Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine
More Addiction Training at Stanford Med School as Opioid Epidemic Surges
New Kaiser Medical School Part of a Growing Trend
Kaiser Permanente to Open a Medical School in Southern California
Sponsored
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She specializes in covering altered states of mind, from postpartum depression to methamphetamine-induced psychosis to the insanity defense. Her investigative series on insurance companies sidestepping mental health laws won multiple awards, including first place in beat reporting from the national Association of Health Care Journalists. She is the recipient of numerous other prizes and fellowships, including a national Edward R. Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.","avatar":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twitter":"adembosky","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"April Dembosky | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/adembosky"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_360674":{"type":"posts","id":"stateofhealth_360674","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360674","score":null,"sort":[1501803148000]},"guestAuthors":[],"slug":"is-it-ok-for-first-year-doctors-to-work-28-hours-in-a-row-new-rule-says-its-fine","title":"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine","publishDate":1501803148,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>It was 1 am at San Francisco General Hospital. Saturday. The ambulances were rolling in one after another. Resident doctor Josie Valenzuela was near the end of her shift, trying to stay awake.\u003c/p>\n\u003cp>“I was really tired. And my back hurt a lot,” she remembers. “My mind was wandering all over the place.”\u003c/p>\n\u003cp>She was caring for a heroin addict, cutting an abscess open on her leg to drain infection. Then her pager went off. Another ambulance was coming in and this would have to wait for later.\u003c/p>\n\u003cp>“So I went to put the scalpel in some sterile towels for when I could come back,” Valenzuela says, “and I cut my left index finger.”\u003c/p>\n\u003cp>The patient had HIV and hepatitis C.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I knew this was a bad exposure, and that all of the blood and pus that was on that scalpel was now touching my bloodstream,” she says.\u003c/p>\n\u003cp>[audio src=\"http:www.kqed.org/.stream/anon/radio//2017/08/28hourworkdayDembosky.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-ultrasound-768x432.jpg\" Title=\"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine\" program=\"The California Report\"]\u003c/p>\n\u003cp>Valenzuela would have to take anti-viral medications that would make her nauseated for weeks. And she’d have to explain to her husband that she may have contracted a life-long disease.\u003c/p>\n\u003cp>“We were going to start trying to have kids soon,” she says, choking up, “and so that would make it complicated for us.”\u003c/p>\n\u003cp>That’s what she was thinking about when she finally left the hospital at 4 in the morning.\u003c/p>\n\u003cp>“I found my car and I was backing out,” she says. “And I mixed up the gas and the brake. I've never done that before, but I backed right into a concrete pole.”\u003c/p>\n\u003cp>Mistakes like these led medical experts at the Institute of Medicine to issue a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23616719\" target=\"_blank\" rel=\"noopener noreferrer\">recommendation \u003c/a>in 2009 that residents' work shifts be capped at 16 hours. Until then, they were allowed to work up to 28 hours. After a year-long review of the scientific literature, the Institute concluded that human performance begins to decline after 16 hours, and the risk of medical errors and car accidents goes up.\u003c/p>\n\u003cp>So, in 2011, the \u003ca href=\"http://www.acgme.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Accreditation Council for Graduate Medical Education\u003c/a> made a rule, saying first-year doctors could only work a maximum of 16 hours per shift.\u003c/p>\n\u003cp>But this year, the council reversed itself, and starting this summer, new doctors can again work up to 28 hours in a row.\u003c/p>\n\u003cp>“I think the majority of patients in the United States expect that their physician will be available to them whether it's daytime, nighttime, Saturday or Sunday,” says Dr. Rowen Zetterman, co-chair of the task force that reviewed and changed the rule.\u003c/p>\n\u003cfigure id=\"attachment_360682\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360682\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-microscope-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Josie Valenzuela looks through a slit lamp at work. The microscope is for examining the eye. \u003ccite>(Georgie Baumann/University of Arizona)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Patient and resident groups wanted to keep the 16-hour rule, Zetterman says. But senior doctors argued that long hours come with the profession. They complained that the shift limits cut into the time they had for teaching in the hospital, compromising the educational integrity of the residency.\u003c/p>\n\u003cp>“You ask residents a question and they'll say, ‘’I'm just covering, I don't know those things.’ That drives the more senior physicians batty,” says Adams Dudley, a pulmonologist and professor at UCSF School of Medicine. “The perception is they don't know what they're doing as well because they spend less time at the hospital.”\u003c/p>\n\u003cp>Physicians grouse that residents don’t seem as invested in the work when shift limits are in effect, he says, because they’re more focused on handing off their patients to others, rather then seeing them through the cycle of illness.\u003c/p>\n\u003cp>“Because they leave, they don't see the evolution of things, and they don't know the patients as well,” Dudley says. “If you're told you must pay attention to leaving, you have to detach yourself from the patient.”\u003c/p>\n\u003cp>Surgical residents complained about this, too.\u003c/p>\n\u003cp>“They would be in the middle of an operation that they felt like they were learning from, and they would hit the end of their 16 hours and be told that they had to leave the operation and go home,” Zetterman says.\u003c/p>\n\u003cp>This hurt morale on the health care team, he says, as other doctors watched first-year residents clock out when they had to stay, and raised patient-safety concerns.\u003c/p>\n\u003cp>“Let's say your copilot kept coming and going throughout the flight and, then was gone. Didn't come back for the remainder that flight,” Zetterman says. “It seems to me that would be disruptive.”\u003c/p>\n\u003cp>It’s unclear what’s riskier for patients: more frequent hand-offs between doctors, or doctors that are just exhausted. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26054323\" target=\"_blank\" rel=\"noopener noreferrer\">Most studies \u003c/a>show little or no change in patient outcomes after shift limits were put in place, suggesting mistakes and miscommunications that resulted from transitions in care offset any gains made from reducing doctor fatigue.