Since 2006, Dr. Darrell Kirch has served as president and CEO of the Association of American Medical Colleges, which represents nearly 400 teaching hospitals and health systems, including Veterans Affairs Department facilities. Before that, Kirch, a psychiatrist and neuroscientist, served as CEO of the Milton S. Hershey Medical Center at Pennsylvania State University, held leadership positions at the Medical College of Georgia, and was acting scientific director at the National Institute of Mental Health. Modern Healthcare reporter Andis Robeznieks recently spoke with Kirch about expanding the physician workforce, efforts to recruit more minority medical students, his organization's legislative agenda, Ebola and innovations in medical education. This is an edited transcript.
Modern Healthcare: Why do you think a record number of students are applying to medical school despite the negativity you hear from many physicians about their profession?
Dr. Darrell Kirch: We're at a time when professions like business and law are seeing dramatic decreases in applications. But we had a record number of nearly 50,000 applicants for the 20,000 first-year positions in medical schools this year. I think today's students hear the negative comments but discount them as coming from people who entered a prior world of medicine and are unhappy with the changes they're seeing.
Our students are looking to the future, and they believe that medicine will continue to be one of the most exciting, gratifying and noble professions they could pursue.
MH: There was an increase in Latino or Hispanic enrollment of about 1.8% and African-American enrollment by about 1.1%. What is being done to recruit more minority medical students?
Kirch: Recently in our medical education meeting, there was a presentation by two extraordinary medical students who had been in Teach for America before medical school. When they got to medical school, they started a program for inner-city black students in the 10th grade to help them become college-ready and then go on to medical careers. Those kinds of efforts I see occurring at almost every one of our schools to improve the pipeline.
The other thing is current minority physicians are doing personal mentoring, creating role models for potential future students. This summer I spoke with the American-Indian physicians, who are doing extraordinary work with American-Indians and Alaska Natives. In fact, we saw one of the biggest jumps in matriculants in that group this year.
MH: How does medical debt affect a young doctor's choice of specialty?
Kirch: The conventional wisdom is that debt causes certain specialty choices among our graduates. In fact, the research data are very different. Recently, there were two studies that showed financial considerations were low on the scale of the things that determined specialty choice. High on the scale were items like: Will I enjoy the work? Will I be able to achieve the kind of work/life balance that I want? Those all ranked much higher than debt. So even though you and I might believe that an average debt of $180,000 would be the determining factor, for reasons we still are trying to fully understand, for students that's not the case.
We've done economic studies that show that with the loan programs that exist and with good debt management, students are still able to manage that debt over their career even if they're in one of the lesser well-compensated specialties.
MH: Any thoughts on how Republican election victories and the new GOP-controlled Congress may affect your member institutions in terms of Medicaid expansion, increased money for graduate medical education, new residency positions, or the teaching health centers?
Kirch: There will be debate and perhaps legislation moved forward related to aspects of the Affordable Care Act. Our position as an association is that it's critically important to insure more people. And the data indicate that the Affordable Care Act both through the exchanges and Medicaid expansion has done that. We would argue strongly against anything that would roll back that insurance coverage. That really affects our member hospitals.
All parts of our community are very, very concerned about how we're going to weather the multidimensional budget constraints we're seeing, whether it's National Institutes of Health funding or threats to decrease rather than expand GME funding. There's a lot of anxiety in our community about those things. In my conversations with people in both parties on Capitol Hill, I have found they understand the need to build the physician workforce. We have 10,000 baby boomers turning 65 every day, and the percentage of physicians who are over 65 is actually greater than the percentage of the population, so we're going to face a wave of retirements. We see members of the House and Senate of both parties understanding this because they're hearing from their constituents about problems with physician access. Unfortunately, we also saw the physician shortage play out in the VA problems last year.
MH: How has the Medicaid expansion benefited AAMC's member institutions?
Kirch: It's been critically important. Our 400 teaching hospital members represent roughly 5% of all U.S. hospitals but deliver 37% of the charity care for the uninsured. Similarly, the percentage of Medicaid nationally that is delivered by our hospitals is 30%. It helps our members greatly when they can move those uninsured into insured status through Medicaid, the exchanges or other mechanisms. We would hope now that the election is behind us, we would see more states with conservative leadership do what Gov. Jan Brewer did in Arizona and expand Medicaid.
MH: How have academic medical centers and teaching hospitals responded to the Ebola crisis?
Kirch: The fact that the University of Nebraska Medical Center, Emory Medical Center and the Clinical Center at NIH each were prepared with the proper containment facilities and protective equipment reflects that our nation needs to have that capacity in reserve. We may not see a large number of Ebola patients, but we will see future pandemics of highly infectious agents. What we need is to have the teaching hospitals, which respond when you have a special crisis like this, better prepared. If it isn't Ebola, if it isn't SARS, it will be the next influenza pandemic.
MH: What about shortening medical school to perhaps three years, or letting people go as fast as they need to learn the material?
Kirch: In all parts of education, we've had this constraint that everything had a specified “time in seat.” The notion that everybody learns at the same rate doesn't fit reality. So there is a lot of interest in creating three-year programs. The innovation is going on into residency, so there are a group of pilot schools that are taking first-year students interested in pediatrics and moving them through not just medical school, but pediatric residency training at their own pace. I think this is the future.
