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Can Medical Education be Disrupted?

Spencer Nam, 4/14/2016

The recent white paper, “Disrupting Law School”, by Michele Pistone and Michael Horn raises a similar question on whether medical schools can be disrupted. If so, what will the disruption dynamics look like?

Professionally, there are many similarities between medicine and law. Both professions are pursued by high achieving individuals with strong academic and professional backgrounds. Entering graduate schools in medicine or law is an extremely competitive process. Both fields require aspiring professionals to take a standardized examination – bar exam in law, and board exam in medicine - to receive practice certifications. Both fields are heavily regulated, keep the number of practitioners limited.

With these similarities in mind, and assuming that legal education is headed for disruption, we examine how medical education might transform in the coming decades. The short answer is that changes we will see in medical education will be quite different from the changes we are seeing in legal education.

While the two fields share many similarities, there are some major differences.

First, today’s legal education is a byproduct of transforming the old system of apprenticeship model. Apprenticeship model is much like a solution shop, where the process of being certified is unknown. Over the past couple of centuries, the old model gave way to a standardized model of law school. Medical education went through a transformation similar to that of legal education, but the outcome has been slightly different. The formalization of medical school occurred in the early 20th century from the Flexnor Report. However, standardizing medical training didn’t quite replace the apprenticeship model that had been in place. Instead, it was added to the apprenticeship model to make the education take longer.

What this means is that medical education is much more integrated with practice of medicine than the legal education is to the field of jurisprudence. As a result, medical education cannot easily transform by itself without affecting the “downstream” part of the value chain. If medical education changes dramatically, the whole practice of medicine will need to change. This is not an easy solution to implement.

Additionally, the field of medicine is one of the few professions where competency does not guarantee credibility. Unlike the legal profession where passing the bar gives a person some level of credibility as a lawyer, passing the medical board has little impact on one being a trustworthy doctor.

Finally, with medical services being paid by third-party insurance companies, disrupting the source of human capital, i.e., medical school, might not gain as much support as disrupting law schools. Disruption is inherently associated with a lower-cost alternative that does not compromise quality. But, in medicine, someone else is paying the bill, making the buyer less sensitive to the price they pay.

Of course, these dynamics are surely changing in medicine, but it is unlikely that medical schools will be at the forefront of disruption in the foreseeable future. Instead, we expect the practice of medicine to be disrupted first, eventually leading to transformation of how healthcare professionals, including physicians, will be educated.