Suffering Medical Education: Follow the Money

While pharma seems to have plenty of money to subsidize dubious marketing schemes (see post here), there is plenty of evidence that primary care and medical education are continuing to suffer from too little money. See for example, two recent stories, one from the UK, one from the US.

From the US, the Detroit News published yet another story about the decline of primary care training. This story contrasted the situation in primary care with that in dermatology. I confess being brought up to think of this specialty as necessary, but not particularly exciting, varied or glamorous. But now, "Droves of the nation's most talented medical students are pursuing careers in dermatology, a field that promises good pay, flexible hours and job opportunities hard to come by in other fields. The surge in dermatology interest comes as doctors flee some of the most critical medical fields -- family practice, internal medicine and obstetrics -- for a slew of reasons.... 'We're very lucky in dermatology that we get to pick our trainees from the best and the brightest,' said Dr. Jack Resneck, an assistant professor of dermatology at the University of California-San Francisco. 'We've certainly seen declining interest in primary care and general surgery residencies,' he added." One particular factor in the imbalance of interest in primary care vs dermatology is the vast sea of debt in which many US medical students swim. "Young doctors easily run up more than $100,000 in education costs by the time they're ready to practice, making a good-paying job a priority." Yet, as we have noted before, the very high and rising cost of going to US medical schools seems to contrast with the little financial support given to US medical school faculty members for actually teaching. Where is all that tuition money going? That's a good question.

Meanwhile, in the UK, the Guardian reported that one result of the growing financial crisis affecting UK hospitals is " Millions of pounds that should be being spent on training junior doctors, nurses and midwives are being withheld in a bid to meet the NHS's financial deficit, Britain's most senior surgeon has warned.
Cash-strapped strategic health authorities are "raiding" an average of 10% of the MPET (multi-professional educational training) budget, which should be spent on improving health professionals' skills, Bernard Ribeiro, president of the Royal College of Surgeons, said. That could have a serious impact on patient care at a time when junior doctors' training - and in particular theatre time - is already being slashed by a reduction in doctors' hours caused by the European working time directive, and by a new training system called Modernising Medical Careers, to be rolled out in August, that will see junior doctors become consultants in seven years rather than the current 11 years or more." One issue is that the money for training is not "ringfenced," which I take to mean that the money, although meant for training, need not actually be spent on training. This recalls the situation of the money spent by Medicare in the US on graduate medical education, which is provided to hospitals to support this function, but without any requirements about how the hospitals must actually use the money (see post here).

Figure out where the money goes, and who sends it there, and you have figured out a lot about what is currently wrong with medical education, and more generally in health care.