Have you ever wondered what your physician’s view of the future of health might be? Or how the perspective of a mid-career physician might compare to that of a medical student? What might each of those individuals have seen or experienced to make their outlooks differ? Where would their ideas align?

I started asking those questions when my friends started medical school. As the daughter of a physician, I had a close second-hand view on how a doctor experienced the evolution of the medical field over the past 10 or 15 years: for example, the frustrations of switching from paper to electronic records, and the hope my father — a residency program director — had for shaping the development of his residents. When my friends started entering the medical field in their early 20s, I started wondering how their experiences would compare to my dad’s. How do their perspectives on what is working and what isn’t in the healthcare system compare to his perspective?

[bctt tweet=”Have you ever wondered what your physician’s view of the future of health might be? Or how the perspective of a mid-career physician might compare to that of a medical student?” username=”healthfurther”]

My questions drove me to schedule a phone interview with my own father, a gastroenterologist and the internal medicine residency program director at East Carolina University’s Brody School of Medicine. I asked him about the challenges and solutions he sees in medicine, and his general vision for the future of health. Then I called a friend from college who is now in her second year studying at Brody. I asked her the same questions. Here is how they responded.

William J. Leland, MD

Program Director, Internal Medicine Residency

Brody School of Medicine, East Carolina University

What do you think is the number one challenge that physicians face today?

The burden of chronic disease. When I was training, people didn’t live as long with as many diseases as they do now. If you had kidney failure, you wouldn’t live long enough to have your lungs fail and your brain fail. The burden of chronic disease is tremendous. It creates a lot of stress for the caretaker. It used to be that you saw the fruit of your labor as the patient got better, but now you’re just patching somebody up for a little while because you know they’ll continue to need a lot of help from the system.

My other biggest problem is the fact that the complexity of taking care of all this creates a strain on the resources of the individuals expected to do it. One of the biggest problems with training doctors coming along is there’s no space to teach the doctors in training, to help them with physical exams, to monitor their professionalism and the way they communicate with each other and their patients. Our days are heavily weighted towards this chronic illness, plus the multiplicity of each clinical task that we have to do. The electronic medical record has created a whole set of work in and of itself. There’s a whole multitude of parameters that you’re graded by. You have to know how to properly code the visit. You don’t just admit people into the hospital anymore; you have to determine how long they’ll be there and put in that note at the very beginning. We are responsible for administrative things as physicians that we didn’t use to have to do.

What’s the number one challenge for physicians-in-training?

We face enormous administrative clinical tasks that are supposed to make the patients safer, supposed to make our system more integrated, but they require an enormous amount of effort. There’s almost no room for anybody else during the day. There’s less and less room for the patient. There’s less and less room to communicate among colleagues. Now try to imagine making the space to adequately train the doctors coming along — that’s a challenge. A lot of these things don’t enhance your relationship with the patient and actually make you feel like your day was rather worthless and leads to these burnout issues that everyone’s facing.

Do you see any solutions to that?

There are a bunch of initiatives about how to get “back to the bedside.” But you can’t just keep adding more people to the team.

What is your vision for the future of health? What are the main barriers to that future, and what are you doing to create the future you envision?

[bctt tweet=”I don’t think that the medical providers should be the ones to necessarily lead and guide the whole health movement. I think that should belong to society and to industry and to food manufacturers and to public school systems.” username=”healthfurther”]

We’re not in the business of health. We’re in the business of healthcare. I don’t think that the medical providers should be the ones to necessarily lead and guide the whole health movement. I think that should belong to society and to industry and to food manufacturers and to public school systems. I do think there are some bright examples of that: like you have a gym in your office now. To me, it’s all about teaching and lifestyle. Culture. You don’t need somebody to go to four years of med school and six years of training to manage an exercise program, or to create a culture where people make good choices for their lives. I don’t think that pressure should be put on health care providers. The pressure on health care providers should be how to restore people to a state of health which they feel is acceptable to them, as much as we can. I just don’t think the (healthcare) system has the bandwidth to do everything. That responsibility belongs to policymakers and parents and rotary clubs, to create a culture.

That’s what I see my role as: It sucks that your body doesn’t work right, and I’m here to help you deal with that. I’m glad there is a system to support people whose bodies do less than they want them to do. But it’s not fair for you to look at the doctors and say, ‘What are y’all going to do about childhood obesity?’

The doctors are managing his liver disease. What’s society going to do about his drinking problem?

Chloe Opper

Third-year medical student

Brody School of Medicine, East Carolina University

What do you think is the number one challenge that physicians face today?

From what I’ve seen and what I’ve heard, documentation is a huge issue. I don’t think that the current system is super efficient. Most doctors and everyone can agree that it’s important to document the patient experience. But the current electronic documentation system is really complex and not easy to use. Doctors spend so much of the day documenting unnecessary things, whether it’s for insurance purposes or administrative purposes. Doctors should be dealing directly with patients instead. Their time is limited.

And these records, they’re not interconnected. Let’s say you have a patient that is out of network or they’re being seen at a different clinic. You don’t have access to their health records. They usually have to fax it over and it gets put in a weird place in your electronic health record as a pdf and it’s a pain to search. The fact that it’s faxed over kind of defeats the purpose of electronic health records in the first place.

It could be a great thing, but the way it’s set up right now is really inefficient.

What would you say is the number one challenge for physicians-in-training like yourself?

