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For the Future of Medicine, Challenges—and Opportunities

Date: January 1, 2013

Although everyone involved in the medical profession is facing a sea change, Paul Rothman is optimistic that with some creative thinking, there are many good solutions waiting to be found.
Although everyone involved in the medical profession is facing a sea change, Paul Rothman is optimistic that with some creative thinking, there are many good solutions waiting to be found. Rothman calls his new position as dean and CEO of Johns Hopkins Medicine his “dream job,” though he’s taking the reigns during a time of major changes in health care delivery. Undaunted by the challenges facing academic medicine, Rothman says he sees opportunities to serve patients in ways that improve both clinical outcomes and use of scarce health care resources, while enhancing the education of the next generation of physicians and researchers.

A rheumatologist and molecular immunologist, Rothman came to Hopkins in July after having served as dean of the Carver College of Medicine at the University of Iowa and leader of its clinical practice plan since 2008. He previously served as head of internal medicine at the University of Iowa, beginning in 2004, and prior to that as vice chairman for research and founding director of the Division of Pulmonary, Allergy and Critical Care Medicine at Columbia University College of Physicians and Surgeons, where he joined the faculty in 1986.

Rothman says he foresees big changes for internists, who will be more in demand with changes in health reform. Fewer medical trainees have been choosing primary care, even at Hopkins, where only a few residents in each class express interest in geriatrics, general internal medicine and community-based medicine.

“General internal medicine has not fulfilled its workforce needs,” Rothman says. “It’s going to be tough.”

A number of factors, including work styles and reimbursement rates, are leading the trend in that direction, he says: “General internal medicine physicians work really hard, and that will only increase as we get 30 million more people in our health care system. General internists will likely become more managers of teams, directing physician extenders, and I think that will be exciting for them.”

Preparing internists for these challenges has been a discussion point, with many people rethinking how internists are trained, Rothman says.

“We have so much more information to master now, but on the other hand, the country thinks they can’t afford this training,” he explains. There have been pressures to decrease the length of internal medicine training by up to 30 percent, he says, even on top of mandated reduced work hours for residents.

“We’ll have to think outside the box about how we train,” Rothman says. “The plan is still in flux, but I think you may see a really disruptive change in the next five to 10 years.”

The Department of Medicine has undertaken several initiatives to spur interest in internal medicine. One is the creation three years ago of the Urban Health Residency, a combined internal medicine/pediatrics program to train primary care physicians in an urban inner-city environment. Two years ago the department started a parallel program in urban health for internal medicine training alone.

In addition, says Department Director Mike Weisfeldt, “We are our ensuring that our medical students have a first-class experience on the Osler Service with a junior resident, not an intern, on each teaching service just to teach medical students.” 

Faculty members from the department have the largest participation in Hopkins’ Colleges Advising Program, which provides medical students with dedicated, longitudinal advisers/mentors responsible for clinical skills training, helping with career and life decisions, and tapping into available resources. Medicine faculty encourage scholarship among medical students, and each year at graduation are presented with many awards from students and faculty for outstanding teaching.