Med School's Business Model Dead?

[twospadz]

Article gives history of medical school business and how it has really always be influenced about money despite the "angelic" image it has maintained in the years. Thoughts?
Med Schools' Business Model Is Officially Dead

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[libertyyne]

i came away reading thinking that medical school funding has focused on ways to make their missions of teaching students viable since tuition has never been enough to sustain a school. But if you look at any DO school in the country it is the exact opposite. They are able to survive on tuition alone. The problem is that it is expensive to teach and provide medical training. The wells that used traditionally subsidize it have dried up, and the corporations that run hospitals have no interest in teaching.

 

[CheGuevaraMD]

NIH award amounts have not kept up with inflation over the years and award rates have become dismally low. Clinical reimbursement has been relatively stable relative to inflation (so far...) and demand for medical care from patients is almost unlimited.

If non-profit medical schools want to remain relevant to universities and hospital systems in this environment, they really need to pivot to a law or business school model. Raise tuition and make begging from donors the second most important activity behind education.

This also means that professors will have to be judged by teaching ability and production of ‘interesting’ research rather than funding alone.

 

[The Knife & Gun Club]

Article gives history of medical school business and how it has really always be influenced about money despite the "angelic" image it has maintained in the years. Thoughts?
Med Schools' Business Model Is Officially Dead

Not gonna lie I thought that was an awe fully written, winding essay with no discernible thesis. The author basically just bitches about how money has always been important for medical education.

This is perhaps the least surprising thing I learned today, considering running any educational endeavor costs money, and schools will always need to be financed somehow. I honestly completely fail to see what the problem with any of that is.

Further he says the model is dead but based on...what? Medical education seems to be doing fine IMO. They have academic doctors who like teaching do the clinical teaching, some deans to run the administration, and some basic science researchers + online videos to teach pre-clinical. Seems totally normal and effective to me.

 

[libertyyne]

Not gonna lie I thought that was an awe fully written, winding essay with no discernible thesis. The author basically just bitches about how money has always been important for medical education.

This is perhaps the least surprising thing I learned today, considering running any educational endeavor costs money, and schools will always need to be financed somehow. I honestly completely fail to see what the problem with any of that is.

Further he says the model is dead but based on...what? Medical education seems to be doing fine IMO. They have academic doctors who like teaching do the clinical teaching, some deans to run the administration, and some basic science researchers + online videos to teach pre-clinical. Seems totally normal and effective to me.

I think the point was that the flexnor model was not financially sustainable. Never has been, and schools have found various ways to finance. The death he is talking about is the physician groups, hospital systems and other income generating arms of medical schools are slowing being divorced from schools leaving them without a funding source.

 

[libertyyne]

From the article

But, medical education no longer depends on an academic faculty. Many schools provide streaming video of canned lectures, which can be accessed at any time, and do not require the physical presence of students or a professor in a lecture hall. When lectures are given in person, the number of attendees is typically sparse. Indeed, the Larner College of Medicine of the University of Vermont has phased out lectures entirely in favor of "active learning." With active learning, medical students are allowed to absorb the necessary information in their own way and on their own time.
​

Nice to see this is being stated publicly. How long before LCME and the Feds embrace the truth?

and then there is this gem:

Now, "academic medicine" is dominated by a corporate model that cares little about any intellectual mission.​

Thanks OP for posting this article.

What do you mean by embrace the truth.

 

[The Knife & Gun Club]

I think the point was that the flexnor model was not financially sustainable. Never has been, and schools have found various ways to finance. The death he is talking about is the physician groups, hospital systems and other income generating arms of medical schools are slowing being divorced from schools leaving them without a funding source.

Ah in that case yea I see his point. It just doesn’t seem that suprising to me.

Med schools serve a need that has to be filled. They’ll have to adapt, but it’ll always work out Somehow.

*Cue the mid levels are taking out jobs post*

 

[Obnoxious Dad]

I happen to know a physician who graduated from a state owned medical school on the east coast. He streamed and saved all of the lectures from his first two years of medical school onto his laptop. He never went to class, other than the anatomy lab and a clinical medicine class. He streamed and saw the videos in his skivvies in his room.

If you can put 95% of the first two years worth of material on a laptop, why are students paying for professors at 170 medical schools to keep reinventing the wheel? These people who are being paid to teach these preclinical classes are perfectly redundant.

This guy is now a faculty member at a prestigious state medical school in the Midwest. He tells me that residents take up his time but medical students aren't really any bother. If students aren't holding things up, and in some cases performing necessary scutwork, why are they being charged $70,000 per year for medical school?

