Dr. Darrell G. Kirch, President and CEO of the Association of American Medical Colleges

Mark Masselli: This is Conversations on Healthcare I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret the countdown is on, the switch to ICD - 10 coding in
st
healthcare takes place October 1 and a lot of medical practices are scrambling right
now.

Margaret Flinter: The much anticipated end line delays switch from ICD - 9 to ICD - 10
codes has generated a lot of anxiety for many practices as it significantly shifts how
billions of dollars in medi cal claims are calculated and built every day. I think some
people were still hoping for a last minute delay but that’s not likely to happen and mostly
I think people are prepared this time.

Mark Masselli: It's time to move on Margaret. And experts pred icted most of the
nation's large hospitals and medical groups whether the transition without too much
difficulty but there could be some short term cash squeezes as the billing codes are
switch to this new more complex coding system.

Margaret Flinter: The y're much more precise and they give us a much better
perspective on public health as well as individual health. The information's more details
more nuance all good in a long run.

Mark Masselli: And the American Medical Association though long oppose to the switch
but earlier this year they struck a deal with CMS and there will be a grace period before
practices are penalize.

Margaret Flinter: And change does seem to be the operative word in healthcare, so
many changes in the professional landscape that' s beginning to have a real impact on
st
medical education which is adapting to 21 century technologies and care models and
thus education as well. And really causing the medical education industry if you will to
reevaluate how that next generation of clini cians is being trained.

Mark Masselli: And that’s something our guest today knows quite a bit about, Margaret
Dr. Darrell Kirch is President and CEO of the Association of American Medical Colleges,
we're looking forward to that conversation.

Margaret Flin ter: And Lori Robertson will be stopping by, the managing editor of
FactCheck.org she's always on the hunt for misstatements spoken about health policy
in the public domain. But no matter what the topic you can hear all of our shows by
going to chcradio. com.

Mark Masselli: And as always if you have comments please email us at
[email protected] or find us on Facebook or Twitter we love hearing from you.

Margaret Flinter: And we'll get to our interview with Dr. Dar rell Kirch in just in moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

(Music)

Marianne O'Hare: I'm Marianne O'Hare with these healthcare headlines. Low does
aspirin a long used preventive against hea rt attack and stroke has been upheld as a
recommended strategy for folks at high risk of cardiovascular disease. Now it appears
there's an added benefit, experts determine taking low does aspirin regularly can help
prevent heart attack stroke and colorect al cancer and the benefits outweigh the risks in
adults ages 50 to 60.

Exposure to air pollution however has an opposite effect, folks expose to fine particulate
and aerosol pollutants have an increase risk for early death. According to a study done
by NY U Langone the largest study that’s come into date, it showed between 3% and
10% increase in development of cardiovascular disease and premature death through
to exposure to find unseen particles and air pollution. According to the study exposure
to this t ype of pollution is particularly lethal because it can easily slip through the lungs
into the blood stream.

We're heading into flu season and according to a recent study three out of four older
Americans over 60 fail to get their single shot only 65% of ad ults get the flu shot and
60% receive a pneumonia vaccine. Upwards of 49,000 Americans can die from flu
complications in any given year according to most recent statistics. Study shows that
money is a hurdle for both patients and providers that needs to be addressed.

And pot use and teens, the recent Johns Hopkins study shows pot use is actually down
among American teens. 15 years ago close to 50% of American teens have reported at
least some marijuana smoking, the study showed a dropped of 40% in 2013. Drug such
as methamphetamine has dropped down to 3% of the population from 9% in 1999. An
observers fear there will be an uptick in marijuana abuse in states like Colorado and
Oregon where it's now much more readily available. I'm Marianne O'Hare with t hese
healthcare headlines.

(Music)

Mark Masselli: We're speaking today with Dr. Darrell Kirch President and CEO of the
Association of American Medical Colleges which represents all accredited US Medical
Schools. Dr. Kirch served as the Dean of the Medica l School and CEO of Hershey
Medical Center and Penn State. A psychiatrist in neuroscientist, he served as acting
Scientific Director at the National Institute of Mental Health, he's a member of the

American Psychiatric Association, American College of Psy chiatrist. He has earned
numerous awards for his work including the outstanding service medal of the United
States Public Health Service and he earned his BA and MD at the University of
Colorado. Dr. Kirch welcome to Conversations on Healthcare.

