Search

Many observers have been concerned about a mismatch between the knowledge, skills, and professional values of newly trained physicians and the requirements of current and future medical practice. We surveyed and interviewed Kaiser Permanente's clinical department chiefs for internal medicine, pediatrics, general surgery, and obstetrics/gynecology to ascertain their views of the perceived gaps in the readiness of newly trained physicians. Nearly half of those surveyed reported deficiencies among new physicians in managing routine conditions or performing simple procedures often encountered in office-based practice. A third of the chiefs noted deficiencies in coordinating care for patients. Filling these and other training gaps will require changes at many levels-from residency programs to Medicare reimbursement policies-to better prepare new physicians for the challenges of working in a health care system evolving to emphasize accountability, quality outcomes, cost control, and information technology.

Analyses of consumer-directed health plans often focus on how use of services under such a plan compares with what use would have been under a more comprehensive benefit design. That's a natural perspective for analysts who observe movement from a world of rich coverage to one of more limited coverage. But the comparison may confuse the message with the messenger. In a world where employers are seeking any port in a storm of unsustainable cost growth, it might be more useful to compare offering a consumer-directed plan to other options that employers could have chosen in constraining health costs.