February 22, 2024

3 surprising lessons American medicine can learn from around the world

As a medical student, I chose Stanford as my residency to learn from Dr. Norman Shumway. Shumway, a giant in the field of cardiovascular surgery, was the first American doctor to perform a successful heart transplant.

But on my way to my career as a cardiac surgeon, I alternated between plastic and reconstructive surgery, including a week of operating in Mexico on children with cleft lips and palates.

On the first day, I watched in awe as the team leader painstakingly realigned the tissues of a three-month-old boy’s lip, mouth and nose, leaving nothing but a faint scar – all in just 90 minutes.

By the time I returned, I had fallen in love with the specialty, changed my professional path and never looked back. Since then, I have had the opportunity to volunteer on mission trips in more than a dozen countries. I took a twenty-year break from those surgical trips when I was selected as CEO at Kaiser Permanente, but last month a mission trip to the Philippines rekindled my passion for global surgery. It also yielded three important lessons about American health care:

1. Without a mission and purpose, medicine proves exhausting

Surgical travel is physically and emotionally demanding. Far from the sterilized hallways of American hospitals, you will be immersed in environments where resources are scarce and needs are overwhelming. In remote villages and underdeveloped cities, you operate in cramped quarters with erratic electricity and limited clean water. The days are long, with five to seven operations in a twelve-hour day.

Each child you treat carries with them a story of hardship and hope, while the eyes of their families are filled with a mix of fear and optimism. And just when you start to get tired from the heat and long for a good night’s sleep, along comes another mother. She spent two days walking through the mountains with a child in her arms, praying that her baby could be added to the surgery schedule. There is no way to say ‘no’ to this. You are immediately reborn.

Later that evening, after the procedure, you carry the child to the recovery room and watch the mother take her baby in her arms. The silent language of her tears fills the room. It is a moment of profound connection, a place where relief, fulfillment and happiness coexist.

You do not return to the United States physically exhausted, but emotionally replenished. Almost every doctor who has participated feels exactly the same.

The current American healthcare system obscures the fundamental mission and purpose that motivates physicians. Doctors are currently caught in a web of administrative tasks and insurance disputes. For many doctors, this noble calling has become just a job.

To revitalize the profession and address the burnout crisis that affects more than 60% of physicians, a revival of purpose is imperative.

To achieve this, we must move away from the transactional ‘fee for service’ financial model, which rewards physicians for the enormous amount of services provided. Instead: a reimbursement model led by physicians who are paid based on the quality of clinical results achieved.

Inherent in the privilege of healing is the obligation to lead this transformation. Taking on that responsibility – and eliminating the care restrictions that insurance companies impose – will rejuvenate healthcare professionals, not further tire them out.

2. American doctors are excellent, but so are doctors around the world

American physicians believe that training outside the United States is second-rate education. It’s time to change that perspective.

During my week in the Philippines, I had the pleasure of working with five local physicians, often at adjacent operating room tables. They had trained all over the world in residency and fellowship programs to maximize their expertise. And for one person, their results matched the quality of the leading children’s hospitals in the United States.

American doctors have access to the best facilities, machines and materials. But the competitive advantage of doctors in other countries is high volume. The best way to hone your skills is through repetition and experience. American surgeons lag behind their global colleagues in this area.

A few years ago, while visiting India, I had the privilege of seeing Dr. to meet Devi Shetty, the country’s top heart surgeon and former doctor to Mother Teresa. Dr. Shetty leads a remarkable team at his hospital in Bangalore, where the scale of operations is staggering. On the day of my visit, his teams performed 40 operations, including a heart transplant—a volume far greater than what is normal in most U.S. hospitals for an entire week. The quality of care was exceptional and met the highest standards I have seen in the United States.

My encounters with the practice of Dr. Shetty in India and with physicians in the Philippines highlight a mutual learning opportunity for the American medical community. American physicians bring a wealth of knowledge that can greatly benefit physicians around the world, but there are equally rich lessons to be learned from the experiences and practices of physicians abroad.

For example, instead of setting minimum standards for surgical volume, as is currently the case in the US, setting benchmarks for superior performance would improve patient outcomes. Combining large-scale surgical experience with advanced technological and facility resources will deliver excellent clinical results. The future of American medicine will benefit from embracing humility and being open to learning from our global colleagues.

3. America’s resources are vast, but access is still scarce

In countries such as the Philippines and India, healthcare challenges are magnified by economic constraints. Despite government coverage, per capita health expenditure remains low: less than $200 in the Philippines and just $60 in India. These financial realities force difficult choices, creating significant gaps between the health care needs of the population and the services available – and between the care provided to rich and poor patients.

Witnessing these disparities firsthand is a poignant reminder of the abundance the United States enjoys, with healthcare spending now exceeding $13,000 per American. And yet, despite our wealth as a nation, independent studies show that America’s health care system ranks last among a dozen wealthy countries and near the bottom among the 38 OECD countries, behind Costa Rica, Estonia and South Korea in terms of more than a dozen health measures.

Our country has earned its distinction as home to the “most expensive and least effective” health care system in the developed world. This isn’t just because of our 30 million uninsured citizens (and tens of millions more who are underinsured). It is the result of decades of underinvestment in primary care, inefficient hospital systems and exorbitant drug prices.

The challenge of transforming American health care is enormous and requires a willingness to embrace change and confront uncomfortable truths. Observing the efficiency and ingenuity of less prosperous countries should inspire a reevaluation of our healthcare delivery practices and healthcare finances.

The biggest problem in our system is not a lack of money. It is the lack of leadership and innovation.

Volunteering on global missions provides invaluable perspectives that can catalyze change in the United States. By learning from countries that are achieving remarkable results with modest resources, we can improve clinical outcomes, reduce physician burnout, and make quality health care accessible and affordable to all Americans.

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