As COVID-19 has accentuated healthcare shortages in the U.S., it has also inspired a generation of students to pursue medical jobs. This last admissions cycle, the Association of American Medical Colleges reported a 17% increase in the number of applicants from the year before. Cultivating those motivated and eager students will be crucial to addressing our healthcare shortage.
As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview David Lenihan.
Dr. David Lenihan is the co-founder and CEO of Tiber Health. He is driven by a relentless commitment to making medical education more accessible for students of all backgrounds and income levels. The Tiber model is inspired by students at Ponce Health Sciences University in Puerto Rico, where Dr. Lenihan serves as President, and Touro College of Osteopathic Medicine in New York, where he served as Dean. Previously, Dr. Lenihan founded a system of outpatient clinics in the UK. With a Ph.D. in Peripheral Neuroscience from the University of Edinburg, where he was also a peripheral nerve surgical fellow, and Juris Doctor from Touro University.
Thank you so much for doing this with us! Recognizing you’ve sat down with us in the past, can you give us a bit of a refresher about what brought you to this specific career path?
As you might remember, my journey started with a car accident, which made me realize that I wanted to be a medical educator — a change from my position at the time as the head of a U.K.-based healthcare services company.
I headed home and started at Washington University in St. Louis doing research. At WashU, I was building my research expertise, but also hadn’t lost my passion and drive for rethinking how we train and prepare our doctors — particularly given the rapid advancements in data and technology that enable us to think differently about long-standing problems. I went on to serve as dean of Touro College and then president of Ponce Health Sciences University. Ultimately, intertwining my love of research, teaching, and business got me to where I am today and was the catalyst for starting Tiber Health.
During COVID-19 what do you think has made your company stand out? Can you share a story?
I think our current health crisis has exacerbated the need for organizations like ours. Particularly when we think about how devastated minority communities have been by COVID-19, it’s becoming increasingly difficult to reconcile the discrepancies between who is going to medical school and who needs care, especially when we know demographic representation in our healthcare professionals has been shown to improve health care access for underserved populations.
Based on my experience at Ponce Health Sciences University, Tiber has been partnering with colleges and universities across the U.S. to create an alternate pathway to medical school for students who are overlooked, might have already been rejected from medical school, or haven’t previously considered an option. Often, many of these students come from minority and rural communities where quality medical care is urgently needed. In the last year, we’ve launched a number of new partnerships with institutions to offer a Masters of Science in Medical Sciences, to help broaden and diversify our physician pipeline. Seeing the demand for this program grow during COVID-19 has really shown me how our company can play a role in addressing critical shortcomings in our healthcare system.
What advice would you give to other healthcare leaders to help their teams to thrive, especially in the next few months?
Right now, more than ever, it is critically important to be flexible and open to new ideas. One of the things COVID-19 has helped many healthcare leaders understand is the importance of collaboration and teamwork, whether it be amongst your own team members or between organizations. Over the last 14 months, I think we saw more collaboration than we have in decades — doctors listened to nurses, hospitals across the country worked together on treatments and traded notes, and different disciplines within healthcare writ large teamed up to answer otherwise unanswerable questions. In the coming months as things begin to reopen and the world adjusts to the new, new norm, I believe continuing that flexibility and open mindedness will be essential to helping keep this positive momentum alive.
Let’s dive into where we are right now. COVID-19 has put intense pressure on an already faltering American healthcare system, leaving many hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think shortages of medical personnel play a role in these struggles?
COVID-19 took everything we knew and flipped it upside down. From the ways we engage socially, to the ways we work and learn, everything basically changed overnight. Arguably, our healthcare system was most hard hit, with frontline workers and medical personnel ravaged by supply deficits and personnel shortages from coast to coast.
First, pre-COVID-19, 95% of medical face masks, 90% of thermometers, and 70% of respirators were manufactured internationally, with nearly half of the U.S. supply of personal protective equipment (PPE) coming from China alone. Naturally, a public health crisis would shock this supply chain, leaving American hospitals severely under resourced in the early months of the pandemic. Of course, overtime, the resilience and determination of global manufacturing overcame this, but it absolutely paralyzed our healthcare networks at the beginning. As we think long term about how to improve or reinforce our healthcare system, thinking through the durability and flexibility of our healthcare supply chains is integral for future preparedness.
Second, our country is faced with a significant shortage in medical personnel, particularly when it comes to physicians. In fact, the Association of American Medical Colleges projects a shortage of up to 122,000 physicians by 2032, which will be most acutely felt in underserved and minority communities. This shortage had a devastating impact on hospitals during the pandemic, but will only become more dire in the next few years unless we put in place models to address this gap in the talent pipeline.