It’s a two-fold question: the medical curriculum and the clinical part. In pre-clinical years it’s really hard — for me, at least — to have a balance between book work and meaningful clinical experiences. Although the medical school experience is designed with some time built in for those clinical experiences, everyone wants to be out in the field rather than in the library. Learning about practicing medicine and doctoring at the same time while you’re a student is hard. When you get to your third and fourth year, physicians expect you to be proficient at all these things — but for the most part, all you’ve done is book work.

Historically, med students were more involved in patient care, whether that’s participating in doing the procedures or even being more involved in writing the notes that actually follow the patient. When you get to your residency, you’re expected to be able to run the hospital — but leading up to that, you’re less involved with actual patient care. The learning curve from being a student to being a resident has always been big. But from what I’ve gathered from conversations and observations, it’s gotten wider in recent years. Although you’re given opportunities throughout your medical education, you really have to take it upon yourself as a student to make the most of those opportunities. The expectations should be high, but it’s difficult to do so, and a lot of the burden ends up on you as a student to be competent on your own.

Do you see any solutions to that?

I think in recent years medical schools have been starting to integrate book-learning with clinical, experiential more… For instance, at Brody, we switched to an 18-month pre-clinical curriculum so that more time can be spent later on in the clinic on rotations. During that 18-month time period, we still have clinical opportunities built in, like a week-long preceptorship. It is a challenging task because although there is clinical time built in, there is a wide range of knowledge we need to amass before we can be competent learners in a clinical setting. I don’t think that can entirely be remedied on a systemic level beyond what schools are already trying to do, but I do think it’s up to the individual learner to take time and volunteer in a clinic or shadow in addition if he or she feels like they’re not getting enough clinical time and he or she is comfortable taking a few hours away from the book work.

What is your vision for the future of health?

My two biggest things are affordability and preventative medicine. They go hand-in-hand because it’s sort of a self-perpetuating cycle. The people who don’t have a primary care doctor get their care at the emergency room, and that drives up cost. People can’t afford to go to the doctor or can’t afford the medications they need — I don’t think that should happen in this country. Nor should people go bankrupt or use their savings to pay off medical bills.

Preventative care should be a top priority for primary care. Even if you’re not in primary care, you can still counsel on prevention. In my ideal world, all healthcare providers, and the government, and nutritionists should really focus on preventative medicine and make sure that affordability is not an issue.

[bctt tweet=”Preventative care should be a top priority for primary care. Even if you’re not in primary care, you can still counsel on prevention.” username=”healthfurther”]

What are the main barriers to that future?

I honestly think it’s our current political climate and situation. Right now it’s really hard to know what the future of healthcare looks like, whether it’s a day-to-day thing or an administration-to-administration thing. Are they going to overhaul the healthcare bill every time there’s a new administration in government? Depending on the way things go, it could have a huge impact on patients, whether they roll out Medicaid and expand it, or cut back.

As physicians, like everyone, we don’t really know what’s going to happen, and that makes it really hard to learn how to do the most affordable, efficient things for our patients. The current Affordable Care Act really focuses on primary and preventative care. With that (policy) being up in the air, it’s really hard to get the foundation in place and move forward. It’s hard to improve things like efficiency and affordability when you can’t get a foothold. It’s hard to serve your patients when you don’t know what system you’re working in.

What are you doing, or plan to do, to create that future?

Right now, the research I’m doing with pediatric obesity – it’s called the MATCH Wellness program: Motivating Adolescents with Technology to CHOOSE Health! It’s in middle schools all across North Carolina. It’s a school-level intervention that promotes fitness, nutrition, and behavior change to combat obesity. I’m looking at social determinants of health and how school environment determines baseline student obesity between schools. If you can prevent one student from being overweight or obese, you can save hundreds of thousands of dollars in medical costs down the road. It doesn’t just affect that student; it affects their entire family.

As a medical student, I want to do preventative medical and primary care — but whatever your future is in medicine, you can already start to take steps towards that. Yeah, it’s such a huge problem to tackle, but if everyone’s like, ‘We can’t, we can’t,’ then it’s never going to get solved, right? Physicians are in such a unique position, and so well respected, so why not try? I do think that we can help policy-makers who know about policy but don’t necessarily know about healthcare. It’s our job to tell them what needs to be done.

It’s interesting that these two, whose age and experience gap tops 30 years, both immediately landed on documentation requirements as the number one challenge for physicians today. The current system of electronic health records hasn’t been implemented smoothly, and it has created a new set of responsibilities for physicians to document procedures in a special code. Both the doctor-in-training and the mid-career doctor interviewed here would agree that the burden of procedure documentation notably restricts the potential of a doctor to help as many patients as possible. Seems like a space ripe for innovation!

The most polarized divergence in opinion that these two medical professionals expressed was their individual takes on the role of a physician in changing the future of health. My father, who has been a doctor since the 80s, is frustrated by a perceived pressure on physicians to create a healthier society on a systemic level. He went into doctoring because of the high emotional reward of that one-on-one doctor-patient interaction, of helping individuals achieve or regain their physical health. He sees massive cultural barriers to an overall healthier society, and he resents any expectation that he as a physician should or could do something to address those systemic issues. On the other hand, Chloe, a second-year med student, is optimistic and ambitious in her goals for the future of our society’s health. She sees the same systemic issues that my more experienced father sees — but unlike him, she is confident in her ability to enact broad-scale change through her envisioned role as a physician.

It’s impossible to tell whether these differences are a result of experience vs. naiveté, realism vs. optimism, personality or other factors entirely. Still, they’re both valid opinions worth considering. Which perspective do you find yourself identifying with more? We’d love to see your responses in the comments on this article!

Photo by Luis Melendez on Unsplash

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