic department, medical director of managed care, corporate operations officer of ambulatory care, special assistant to the president of a big ten university for managed care, search consultant, chief knowledge officer of a genomics bio-tech start up, president and ceo of an educational consortium, chief medical officer of a delivery system, president and ceo of an evidence based medicine institute, and health policy professor at a school of population health.

My only educational credentials are a bachelor’s degree in history and a MD degree.  Although I have taught in MBA programs, I do not have a MBA degree.  Although I headed up a genomics repository of DNA, I had to teach myself genomics and proteomics on my own.  Although I teach health policy and population health, I did formally study these subjects.  I have discovered that if I read a lot, go to conferences in different fields, and talk to smart people, I can pick up what I need to know without going on to obtain lots of graduate degrees.

3. Everything is in the New York Times and The Wall Street Journal

I am amazed at how much I am able to keep up with payment reform, federal health care reform, and major trends just by reading these two newspapers every day.  It is also good to see how liberals and conservatives interpret the same story, often with dramatically different conclusions.

4. The Killer App in Social Media is Community

Twitter has become the most important technology in my career as a physician executive.  I follow about 2000 key opinion leaders in health care, and about 7000 people follow me.

I use twitter to crowdsoure subjects that I need to master in order to give keynotes or consult with health care systems.  For example, Einstein Medical School asked me to come give a presentation on social media and undergraduate medical school education.  In order to prepare for a subject that I had not thought about much, I tweeted the following: “Help; need best practices of social medical and medical school education.”

I received responses from all over the world that formed the basis for my all day seminar that was well received and consisted of concrete examples of medical educators from the Cleveland Clinic to the UK using twitter and facebook in ways I had never imagined.

An important point here is that it is now my obligation to my social media community of practice to provide knowledge to others when they are reaching out for assistance.

5. If I can’t understand it, I don’t believe it

When I started out in leadership roles, I did not always trust my own judgment.  I sometimes thought I was not smart enough to grasp situations that made no sense to me.

When I was Interim Head of pathology at Iowa, I thought my lack of training in clinical pathology was the reason I could not understand the classification of all the technologists in the hospital labs.  It took a while to grasp that job classifications and titles had multiplied and proliferated in a way that did not serve us well in a changing health care environment.  It was only when I truly understood that the system did not make sense that I could lead a simplification of job titles that made more sense in that time of managed care.

I will never forget going to a meeting in Palm Springs of venture capitalists.  What made them different from others I had encountered was their skepticism and insistence that they understand how start-up companies would make money.  If they could not understand the business plan, they did not invest.

6. You Will Fail; Do it Quickly and Cheaply

A successful entrepreneur in Iowa taught me that failure is inevitable.  The trick is to recognize when you have failed, learn from it, and move on as quickly and cheaply as possible.  When I was helping to raise $36 million dollars for a genomics company, I was amazed to learn from venture capitalists that they do not try to predict winners and losers.  They do not think it is possible.  When they invest in 20 companies, they are hoping that one of them will be a Google or apple.  They fully expect the others to fail.

I have noticed that health care organizations have a hard time killing programs that are simply not working.

7. You Must Become a Life Long Learner

When I graduated from Case Western Reserve School of Medicine in 1980, there was no Internet, no Google, no disease called AIDS, and no smartphones.  You must continue to learn about the world you live in, and the world will continue to change in amazing and confusing ways.

8. Master the Gartner Hype Cycle and Learn Behavioral Economics

Do yourself a favor.  Master the Gartner Hype Cycle to understand why all those revolutionary disruptive technologies fail and those startup stocks go down (http://www.gartner.com/it/products/research/media_products/book/index.jsp)

Read Nobel Prize winner Daniel Kahneman’s book Thinking, Fast and Slow; you will understand why you and those you work with are often irrational and annoying.

Kent Bottles, MD, is past-Vice President and Chief Medical Officer of Iowa Health System (a $2 billionhealth care organization with 23 hospitals). He was responsible for the day-to-day operations of a large education and research organization in Michigan prior to his work with in Iowa with IHS. Kent posts frequently at his blog, Kent Bottles Private Views.

Annie Lowrey’s July 28 article “Doctor shortage likely to worsen with health law” in the New York Times noted the growing shortage of primary care doctors particularly in economically disadvantaged communities, both in rural and inner-city America. This problem will likely get worse before it gets better as more Americans gain coverage and seek a regular source of care. As the article suggests, training more doctors and incentivizing them to pursue careers in primary care will be a key part of the solution. And it will require a multipronged campaign, using both some of the traditional strategies for workforce renewal and a few unique tactics not typically deployed in efforts to fix health care.

The primary care workforce pipeline had dried up before the Affordable Care Act was passed. Currently, one out of every five Americans lacks access to primary care. As a result, up to 75% of the care delivered in emergency departments these days is primary care . This overcrowds and overburdens EDs, raises costs, and limits EDs’ ability to do what they were designed to do: provide acute, emergency care that makes the difference between life and death. So the primary care shortage threatens our access not only to primary care but also to emergency care.

