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December 8, 2015

Merging the Health System and Education Silos to Better Educate Future Physicians

Author Affiliations
  • 1VA Los Angeles Healthcare System, Los Angeles, California
  • 2Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles
  • 3Department of Medicine, University of Chicago, Chicago, Illinois
JAMA. 2015;314(22):2349-2350. doi:10.1001/jama.2015.13574

The Affordable Care Act (ACA) is shifting physician reimbursement from volume to value. Academic medical centers (AMCs) are responsible for educating future physicians so that they will acquire the skills to practice value-based care. However, the linkages between the leaders of health systems and leaders of residency education may be tenuous, primarily because these leaders exist in separate silos in AMCs.

Even though the American College of Physicians, Institute for Healthcare Improvement, Veteran Affairs Centers of Excellence, and others have created curricula to teach residents principles of value-based care and population health, the practice models that residents are immersed in result in powerful imprinting on future decision making and practice.1 If residents observe attending physicians frequently order unnecessary computed tomography scans due to perverse financial incentives, residents may be more likely to adopt this practice. Similarly, regional spending patterns in which physicians train are associated with their future spending patterns in practice.1 In this Viewpoint, we outline 3 steps AMCs can use to accomplish their dual missions of delivering high-quality care and preparing the next generation of physicians for new models of value-based care and population health.