\u003c/p>\n\u003cp>If that's the case, Dr. Josie Valenzuela believes there should be more focus on residents’ well-being, in addition to patients. And while the shift limit was extended to 28 hours in the regulatory, other rules require residency programs to provide more support for residents who feel burned out, stressed, or depressed, including \u003ca href=\"https://ww2.kqed.org/news/2017/07/05/physicians-are-human-beings-new-rules-aim-to-battle-burnout-in-medical-residencies/\" target=\"_blank\" rel=\"noopener noreferrer\">24/7 access\u003c/a> to a mental health professional.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Valenzuela is in her last year of residency now. She says she was lucky after that accidental cut. After nearly a year of periodic checks, she's been officially declared negative for HIV and hepatitis C. Next year, she and her husband plan to have a baby.\u003c/p>\n\n","blocks":[],"excerpt":"Medical education council scraps old rules that limited beginner doctors to 16-hour shifts. This summer, the 28-hour max is back.","status":"publish","parent":0,"modified":1501897616,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1009},"headData":{"title":"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine | KQED","description":"Medical education council scraps old rules that limited beginner doctors to 16-hour shifts. This summer, the 28-hour max is back.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine","datePublished":"2017-08-03T23:32:28.000Z","dateModified":"2017-08-05T01:46:56.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"360674 https://ww2.kqed.org/stateofhealth/?p=360674","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/03/is-it-ok-for-first-year-doctors-to-work-28-hours-in-a-row-new-rule-says-its-fine/","disqusTitle":"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine","path":"/stateofhealth/360674/is-it-ok-for-first-year-doctors-to-work-28-hours-in-a-row-new-rule-says-its-fine","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was 1 am at San Francisco General Hospital. Saturday. The ambulances were rolling in one after another. Resident doctor Josie Valenzuela was near the end of her shift, trying to stay awake.\u003c/p>\n\u003cp>“I was really tired. And my back hurt a lot,” she remembers. “My mind was wandering all over the place.”\u003c/p>\n\u003cp>She was caring for a heroin addict, cutting an abscess open on her leg to drain infection. Then her pager went off. Another ambulance was coming in and this would have to wait for later.\u003c/p>\n\u003cp>“So I went to put the scalpel in some sterile towels for when I could come back,” Valenzuela says, “and I cut my left index finger.”\u003c/p>\n\u003cp>The patient had HIV and hepatitis C.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I knew this was a bad exposure, and that all of the blood and pus that was on that scalpel was now touching my bloodstream,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audio","attributes":{"named":{"src":"http:www.kqed.org/.stream/anon/radio//2017/08/28hourworkdayDembosky.mp3","image":"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-ultrasound-768x432.jpg","title":"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine","program":"The California Report","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Valenzuela would have to take anti-viral medications that would make her nauseated for weeks. And she’d have to explain to her husband that she may have contracted a life-long disease.\u003c/p>\n\u003cp>“We were going to start trying to have kids soon,” she says, choking up, “and so that would make it complicated for us.”\u003c/p>\n\u003cp>That’s what she was thinking about when she finally left the hospital at 4 in the morning.\u003c/p>\n\u003cp>“I found my car and I was backing out,” she says. “And I mixed up the gas and the brake. I've never done that before, but I backed right into a concrete pole.”\u003c/p>\n\u003cp>Mistakes like these led medical experts at the Institute of Medicine to issue a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23616719\" target=\"_blank\" rel=\"noopener noreferrer\">recommendation \u003c/a>in 2009 that residents' work shifts be capped at 16 hours. Until then, they were allowed to work up to 28 hours. After a year-long review of the scientific literature, the Institute concluded that human performance begins to decline after 16 hours, and the risk of medical errors and car accidents goes up.\u003c/p>\n\u003cp>So, in 2011, the \u003ca href=\"http://www.acgme.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Accreditation Council for Graduate Medical Education\u003c/a> made a rule, saying first-year doctors could only work a maximum of 16 hours per shift.\u003c/p>\n\u003cp>But this year, the council reversed itself, and starting this summer, new doctors can again work up to 28 hours in a row.\u003c/p>\n\u003cp>“I think the majority of patients in the United States expect that their physician will be available to them whether it's daytime, nighttime, Saturday or Sunday,” says Dr. Rowen Zetterman, co-chair of the task force that reviewed and changed the rule.\u003c/p>\n\u003cfigure id=\"attachment_360682\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360682\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-microscope-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Josie Valenzuela looks through a slit lamp at work. The microscope is for examining the eye. \u003ccite>(Georgie Baumann/University of Arizona)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Patient and resident groups wanted to keep the 16-hour rule, Zetterman says. But senior doctors argued that long hours come with the profession. They complained that the shift limits cut into the time they had for teaching in the hospital, compromising the educational integrity of the residency.\u003c/p>\n\u003cp>“You ask residents a question and they'll say, ‘’I'm just covering, I don't know those things.’ That drives the more senior physicians batty,” says Adams Dudley, a pulmonologist and professor at UCSF School of Medicine. “The perception is they don't know what they're doing as well because they spend less time at the hospital.”\u003c/p>\n\u003cp>Physicians grouse that residents don’t seem as invested in the work when shift limits are in effect, he says, because they’re more focused on handing off their patients to others, rather then seeing them through the cycle of illness.\u003c/p>\n\u003cp>“Because they leave, they don't see the evolution of things, and they don't know the patients as well,” Dudley says. “If you're told you must pay attention to leaving, you have to detach yourself from the patient.”\u003c/p>\n\u003cp>Surgical residents complained about this, too.\u003c/p>\n\u003cp>“They would be in the middle of an operation that they felt like they were learning from, and they would hit the end of their 16 hours and be told that they had to leave the operation and go home,” Zetterman says.\u003c/p>\n\u003cp>This hurt morale on the health care team, he says, as other doctors watched first-year residents clock out when they had to stay, and raised patient-safety concerns.\u003c/p>\n\u003cp>“Let's say your copilot kept coming and going throughout the flight and, then was gone. Didn't come back for the remainder that flight,” Zetterman says. “It seems to me that would be disruptive.”\u003c/p>\n\u003cp>It’s unclear what’s riskier for patients: more frequent hand-offs between doctors, or doctors that are just exhausted. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26054323\" target=\"_blank\" rel=\"noopener noreferrer\">Most studies \u003c/a>show little or no change in patient outcomes after shift limits were put in place, suggesting mistakes and miscommunications that resulted from transitions in care offset any gains made from reducing doctor fatigue.