How did we get here? Many are quick to point to primary care doctors’ low salaries compared to those of their sub-specialist colleagues. Indeed, choosing a career in primary care rather than a sub-specialty means walking away from 3.5 million dollars of additional lifetime earnings.That’s tough to do when you’re looking at $150-200,000 of debt, which is the average debt of an American medical student at graduation.But the crisis in our primary care pipeline goes far beyond the money.

Medical schools aren’t recruiting enough of the right people in the first place. Numerous studies show that people from rural and lower SES communities are more likely not only to pursue primary care careers but also to return to those disadvantaged communities to practice. Unfortunately, medical schools’ acceptance of applicants from these communities has declined substantially in recent years. Instead, medical school admissions criteria favor more affluent applicants who are ultimately more likely to pursue sub-specialty careers.

Further, these same medical schools have been actively discouraging primary care careers for decades. This is due partly to cultural biases that place super-specialized medicine on a pedestal over generalism, which is due in part to how NIH research dollars flow, predominantly supporting cutting edge biomedical/technological research usually advanced by sub-specialists. The result is that primary-care-oriented trainees face four long years of admonishments against primary care careers – a hidden curriculum in which generalists are portrayed as nothing more than referral centers and lectures from so-called primary care mentors warn trainees against primary care careers at all costs. It’s no wonder fewer than 20% of Americanmedical school graduates are choosing to go into primary care today. We’ve all but legally barred them from doing so.

If that weren’t enough, in their rotations, trainees see the most dysfunctional, antiquated and frustrating approaches to primary care delivery that exist in our health care system. The combination of a sicker, more-complex-than-average patient population, inadequate funding and support for improvement efforts, and predominantly part-time faculty who are frequently not available for teaching or improvement activities has created a toxic milieu. I can’t tell you how many primary care students and residents have noted that it feels like their clinics were specifically designed to destroy their interest in primary care.

Trainees need exposure to the existing models of care delivery that are transforming primary care to work better for patients, providers and payers. Patient-centered medical home (PCMH) practices, which use highly-coordinated, enhanced access, team-based care, are showing exciting results : higher quality of care, decreased ED visits and hospitalizations, happier patients, and lower overall spending. And it seems that exposure to this new model of care is one of the best ways to help trainees see a future for themselves in primary care. The problem is, only a tiny group of trainees are exposed to these types of clinics due to poor penetration of this model in the academic environment . This is something that needs to be remedied.

Revitalizing the primary care pipeline is going to require a multipronged campaign, with the greatest thrust being a change in the way we pay physicians in order to create greater equity between sub-specialist and generalist salaries. If we really value primary care as the foundation of our health care system, purchasers must invest in it and give clinicians the financial support they need to do their job well. We must also expand the definition of a ‘primary care provider’ to include Nurse Practitioners and Physician Assistants, two critical members of the primary care team who can immediately expand access to high value primary care services in communities across America.

As the patient-centered medical home model spreads across the country, academic leaders must ensure it also takes root in our medical school practices, where trainees are both learning what it means to deliver high-value care and making career decisions. We’re increasingly realizing that trainees not only have much to gain from these experiences, but they have much to give. And the sooner we get medical students involved in inter-professional training opportunities with nursing students, social work students, etc, the better. ‘Learners learning together’ is a critical first step to get trainees used to practicing as a team – which is one of the key ingredients of high value primary care delivery.

American medical schools must be held accountable for producing the primary care providers this country needs. This means not only reinvigorating primary care programming and developing new approaches to recruitment and retention of those individuals most predisposed to primary care careers, but also teaching the actual patient-centered, team-based skills that providers need in order to deliver high-value care today. The public cannot afford to wait for medical schools to do the right thing. We must leverage our collective power as purchasers and consumers to demand that these institutions break from their “business as usual,” specialty-focused approach to training. Maybe it’s time for a national campaign to publicly call on all American medical schools to step up to the plate and start revitalizing the primary care pipeline.

Finally, we – from academic faculty to laypeople – must all recognize the role we play in perpetuating the bias in America that being a primary care provider just isn’t good enough. Whether it’s through our questions tofamily members in medical school about what “specialty” they’re going to pursue, or our negative responses to their explicit intentions to practice primary care, we make clear that we wish they’d do anything *but** *go into primary care. I implore all of us to face up to our responsibility to remedy and reverse these biases. So, next time a student tells you he or she is planning to pursue a primary care career, do yourself, your country and the future generations of Americans – who are currently on target to not have access to their own primary care provider – a favor and thank that student for doing the right thing.

We’ll never achieve real health care reform without a foundation of robust primary care in this country. However, fixing the pipeline is no small undertaking. It will require a multifaceted approach to remedy the financial, academic, cultural and political challenges that have plagued the primary care pipeline for years. It will also require us thinking more expansively and inclusively about the definition of a primary care provider. But to increase the primary care physician supply, our course is clear: we must come together now, as a nation, and both collectively demand more from our medical schools while also providing that system with the support it needs to change. Without that, it will be next to impossible to help our academic medical machine break free from it’s specialty-centric approach to workforce creation.

Andrew Morris-Singer, M.D., co-founded the precursor to Primary Care Progress to advocate for improved primary care programming at Harvard Medical School. He now serves as President of Primary Care Progress and speaks regularly on the topic of clinical innovation in primary care,primary care advocacy and trainees’ critical role in that process.