 

[afib123]

I happen to know a physician who graduated from a state owned medical school on the east coast. He streamed and saved all of the lectures from his first two years of medical school onto his laptop. He never went to class, other than the anatomy lab and a clinical medicine class. He streamed and saw the videos in his skivvies in his room.

If you can put 95% of the first two years worth of material on a laptop, why are students paying for professors at 170 medical schools to keep reinventing the wheel? These people who are being paid to teach these preclinical classes are perfectly redundant.

This guy is now a faculty member at a prestigious state medical school in the Midwest. He tells me that residents take up his time but medical students aren't really any bother. If students aren't holding things up, and in some cases performing necessary scutwork, why are they being charged $70,000 per year for medical school?

This is what I posted but deleted since I didn't think it was relevant to this post. But same feeling. I don't understand why we are paying that much for the first 2 years. With boards and beyond and other online resources, lot of my classmates including me never streamed a lecture in 2nd year. I know for a fact 90% of people stopped going to class. Why do we need such big auditoriums and faculty? I am sure there are lots of amazing physicians that will be willing to do lectures on a subject like cardiology and sell them for a fractional cost for 5-10 years. I would for sure if I am a private practice attending. Boards and Beyond Dr. Ryan is already doing this. All I really need for the first 2 years is a small facility to host standardized patients and a small lab for anatomy dissections.
The reason I deleted my post was because some people say medical schools are losing money on students, but I think the tuition I pay at least the first 2 years is not worth my money.

 

[Obnoxious Dad]

This is what I posted but deleted since I didn't think relevant to this post. But same feeling. I don't understand why we are paying that much for the first 2 years. With boards and beyond and other online resources, lot of my classmates including me never streamed a lecture in 2nd year. I know for a fact 90% of people stopped going to class. Why do we need such big auditoriums and faculty? I am sure there are lots of amazing physicians that will be willing to do lectures on a subject like cardiology and sell them for a fractional cost for 5-10 years. I would for sure if I am a private practice attending. Boards and Beyond Dr. Ryan is already doing this. All you really need for the first 2 years is a small facility to host standardized patients, a small lab for anatomy dissections.
The reason I deleted my post was some people say medical schools are losing money on students, but I think the tuition I pay atleast the first 2 years is not worth my money.

You got it. Now you can look forward to lots of ad hominem posts implying or declaring that you are ungrateful, uninformed and/or too young to understand. When you get to your third year and you are in a patient's room standing behind an intern, who is standing behind a senior resident, who is standing behind a fellow and you aren't allowed to say or do anything, you are going to ask yourself what the heck am I paying for? That will go double in your fourth year except for a subinternship which might actually require a faculty member to spend time with you. I would advise you not to share your concerns with anyone who has the authority to ruin your career. The response will most likely be vindictive and condescending because deep down inside he or she will agree with you.

 

[MSTPlease]

This is what I posted but deleted since I didn't think relevant to this post. But same feeling. I don't understand why we are paying that much for the first 2 years. With boards and beyond and other online resources, lot of my classmates including me never streamed a lecture in 2nd year. I know for a fact 90% of people stopped going to class. Why do we need such big auditoriums and faculty? I am sure there are lots of amazing physicians that will be willing to do lectures on a subject like cardiology and sell them for a fractional cost for 5-10 years. I would for sure if I am a private practice attending. Boards and Beyond Dr. Ryan is already doing this. All you really need for the first 2 years is a small facility to host standardized patients, a small lab for anatomy dissections.
The reason I deleted my post was some people say medical schools are losing money on students, but I think the tuition I pay atleast the first 2 years is not worth my money.

I don't really think the physical lecture halls are the reasons medical schools lose money. I never thought Sinai was revolutionary in the idea that the med student lecture halls are also used by other groups on campus (e.g. clinical departments, basic science departments). Am I wrong? Do schools build these lecture halls and then just let them sit empty every moment the med students aren't in a lecture?

 

[Mr.S]

This is what I posted but deleted since I didn't think it was relevant to this post. But same feeling. I don't understand why we are paying that much for the first 2 years. With boards and beyond and other online resources, lot of my classmates including me never streamed a lecture in 2nd year. I know for a fact 90% of people stopped going to class. Why do we need such big auditoriums and faculty? I am sure there are lots of amazing physicians that will be willing to do lectures on a subject like cardiology and sell them for a fractional cost for 5-10 years. I would for sure if I am a private practice attending. Boards and Beyond Dr. Ryan is already doing this. All I really need for the first 2 years is a small facility to host standardized patients and a small lab for anatomy dissections.
The reason I deleted my post was because some people say medical schools are losing money on students, but I think the tuition I pay at least the first 2 years is not worth my money.

