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CLINICIAN to CLINICIAN

Considering a new medical school: What is Allina thinking?

What are you thinking? It is a question I ask my child when I see some of her more "interesting" choices. It also is a question many are asking about the idea of partnering with the University of St. Thomas to start a new medical school.

Let me explain our thinking.

Our community's health and wellness needs

The overarching issue is how we will best meet the health and wellness needs of our community in the future.

For example, we have an aging population and one making many unhealthy lifestyle choices. As a result, growth of chronic illness is bourgeoning. The number of people over the age of 65 is doubling in the next three decades to over 80 million. Over 90 percent of Americans in that age group have at least one chronic illness.

Childhood obesity, tobacco use and other lifestyle issues ramp up the percentage of those impacted by chronic illness. These illnesses take a significant human toll on our patients, their loved ones, and our broader community.

Chronic illness also is responsible for 83 percent of health care spending. So when chronic illness is left unaddressed, we have fewer dollars to care for the health of our community.

Preventing chronic illness and decreasing its burden

As clinicians, we need to play an important role both in preventing chronic illness and decreasing its burden. We need to assure we have the folks to provide the right care in the best way. There are many approaches to answer this need:

• educating more clinicians
• extending the reach of doctors and nurses by using more multi-disciplinary care teams
• better supporting the patient to better manage their own healing
• rewarding clinicians who bear the burden for meeting the needs of the community – chronic illness, mental health, preventative health, to name a few

More primary care clinicians and new models of caring

There is a need to educate more primary care clinicians and to provide new models of caring that emphasize teamwork in the delivery of comprehensive and coordinated care.

When it comes to educating more clinicians, the need is clear.

• It is estimated that we'll have a shortage of 70,000 physicians and 900,000 nurses in the U.S. by 2020.
• From 2000 to 2004, the number of primary care physicians in Minnesota increased by only 20, while the number of specialty care physicians rose by 129.
• Two-thirds of the primary care residents in the Twin Cities come from other states or countries and do not choose to stay and practice here.

In addition to the need for more clinicians, we believe that there is an opportunity to create a truly innovative model of medical education -- one that:

• focuses on attracting and retaining students interested in primary care to serve both individual patients and our community as a whole
• will teach students to work in multi-disciplinary teams
• optimize the clinical record
• explore the intersection between Western and complimentary medicine
• continually improve the quality and safety of care
• promote wellness
• enable patients to manage their own care

Seeking answers to difficult and complex questions

As we embark on a study with St. Thomas to answer difficult and complex questions about such a project, we also must ask ourselves, our medical staffs and our broader community of stakeholders:

• What is Allina's role in influencing/answering the future health care of community?
• How do we deal with the tension of this obligation with our need to focus on the short-term needs?
• In the best-case scenario, the first medical school class likely won't be practicing until 2017. How can we anticipate what our health care system will look like then?
• Are resources best used to educate physicians in innovative ways to meet health care needs or should they be best used in other ways? For example, would an investment to increase the number of nurse practitioners be more cost-effective and consistent with Allina's long term strategic vision and be a better use of resources than training primary care physicians?

In addition, we must be clear about the implications of a secular organization partnering with a faith-based organization to train medical students. This is the very first question the joint Allina-St. Thomas feasibility study committee is wrestling with.

What are you thinking?

As this work advances, input from medical staffs and other clinicians will be critical.

While it is yet unclear whether we will proceed in this endeavor, it is clear that this is opening an important dialog which speaks to the long-term health needs of our community.

I welcome your thoughts and observations about these issues. Please e-mail me.  

First published: 06/20/2007
Last updated: 06/20/2007

Reviewed by: Penny Ann Wheeler, MD, chief clinical officer, Allina Hospitals & Clinics