\u003c/p>\n\u003cp>If that's the case, Dr. Josie Valenzuela believes there should be more focus on residents’ well-being, in addition to patients. And while the shift limit was extended to 28 hours in the regulatory, other rules require residency programs to provide more support for residents who feel burned out, stressed, or depressed, including \u003ca href=\"https://ww2.kqed.org/news/2017/07/05/physicians-are-human-beings-new-rules-aim-to-battle-burnout-in-medical-residencies/\" target=\"_blank\" rel=\"noopener noreferrer\">24/7 access\u003c/a> to a mental health professional.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Valenzuela is in her last year of residency now. She says she was lucky after that accidental cut. After nearly a year of periodic checks, she's been officially declared negative for HIV and hepatitis C. Next year, she and her husband plan to have a baby.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360674/is-it-ok-for-first-year-doctors-to-work-28-hours-in-a-row-new-rule-says-its-fine","authors":["3205"],"categories":["stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_2616","stateofhealth_2828","stateofhealth_2519","stateofhealth_3146"],"featImg":"stateofhealth_360675","label":"stateofhealth"},"stateofhealth_217466":{"type":"posts","id":"stateofhealth_217466","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"217466","score":null,"sort":[1469641121000]},"guestAuthors":[],"slug":"more-addiction-training-at-stanford-med-school-as-opioid-epidemic-surges","title":"More Addiction Training at Stanford Med School as Opioid Epidemic Surges","publishDate":1469641121,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Jonathan Goodman can recall most of the lectures he's attended at the Stanford University School of Medicine. He can recite detailed instructions given more than a year ago about how to conduct a physical.\u003c/p>\n\u003caside class=\"pullquote alignright\">Stanford's medical school may offer an example of what change in teaching about addiction can look like.\u003c/aside>\n\u003cp>But at the end of his second year, the 27-year-old M.D.-Ph.D. student could not remember any class dedicated to addiction medicine. Then he recalled skipping class months earlier. Reviewing his syllabus, he realized he had missed the sole lecture dedicated to that topic.\u003c/p>\n\u003cp>\"I wasn't tested on it,\" Goodman says, with a note of surprise.\u003c/p>\n\u003cp>Americans are \u003ca href=\"http://www.npr.org/sections/health-shots/2016/06/01/479440834/in-opioid-crisis-it-s-important-to-know-which-drugs-caused-a-death\" target=\"_blank\">overdosing on opioids\u003c/a> such as heroin and prescribed painkillers at epidemic rates, and the nation's doctors appear to be inadequately prepared to help.\u003c/p>\n\u003cp>The problem begins in medical school.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A \u003ca href=\"http://www.centeronaddiction.org/addiction-research/reports/addiction-medicine\" target=\"_blank\">report\u003c/a> in 2012 by The National Center on Addiction and Substance Abuse revealed that medical schools devoted little time to teaching addiction medicine — only a few hours over the course of four years. Since then, the number of Americans overdosing from prescribed opioids has surpassed \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">14,000 per year\u003c/a>, quadrupling from 1999 to 2014.\u003c/p>\n\u003cp>But Stanford's medical school may offer an example of what faculty-driven change in teaching about addiction can look like.\u003c/p>\n\u003cp>The school began retooling its curriculum after the director of its addiction medicine fellowship, \u003ca href=\"https://med.stanford.edu/profiles/anna-lembke\" target=\"_blank\">Dr. Anna Lembke\u003c/a>, expressed concern about its meager offerings in that field.\u003c/p>\n\u003cp>Lectures on addiction will no longer be folded into the psychiatry series as a side note, but instead will be presented as a separate unit relevant to future doctors in any subspecialty, Lembke says. And that training will continue when the students leave the classrooms for clinical rotations.\u003c/p>\n\u003cp>\"We're at the very bottom of a very long uphill road,\" says Lembke, who gave the lecture Goodman missed.\u003c/p>\n\u003cp>Medical faculties have traditionally eschewed teaching the subject, in part because many physicians viewed addiction as a personal vice rather than a disease. And, even now, some doctors who specialize in addiction treatment are skeptical that the best care for the problem comes out of a medical model.\u003c/p>\n\u003cp>For example, \u003ca href=\"https://www.youtube.com/watch?v=0Ueb-7ZxltQ\" target=\"_blank\">Dr. Joe Gerstein\u003c/a>, a retired internist and clinical assistant professor at Harvard Medical School, is founding president of \u003ca href=\"http://www.smartrecovery.org/intro/\" target=\"_blank\">SMART Recovery\u003c/a>, an international program that emphasizes cognitive behavioral therapy and positive thinking to help people beat their drug habit.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"Clearly, if you've got an addiction, you've been making a lot of bad choices,\" says Gerstein. Framing substance abuse strictly as a disease ignores the fact that some people are able to quit their use of a drug with willpower, he says.\u003c/p>\n\u003cp>Still, those who believe in the value of medical treatment for addiction say it can no longer be an afterthought in medical education. Because the current opioid epidemic is largely linked to prescribed opioid painkillers, many doctors are being forced to grapple with addicted patients in their practices. In March, the American Board of Medical Specialties \u003ca href=\"http://www.abms.org/news-events/abms-officially-recognizes-addiction-medicine-as-a-subspecialty/\">officially recognized\u003c/a> addiction medicine as a subspecialty.\u003c/p>\n\u003cp>In a March \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20RecoveryReachMAT.pdf\" target=\"_blank\">report\u003c/a>, the California Health Care Foundation cited inadequate medical school training as one of the challenges in treating patients addicted to opioids.\u003c/p>\n\u003cp>The White House has also been pressuring medical schools to improve instruction on opioid addiction by issuing pledges for schools to sign, promising to change their curricula. But as recently as April, Lembke hadn't yet heard of any concrete plans to change Stanford's curriculum.\u003c/p>\n\u003cp>In late spring, however, she was asked to meet with the dean of the medical school about bolstering education in addiction medicine. Working with fellow faculty members, Lembke is now expanding addiction medicine beyond the lone talk she gives on opioids each year to a series of lectures that recommend and teach alternative treatments for pain, like acupuncture or massage.\u003c/p>\n\u003cp>Lembke will also seek an endorsement of her fellowship program by the Accreditation Council of Graduate Medical Education. Accreditation can help programs get additional funding.\u003c/p>\n\u003cp>One of Lembke's Stanford colleagues, \u003ca href=\"https://med.stanford.edu/profiles/jordan-newmark\" target=\"_blank\">Dr. Jordan Newmark\u003c/a>, who directs education in medical school's pain division, is seeking to increase medical students' training on opioids in their third and fourth years. His plans for clinical training sessions include having actors portray patients with opioid addictions.