Assuming the existing paradigm of medical school education is tired and in need of replacement, the next question is why hasn’t it happened? Technology change is all around us. Students have replaced memorization and note cards with the EHRs, phones, laptops, and Google. Yet the system is relatively unchanged. How come?

A review of creative destruction is helpful. The original theory of creative destruction (replacement of old with new) was that downturns in the economy spurred such destruction. This “liquidation model” proposed that when things go bad people revisit resource allocation and come up with novel solutions. The application of this model to medicine would infer that the unending growth and riches of healthcare is the problem. Additionally, the ability to dump more and more debt onto medical students (thus forcing students to choose high paid specialties focusing on procedures) has further enhanced the riches of the industry. The end result of all this largesse is that the healthcare aspect of the economy has been protected from from the risks (and destructive value) of recession. Without downturn there is complacency and thus stagnation.

So for us to move out the current “Normal Science” and shift the paradigm, we would then need something bad to happen in terms of health care. Now, since health care is 17% of GDP, you can argue either way.

  • Option #1: No way can that happen, as it will cause our entire economy will crash.
  • Option #2: It is inevitable. How much longer can the US remain competitive when it spends twice what any other country spends and still does not provide health care to everyone?

We do not have the magic ball to predict which one will win. Sadly, based on the above theory, we lose either way. If everything stays rosy then medical student changes. If health care in the US crashes, then medical student training changes but the system is in chaos.

Picture Credit: The Opte Project under CC BY 2.5