TAMPA — The scandal over patient care at the nation's veterans hospitals has pushed to the forefront a long-simmering issue: The critical shortage of primary care doctors.
One of the big reasons for that problem? Medical students, carrying an average education debt of $170,000, are more likely to pursue higher-paying specialities than primary care.
"The single biggest deterrent for students going into primary care is their level of debt,'' said Dr. Charles Lockwood, the new dean of University of South Florida's Morsani College of Medicine. "It's something I take personally.''
Less than a month on the job, Lockwood is making that situation a priority, seeking to reduce medical school tuition and tap alumni in order to bolster scholarships.
At the same time, he wants to train doctors to focus on patients' costs, considering for instance whether a pricey test or pricey drug is really needed.
And he wants to address another key issue in a state that still has millions of uninsured residents. He thinks the state's medical schools could team up and push harder to get Florida to accept $50 billion in federal Medicaid expansion funds state leaders have refused.
"If I were a tea partier, I'd have to say to myself, 'Why is it Florida is sending its federal tax dollars to New York so they can expand Medicaid?' " Lockwood said. "That doesn't make a whole lot of sense."
Lockwood, 59, came to USF less than a month ago from his previous post as dean of Ohio State University College of Medicine. Like his predecessor at USF, Dr. Stephen Klasko, Lockwood is an obstetrician who plans to continue delivering babies. He also intends to continue his internationally recognized research in premature and high-risk births.
But while Klasko pushed early in his tenure for USF to build its own teaching hospital, Lockwood said the school is better positioned without one, given the economics of hospitals.
Lockwood and his wife, Nancy, a retired pediatric nurse practitioner, are renting a home on Harbour Island until they can sell their Ohio home.
They have an adult son, John, who's studying for his MBA at Ohio State. Their daughter, Sarah, died last year at 28 after battling a rare cancer. Lockwood said that painful loss was part of what pushed him and his wife to seek a new start in Florida.
Here's Lockwood on some issues raised by the Times.
What can USF do to increase the number of medical students getting into primary care?
There is (also) a serious shortage of residency slots. So even if we were able to increase the number of medical students interested in primary care, if they don't have residency slots, that's a major problem. That's something medical schools haven't done enough to address.
The single biggest deterrent for students going into primary care is their level of debt. It's something I take personally.
If you were to ask what my proudest accomplishment at Ohio State was, it was in freezing tuition and dramatically increasing scholarships. We're committed to doing that here. I will make it my job to increase scholarship giving by alumni.
How does the federal government's coming shift in how health care is paid for — away from paying for each treatment and toward paying for results — affect your curriculum and programs?
In the fee-for-service model, you want to do as many procedures as you can to generate revenue you can reinvest in research and education. But in the new model of care, we'll have in this country over the next decade, we're going to be paid primarily to take care of populations. (Meaning providers will be paid to keep people healthy and out of the hospitals.) We have to be as efficient in our care as we can be while at the same time being as effective as we can be. That notion of value has been missing from health care.
So would that be reflected in classes where students learn about health care costs?
Absolutely. . . . Ultimately we want them to think: 'Will this test matter? Will it impact care in a meaningful way? And what does it cost to do that test?'
USF's primary partner is Tampa General, and your predecessor worked to add partners. Do you foresee continuing in that way?
Our mission is to take care of patients across the region and ensure that population is healthy. That means by definition, we'll need multiple partners. It's clear Tampa General is our primary partner. . . . But I'm also looking forward to partnering with other health systems around the region, the state and maybe across the region of the country.
Are new collaborations in the works?
Well, there are going to be opportunities to partner on special projects. Moffitt just announced a joint collaboration with Ohio State (to create a patient database for research). I was working that from the other end just a few months ago. You're going to see more and more of those specialty, focused partnerships and collaborations. People have talked about the future of health care being 10 or 20 huge regional or national health systems. I don't know that I subscribe to that thesis, but I do think scale is going to be critical.
Jodie Tillman can be reached at [email protected] or (813) 226-3374.