An interview with Dr. Susan Kirk, co-director of UVA’s High Risk Medical Obstetrical Clinic and Associate Dean for Graduate Medical Education.
Many Virginians have to travel long distances to access medical care, but I am fortunate to live in a town with two hospitals. One is a community hospital and the other is an academic medical center (AMC). I sometimes hear people ask questions about the differences between the way the two operate, wondering if each offers equal care. I’ve heard people express hesitation about what they perceive to be the inconveniences of a teaching hospital — things like, “I don’t want to be practiced on by students!”
Susan Kirk, MD, has written about the important role AMCs play in our healthcare system.
In an effort to get to the facts about an AMC, I asked Kirk some questions of my own.
Myth #1: It’s not a big deal that we have an AMC here in Charlottesville. Aren’t they everywhere?
Actually, no. There are only about 400 teaching hospitals in the country, making up only six percent of all hospitals. The number of major academic medical center is even less, around 120.
We are very lucky here in Charlottesville to have one.
Myth #2: UVA is “rich”; it has a lot of money, more than a regular hospital.
When it comes to money, an AMC may receive different types of funding that, added together, may seem like a lot. But it’s important to know that AMCs, often considered “safety-net hospitals,” receive funds to care for the poor, the uninsured and underinsured. Unlike other hospitals, AMCs:
- Take patients without insurance that other places may turn away
- See patients on Medicaid and Medicare
- Spend a lot of money training residents
- Need money for research
Myth #3: If I go to a teaching hospital, doctors and students will experiment on me for training purposes.
It is false to believe any experimentation occurs at a teaching hospital. Compared to a community hospital, Kirk says, “The medical care and surgeries are the same. We might be more cutting edge, but our patients receive treatments that are tried and true, not experimental. We do offer many opportunities for any person who wishes to participate in a clinical trial, where the newest treatments are investigated, but this is strictly voluntary.”
And according to safety data, teaching hospitals have better quality scores than nonteaching hospitals.
Who Sees You at a Teaching Hospital?
A few definitions:
Part of the faculty, has completed all training and is board-certified.
Has graduated from medical school, is licensed, but hasn’t completed the hands-on training, called a residency, needed to become an MD.
Has completed basic residency training, but needs subspecialty training to become board-certified in a specialty area.
Not yet graduated from medical school, these students spend most of their time as observers or learning how to take a basic history or perform a physical exam.
Myth #4: Getting taken care of by residents and students means I’ll get sub-par treatment.
Kirk believes the opposite, that being a role model and teacher to medical students holds her to a higher standard of performance.
“I would say that one of the real joys and benefits about being around learners is that they’re always asking questions, so they force you to stay on top of the latest developments in medicine. You have to self-educate constantly,” she says.
“People ARE learning on the job — that part is true. But unless we don’t want to have any physicians in twenty years, there will always be the need for training sites.” For Kirk, it is an honor to hold the role of an educator and help mold her students. “You want the next generation of doctors to not only be skilled at providing care but to learn how to deliver care that is compassionate and professional as well.”
Myth #5: A doctor who is also a teacher has less time for me, the patient.
For Kirk, teaching takes time on her end, not for the patient. Students come to her with a spectrum of experience. She explains, “With the newest or least-experienced learners, it’s more time-consuming, allowing them to go through the motions themselves, and then going through it with them. But once you can trust them to do things right, they make you more efficient; they’re an extra pair of hands.”
And for patients, doctors-in-training can actually translate to more time and attention about their health. “Rather than the high volume, too-busy private practice doctor, our patients get more time to talk with a resident, delivering a more enriched experience for them.”
Myth #6: Going to a teaching hospital means I’ll have no privacy.
Kirk finds this concern rare. “Most patients take pride in helping to educate the next generation of doctors. I always encourage patients to allow residents to work with them, because that is our mission. But speaking for myself, if someone were very uncomfortable being seen by a learner, I would honor that.”
Myth #7: Why should I care whether or not my hospital conducts research?
Here are three reasons to care:
- It helps the doctors and staff to be better educated about newly available treatments for your condition.
- You could be in a study that benefits you personally and contributes to the discovery of a cure.
- Knowing your hospital is trying to improve the health of our country is a very positive thing. We’re not just in it to make a buck but to improve the health of people in general.
Myth #8: No one chooses an AMC over a community hospital for standard care.
On the contrary, many patients prefer an AMC for primary and standard care, knowing that “the full breadth of services are available” if and when specialty services are needed. “We have everything from molecular genetics to specialists in thyroid disease,” Kirk adds. “An AMC attracts people who have a very highly specialized piece of knowledge that might not necessarily seen in a community hospital, although we also have some of the best primary care physicians in the commonwealth.” And for some people, having access to the latest and the best means they don’t have to worry that they are missing out on something.
Do you have concerns or questions about academic medical centers?
Let us know in the comments below and we’ll find the answers.