\u003c/p>\n\u003cp>The next hurdle is to recruit doctors to specialize in addiction medicine, says \u003ca href=\"http://www.centeronaddiction.org/about/staff-biographies\" target=\"_blank\">Emily Feinstein\u003c/a>, director of health law and policy at the National Center on Addiction and Substance Abuse.\u003c/p>\n\u003cp>Among the challenges in getting young doctors interested in the field, Feinstein says, are low insurance reimbursement rates and having to deal with patients who can be difficult behaviorally because of their drug use.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It's best to reach doctors at the start of their careers, Lembke says — before they've established a practice and get set in their ways.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=As+Opioid+Epidemic+Surges%2C+Medical+Schools+Must+Change+To+Keep+Pace&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Most medical schools offer little teaching about opioid addiction. Stanford University's medical school is trying to change that.","status":"publish","parent":0,"modified":1469641227,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":819},"headData":{"title":"More Addiction Training at Stanford Med School as Opioid Epidemic Surges | KQED","description":"Most medical schools offer little teaching about opioid addiction. Stanford University's medical school is trying to change that.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"More Addiction Training at Stanford Med School as Opioid Epidemic Surges","datePublished":"2016-07-27T17:38:41.000Z","dateModified":"2016-07-27T17:40:27.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"217466 http://ww2.kqed.org/stateofhealth/?p=217466","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/27/more-addiction-training-at-stanford-med-school-as-opioid-epidemic-surges/","disqusTitle":"More Addiction Training at Stanford Med School as Opioid Epidemic Surges","customPermalink":"2016/07/27/opioid-epidemic-stanford-addiction-training/","nprImageCredit":"Matt Lincol","nprByline":"Natalie Jacewicz","nprImageAgency":"Getty Images/Cultura Exclusive","nprStoryId":"487394411","nprApiLink":"http://api.npr.org/query?id=487394411&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/07/27/487394411/as-opioid-epidemic-surges-medical-schools-must-change-to-keep-pace?ft=nprml&f=487394411","nprRetrievedStory":"1","nprPubDate":"Wed, 27 Jul 2016 05:00:00 -0400","nprStoryDate":"Wed, 27 Jul 2016 05:00:13 -0400","nprLastModifiedDate":"Wed, 27 Jul 2016 05:00:13 -0400","path":"/stateofhealth/217466/more-addiction-training-at-stanford-med-school-as-opioid-epidemic-surges","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Jonathan Goodman can recall most of the lectures he's attended at the Stanford University School of Medicine. He can recite detailed instructions given more than a year ago about how to conduct a physical.\u003c/p>\n\u003caside class=\"pullquote alignright\">Stanford's medical school may offer an example of what change in teaching about addiction can look like.\u003c/aside>\n\u003cp>But at the end of his second year, the 27-year-old M.D.-Ph.D. student could not remember any class dedicated to addiction medicine. Then he recalled skipping class months earlier. Reviewing his syllabus, he realized he had missed the sole lecture dedicated to that topic.\u003c/p>\n\u003cp>\"I wasn't tested on it,\" Goodman says, with a note of surprise.\u003c/p>\n\u003cp>Americans are \u003ca href=\"http://www.npr.org/sections/health-shots/2016/06/01/479440834/in-opioid-crisis-it-s-important-to-know-which-drugs-caused-a-death\" target=\"_blank\">overdosing on opioids\u003c/a> such as heroin and prescribed painkillers at epidemic rates, and the nation's doctors appear to be inadequately prepared to help.\u003c/p>\n\u003cp>The problem begins in medical school.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A \u003ca href=\"http://www.centeronaddiction.org/addiction-research/reports/addiction-medicine\" target=\"_blank\">report\u003c/a> in 2012 by The National Center on Addiction and Substance Abuse revealed that medical schools devoted little time to teaching addiction medicine — only a few hours over the course of four years. Since then, the number of Americans overdosing from prescribed opioids has surpassed \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">14,000 per year\u003c/a>, quadrupling from 1999 to 2014.\u003c/p>\n\u003cp>But Stanford's medical school may offer an example of what faculty-driven change in teaching about addiction can look like.\u003c/p>\n\u003cp>The school began retooling its curriculum after the director of its addiction medicine fellowship, \u003ca href=\"https://med.stanford.edu/profiles/anna-lembke\" target=\"_blank\">Dr. Anna Lembke\u003c/a>, expressed concern about its meager offerings in that field.\u003c/p>\n\u003cp>Lectures on addiction will no longer be folded into the psychiatry series as a side note, but instead will be presented as a separate unit relevant to future doctors in any subspecialty, Lembke says. And that training will continue when the students leave the classrooms for clinical rotations.\u003c/p>\n\u003cp>\"We're at the very bottom of a very long uphill road,\" says Lembke, who gave the lecture Goodman missed.\u003c/p>\n\u003cp>Medical faculties have traditionally eschewed teaching the subject, in part because many physicians viewed addiction as a personal vice rather than a disease. And, even now, some doctors who specialize in addiction treatment are skeptical that the best care for the problem comes out of a medical model.\u003c/p>\n\u003cp>For example, \u003ca href=\"https://www.youtube.com/watch?v=0Ueb-7ZxltQ\" target=\"_blank\">Dr. Joe Gerstein\u003c/a>, a retired internist and clinical assistant professor at Harvard Medical School, is founding president of \u003ca href=\"http://www.smartrecovery.org/intro/\" target=\"_blank\">SMART Recovery\u003c/a>, an international program that emphasizes cognitive behavioral therapy and positive thinking to help people beat their drug habit.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\"Clearly, if you've got an addiction, you've been making a lot of bad choices,\" says Gerstein. Framing substance abuse strictly as a disease ignores the fact that some people are able to quit their use of a drug with willpower, he says.\u003c/p>\n\u003cp>Still, those who believe in the value of medical treatment for addiction say it can no longer be an afterthought in medical education. Because the current opioid epidemic is largely linked to prescribed opioid painkillers, many doctors are being forced to grapple with addicted patients in their practices. In March, the American Board of Medical Specialties \u003ca href=\"http://www.abms.org/news-events/abms-officially-recognizes-addiction-medicine-as-a-subspecialty/\">officially recognized\u003c/a> addiction medicine as a subspecialty.\u003c/p>\n\u003cp>In a March \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20RecoveryReachMAT.pdf\" target=\"_blank\">report\u003c/a>, the California Health Care Foundation cited inadequate medical school training as one of the challenges in treating patients addicted to opioids.