But you can say the same thing about College courses, high school courses, etc etc.

Fire all the English 101, Calculus 101 teachers and just have a few all star lecturers and pay them $$$$$ and have them develop a all star curriculum and have every single student go through that curriculum. Stream them the every student. Thats what the colleges are desperately afraid of anyway. Medical schools no exception. That is a viable business model.

I found the article to be a great synopsis of the development of medical education.

 

[kb1900]

I don't really think the physical lecture halls are the reasons medical schools lose money. I never thought Sinai was revolutionary in the idea that the med student lecture halls are also used by other groups on campus (e.g. clinical departments, basic science departments). Am I wrong? Do schools build these lecture halls and then just let them sit empty every moment the med students aren't in a lecture?

Yeah actually some schools do - massive lecture halls that can seat 300+ people with flatscreens everywhere only to be used 15-20 hours a week. It’s kind of pathetic but definitely happens. Whether it’s even a remotely significant cost in the larger scheme of things, I don’t know

 

[Goro]

I happen to know a physician who graduated from a state owned medical school on the east coast. He streamed and saved all of the lectures from his first two years of medical school onto his laptop. He never went to class, other than the anatomy lab and a clinical medicine class. He streamed and saw the videos in his skivvies in his room.

If you can put 95% of the first two years worth of material on a laptop, why are students paying for professors at 170 medical schools to keep reinventing the wheel? These people who are being paid to teach these preclinical classes are perfectly redundant.

This guy is now a faculty member at a prestigious state medical school in the Midwest. He tells me that residents take up his time but medical students aren't really any bother. If students aren't holding things up, and in some cases performing necessary scutwork, why are they being charged $70,000 per year for medical school?

Another old model that is dying is the Sage ont he Stage passively filling up young brains with wisdom. This is being replaced by active learning, especially the latest trend, TBL. For that, you still need a classroom because the student come and work with each other. There is data that shows this helps retain info longer.

So yeah, students could be learning things online, but to better assess them (and teach them) they need to show up. And that's just for the basic science didactics...you still have to show up for labs and all the "what doctors do stuff".

There's not going to be a single model of medical education, given by ten people beamed nationwide. Just don't go there. At best, you'll find Faculty agree on 80% of what's important, and fight tooth and nail over the other 20%. And that's just within the same discipline. Trying to get people to agree across disciplines is like herding cats.

Another model of medical education that seems to be growing is the hospital with the med school attached (not the other way around). Kaiser, CalU, Geisinger, Hofstra, and to some extent Seton Hall follow this. Mayo and Case pioneered it.

And please get out of the mindset that medical education stops at Step I. It's a four year process.

And also stop with the n=1 examples. They don't apply nationwide. Most of the residents and attendings on SDN have stated that while they like teaching students, they are still a significant drag on thier clinical time.

 

[MSTPlease]

Most of the residents and attendings on SDN have stated that while they like teaching students, they are still a significant drag on thier clinical time.

"Show me a [student] who only triples my work and I will kiss his feet."

 

[kb1900]

Another old model that is dying is the Sage ont he Stage passively filling up young brains with wisdom. This is being replaced by active learning, especially the latest trend, TBL. For that, you still need a classroom because the student come and work with each other. There is data that shows this helps retain info longer.

So yeah, students could be learning things online, but to better assess them (and teach them) they need to show up. And that's just for the basic science didactics...you still have to show up for labs and all the "what doctors do stuff".

There's not going to be a single model of medical education, given by ten people beamed nationwide. Just don't go there. At best, you'll find Faculty agree on 80% of what's important, and fight tooth and nail over the other 20%. And that's just within the same discipline. Trying to get people to agree across disciplines is like herding cats.

Another model of medical education that seems to be growing is the hospital with the med school attached (not the other way around). Kaiser, CalU, Geisinger, Hofstra, and to some extent Seton Hall follow this. Mayo and Case pioneered it.

And please get out of the mindset that medical education stops at Step I. It's a four year process.

And also stop with the n=1 examples. They don't apply nationwide. Most of the residents and attendings on SDN have stated that while they like teaching students, they are still a significant drag on thier clinical time.

Despite all the hate that problem / small group based learning gets on this forum, I think it is unequivocally the best a school can offer its students in terms of getting them to synthesize pathophys and pharm information for their rotations.

But I may be biased by the high quality experiences I’ve had with it

 

[W19]

We need a modern Flexner Report...

 

[MSTPlease]

We need a modern Flexner Report...

Weird flex but ok