FHC #48: Marty Makary on breaking the rules of medical education

Season seven of the Fixing Healthcare podcast focuses on the unwritten and outdated rules of American healthcare—many of which Dr. Marty Makary would badly like to see broken.

In this episode, the nationally renowned surgeon, author and educator sets his sights on the outrageous rules of medical education, healthcare spending, the “appropriateness of care” and much more.

With cohosts Dr. Robert Pearl and Jeremy Corr, Dr. Makary shares his candid comments on the rules of American medicine that need to be broken.

Interview Highlights

On the ills of medical education

“The AAMC continues to inflict tremendous damage on a generation of young people, who are trying to learn how to be great doctors. They’re forcing them to do all of this rote memorization, and it comes at the exclusion of other important skill sets … The AAMC has too much power. It’s the concentration of power in medicine, it’s not healthy. And by the way, many of these organizations lack diversity. Look at the editorial board of the New England Journal of Medicine and JAMA, I think it was like one African-American out of 50 editors.”

On the cost crisis in healthcare

“Well, I think the cost crisis in healthcare is really a function of three factors. One is pricing failures in the marketplace that enable price gouging, and they also enable the second factor which is a giant growth of a middleman industry. This is a group of thousands of millionaires that we’ve created who are not patient facing, who are not contributing to patient outcomes … And finally, the third biggest driver of our cost crisis is care coordination.”

On the price of medicine

“Financial toxicity is a medical complication, and billing quality is medical quality. These are things that are measurable, but up till now, we’ve only been measuring infection rates and readmission rates. We’ve got to start measuring billing quality performance and the price of services.”

On end-of-life care

“I can point and show you in detail areas of waste in healthcare where anybody, doesn’t matter what political party they have allegiance to, will agree that it’s egregious, it’s corrupt, it should stop, and it is wrong. Now, there’s a lot of those things in healthcare, actually. There’s a lot of area where there’s broad consensus, but reining in inappropriate care at the end of life is one of the most challenging, because it is still and always will be an art form. It’s not something that can be managed with policies or rules.”

On the rat race in academic medicine

“There was a time in the medical profession where in order to get a medical degree in the English empire, you had to have a degree from Oxford or Cambridge, at a time when neither Oxford nor Cambridge offered pre-medical education. It was just a royal lineage, if you will. It was an oligarchy, and they had all of these rules and we still have these rules in American medicine. And many of them live in this so-called academic promotion process, and that is a major barrier in my opinion to scientific advancement. People playing the game to get promoted, and we see that a lot.”

READ: Full transcript with Marty Makary

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Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders.

Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.