\u003c/p>\n\u003cp>The White House has also been pressuring medical schools to improve instruction on opioid addiction by issuing pledges for schools to sign, promising to change their curricula. But as recently as April, Lembke hadn't yet heard of any concrete plans to change Stanford's curriculum.\u003c/p>\n\u003cp>In late spring, however, she was asked to meet with the dean of the medical school about bolstering education in addiction medicine. Working with fellow faculty members, Lembke is now expanding addiction medicine beyond the lone talk she gives on opioids each year to a series of lectures that recommend and teach alternative treatments for pain, like acupuncture or massage.\u003c/p>\n\u003cp>Lembke will also seek an endorsement of her fellowship program by the Accreditation Council of Graduate Medical Education. Accreditation can help programs get additional funding.\u003c/p>\n\u003cp>One of Lembke's Stanford colleagues, \u003ca href=\"https://med.stanford.edu/profiles/jordan-newmark\" target=\"_blank\">Dr. Jordan Newmark\u003c/a>, who directs education in medical school's pain division, is seeking to increase medical students' training on opioids in their third and fourth years. His plans for clinical training sessions include having actors portray patients with opioid addictions.\u003c/p>\n\u003cp>The next hurdle is to recruit doctors to specialize in addiction medicine, says \u003ca href=\"http://www.centeronaddiction.org/about/staff-biographies\" target=\"_blank\">Emily Feinstein\u003c/a>, director of health law and policy at the National Center on Addiction and Substance Abuse.\u003c/p>\n\u003cp>Among the challenges in getting young doctors interested in the field, Feinstein says, are low insurance reimbursement rates and having to deal with patients who can be difficult behaviorally because of their drug use.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It's best to reach doctors at the start of their careers, Lembke says — before they've established a practice and get set in their ways.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=As+Opioid+Epidemic+Surges%2C+Medical+Schools+Must+Change+To+Keep+Pace&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/217466/more-addiction-training-at-stanford-med-school-as-opioid-epidemic-surges","authors":["byline_stateofhealth_217466"],"categories":["stateofhealth_2746"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2616","stateofhealth_2519"],"featImg":"stateofhealth_217467","label":"stateofhealth"},"stateofhealth_125856":{"type":"posts","id":"stateofhealth_125856","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"125856","score":null,"sort":[1450475596000]},"guestAuthors":[],"slug":"new-kaiser-medical-school-part-of-a-growing-trend","title":"New Kaiser Medical School Part of a Growing Trend","publishDate":1450475596,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>Thursday’s \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/17/kaiser-permanente-to-open-a-medical-school-in-southern-california/\" target=\"_blank\">announcement\u003c/a> by Kaiser Permanente that it plans to open its own medical school in Southern California has attracted a lot of attention in the health care community.\u003c/p>\n\u003cp>But Kaiser is actually at the trailing edge of a medical school expansion that has been unmatched since the 1960s and 1970s, say medical education experts. In the past decade alone, according to the \u003ca href=\"https://www.aamc.org/newsroom/newsreleases/436326/20150630_threenewlyaccreditedmedschools.html\" target=\"_blank\">Association of American Medical Colleges\u003c/a>, 20 new medical schools have opened or been approved.\u003c/p>\n\u003cp>That’s no coincidence. In 2006, the AAMC called for a \u003ca href=\"https://www.aamc.org/download/82874/data/helpwanted.pdf\" target=\"_blank\">30 percent increase\u003c/a> in medical school graduates by 2015 to meet a growing demand, both through expanded class sizes and newly created medical schools.\u003c/p>\n\u003cp>“We’re on track to meet that 30 percent increase in the next three or four years,” said Atul Grover, AAMC’s chief public policy officer. “Enrollment is already up 25 percent since 2002.”\u003c/p>\n\u003cp>Many of the new schools focus on producing more \u003ca href=\"http://www.npr.org/sections/health-shots/2013/04/02/175945921/new-medical-school-wants-to-build-ranks-of-primary-care-doctors\" target=\"_blank\">primary care doctors\u003c/a> — those specializing in pediatrics, family medicine or general internal medicine. In fact, Kaiser Permanente already has a partnership with the UC Davis on a \u003ca href=\"http://www.ucdmc.ucdavis.edu/publish/news/newsroom/9071\" target=\"_blank\">fast-track training program\u003c/a> for primary care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But Kaiser leaders say their new school (projected to enroll its first class in 2019) is about more than just primary care.\u003c/p>\n\u003cp>“We need to prepare physicians for the way health care is delivered in the future,” said Dr. Edward Ellison, executive medical director for the Southern California Permanente Medical Group. He said students need to learn not just medicine, but about integrated systems of care and how to work in a much different medical environment. “Our advantage is we can start from scratch,” he said.\u003c/p>\n\u003cp>Another advantage is the HMO’s deep pockets.\u003c/p>\n\u003cp>“They’ve got huge resources,” said George Thibault, president of the \u003ca href=\"http://macyfoundation.org/\" target=\"_blank\">Josiah Macy Jr. Foundation\u003c/a>, which focuses on medical education. “This is a grand experiment, but if anybody can do it, Kaiser can.”\u003c/p>\n\u003cp>Kaiser Permanente is far from the first health care provider to launch its own medical school — the \u003ca href=\"http://www.mayo.edu/mms/\" target=\"_blank\">Mayo Clinic\u003c/a> has had one since 1972 and is about to expand that school from its home base in Minnesota to its satellite campuses in Arizona and Florida.\u003c/p>\n\u003cp>Thibault said health-provider systems are already heavily involved in the new medical schools, often as partners with degree-granting universities, “which itself is a new trend.” For example, on Long Island, the North Shore-LIJ Health System \u003ca href=\"http://medicine.hofstra.edu/about/history/index.html\" target=\"_blank\">co-launched a medical school\u003c/a> with Hofstra University in 2011.\u003c/p>\n\u003cp>One big question is whether all these new schools will eventually produce more students than there are residency positions, which are necessary to complete the training. The federal government, which funds the majority of those residencies through the \u003ca href=\"http://economix.blogs.nytimes.com/2013/12/17/how-medicare-subsidizes-doctor-training/?_r=0\" target=\"_blank\">Medicare program\u003c/a>, capped the number of residencies it would fund in the \u003ca href=\"http://www.commonwealthfund.org/publications/fund-reports/1997/sep/an-examination-of-key-medicare-provisions-in-the-balanced-budget-act-of-1997\" target=\"_blank\">1997 Balanced Budget Act\u003c/a>.\u003c/p>\n\u003cp>Currently there are about 27,000 residency slots available each year, which are filled by students who have earned M.D. or D.O. degrees (doctors of osteopathy) in the U.S., as well as foreign medical school graduates and U.S. citizens who have graduated from medical schools overseas.\u003c/p>\n\u003cp>Between the new M.D.