BOB DYLAN WAS RIGHT (AGAIN): THE BUSINESS OF MEDICINE FOR RESIDENTS, FELLOWS AND NURSE PRACTIONERS.

Three weeks ago the American Association of Medical Colleges very quietly released a document entitled “AAMC Guidance on Peaceful Protests by Medical Students and Residents.”  

In response to the growing number of physician voices sounding the alarm about the on-going attack on science, the lack of political leadership during the on-going COVID-19 crisis, attempts to distort and/or hide critical metrics on the spread of the disease, Whitecoats for Black Lives, and other demonstrations by health care workers of all kinds, the AACM spoke.  

Making it clear that medical students should feel free to lawfully and peacefully protest, and that they should engage their peers and academic directors in issues related to systemic racism, opening the conversation to find a new and better way to provide healthcare and not be concerned about the consequences of doing so.  Medical schools should not see this kind of engagement as a stain on a student’s career, admission to medical school or residency/fellowship, and only asked that students wearing the “white coat” reflect and uphold the “virtues associated with medicine—humility, compassion, integrity, accountability, ethics and humanism” when engaging in protest.  

​To restate the famous Dylan phrase:  The times they are a changin’……..
COVID has certainly thrown the future of how medicine is delivered up in the air, with it’s impact on the healthcare system and the vulnerable in our society creating new dialogue on how the delivery of medicine can be better, more equitable throughout all classes of our society, and more appropriately prepared for pandemics so as to avoid another tragedy like we are experiencing now.  

But what’s most impressive to me is that the AAMC has now given it’s blessing to the engagement of residents and fellows, recommending they become part of the conversation, i.e,, part of the solution to these problems.  Although their directive is couched in terms of conversation about these issues, it’s as close as anything I’ve seen suggesting the medical students of all types enter into a discourse that has become distinctly political over the past four months.  Bravo to them, and to all of you who remain mindful of what is going on, alert to the issues that will face you when you leave academia and become responsible for patients and the society around you.

All of this has developed as the impact of COVID on the business of medicine has clearly started a new conversation about this as well.  There have been developments that sound the bell of evolution to a lethargic medical system.  Physicians, normally the quiet class of professionals, afraid to appear to be breaking laws against “unionization,” have been liberated to speak their mind as never before.

New ways of improving healthcare have grown from infancy to maturity in months in the area of telehealth, for example, where care has expanded to include mental health and allowed physicians to practice across state lines.  Licensing has been streamlined to allow physicians to be “deployed” in areas that are underserved or need greater physician presence.  CMS has moved to push outpatient procedures from hospitals to surgery centers.  Direct primary care, a version of concierge medicine, is on the radar of managed care (although the concept needs development in addressing how it helps provide services to the poorer segments of society).  And there are  more on the way—it appears that the looming physician shortage, and how to provide service to all of our society, will finally be addressed through the shear impact of COVID, George Floyd, the attacks on science, and the new voice that wants a seat at the table—resident, fellows, and other healthcare providers who are the future care in this country.

Bob Dylan also said, “You need something to open up a new door, to show you something you’ve overlooked a hundred times or more.”  The door has opened.  Engage.  Be part of the conversation.
​---TOM ELLIS III.  July 2020  www.FirstMEDPractice.com