Medical education

To solve the problem of too few clinical rotation sites, leaders in medicine consider business solutions

The shortage of preceptors and rotation sites, if not corrected, could create a full-blown crisis in health care.

I remember the first time I noticed it. It was like something huge had just happened and no one seemed to know, all before COVID had even hit. I was eating my lunch in a virtual department meeting, going through the cursory division reports. When we came to medical student rotations, the director noted, “We have fewer rotations for our medical students than we used to have. [Another] school is now using some of the medical student rotations at the X hospital.”

The school referenced was multiple states away. I wondered how a school was able to “secure” rotation slots from a hospital hundreds of miles away from their home base medical school. This was before COVID, before “The Great Resignation” and clinician burnout hit the health care industry so hard.

More students, fewer staff

Fast-forward to today: I now serve as an administrator managing multiple medical student rotation sites. I also establish and manage preceptor rotation educational opportunities. Managing rotations in the current landscape typically involves navigating the increase in medical schools and students along with hospital staffing shortages and shifts in rotation availabilities.

These days, it is not uncommon for hospitals and larger rotation sites to have quarterly medical trainee coordination meetings, where administrators from multiple medical schools work with hospital administrators to divide up and share rotations.

I have worked with community-based hospitals that previously offered rotations to medical students from all over the country, but now have exclusive opportunities solely reserved for a single large, university-based MD medical school. In some states, large university systems have acquired large hospital systems where the satellite facilities, once open community-based hospitals, have now begun to work exclusively with large academic institutions and universities.

The Great Resignation

Is this just perception bias? Or perhaps predictable sequelae of events across the medical profession. While some industries seem to be bouncing back from “The Great Resignation,” with staffing now close to pre-pandemic levels, the great resignation hit the health care workforce particularly hard.

Using an economic modeling approach of supply versus demand, let’s take a look at demand on the health care industry and needs as a whole. Experts predict the number of individuals age 65 or over in the U.S. will increase from 16.8% to 21% by 2030, resulting in a rapidly growing population of patients who need more health care services and have more medically complex cases.

Because of the extensive burnout among physicians and nurses through COVID, the amount of health care workers intending to stay within the workforce is at great risk. Findings of a 2021 Mayo survey of health care professionals revealed that one in five physicians and two in five nurses intend to leave their practice altogether within the next two years. Physician shortages are expected to rise from 54,100 since COVID to 139,000 by 2033: “The physician shortage can justly be characterized as a looming public health crisis,” James Taylor, group president of the leadership solutions division at AMN Healthcare, told Time.

In education, both nursing and physician training institutions have suffered. Nursing colleges turned away 80,407 applicants in 2019-2020 due to lack of faculty available to teach. Even prior to COVID, 44% of medical school deans reported concerns about not having enough training sites for students, according to an AAMC survey.

As an administrator of clinical training sites at a medical school, I have seen an increase in demand for health care services with a decrease in physicians, nurses and staff providing the services needed. Medical schools across the nation are finding it challenging to secure clerkship sites and preceptors.

Business-focused approaches

Due to increased demand for clinical rotation sites, and clinicians experiencing significant burnout themselves, institutions are exploring more business-focused approaches to securing clinical training sites and rotations. As an assistant dean of clinical education for a medical school, I have encountered situations where hospitals and clinics require medical schools to cover the costs associated with training medical students, sometimes at increased rates.

With the growing need for clinical training sites, I have witnessed an increased need for institutions to consider paying more per medical trainee for training opportunities. Other solutions proposed include developing new clerkship sites, providing remote access for training, increasing collaborations, offering incentives such as tax credits or CME credits to preceptors and paying (increased) stipends to preceptors or hospitals to support clinical training opportunities. As both a preceptor of medical students and an administrator in preceptor recruitment, the most successful incentive I’ve encountered is offering payments to preceptors for educating trainees when (depending on employer contracts) the preceptors are able to receive direct compensation for their investment of time.

The bottom line is that we have a decreased workforce of health care professionals available to train medical students and an increased projected need for physicians. Without significant changes to our current medical training models, the projected shortages will create a crisis.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

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