How BYU’s new medical school could change our nation’s health care system

The founders of Johns Hopkins Medical School could have chosen to limit their plans to simply graduating excellent physicians. But their vision was much grander. They had the health of the entire society in mind, for generations to come. They wanted to transform the existing system. And they played an outsized role in that.

Brigham Young University could do the same.

BYU recently announced this plans for a new medical school. I am confident that Provo’s medical graduates will excel, save lives and alleviate suffering. But when they enter the real world of medicine, they will encounter an incredibly flawed system and quickly become part of that system. I am an ER doctor and I witness and experience the frustrations every day.

Readers are likely already aware of the many challenges and shortcomings of our healthcare system: misaligned financial incentives that lead to widespread bankruptcy; high levels of burnout among healthcare providers; about the levels of mental health problems; maternal mortality rates that are unacceptably high, especially among black women; metabolic diseases such as diabetes; and fragmented and wasteful care, to name a few.

Don’t get me wrong. The nurses, administrators, fellow physicians and many others I work with in healthcare are some of the most brilliant, caring and hardworking people I know. And I am very proud of the care we provide. But we have inherited a system that makes little sense on so many levels.

In 1893, when the first medical students enrolled at Johns Hopkins in Baltimore a vision was already ready for the premier hospital and medical school in the country, and indeed the world. They took steps that were revolutionary and risky at the time. They embraced the scientific method. They admitted women, but only afterward Mary Elizabeth Garrett placed that provision on her donation to the school. They have increased the entry requirements. They promised (on behalf of benefactor Johns Hopkins) to provide care to everyone, regardless of skin color or ability to pay. They linked the medical school to the hospital and research institutes.

The model that took shape at Johns Hopkins spread to other schools over the years. As medical graduates from this new era of medical schools established their practices in communities across the country, they created hospitals and worked with nurses. The healthcare system we know today has solidified.

But not all developments were positive. The ideal of health care for all was not realized, and women, people of color and the poor were too often left behind. Science doesn’t always trump authority. Our national health care policy has been riddled with unexpected negative consequences in recent decades. We as a society have placed an excessive emphasis on episodic treatments, not health. Today our system feels stuck, hopeless.

For me, it’s energizing to think that change was also very difficult for the founders of Johns Hopkins. They have transformed the system. Why can’t we? What steps can planners for BYU’s new medical school take to catalyze the transformation of global health systems? I propose the following:

1. Develop and disseminate a bold and clear vision at scale. I propose: “We aim to catalyze a new paradigm for our healthcare system, based on health and well-being for all, at the lowest cost to the system.”

2. Create an institute at BYU for healthcare systems transformation. Considering that less than 20% of our health status because of healthcare, the institute would transcend disciplines and departments.

3. Ground the institute in complex, adaptive social systems theory and methods. After all, our healthcare system is more like an ecosystem than a machine. The various people and organizations that influence health are constantly adapting over time, with tension between a shared vision of health for society and narrower short-term goals.

4. Require that all students attending BYU medical school major as pre-medical students in healthcare systems transformation, and that all other health professionals (nursing, public health, etc.) minor in it. While there are advantages to a diversity of majors (I studied philosophy, after all), the need to transform our healthcare system is great and outweighs any disadvantages.

5. Lead the world in competency-based licensing and certification for healthcare professionals. For example, give a nurse practitioner with extensive experience and excellence in a particular medical specialty the opportunity to become a physician certified in that specialty in much less than the current seven to eleven years.

The founders of Johns Hopkins made history and improved the health of millions of people because they dreamed big, and they relentlessly insisted that the bold vision—not the status quo or hereditary conventions—would determine the details of their journey. I hope BYU does the same.

Chad Swanson, DO, is a full-time emergency physician in Orem, Utah, and he plays no role in BYU’s medical school planning. He is an alumnus of both BYU (BA in Philosophy) and Johns Hopkins (MPH) and has published academic articles in scientific journals, including the Lancet, on transforming healthcare systems. He currently posts daily YouTube videos about transformational change and is writing a nonfiction book about a visionary black physician from 1890s Raleigh named Lawson Scruggs. Recently he gave one TEDx lecture on the life of Dr. Scruggsand the consequences for today.

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