Clinicians Can Treat Health Care Crisis

Clinician leaders can and must deal with the crisis besetting health care in the United States and around the globe.

“It is high time that we exert our leadership for the sake of the people we serve,” said Darrell G. Kirch, MD, president and CEO of the Association of American Medical Colleges. “Our patients depend on us, and future generations of patients depend on us.”

Dr. Kirch delivered the keynote address during the opening session on Saturday. He laid out six key challenges facing health care around the world. Clinicians are best equipped to meet all six.

The first challenge is the disruption of health care by successive mergers, acquisitions, and breakups. Consolidating medical practices, hospitals, and systems into ever-larger business units gives the anatomic appearance of integration but fails to achieve physiologic integration. Patient care suffers.

“We do a much better job of rescuing people than we do in keeping them well,” he said. “And we are spending more than we can afford. Clinicians have ceded leadership to others, and health care has lost the balance between business rigor and clinical sensitivity.”

The second challenge: living in a post-truth era where personal belief, opinion, and emotion mean more than evidence.

“That is an existential challenge to medicine,” Dr. Kirch said. “The only people who are in a position to speak to the value of science are the people who do it. We can counteract post-truth, but only if we exert our leadership.”

The third challenge is education. Not education spending, but the process of education.

“Our students are tired of the sage on the stage,” Dr. Kirch said. “They are ready to adapt new technology, apps, artificial intelligence, virtual reality, and high-definition simulation to learning. As educators, we must take the lead in meeting that challenge.”

Inequality is the fourth key challenge. There is a straight line between income disparities and health disparities, Dr. Kirch noted. One of the best predictors of health status is income and educational status.

“Health inequalities are some of the most pernicious challenges to health,” he said.

The fifth challenge is burnout and depression. Just as “to err is human” focused attention on quality in health care, the spotlight today must shine on the reality that physicians are not immune to human frailties.

Lack of leadership is the final challenge.

“We must face the brutal realities and set the course to prevail against these challenges,” Dr. Kirch said. “It is so easy to get inspired to lead in health care because of our foundation in clinical ethics. Do good for patients, avoid harm, respect their autonomy, and build social justice. It is not ethically correct to have haves and have-nots in health care.”