Photo by Chris T. Anderson, copyright 2004

“We want to produce change agents,” says Diane Rittenhouse, co-director of the "Health Care System and Physician Leader" Area of Concentration (AoC) Program at UCSF. “We want to teach physicians not only how to practice high quality medicine but how to influence the health care system.”

Assistant Professor in the Department of Family and Community Medicine, Rittenhouse is as enthusiastic as she is adamant about the need for more physicians to understand this country’s health care system—and become actively involved in shaping its future. “Doctors are working in a system under a lot of stress. Costs are going through the roof, the number of uninsured continues to rise, errors are rampant, and the demand for technological advances is greater than anyone can afford. We need to find creative solutions to these problems, and we need physician leaders who understand how medicine is organized, financed and delivered to contribute to this discussion.”

Integrating health policy into the curriculum

It is toward this end that UCSF is integrating education about health policy and the health care system into the required medical school curriculum, as well as supporting students’ interest in the field through the Health Care System and Physician Leader AoC, led by Josh Adler, Diane Rittenhouse, and Jack Resneck, Jr.

Bridget Harrison, a fourth year student who is currently getting a masters at UC Berkeley’s School of Public Health, has been intimately involved with both endeavors since entering as part of the Class of 2005—the first class to be fully immersed in the new curriculum.

While she knew little about policy issues when she came to UCSF, Harrison nevertheless had a sense that “something needed to change.” As she learned more about the barriers to health care facing the poor and increasingly the middle class, “It led me down the path of policy. It became clear that one of the ways we can remedy the problem is to provide health insurance to everyone. The U.S. and South Africa are the only two industrialized countries without that perspective.”

Harrison realized early into her first year that while she had ideals about how the health care system should run, she had very little practical knowledge about how it actually works. And so, along with a few classmates, she put together a seven-week evening elective course on the topic, which turned out to be such a success that it continues to be offered each fall and currently serves as the required core course for the Health Systems AoC.

Evaluating public health systems and Medicaid

Like the five other tracks within UCSF’s optional AoC Program, the Health Care System pathway gives students support and credit for obtaining in-depth experience in a particular subject area and culminates in a fourth year “legacy” project. While the Health Care System program is still too new to produce any formal “legacies,” students have already begun to pursue a wide range of projects.

Harrison, for instance, took an elective course in Cuba on the country’s public health system, while another student spent the summer working for the Kaiser Commission on Medicaid and the Uninsured. Yet another student put together a month-long elective helping a community clinic develop a searchable patient database, while another shadowed a hospital administrator to learn about the health care system from that perspective.

Currently students are putting together a program by which first and second year students can become involved in multi-disciplinary efforts to improve quality of care at the UCSF Medical Center. Potential Health Care System AoC legacies might include a health services research article, an issue brief for an advocacy organization, a bill written for a political entity, or the implementation of a quality improvement project at a health plan.

Stretching traditional concept of what doctors do

With discussions and decisions regarding health care on the front page every day, the importance of teaching students about the health care system and health policy cannot be underestimated, says Rittenhouse. “Physicians resent organizations and people with non-medical backgrounds dictating what they can and cannot do. But if physicians aren’t out there, they can’t contribute to that larger discussion.”

This “discussion” stretches the traditional concept of what doctors do and even what medical school is all about, according to Rittenhouse, but it’s critical that physicians take their place at the table. “As doctors we have a dual responsibility to the individual patient and to the larger population. What’s the very best thing for this patient? What’s the best thing for this population? What are the trade-offs?"

Integrating patient care with stewardship for the entire community is Harrison’s goal. “I want to take care of people one on one, and help them live the healthiest, happiest lives they can as their personal doctor.” At the same time, she wants “to improve health for entire communities, even nations, by improving laws and regulations.” Finding this balance will be her ongoing challenge as a physician leader—a challenge she is excited and increasingly prepared to face.


Source: Lisa Zimmerman