June 18, 2004

Reforming education of medical professionals focus of Jacobson address

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Vice Chancellor Harry Jacobson, M.D., presented a lecture titled “Reforming Medical Education and Health Care” to VUSN students and faculty Tuesday afternoon. Photo by Dana Johnson

Reforming education of medical professionals focus of Jacobson address

Faculty, staff and students from the School of Nursing were all ears Tuesday, when Vice Chancellor for Health Affairs, Harry Jacobson, M.D., visited the school to talk about reforming the education of medical professionals, including nurse practitioners.

“No one is happy, from the patients, to the employers, caregivers, hospitals, health plans and drug companies,” said Jacobson. “People want to pay less and less for health care. People today, whether seeing an advanced practice nurse or a physician, are paying less than they do if they get a manicure or take their dog to a vet. You have to really wonder where our values are,” he added.

Jacobson said he agreed with a Council of Economic Advisors report that said potentially up to one-third of what we spend on health care is wasted, and coupled with 41 million uninsured Americans, he said it’s clear the need for reform at all levels, including education.

Jacobson said the key to reforming medical education centers around evidence-based practice. Variations in practice waste thirty cents of every dollar spent on health care. He referenced a study that showed large physician groups are using only one-third of the recommended care-management processes or evidence-based methods of treatment for asthma, congestive heart failure, depression and diabetes. Yet the four conditions reportedly account for about 140,000 deaths and more than $143 billion dollars in costs each year in the United States.

“Evidence-based practice is not routinely followed by all providers, it’s not understood by consumers, adherence by providers and patients is not paid for by payers, and evidence-based medicine is fast-changing, dynamic, and difficult to stay abreast,” said Jacobson.

Nurses, he said, play an important role in re-shaping the future of evidence-based practice.

“There’s a tremendous role and opportunity for nurses in getting all providers to adhere to practice standards and chronic disease management, and patient compliance,” said Jacobson. He said some of the key roles for nurses are managing chronic patients for superior outcomes at a lower cost, prevention, screening and early detection, outreach and access in rural and underserved areas, a niche where Jacobson said nurses have historically excelled, and focusing on extended specialty care.

Health care informatics also plays a large role in implementing provider practice standards. Though providers have access to a wealth of information, Jacobson said it’s important not to become information dependent.

“What we want you to do is think. Let the information come to you and then learn how to use it,” he said. “If we’re going to reform medical education, we need to focus less on what people know and more on how they gather information.” Jacobson added that in addition to having the information at hand, it’s also crucial to have support at the time a decision must be made.

Another emerging issue has been how to synergize the employment of nurse practitioners and physicians. Jacobson said new regulations limiting the number of hours residents can work have had a positive impact for nurse practitioners.

“We hired nurse practitioners to fill in and do that work, and they are perfectly trained and well qualified to do so,” said Jacobson.

He said what is happening at Vanderbilt has happened in teaching institutions across the country, opening the door to practice for many more nurse practitioners as their role in all areas of health care evolves.

“We have this great School of Nursing and School of Medicine right here; we need to be a leader in defining how these roles work,” said Jacobson. “We’ve got to reform health care from within and the key is nothing is permanent unless we start with the education and how we train our future providers.”