Dr. Darr ell G. Kirch: Thank you so much it's a pleasure.

Mark Masselli: We happen to have both the blessings and the curse of all of the
transformations that are going on in the healthcare spectrum. And, you know, in a
recent speech to your colleagues you sugge sted that the world of medical education
must be focused in on resilience during this critical juncture in healthcare. I wonder if
you could share with our listeners why the other focus in on resilience?

Dr. Darrell G. Kirch: I feel and many of my collea gues feel that the rapidity of advancing
science together with all the demands to develop new models for delivering care and
financing healthcare together with a need to prepare workforce that’s ready to work in
that new environment is an unprecedented amo unt of change. And the reality is
unfortunately the data show that a lot of physicians are experiencing what we would
could burnout in the face of that. In fact there was a study published I think it was 2012
over 45% were experiencing symptoms of burnou t. And then what concern me than
more deeply when I read the study was they also have screening questions for
depression and over 40% screened positive for depression.

So there is an inescapable conclusion here that the amount of change the rapidity of
ch ange is creating tremendous feelings of burnout depression and worse for our
colleagues. I think that physicians come to medicine and prove that they are resilient
people. So what I emphasized in the talking reference is the importance of cultivating
the ir own inherent resilience remembering why they came to medicine in the first place.
Developing stronger networks of support, we 're putting a lot of our energy into working
on that topic.

Margaret Flinter: I'm not sure I have heard a more clearing call a lso for the
development of a teen culture in healthcare as we look at the demands on time on data
all of the new technologies. And when you now think about taking all of the thing that
you’ve learned in those very sobering statistics and applying it to th e training of the
healthcare professions and in your case specifically of medical students. How do you
look at modifying the training to a new reality so that people are prepared for this very
different healthcare system than the one that existed even ten years ago?

Dr. Darrell G. Kirch: Decades ago when I was a medical student, the emphasis was on
me as an individual and on my accumulation of fact based knowledge. But now what
we're realizing in medical education and training is that there are competenc ies beyond
your sheer medical knowledge that are equally important. And so when you visit

medical schools as I do you see a lot of emphasis on patient care in skills like
communication. You see a lot of attention to working within complex systems and als o
one of the key competencies we feel is the ability to work in interprofessional teams.
Physicians of my generation were taught how to be independent practitioners. Now,
we're all interdependent. The interdependences with our nursing colleagues, our
ph armacy colleagues and others that’s a huge culture shift. For today's student they
haven't known that old culture. So I find a lot of energy and excitement among people
in medical school and residency training today when they see the kind of mutual suppo rt
that they can give each other and how much these teams can accomplish compared to
what a single individual can accomplish for our patients.

Mar k Masselli : Well we seem to have a physician shortage looming on the horizon
some 50,000 to 90,000 physicians by 2025. And you noted in a recent talk that you
gave at the Aspen Institute that the solution is simply not going to be found with more
nurse practitioners but there's seems to be a lack of funding support for residencies and
wonder if you could sort of elaborate for our listeners some of the strategies that you're
working on and associations working on to create more sustainable funding residencies
to meet some of the pent - up demand that’s out there.

Dr. Darrell G. Kirch: Right the American population is not only growing but it is ageing.
10,000 baby boomers turn 65 every day, that is automatically guaranteeing that we face
a need for increased healthcare. We feel that this is an all hands on deck problem, we
definitely need to use other practitioners more carefully, we need to adopt new care
models, we need to drive unnecessary testing and treatment out of the system. But
even if we do those things we are concern that we will face shortages. The major
funding source for residency training in this co untry comes from funds drawn from
Medicare. And unfortunately those funds have been frozen at the same level since
1997.

We have been advocating very strongly for increasing the amount of those funds, we
also advocate for programs like the National Health Service Corps that offer scholarship
support in return for service in underserved areas. We feel that there need to be
solutions coming from multiple fronts, we don’t have doctors freeze dried on a shelf
that’s a long pipeline to create doctors and we ne ed to be building that pipeline now.

Margaret Flinter: I know a number of medical schools are looking innovative ways to
attract more minority group members into medicine. And there are other medical
schools seeking to attract students from non - tradition al pre - med majors the so called
HUMEDS the humanity students who are able to transition to medical school without
destroying background and the sciences and the MCATs have undergone some major
revisions to ensure a more robust set of competencies for incom ing medical students.

