(l-r) Second-year medical student Varun Jain and Dr. Andrew Parsons, Assistant Professor of Medicine and Public Health Sciences
The cost of healthcare and the downstream effects it can have on a patient — financially and medically — can be devastating. Two of our medical students are looking to combat this with the creation of the High-Value Care Speaker Series.
Second-year UVA School of Medicine student Varun Jain and third-year medical student Becca Kowalski have organized this speaker series. High-value care aims to deliver patient-centered care, providing the best possible outcomes, for the right price. This series will bring expert physician speakers to the University of Virginia (virtually, of course) from across the country to discuss rising healthcare costs and how they impact patients and future physicians.
What Is the High-Value Care Speaker Series?
The goal of the series is to develop a grassroots movement of high-value care among medical students nationwide. “When we speak about value in healthcare,” says Jain, “it’s a very simple equation: Value = Patient Outcome/Cost.”
“Obviously, we want to improve the outcomes and decrease the cost; however, this is much easier said than done. One of the main issues is a culture of medical overuse (e.g., ordering excessive tests, recommending unnecessary procedures) that results in patients with worse medical and financial outcomes. To combat this situation, we aim to foster a culture in which the physician-leaders of tomorrow are deploying care that is patient-centered, evidence-based, and financially tolerable in every way.”
Faculty mentor and principal investigator, Andrew Parsons, MD, Assistant Professor of Medicine and Public Health Sciences, says, “This series is a curriculum, of sorts, dedicated to increasing education in high-value practice for medical students around the country. High-value care balances the benefits and harms of tests and treatments to ensure the best outcomes for patients at the lowest cost.”
“Varun has led the charge along with other medical students to create the speaker series, recruiting medical students across the country and expert speakers to discuss topics of importance within the field of high-value care.”
Leading the Discussion
When discussing how to hold virtual meetings about high-value care in the setting of COVID, Kowalski and Jain realized that there was no need to limit these meetings to UVA medical students. “A greater number of national attendees would allow us also recruit speakers from all over the United States,” says Jain. “As a result, Becca and I put forth a plan to Dr. Parsons, and another mentor of ours, Dr. Amit Pahwa at The Johns Hopkins University [JHU] School of Medicine, who introduced us to medical student colleagues at JHU, University of North Carolina, and Stanford via the Choosing Wisely STARS Program.”
Parsons says that literature shows that the regional healthcare intensity where medical students attend school or where residents train impacts how they practice in the future. “Also,” he says, “medical students endorse barriers to high-value care and encounter conflicting role-modeling behaviors, which are related to regional healthcare intensity. Enhancing role modeling in the learning environment may help prepare future physicians to address healthcare costs. We know from a national survey of medical school educators that 67% of medical schools do not have structured high-value care curriculum and 70% feel their high-value care education is inadequate.
“UVA is leading the way in this regard, as we have incorporated education in high-value care at various places throughout the curriculum. Varun and Becca have added even more creative and effective initiatives.”
Early Days, Early Success
The series has had a tremendous response: 600 medical students from approximately 30 institutions across the country have signed up for the listserv. Of those, over 170 students attended the first meeting in early September.
Future speakers include Dr. Sara Keller of The Johns Hopkins University School of Medicine (Oct. 29) and Dr. Suchita Shah Sata of Duke University School of Medicine (Nov. 17). Dr. Keller will discuss the drivers of medical waste and Dr. Sata will talk about solutions being implemented at the physician-patient and systemic levels. Dr. Parsons will be on the schedule as well, speaking about “Cognitive Bias and Value: Leveraging Clinical Reasoning Skills to Promote High-Value Decision-Making.” (Date to be determined.)
The sessions are recorded and the team is working on a publicly accessible archive from which people can access the recordings. Until the archive goes live, recordings are available by emailing Jain.
This Project is Personal
Jain shares that he grew up with a heart disease that, now as an adult, realizes was extremely expensive for his parents to treat. “Thankfully,” he says “my family could sustain that burden, but many more families cannot. One of the main reasons I came to medical school was to leverage the physician role to mitigate the financial harms that healthcare inflicts on too many Americans.
“The idea that this speaker series may be a small step toward helping physicians-in-training understand the financial consequences of their clinical decisions and take on a similar mantle of financial harm mitigation is invigorating to me. Even if a student only comes to one of our talks, as long as we are that much closer to parents no longer having to choose between medical care and food for their children, I will be satisfied.”
Parsons says its rewarding to see medical students, usually consumed with studying for test after test, become engaged in meaningful efforts to improve healthcare at such an early stage in their medical education. “Varun and his fellow students are leaders in their medical schools and well on their way to becoming leaders in this field,” he says. “Their creativity, enthusiasm, and positive persistence are inspiring.
Thank you, Varun, Becca, Dr. Parsons, and all who have a hand in bringing focus to this important healthcare issue. Your passion and dedication are inspiring.
R.J. Canterbury, MD, MS, DLFAPA
Wilford W. Spradlin Professor
Senior Associate Dean for Education