About That Next Generation of Clinicians...

I saw a report last week – Clinician of the Future 2023 Education Edition, from Elsevier Health – that had some startling findings, and which didn’t seem to garner the kind of coverage I might have expected.  Aside from Elsevier’s press release and an article in The Hill, I didn’t see anything about it.  It’s worth a deeper look.

It's an uncertain future for clinicians. Credit: Bing

The key finding is that, although 89% say they are devoted to improving patients’ lives, the majority are planning careers outside patient care.  Most intend to say in healthcare, mind you; they just don’t see themselves staying in direct patient care.

We should be asking ourselves what that tells us.

The report was based on a survey of over 2,000 medical and nursing students, from 91 countries, as well as two roundtable sessions with opinion leaders and faculty in the United States and United Kingdom.  Since I’m in the U.S. and think most about U.S. healthcare, I’ll focus mostly on those respondents, except when they’re not split out or where the U.S. responses are notably different.

Overall, 16% of respondents said they are considering quitting their medical/nursing studies (12% medical, 21% nursing), but the results are much worse in the U.S, especially for medical students – 25% (nursing students are still 21%).  That figure is higher than anywhere else. Globally, a third of those who are considering leaving are planning to leave healthcare overall; it’s closer to 50% in the U.S.

Credit Elsevier, Clinician of the Future report

Tate Erlinger, vice president of clinical analytics at Elsevier, noted: “There were several things [that] sort of floated to the top at least that caught my attention. One was sort of the cost, and that’s not limited to the U.S., but the U.S. students are more likely to be worried about the cost of their studies.”  Overall, 68% were worried about the cost of their education, but the figure is 76% among U.S. medical students (and for UK medical students).  

Having debt from their education is a factor, as almost two-thirds of nursing students and just over half of medical students are worried about their future income as clinicians, with U.S. medical students the least worried (47%).

It’s worth noting that 60% are already worried about their mental health, and the future is daunting: 62% see a shortage of doctors within ten years and 64% see a shortage of nurses. Globally, 69% of students (65% medical, 72% nursing) are worried about clinician shortages and the impact it will have on them as clinicians.

Where it gets really interesting is when asked: “I see my current studies as a stepping-stone towards a broader career in healthcare that will not involve directly treating patients.” Fifty-eight percent (58%) agreed (54% medical, 62% nursing). Every region was over 50%. In the U.S., the answer was even higher – 61% overall (63% medical, 60% nursing).

Dr. Sanjay Desai, one of the U.S. roundtable panelists, said: “I know this might evolve as they go through their education, but 6 out of 10 in school, when we hope that they’re most excited about that career, are looking at it with skepticism. That is surprising to me.” 

Me too.

The ratings on the education they are getting are good news/bad news.  Seventy-eight percent (78%) agreed that their school is “adequately preparing me to communicate and engage with a diverse patient population,” and 74% that the curriculum has been adapted to the skills that today’s clinicians need, but, honestly, wouldn’t you hope those percentages would be higher? 

Perhaps this is explained in part by only 51% reporting they have used A.I. in their training and only 43% agreeing their instructors welcome it.  The latter percentage is 49% in the U.S.  Overall, 62% are excited about the use of AI in their education, although only 55% in the U.S. (57% medical, 53% nursing).

Similarly, 62% think the potential for AI to help clinicians excites them, but only 55% in the U.S. (58% medical, 52% nursing).  Seventy percent (70%) think AI will aid in diagnosis, treatment, and patient outcomes, but, again, the U.S. lags: 64%, same for medical and nursing. Still, only 56% (globally and in the U.S.) agree that within 10 years clinical decisions will be made with the assistance of AI tool.

Dr. Desai was emphatic about use of AI: “It’s here and it’s going to stay. There are some who have said that we should slow down until the frameworks and the guardrails for ethics and for appropriate use, etc., are in place, and I think that’s wise. But I think we need to accelerate that, because as technology outpaces our organization of the space, there are risks.” Another U.S. panelist, Dr. Lois Margaret Nora, was more circumspect: “AI can turn out great, and it can turn out really terrible, and understanding the difference, I think, is an issue that is going to be very important in education.”

More broadly, 71% believe the widespread use of digital health technologies will enable the positive transformation of healthcare, although only 66% in the U.S., but 60% fear that will be a “challenging burden on clinicians’’ responsibilities.” For once, U.S. students were less pessimistic: only 52% have the same fear (51% medical, 54% nursing). 

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It’s disturbing but not surprising that a quarter of U.S. medical students, and a fifth of nursing students, are considering leaving school.  The lengthy time it takes and the corresponding debts are daunting.  Of more concern is that so many – over 60% for both medical and nursing students – are already planning for a career that doesn’t involve patient care. Are those schools the right place for such students?  Have careers involving direct patient care become that bad? 

It's also clear that the world is changing more rapidly than medical/nurse schools or their students.  They’re not ready for an AI world, they’re not even fully prepared for a digital health world. These students are going to be the vanguard in deploying the new tools that are coming available, and they’re neither adequately trained nor quite enthusiastic about them.     

Jan Herzhoff, President of Elsevier Health, summarized the report’s implications: “It’s clear that healthcare across the globe is facing unprecedented pressures, and that the next generation of medical and nursing students are anxious about their future. Whether through the use of technology or engaging learning resources, we must support students with new and innovative approaches to enable them to achieve their potential. However, the issues raised in this report can’t be tackled in isolation; it is essential that the whole healthcare community comes together to ensure a sustainable pipeline of healthcare professionals.”

Let’s get on that, then.