How do you see them facilitating different crop of medical students and physicians who
can really meet these evolving health challenges we've been talking about?

Dr. Darrell G. Kirch: We know the evidence is clear that minority popu lations in our
country experience worse health status on multiple indicators and we also know that
people from those own minority communities who become physicians are more likely to
return to those communities work with those patients and address themselv es
disparities. So from our perspective this isn’t a political issue it's diversity and the
workforce becomes very much a healthcare outcomes issue. Traditionally medicine
and especially our own AMC MCAT test focused on the physical sciences exam has
und ergone a major revision this year to include the social and the behavioral sciences.

This has been very well received especially my patient groups that I speak with. They
want physicians who have a broad perspective on their context more than just their
b iochemical and genetic makeup. And so we're trying to broadened the perspective at
the very beginning of the pipeline with the test that students take as they apply to
medical school. When I went to medical school actually I came from the humanities
back ground I was a philosophy major, but I was a rarity now we're already seeing more
and more students come from those kinds of background feeling that medicine is more
than just the equations and chemical formulas and that the human side of medicine is
equal ly important.

Mark Masselli: We're speaking today with Dr. Darrell Kirch President and CEO of the
Association of American Medical Colleges which represents all accredit US Medical
Schools and various other teaching institutions. And Dr. Kirch really talk ed about being
a vehicle for transforming healthcare and the transformation of medical education and I
think along with that is the rule that the academic medical centers play. And we've been
blessed on our show to have a number of a very interesting gues t talking about the
transformations going on at their medical schools. If you could synthesize for our
listeners about how we can take all this interesting transformation that’s going on in a
way that might help the rest of our systems benefit from the in novation.

Dr. Darrell G. Kirch: The experiences I have when I visit medical schools are very
gratifying. Every campus I visit has some innovation in medical education going on, so
the role we're trying to play as an association is to help all these liter ally thousands of
medical educators who are deeply passionate people. Our goal is to help all of them
create a national and even international learning community where they share this
innovations with one another where technological application or a new t echnique in
designing the classroom so called flipped classrooms where the students take a much
more active role and leading their learning. We try to disseminate this through learning
communities.

The combination of this really is coming up for us in a f ew weeks in Baltimore where we
will have an annual medical education meeting that at this point looks like it will have
over 2000 medical educators from North America and beyond. We've left the world
where curriculum is a very static thing that was redesi gned only once a decade to now
there are innovations that are breaking through in a curriculum literally on a daily basis.
One of the specially gratifying things is how many of them are led by our own students
and residence, they're so technologically sav vy, they're so creative and they're so
passionate they're doing incredible things that are becoming adopted by their
colleagues around the country. It's a very exciting time.

Margaret Flinter: Well we couldn’t agree with you more -- we take a lot of sati sfaction
from seeing just how excited our students and trainees of all the health professions are
and how committed they are to really creating that healthcare system of the future. But,
you know, in all the visionary work we're talking about I like to ge t your perspective on
one piece little more mundane and that’s what are we doing into teach a health
profession students or medical students in particular about cost, that suddenly is a area
where we've been confronted with the need for so much greater tra nsparency for the
sake of patients. What's the thinking within the medical education community about
really preparing the providers of the future to be able to understand cost talk about cost
communicate cost with their patients?

Dr. Darrell G. Kirch: Hi storically we believed that considering cost in healthcare for
physician was somehow even an ethical violation. But the reality is resources are finite
and we need to make sure that when we are applying resources we are doing it to the
right person in the right way at the right time. Now the stage has totally shifted the vast
majority of our schools when surveyed in one way or another are including education
teaching telling their students about tools to help them assess the cost benefit different
kinds o f treatments.

I would underscore that some people politically push back on this describing it as a sort
of rationing. The reality is we have a huge amount of resources in the United States
that we apply to healthcare 3 trillion dollars a year. The proble m they aren’t always well
allocated, we can do a much better job without but we can't do it if we're flying blind. So
this shift now is I think deeply embedded in a medical education at both the student
level and the resident level. And we have an ethica l obligation to do the best we can as
far as many patients as possible and that means paying careful attention to our
resources.

Mark Masselli: Dr. Kirch we're not the only country facing challenges and training
clinicians and emerging technologies like T elehealth and online education and showing
some great potential around the world. I'd be interested in your long term of vision of

where you see medical education headed not just here in America but in the global
community.