-granting schools and \u003ca href=\"http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Pages/growth-in-osteopathic-medical-students.aspx\" target=\"_blank\">a rapid expansion\u003c/a> of osteopathic medical schools, AAMC’s Grover said, demand will soon outstrip supply. Residency slots “are growing at about 1 percent per year,” he said (mostly funded by health systems themselves since Medicare will not), “while undergraduate medical education is growing about 3 percent per year.”\u003c/p>\n\u003cp>But Edward Salsberg of George Washington University, who has spent a career documenting health workforce trends, said any potential conflict is still a long way off.\u003c/p>\n\u003cp>“When you start with an excess of 7,000 slots” of residencies over graduating U.S. medical students, “it takes a very long time” to consume that excess, he said. By the year 2024, he and others concluded in a recent article in the \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1511707\" target=\"_blank\">New England Journal of Medicine\u003c/a>, there will still be 4,500 more slots than graduates.\u003c/p>\n\u003cp>“So yes, U.S. medical students will have a slightly more limited range of specialties to choose from,” said Salsberg, “but still plenty of room.”\u003c/p>\n\u003cp>There are also questions about whether there even is a \u003ca href=\"http://www.npr.org/sections/health-shots/2014/11/18/360145347/doctor-shortage-looming-maybe-not\" target=\"_blank\">doctor shortage\u003c/a> that all these new schools are aiming to alleviate.\u003c/p>\n\u003cp>Grover, whose organization has led the call for more doctors, said the anticipated shortage of primary care physicians might not be as acute as originally thought. That’s because the U.S. is producing dramatically more \u003ca href=\"http://healthaffairs.org/blog/2015/05/26/the-nurse-practitioner-physician-assistant-and-pharmacist-pipelines-continued-growth/\" target=\"_blank\">nurse practitioners and physician assistants\u003c/a>, who also provide primary care.\u003c/p>\n\u003cp>That’s probably a good thing, at least in supply terms, said Thibault of the Macy Foundation. Because it turns out that many students graduating from new primary care-focused school’s programs are in fact opting to become specialists instead.\u003c/p>\n\u003cp>“The career choices in the new schools look remarkably similar to career choices of more traditional schools,” he said. The graduating medical students “are responding to the same set of signals and stimuli” about prestige, income and lifestyle.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Julie Rovner is a reporter with \u003c/em>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003cem>\u003ca href=\"http://www.kff.org/\">Kaiser Family Foundation\u003c/a>\u003c/em>\u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003cem>and is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Kaiser is the latest of 20 U.S. medical schools opened in the past decade to boost the number of primary care doctors.","status":"publish","parent":0,"modified":1450476118,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":941},"headData":{"title":"New Kaiser Medical School Part of a Growing Trend | KQED","description":"Kaiser is the latest of 20 U.S. medical schools opened in the past decade to boost the number of primary care doctors.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"New Kaiser Medical School Part of a Growing Trend","datePublished":"2015-12-18T21:53:16.000Z","dateModified":"2015-12-18T22:01:58.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"125856 http://ww2.kqed.org/stateofhealth/?p=125856","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/12/18/new-kaiser-medical-school-part-of-a-growing-trend/","disqusTitle":"New Kaiser Medical School Part of a Growing Trend","source":"Kaiser Health News","sourceUrl":"http://khn.org/news/new-kaiser-permanente-med-school-part-of-a-growing-trend/","nprByline":"Julie Rovner","path":"/stateofhealth/125856/new-kaiser-medical-school-part-of-a-growing-trend","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Thursday’s \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/17/kaiser-permanente-to-open-a-medical-school-in-southern-california/\" target=\"_blank\">announcement\u003c/a> by Kaiser Permanente that it plans to open its own medical school in Southern California has attracted a lot of attention in the health care community.\u003c/p>\n\u003cp>But Kaiser is actually at the trailing edge of a medical school expansion that has been unmatched since the 1960s and 1970s, say medical education experts. In the past decade alone, according to the \u003ca href=\"https://www.aamc.org/newsroom/newsreleases/436326/20150630_threenewlyaccreditedmedschools.html\" target=\"_blank\">Association of American Medical Colleges\u003c/a>, 20 new medical schools have opened or been approved.\u003c/p>\n\u003cp>That’s no coincidence. In 2006, the AAMC called for a \u003ca href=\"https://www.aamc.org/download/82874/data/helpwanted.pdf\" target=\"_blank\">30 percent increase\u003c/a> in medical school graduates by 2015 to meet a growing demand, both through expanded class sizes and newly created medical schools.\u003c/p>\n\u003cp>“We’re on track to meet that 30 percent increase in the next three or four years,” said Atul Grover, AAMC’s chief public policy officer. “Enrollment is already up 25 percent since 2002.”\u003c/p>\n\u003cp>Many of the new schools focus on producing more \u003ca href=\"http://www.npr.org/sections/health-shots/2013/04/02/175945921/new-medical-school-wants-to-build-ranks-of-primary-care-doctors\" target=\"_blank\">primary care doctors\u003c/a> — those specializing in pediatrics, family medicine or general internal medicine. In fact, Kaiser Permanente already has a partnership with the UC Davis on a \u003ca href=\"http://www.ucdmc.ucdavis.edu/publish/news/newsroom/9071\" target=\"_blank\">fast-track training program\u003c/a> for primary care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Kaiser leaders say their new school (projected to enroll its first class in 2019) is about more than just primary care.\u003c/p>\n\u003cp>“We need to prepare physicians for the way health care is delivered in the future,” said Dr. Edward Ellison, executive medical director for the Southern California Permanente Medical Group. He said students need to learn not just medicine, but about integrated systems of care and how to work in a much different medical environment. “Our advantage is we can start from scratch,” he said.\u003c/p>\n\u003cp>Another advantage is the HMO’s deep pockets.\u003c/p>\n\u003cp>“They’ve got huge resources,” said George Thibault, president of the \u003ca href=\"http://macyfoundation.org/\" target=\"_blank\">Josiah Macy Jr. Foundation\u003c/a>, which focuses on medical education. “This is a grand experiment, but if anybody can do it, Kaiser can.”\u003c/p>\n\u003cp>Kaiser Permanente is far from the first health care provider to launch its own medical school — the \u003ca href=\"http://www.mayo.edu/mms/\" target=\"_blank\">Mayo Clinic\u003c/a> has had one since 1972 and is about to expand that school from its home base in Minnesota to its satellite campuses in Arizona and Florida.\u003c/p>\n\u003cp>Thibault said health-provider systems are already heavily involved in the new medical schools, often as partners with degree-granting universities, “which itself is a new trend.” For example, on Long Island, the North Shore-LIJ Health System \u003ca href=\"http://medicine.hofstra.edu/about/history/index.html\" target=\"_blank\">co-launched a medical school\u003c/a> with Hofstra University in 2011.