As a healthcare leader how do you think we address these challenges, particularly when it comes to physician shortages? How can a new focus on increasing physician diversity also help to address these challenges?
As our country grows increasingly diverse, there’s an urgent need for physicians who can understand and connect with diverse communities, in both urban and rural parts of the country. Although 20 percent of Americans live in rural communities, just 11 percent of physicians practice in them; and only about 4 percent of today’s U.S. medical students are from rural areas. This need was, as we’ve already discussed, massively accelerated by the pandemic.
We need to fundamentally reexamine how young people are prepped for medical school and how schools design their admissions process. Currently, far too many qualified applicants — particularly those from communities in medical deserts — are disqualified due to criteria that turn out to be poor indicators of whether or not a candidate might be a strong doctor. That must change.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
There are a number of steps — requiring active engagement from individuals, corporations, communities, etc. — that could help address these problems:
Encourage medical education providers to admit students from lower socioeconomic backgrounds, and provide incentives to encourage these students to return to the workforce in their home communities after graduating.
Thoughtfully and strategically implement the provisions from the Consolidated Appropriations Act of 2021 (CAA) — the budget bill recently passed by Congress at the end of 2020. The bill designates three specific provisions that will significantly impact graduate medical education (GME), including creating 1,000 new Medicare-funded residency positions, the expansion of funding for rural training, and the chance to reset hospital FTE caps and per resident amounts (PRAs). This provides a huge opportunity to expand the number of residents — and doctors — we’re introducing to high need areas.
You’ve mentioned supporting alternative pathways to medical school as a solution to a number of challenges in our current healthcare system. I’d be interested to learn how you see the MCAT playing a role in that process and how you might suggest amending medical school admissions more broadly?
The MCAT has a longstanding reputation as weeding out potential medical school candidates, meaning many potential students are left without a clear pathway to a job if they are not admitted to medical school. As we think about creating a more diverse talent pipeline in the medical field, reexamining the role the MCAT plays in medical school admissions is an important step in ensuring medical schools are evaluating a pre-med student on more than just a single MCAT score.
To address that, Tiber’s model is transforming how we evaluate pre-medical master’s students and improve the admissions process for medical schools. In this evaluation process, we use an intuitive approach to evaluating pre-med students by collecting in-class quiz data and exam results from the same curriculum as the first year of medical school. With that information in hand, we can accurately predict student potential in medical school and help prepare students accordingly.
How do you think COVID-19 has impacted the process of recruiting and training the next generation of students who are interested in entering the medical field?
Right now, we’re seeing an unprecedented number of medical school applicants, which is very exciting. As COVID-19 has accentuated healthcare shortages in the U.S., it has also inspired a generation of students to pursue medical jobs. This last admissions cycle, the Association of American Medical Colleges reported a 17% increase in the number of applicants from the year before. Cultivating those motivated and eager students will be crucial to addressing our healthcare shortage.
Has our current environment inspired you to work on any exciting new projects? How do you think that will help people?
On April 9, a volcano on the island of St. Vincent exploded, forcing thousands of residents to evacuate — while leaving an unknown number more in the path of the volcano’s destruction. This kind of emergency requires a rapid response team that can provide both cultural and medical support on an accelerated timeline.
I believe this kind of work is essential to who we are and what we can provide as medical professionals, which is why I’m working with our teams to develop a proactive rapid response team that can always be on standby to provide emergency aid across North America. It’s become a passion project of mine during the pandemic.
But, what’s important to me is that this team provides more than just the technical medical assistance — it can also navigate the cultural topography of communities where crisis strikes. Breaking down those cultural barriers is essential to helping people, especially in emergency situations that might be particularly frightening or traumatizing for the people experiencing them. In the future, I hope this kind of team can help provide care, save lives, and ultimately play a role in shaping the stability of communities.
What have you been reading or listening to lately to inspire you to be a better healthcare leader? Can you explain why you like them?
Over the last year, one of the things that has struck me is the increased volume of stories of people helping each other. The notion of people helping each other or looking out for each other was certainly present before COVID-19 struck, but I think the spotlight on the courage, generosity, and good will of so many people is extraordinary. From local news to national news, I have enjoyed and been hugely inspired by those stories, finding them to be good not only for my own morale but for the health of the nation at large. I hope in the future, we can continue to integrate more of those types of human-first spotlights into our general news.
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Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.