Dr. Darrell G. Kirch: I've bee n privileged in this position to visit with associations and
medical educators visit medical schools and teaching hospitals in Europe, Africa,
Central America, Asia. Not too many years ago the challenge for the medical schools in
Sub - Saharan Africa was ob taining text books, today now the efforts have (inaudible
18:47 ) to give them broad hand access they can tap into curricular materials that the
AMC put online.

So as there's more and more sharing of information of curricular tools, I think it's good
for th e global as a whole, I think it raises the quality of medical education everywhere. I
think my observation is in America just as we are leaders in science we are leaders in
medical education and it's still true that people from all over the globe will com e here to
seek all a part of their training. Our goal as an association and the goals of our
members is to be more generative and help disseminate that knowledge to the people
who aren't able to come here. And I think we're in a real breakthrough period in this
regard.

Margaret Flinter: We 've been speaking today with Dr. Darrell Kirch President and CEO
of the Association of American Medical Colleges for more information you can go to
AAMC.org. Dr. Kirch thank you so much for joining us on Conversations on Healthcare
today.

Mark Masselli: At Conversations on Healthcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck. org a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: Well we've seen republicans misrepresenting Planned Parenthood
services but democ rats do it too. Senath minority leader Harry Reid claims that 30% of
US women get their healthcare from Planned Parenthood, not true. By one measure
the number is less than 3%. More than 106 million adult women visited a healthcare
professional in 2012 according to the CDC. That same year Planned Parenthood says
its health centers saw approximately 3 million patients which would be 2.8% of all
women who visited a healthcare professionals in 2012 not 30% as Reid said. Reid's
spokesman has (inaudible 21: 01 ) misspoke and meant to say that one in five or 20% of
-- have visited a Planned Parenthood clinic at least once in their lifetime. Reid in fact
have used that statistic before but that’s (inaudible 21:14 ) is questionable. Planned
Parenthood itself said the statistic on its website but doesn’t identified the source
however a Huffington Post Yougov online survey from 2013 reported that 20% of

respondent said they had personally visited a Planned Parenthood . That’s not a
scientific survey instead respondents are recruited through online advertising and they
agree to participate in surveys. The American association for public opinion research
has said that Yougov's polling method has "little grounding in th eory" and that’s my fact
check for this week I'm Lori Robertson Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy C enter at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

(Music)

Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and to everyday lives. As the saying goes music
soothes the savage beast. And according to a recent study conducted by Queen's
University in Belfast, Irelan d there is some empirical data to back that up. In a first of
kind longitudinal study children suffering from a variety of behavioral and emotional
conditions who are expose to music therapy and addition to traditional therapies have
far better outcomes t han those children in a control group that offer traditional therapy
without music therapy.

Dr. Sam Porter: It's not a matter of them been given music or choosing music they
actually make music along with music therapist assisting them. So the idea is fo r them
to express themselves through music.

Margaret Flinter: Lead researcher Dr. Sam Porter said there's been anecdotal evidence
that music improves mood in children and adolescence as well as adults. But his study
reveal just how effective the music th erapy was.

Dr. Sam Porter: Our primary item was an improvement in communication now there
were two very interesting secondary outcomes levels of depression and levels of self
esteem. And in the secondary outcomes we find a statistically significant diffe rence
between the control group and the intervention group.

Margaret Flinter: Dr. Porter says when the group gave a musical therapy it showed
overtime more interaction with their surroundings and a better response to the
traditional therapies as well. An d he says the effects were sustained overtime.

Dr. Sam Porter: I mean that’s one of the marvelous things about music therapy. It's the
things that (inaudible 23:55 ) there are no side effects it is not a dangerous therapy to
get kids involved and it is a productive way of getting kids to improve their health. That
is just such a good way and a harmless way of doing things.

Margaret Flinter: The study was conducted in conjunction with the Northern Ireland
Music Therapy Trust (inaudible 24:13 ) the promisin g findings as an incentive to
incorporate this relatively low cost non invasive therapy into standard protocols as an
additional tool to enhance outcomes for the youth population which often suffers
negative side effects from a powerful medications. A sim ple targeted music therapy
approach age appropriate and showing great advocacy and improving outcomes for
young patients with lasting benefits now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare, I'm Margaret Flinter.

M ark Masselli: And I'm Mark Masselli, peace and health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.