\u003c/p>\n\u003cp>One big question is whether all these new schools will eventually produce more students than there are residency positions, which are necessary to complete the training. The federal government, which funds the majority of those residencies through the \u003ca href=\"http://economix.blogs.nytimes.com/2013/12/17/how-medicare-subsidizes-doctor-training/?_r=0\" target=\"_blank\">Medicare program\u003c/a>, capped the number of residencies it would fund in the \u003ca href=\"http://www.commonwealthfund.org/publications/fund-reports/1997/sep/an-examination-of-key-medicare-provisions-in-the-balanced-budget-act-of-1997\" target=\"_blank\">1997 Balanced Budget Act\u003c/a>.\u003c/p>\n\u003cp>Currently there are about 27,000 residency slots available each year, which are filled by students who have earned M.D. or D.O. degrees (doctors of osteopathy) in the U.S., as well as foreign medical school graduates and U.S. citizens who have graduated from medical schools overseas.\u003c/p>\n\u003cp>Between the new M.D.-granting schools and \u003ca href=\"http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Pages/growth-in-osteopathic-medical-students.aspx\" target=\"_blank\">a rapid expansion\u003c/a> of osteopathic medical schools, AAMC’s Grover said, demand will soon outstrip supply. Residency slots “are growing at about 1 percent per year,” he said (mostly funded by health systems themselves since Medicare will not), “while undergraduate medical education is growing about 3 percent per year.”\u003c/p>\n\u003cp>But Edward Salsberg of George Washington University, who has spent a career documenting health workforce trends, said any potential conflict is still a long way off.\u003c/p>\n\u003cp>“When you start with an excess of 7,000 slots” of residencies over graduating U.S. medical students, “it takes a very long time” to consume that excess, he said. By the year 2024, he and others concluded in a recent article in the \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1511707\" target=\"_blank\">New England Journal of Medicine\u003c/a>, there will still be 4,500 more slots than graduates.\u003c/p>\n\u003cp>“So yes, U.S. medical students will have a slightly more limited range of specialties to choose from,” said Salsberg, “but still plenty of room.”\u003c/p>\n\u003cp>There are also questions about whether there even is a \u003ca href=\"http://www.npr.org/sections/health-shots/2014/11/18/360145347/doctor-shortage-looming-maybe-not\" target=\"_blank\">doctor shortage\u003c/a> that all these new schools are aiming to alleviate.\u003c/p>\n\u003cp>Grover, whose organization has led the call for more doctors, said the anticipated shortage of primary care physicians might not be as acute as originally thought. That’s because the U.S. is producing dramatically more \u003ca href=\"http://healthaffairs.org/blog/2015/05/26/the-nurse-practitioner-physician-assistant-and-pharmacist-pipelines-continued-growth/\" target=\"_blank\">nurse practitioners and physician assistants\u003c/a>, who also provide primary care.\u003c/p>\n\u003cp>That’s probably a good thing, at least in supply terms, said Thibault of the Macy Foundation. Because it turns out that many students graduating from new primary care-focused school’s programs are in fact opting to become specialists instead.\u003c/p>\n\u003cp>“The career choices in the new schools look remarkably similar to career choices of more traditional schools,” he said. The graduating medical students “are responding to the same set of signals and stimuli” about prestige, income and lifestyle.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Julie Rovner is a reporter with \u003c/em>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003cem>\u003ca href=\"http://www.kff.org/\">Kaiser Family Foundation\u003c/a>\u003c/em>\u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003cem>and is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/125856/new-kaiser-medical-school-part-of-a-growing-trend","authors":["byline_stateofhealth_125856"],"categories":["stateofhealth_14"],"tags":["stateofhealth_2607","stateofhealth_2616","stateofhealth_2519"],"featImg":"stateofhealth_125861","label":"source_stateofhealth_125856"},"stateofhealth_125242":{"type":"posts","id":"stateofhealth_125242","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"125242","score":null,"sort":[1450389275000]},"guestAuthors":[],"slug":"kaiser-permanente-to-open-a-medical-school-in-southern-california","title":"Kaiser Permanente to Open a Medical School in Southern California","publishDate":1450389275,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Kaiser Permanente, the managed health care giant that now offers patients an integrated system combining insurance, hospitals and outpatient physicians, is adding a medical school to its portfolio, the company announced Thursday.\u003c/p>\n\u003cp>The nonprofit HMO, based in Oakland, will open the Kaiser Permanente School of Medicine in Southern California in 2019. No specific site has yet been selected.\u003c/p>\n\u003cp>\"This is a natural evolution for us,\" Kaiser's CEO Bernard Tyson said in an interview. \"We are very motivated in being part of the transformation of the entire health care ecosystem.\"\u003c/p>\n\u003cp>Kaiser says it will base physician training on \"strategic pillars\" including providing care beyond traditional medical settings, emphasizing collaboration and teamwork, and addressing health disparities.\u003c/p>\n\u003cp>Kaiser has long been lauded by health care experts as delivering high quality care to its population of 10.2 million patients. Kaiser is known for providing coordinated care in a technology-driven environment. It was an early adopter of electronic health records and uses its system to reach patients about basic and complex medical needs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We now want to take all of our learnings and understanding of how to care for population and individuals and teach it more upstream for the future physicians of the 21st century,\" Tyson said.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/238062573\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Kaiser says it is committed to attracting a diverse pool of students \"to better reflect the communities we serve,\" said Dr. Edward Ellison, executive director of the Southern California Permanente Medical Group. \"We've been able successfully to move, not completely, to closing the care gaps in health disequities for different populations, ... and we see that type of work in informing the medical students and how we educate them.\"\u003c/p>\n\u003cp>In a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/12/16/study-west-eliminates-race-gap-on-key-health-measures-disparities/\" target=\"_blank\">major analysis\u003c/a> last year, Kaiser was cited as closing the race gap in managing heart disease and diabetes, diseases which account for much of the reason African Americans have shorter life expectancies than caucasians.\u003c/p>\n\u003cp>The HMO has long been involved in medical education, but at the residency level, training more than 600 residents every year.\u003c/p>\n\u003cp>Kaiser's move is unusual. The nation's 145 medical schools are mostly affiliated with universities, although the Mayo Medical School campus operates within the Mayo Clinic in Rochester, Minnesota.