DR. CLAY JOHNSTON AIMS TO TRAIN PHYSICIAN LEADERS TO FIX A BROKEN MEDICAL SYSTEM
For entrepreneurs, nothing compares to the feeling of building a vision from the ground up. For Dr. Clay Johnston, the dean of the new Dell Medical School at the University of Texas-Austin, that vision is becoming a reality as the first new medical school to be built at a top tier university in the last 50 years begins educating its first class of doctors.
The initial vision for DellMed, as it’s called for short, was to build a vital, inclusive health ecosystem, whose mission is to innovate a new health care delivery system by educating leaders in the field and improving health in the local community, serving as a model for the rest of the country. That service obligation is the most important aspect of the new medical school, says Johnston.
To begin creating a community-focused ecosystem for health, Johnston says it’s necessary to focus on what medical education is lacking in today’s environment. “We need physician leaders,” he said. “We need to understand being creative, understand what leadership means, have better communication skills, understand design and designing systems of care.” All of those are key components of DellMed.
Then, the school — its students, faculty, and leadership — must take that new understanding into the existing medical community, building new, patient-centric infrastructures. “In the past the thinking was, ‘The margins on this kind of care are particularly good, so let’s do this because we can make a lot of money on this procedure,’” Johnston said. But under the system DellMed hopes to create, payers will pay for better outcomes for patients, not for more surgeries.
“The number one expenditure today in Medicare is joint replacement,” Johnston said. “Rather than getting paid for doing the surgery, we want to get paid for taking care of patients with joint pain. We want to get paid based on our ability to have patients be pain free and getting them back to their regular life — not on doing more surgeries.”
That would be a major departure from the way the system currently works. “In our current fee-for-service system, the whole system would get paid twice if the first joint replacement fails,” Johnston said. Under the system envisioned by DellMed, the hospital would be incentivized to make sure the replacement surgery succeeds, because they would receive payment only once — a second surgery would be on the house. “That’s what most payers want and those are the ones we want to work with,” he said.
The hitch Johnston envisions is in getting the rest of the medical community on board. “If no one will pay for it, we can’t do it,” he said. To get the kind of buy in they need to make this new concept the standard, Johnston says he’ll have to collect more data proving DellMed’s system truly does lead to better outcomes.
DellMed’s Curriculum Nurtures Not Only Physicians, but Physician Leaders
But while DellMed figures out how to more efficiently pay for treatments, it is also going to change the way it educates new doctors. The curriculum at the school is not like curricula at other established medical schools, which Johnston calls “gigantic factories of health care.” He doesn’t argue with their success, but says that success has not provided them with an incentive to change.
“We have the benefit of being brand new,” he said. The curriculum reflects that outlook. “We don’t do typical lectures in classrooms,” Johnston added. “When students are together it’s more group problem solving.”
The first year at DellMed is spent learning the basic sciences, something that takes two years at the typical medical school. The second year focuses on health care delivery — 48 weeks of clinical instruction. It’s the third year that sets DellMed apart. This is called the “growth year,” with a nine-month block concentrating on innovation, leadership and discovery. The goal is to prepare physician leaders who will have a hand in transforming health care. Students can choose to concentrate on population health or health care design, or they can opt to do research.
During the growth year, students work across disciplinary boundaries. In health care design, students will collaborate with the College of Fine Arts and the Design Institute for Health to work on problem solving and incorporate “design thinking” to figure out not only what happens when a person gets sick, but how populations can stay well. They’ll learn leadership techniques from renowned leadership coach Eddie Erlandson, whose resume includes work with Dell Computers, Coca-Cola and the Boston Red Sox. DellMed and the College of Communications collaborate to teach physicians better communications skills.
“From there,” Johnston said, “they work on projects in teams. We have a payer lined up, and if the project is successful, it will be spread through the system. The students become part of the team that’s proposing and looking for those innovations. They will work with senior physicians and engineers.”
DellMed Graduates are Prepared to Become Change Agents
When DellMed’s newly-minted doctors leave the school and go out into the existing medical system, will they be able to make the transition? Johnson thinks they’ll become leaders in the transition. “Our people become the change agents wherever they go,” he said. “The transition will not necessarily be easy, but you always remember the world you grew up in and bring a bit of that with you wherever you go.”
To attract the kind of person interested in an innovative medical education, DellMed screens applicants differently – becoming a DellMed student is more than a high MCAT score. Johnston said it’s a much more extensive interview process than the one he went through. “We had teams of students solving a problem and we watched how they did,” he said. “We also did rapid responses to questions with situational type questions and watched their responses.”
Those students accepted into the medical school will eventually work in the community, and one of the key constituents of DellMed is Central Health — the public entity in Austin that works to provide quality, cost-effective health care to uninsured, underinsured, and low-income residents. Johnston says Central Health is open to new ideas about spending taxpayer dollars more effectively.
“We are already helping them with things like benefit plan design,” he said. “For them as a payer, the biggest problem is access, they have a long wait list to see specialists, especially in orthopedics. We’ve made strides already in shortening that wait time.”
Besides Central Health, DellMed is working with the VA — Veterans’ Affairs — on their long wait lists. Johnston praised the VA for its willingness to embrace innovation that allows more access and provides better health benefits. “They also have great data systems, so you can see the impact of the interventions provided,” he said.
Johnston started with a blank slate and the benefit of being brand new, brought to life by the community and UT to do something better. And like any entrepreneur, he’s taking full advantage in bringing his vision to life.