1	THE HEALTH VULNERABLE: The Role of Medical Education Barbara Ross-Lee, D.O. Vice President for Health Sciences and Medical Affairs New York Institute of Technology
2	U.S. HEALTHCARE The United States Healthcare System is able to deliver the best healthcare in the world.
3	SYSTEM CHARACTERISTICS Disease focused Insurance based Employment dependent Government programs (entitlements, safety net programs, Medicare, Medicaid, Veterans Administration, Federal/State employees, etc.)
4	THE HEALTH VULNERABLE DEFINITION: An identifiable population whose health status is compromised because of 1) socio-economic and/or socio-cultural determinants which characterize them or their life circumstance and 2) the construct, the characteristics, and/or the challenges of the healthcare delivery system.
5	DETERMINANTS OF HEALTH VULNERABILITY Economic status Geographic residence (urban/rural/frontier) Gender Age Race/ethnicity Language
6	HEALTH SYSTEM CHALLENGES Access Cost Quality Behaviors
7	ACCESS Poverty Insurance status (uninsured/underinsured) Provider type and availability Service availability Transportation Language
8	COST Growing percentage of GDP Limitation on Medicare expansion with growth in the aging population Medicaid linked to state economics Patient share of coverage increasing Employer costs escalating – compromising market competition Safety net programs/service initiatives experiencing decreased funding
9	QUALITY Institutional outcome assessments Provider/system errors Patient education/compliance Fragmented system with loose provider networks which compromise continuity of care Standards of care (formative)
10	BEHAVIORS Patients Health Seeking Lifestyle Providers Unconscious bias Cultural insensitivity Professionalism Systems Commercialism
11	HEALTH DISPARITIES Health disparities are the outcome results of health vulnerability.
12	MEDICAL EDUCATION Institutional Missions Societal Covenant – Preparation of the workforce to meet the evolving healthcare needs of the future Relationship to the healthcare delivery system
13	MEDICAL EDUCATION CONTINUUM
14	MEDICAL EDUCATION Historically, the medical schools, and by extension teaching hospitals, determined what, when, and how health (disease) care was delivered, through the research which expanded the biomedical knowledge base, and the education and skills training that produced physicians. Needless to say the focus was on disease.
15	INHERENT MEDICAL EDUCATION CHALLENGES Rapidly expanding biomedical knowledge base Predict tomorrows healthcare challenges to prepare a competent workforce Traditional organization is fragmented; lacks continuity (ed. silos); time inefficient Appropriate integration of technology without compromising professionalism Pathology focused; health system, health policy, prevention, health promotion, cultural competency NOT emphasized
16	EMERGING CHALLENGES Societal Covenant – communities Institutional culture Supply of physicians Type of physicians (Generalist vs Partialists) Effectiveness of physicians- competencies
17	SOCIETAL COVENANT CHANGING POPULATION DEMOGRAPHICS HEALTH STATUS OF POPULATION PERSISTENT HEALTH DISPARITIES CHANGING PHYSICIAN DEMOGRAPHICS QUALIFIED/COMPETENT PREVENTION/HEALTH PROMOTION
18	INSTITUTIONAL CULTURE Faculty Diversity Faculty Development Effort Distribution Tenure Research/scholarship-disparities Research/scholarship-communities Community Service
19	INSTITUTIONAL CULTURE Curriculum Community Service-learning Health system and health policy Re-evaluate 4^th year education Teach and evaluate cultural competency Expand clerkship training requirements to include community service placements Student diversity Community based residency training
20	PHYSICIAN SUPPLY There are approximately 700,000 practicing physicians in the U.S. One out of three practicing physicians is over the age of 55, and 100,000 are over 65. Many are expected to retire within the next 5 to 15 years.
21	PHYSICIAN SUPPLY The first of the baby boomers turn 65 in 2010 and the US Census Bureau estimates that the nation’s population over the age of 62 will increase from 46 million now to 83 million by 2030
22	PHYSICIAN SUPPLY A number of studies have estimated that by 2020 the U.S. will be short anywhere from 24,000 to 200,000 physicians. Richard ‘Buz’ Cooper projects that by 2020 the U.S. may lack as many as 200,000 physicians and 800,000 nurses. (synergy)
23	TYPE OF PHYSICIAN GENERALIST VERSUS SPECIALIST Reimbursement incentives aligned with specialty care Educational debt load increasing Liftestyle Gender impact Health professions expanded scope of practice (primary care)
24	COMPETENCIES Health system - navigation Cultural competency Community (power) structures