Monday, 6/30/97 Health care system reform group causes
controversy EDUCATION: Managed care versus patient interest the
crux to university doctoral faculty
By Kathryn Combs Daily Bruin Contributor While the American
health care system rapidly changes to incorporate the efficient
lessons of managed care, it is the physicians and medical students
who are being left in the dark. The University of California, the
nation’s largest single provider of medical education and clinical
care, houses more than 12,000 students annually who attend one of
five UC medical campuses. The UC trains two-thirds of those
entering the medical profession in California. As befitting the
UC’s significance, a Commission on the Future of Medical Education
formed last August by UC President Richard Atkinsons is developing
new initiatives to revamp medical education. The commission’s
recommendations are still under discussion, but have already met
with some resistance from inside the system. The size,
configuration and quality of California’s health care workforce
will be addressed by the commission, as well as ways that the UC
could effectively fulfill the state’s present and future health
needs. The coming of managed health care in California is a
pressing issue in health care, one that can not be ignored by
either the medical schools or their students, said Dr. Charles
Lewis, director of the Center for Health Promotion and Disease
Prevention and a commission member. Managed care was first
developed in the 1980s by companies who found the cost of providing
health care for their employees to be too high. "General Motors
(GM) and other companies started to realize that they were spending
more on their health insurance than on their raw materials," Lewis
said. Many corporations worked with insurance companies to provide
medical benefits and health care for a preset number of employees,
assigned to a specific group of doctors. Those doctors were paid a
set amount of money per employee, regardless of services rendered.
Many have condemned the results. "Cost control has occurred at the
cost of doctor and patient autonomy," Lewis said, "and the
constraints are being felt by all, particularly by physicians who
have never operated in this environment before." Opponents of
managed care argue that number-crunching priorities impinge on the
traditional working of the medical profession. In the past, medical
students have specialized, in fields such as neurosurgery or
cardiology. But because of the nature of the managed care system,
more primary care physicians are needed. "Primary care physicians
(are) our gatekeepers," Lewis said. They keep the gate shut on
access to high cost examinations and tests." Lewis, the only UC
faculty member on the commission, said the preliminary findings of
the commission released last October focused too much on managed
care. "The commission’s goals and outlines are overly influenced by
the perspective that every graduate of the UC will end up working
in a managed care program," Lewis said. He stressed that the
commission needed to carefully consider the suggestions that they
make to medical school faculty. "(According to) the bylaws of the
university, only the faculty of the school of medicine may make
changes," Lewis said. "(The faculty) has the responsibility to
develop criteria for admission, establishing the curriculum and
deciding who graduates," Lewis added. Michael Wilkes, chair of the
UCLA doctoring curriculum and a professor of medicine, said that
while the intent and purpose of the commission was appropriate,
their awareness of the evolving health care system was weak. "The
preliminary report had no connection with medical education,"
Wilkes said. "It would be like having an environmental policy for
California drafted by people from the other 49 states without any
clue as to what is going on first," he said. Wilkes stressed that
managed care, although an important medical issue now, may not be
as important in years to come. "Managed care is a fad, probably
measured in single-digit years," Wilkes said. "We are doing an
enormous amount in (teaching our students) the principles that
underlie primary care," Wilkes said. "We would rather teach them
the foundations of good practice … but not teach them specific
knowledge that would exclusively allow them to practice in a
managed care institution," Wilkes said. "The message that we as
medical students have begun to get is that health care is becoming
more conscious of the market economy,"said Francis Chang,a
third-year M.D. and Ph.D. student. "From talking to professors and
other doctors, I’ve seen there are two sides. There are people who
lament the passing of the golden age where you have doctor autonomy
and the best interest of the patient at heart," Chang said. "And
then there are others who believe that the system is bloated and
that this will be an improvement of managing our resources,"Chang
concluded. UCLA’s medical students will be prepared to enter the
medical field, according to Neil Parker, the associate dean of
graduate school medical education. "The UCLA School of Medicine is
already, and has been, teaching the students both about managed
care and good management of care," Parker said. "The challenge that
the students are going to face is an ever-evolving system of the
economic care of patients," he said "Managed care is just another
economic style of practice,"he said. "We’ve always managed care and
existed with limited resources." Previous Daily Bruin Story Regents
discuss ill health of UC med system, January 19, 1995