As federal officials determine when and how to reopen the country, numerous public health experts fear that the United States is significantly short of the public health workers needed to mitigate another occurrence and properly perform contract tracing. 

On April 8, 2020 JAMA published an editorial co-authored by Dr. Josh Sharfstein and Dr. Howard Bauchner proposing a public health response to the COVID-19 pandemic by electively suspending medical education for the medical students of the class of 2024 and implementing a National Service Program for interdisciplinary graduate students. 

Dr. Jamar Slocum, on behalf of the Beyond Flexner Alliance, recently sat down with Dr. Josh Sharfstein, to discuss his recent editorial and its impact on medical education. Dr. Sharfstein is the current Vice Dean for Public Health Practice and Community Engagement for the Bloomberg School of Public Health and Director of the Bloomberg American Health Initiative. He previously served as Principal Deputy Commissioner of the U.S. Food and Drug Administration, Commissioner of Health for Baltimore City, and health policy advisor for Congressman Henry A. Waxman.
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This discussion has been edited for length and clarity. 

Medical Schools Do Need an Overhaul. Doctors need to be trained in public health, health equity, and social justice.

COVID-19 is laying bare society’s underlying structural inequities that increase the risk of exposure, infection, and death for minority and disadvantaged communities across the US. The pandemic is also disproportionately affecting healthcare workers, who continue to work despite insufficient personal protective equipment and further, face disciplinary actions for speaking out.
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Despite these realities, Dr. Stanley Goldfarb in his April 13 commentary suggests “doctors should be trained in pandemics, not injustice,” and that “the medical profession should abandon the fantasy that physicians can be trained to solve the problems of poverty, food insecurity and racism.” Clinical care is estimated to account for only 10-20% of what ultimately impacts health outcomes. Social determinants of health – health behaviors, social and economic factors, and the physical environment – account for the other 80-90% (National Academy of Medicine). The attitude that physicians should focus solely on clinical care aims to disempower the profession and frankly, is dangerous.

​In today’s complex health care environment, given that stakeholders and policy experts commonly expect demonstrable evidence of quality, accountability and improvement, measurement has become an integral part of doing business. Now that social mission has been identified as part of the mission of health professions education, there is a desire to obtain and quantify data to advance health equity and reduce health disparities. The measurement of social mission performance in health professions schools is nascent. Various organizations such as THEnet and ASPIRE have pioneered the development of measurement tools. There is promising consistency in the philosophies that govern the measurement tools of these two organizations and leadership at schools using these tools have described great benefits in going through the assessment process. However, usage has been mostly limited to medical schools rather than health professions schools in general, and the tools themselves are primarily targeted to schools looking to excel in social mission, rather than all comers.

​Republicans and Democrats in Congress continue to battle over repealing the Affordable Care Act (ACA).  Whether ACA is carried out as planned or replaced with something entirely new, our physician workforce is unlikely ready to meet the changing healthcare needs of the nation. Shifts in demographics, the rise of chronic disease, and escalating health care costs are placing new demands on the knowledge and skills of our doctors.  Most American medical schools, however, continue to educate their student doctors in the same ways of decades past.The Association of American Medical Colleges predicts a shortage of 35,600 primary care doctors by 2025. We need more primary care physicians and a more diverse workforce, in cities as well as rural communities and formally designated health professional shortage areas.  We need a workforce that understands the importance of prevention and is judicious in its use of limited financial resources for health.Medical schools are a key part of the supply pipeline that can help meet the changing health demands of the American people, but are they aligned with the nation’s emerging healthcare needs?  Do they even consider themselves part of this essential pipeline?