\u003c/p>\n\u003cp>\"There are precedents, but this will be different,\" John Prescott, chief academic officer with the American Association of Medical Colleges, said of Kaiser's new school. \"It's an integrated health care system that's looking at developing a medical school. I think there will be some surprises as the school unfolds.\"\u003c/p>\n\u003cp>Prescott said the school will need to be accredited and that process could take several years. Twenty new medical schools have opened in the U.S. since 2002, he said, and many of them feature \"innovative models,\" he said.\u003c/p>\n\u003cp>Still, building a new medical school is \"fraught with risk,\" said John Deane, president of Advisory Board Consulting and Management. He said it could be a \"huge waste of money\" if Kaiser were to replicate the existing model of specialty-focused academic medical centers.\u003c/p>\n\u003cp>\"On the other hand,\" he said, \"they have an opportunity to do this in a new and different way that could be a form of disruptive innovation that could become a new standard for teaching doctors.\"\u003c/p>\n\u003cp>Tyson and Ellison both seemed focused on innovation as opposed to status quo.\u003c/p>\n\u003cp>\"We are excited to be on the frontier of creating a new medical school and thinking about how do we transform a medical education to meet the transformative needs of health care in this country, today, and into the future.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I'm as interested and motivated and part of the sponsorship of this 21st century new medical school if I were a physician myself,\" Tyson said.\u003c/p>\n\n","blocks":[],"excerpt":"The HMO giant plans to open the school in 2019 and enroll 40-50 students from across the country in its first class.","status":"publish","parent":0,"modified":1450417557,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":649},"headData":{"title":"Kaiser Permanente to Open a Medical School in Southern California | KQED","description":"The HMO giant plans to open the school in 2019 and enroll 40-50 students from across the country in its first class.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Kaiser Permanente to Open a Medical School in Southern California","datePublished":"2015-12-17T21:54:35.000Z","dateModified":"2015-12-18T05:45:57.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"125242 http://ww2.kqed.org/stateofhealth/?p=125242","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/12/17/kaiser-permanente-to-open-a-medical-school-in-southern-california/","disqusTitle":"Kaiser Permanente to Open a Medical School in Southern California","path":"/stateofhealth/125242/kaiser-permanente-to-open-a-medical-school-in-southern-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Kaiser Permanente, the managed health care giant that now offers patients an integrated system combining insurance, hospitals and outpatient physicians, is adding a medical school to its portfolio, the company announced Thursday.\u003c/p>\n\u003cp>The nonprofit HMO, based in Oakland, will open the Kaiser Permanente School of Medicine in Southern California in 2019. No specific site has yet been selected.\u003c/p>\n\u003cp>\"This is a natural evolution for us,\" Kaiser's CEO Bernard Tyson said in an interview. \"We are very motivated in being part of the transformation of the entire health care ecosystem.\"\u003c/p>\n\u003cp>Kaiser says it will base physician training on \"strategic pillars\" including providing care beyond traditional medical settings, emphasizing collaboration and teamwork, and addressing health disparities.\u003c/p>\n\u003cp>Kaiser has long been lauded by health care experts as delivering high quality care to its population of 10.2 million patients. Kaiser is known for providing coordinated care in a technology-driven environment. It was an early adopter of electronic health records and uses its system to reach patients about basic and complex medical needs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We now want to take all of our learnings and understanding of how to care for population and individuals and teach it more upstream for the future physicians of the 21st century,\" Tyson said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/238062573&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/238062573'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Kaiser says it is committed to attracting a diverse pool of students \"to better reflect the communities we serve,\" said Dr. Edward Ellison, executive director of the Southern California Permanente Medical Group. \"We've been able successfully to move, not completely, to closing the care gaps in health disequities for different populations, ... and we see that type of work in informing the medical students and how we educate them.\"\u003c/p>\n\u003cp>In a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/12/16/study-west-eliminates-race-gap-on-key-health-measures-disparities/\" target=\"_blank\">major analysis\u003c/a> last year, Kaiser was cited as closing the race gap in managing heart disease and diabetes, diseases which account for much of the reason African Americans have shorter life expectancies than caucasians.\u003c/p>\n\u003cp>The HMO has long been involved in medical education, but at the residency level, training more than 600 residents every year.\u003c/p>\n\u003cp>Kaiser's move is unusual. The nation's 145 medical schools are mostly affiliated with universities, although the Mayo Medical School campus operates within the Mayo Clinic in Rochester, Minnesota.\u003c/p>\n\u003cp>\"There are precedents, but this will be different,\" John Prescott, chief academic officer with the American Association of Medical Colleges, said of Kaiser's new school. \"It's an integrated health care system that's looking at developing a medical school. I think there will be some surprises as the school unfolds.\"\u003c/p>\n\u003cp>Prescott said the school will need to be accredited and that process could take several years. Twenty new medical schools have opened in the U.S. since 2002, he said, and many of them feature \"innovative models,\" he said.\u003c/p>\n\u003cp>Still, building a new medical school is \"fraught with risk,\" said John Deane, president of Advisory Board Consulting and Management. He said it could be a \"huge waste of money\" if Kaiser were to replicate the existing model of specialty-focused academic medical centers.\u003c/p>\n\u003cp>\"On the other hand,\" he said, \"they have an opportunity to do this in a new and different way that could be a form of disruptive innovation that could become a new standard for teaching doctors.\"\u003c/p>\n\u003cp>Tyson and Ellison both seemed focused on innovation as opposed to status quo.\u003c/p>\n\u003cp>\"We are excited to be on the frontier of creating a new medical school and thinking about how do we transform a medical education to meet the transformative needs of health care in this country, today, and into the future.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I'm as interested and motivated and part of the sponsorship of this 21st century new medical school if I were a physician myself,\" Tyson said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/125242/kaiser-permanente-to-open-a-medical-school-in-southern-california","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_803","stateofhealth_2616","stateofhealth_2519"],"featImg":"stateofhealth_118352","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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