The founders of the Johns Hopkins Medical School could have chosen to limit their plans to simply graduating outstanding physicians. But their vision was much grander. They had the health of the whole of society, for generations to come in mind. They set out to transform the existing system. And they played an outsized role in doing just that.
Brigham Young University could do the same.
BYU recently announced plans for a new medical school. Physician graduates in Provo will excel, save lives and relieve suffering, I am sure. But when they enter the real world of medicine, they will encounter an incredibly flawed system, and quickly become part of that system. I’m an ER physician, and I witness and experience the frustrations every day.
Readers are likely already aware of the many challenges and short-comings of our health system: misaligned financial incentives leading to widespread bankruptcy; high levels of burnout among healthcare providers; concerning levels of mental health challenges; maternal mortality rates that are unacceptably high, especially among black women; metabolic illnesses such as diabetes; and fragmented and wasteful care, to name just a few.
Don’t get me wrong. The nurses, administrators, fellow physicians and many others that I work with in health care are some of the most brilliant and caring and hard-working people that I know. And I am very proud of the care that we provide. But we inherited a system that makes little sense on so many levels.
In 1893, when the first medical students matriculated at Johns Hopkins in Baltimore there was already a vision in place for the premier hospital and medical school in the nation, even the world. They took steps that were, at the time, revolutionary and risky. They embraced the scientific method. They admitted women — though only after Mary Elizabeth Garrett placed that stipulation on her donation to the school. They elevated the admissions requirements. They committed (as mandated by benefactor Johns Hopkins) to providing care for everyone, regardless of skin color or ability to pay. They linked the medical school with the hospital and research institutes.
The model that solidified at Johns Hopkins spread to other schools over the years. As medical graduates from this new age of medical schools established their practices in communities across the country, they created hospitals and worked beside nurses. The health system that we are familiar with today solidified.
But not all the developments were positive. The ideal of healthcare for all wasn’t realized, and women, people of color and the poor were too often left behind. Science didn’t always trump authority. Our national health policies over the decades have been riddled with unanticipated negative consequences. We as a society placed an outsized emphasis on episodic treatments, not health. Today our system feels stuck, hopeless.
For me, it’s energizing to remember that change was also very difficult for the founders of Johns Hopkins. They transformed the system. Why can’t we? What steps could the planners for the new BYU medical school take to catalyze global health systems transformation? I suggest the following:
Develop and widely disseminate a bold and clear vision. I suggest “We aim to catalyze a new paradigm for our health system, grounded in health and well-being for all, at the lowest cost for the system.”
Create an institute at BYU for health systems transformation. Given that less than 20% of our health status is due to healthcare, the institute would cross disciplines and departments.
Ground the institute in complex, adaptive social systems theory and methods. Our health system, after all, is more like an ecosystem than a machine. The various diverse people and organizations that influence health are continuously adapting over time, with tension between a shared vision of health for society, and more limited short-term goals.
Require that all matriculants into the BYU medical school major as pre-medical students in health systems transformation, and that all other health professionals (nursing, public health, etc) minor in it. While there are advantages to a diversity of majors (I was a philosophy major, after all), the need for transforming our health system is great, and outweighs any downside.
Lead the world in competency-based health professional licensing and certification. For example, allow a nurse practitioner with extensive experience and excellence in a given medical specialty the opportunity to become a physician certified in that specialty in much less than the current seven to 11 years.
The founders of Johns Hopkins made history and improved the health of millions because they dreamed big, and they relentlessly insisted that the bold vision — not the status quo or inherited conventions — determine the details of their journey. I hope that BYU does the same.
(Chad Swanson) Chad Swanson, D.O., is a full-time emergency physician in Orem, Utah.
Chad Swanson, D.O., is a full-time emergency physician in Orem, Utah, and he has no role in planning for the BYU medical school. He is an alumnus of both BYU (BA in Philosophy) and Johns Hopkins (MPH) and has published academic papers in scientific journals including the Lancet on transforming health systems. He is currently posting daily YouTube videos on transformational change, and writing a nonfiction book about a visionary black physician in 1890s Raleigh named Lawson Scruggs. He recently gave a TEDx talk on Dr. Scruggs’ life, and implications for today.
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