U.S. medical education lacks health systems science: educator
TEXAS, UNITED STATES — Across America’s sprawling healthcare landscape, a critical educational gap has emerged that many experts believe contributes to systemic inefficiencies. Medical educator Janet Lieto recently highlighted this concern, pointing to the absence of health systems science (HSS) training in traditional medical curricula.
Lieto’s commentary, published on KevinMD, emphasizes HSS as the essential “third pillar” of medical education that complements the long-established basic and clinical sciences. “Most medical schools continue to teach the two pillars of medical education: basic sciences and clinical sciences, with little regard to the third pillar of medical education: health systems science,” she notes.
This third pillar represents a comprehensive approach to healthcare delivery, focusing on quality improvement, cost management, and population health outcomes. The framework integrates professional collaboration, ethical considerations, patient safety protocols, social health determinants, and value-based care principles.
The “broccoli” problem in healthcare training
In her analysis, Lieto cleverly references academic literature that characterizes HSS as medical education’s “broccoli” — nutritionally vital but not always appealing to students. This metaphor underscores the challenge educators face in conveying HSS’s long-term value.
“Do we really need to ‘hide the broccoli,’ or should we be embracing the broccoli, loving the broccoli, and explicitly connecting the students to the importance of having this broccoli to guard [healthcare] professionals against ‘burnout,’ which is really ‘moral injury’?” Lieto asks.
The challenge, according to Lieto, lies in implementing HSS within the constraints of academic calendars, limited hours, and board exam preparation that currently includes minimal HSS content. However, she argues that this integration is essential for developing physician leaders capable of addressing systemic healthcare issues.
“We cannot reform and improve the U.S. [healthcare] system without reforming the way undergraduate medical education is taught,” she argues. “Now is the time for medical educators to act and insist on reform and perhaps an overhaul of medical education, as it occurred over 100 years ago in the Flexner Report.”
As healthcare systems worldwide face increasing pressure to deliver better outcomes at lower costs, this call for educational reform highlights a potential path forward through better-prepared medical professionals equipped to address systemic challenges rather than just individual patient care.
HSS skills critical in era of healthcare outsourcing
The importance of HSS training becomes particularly evident as healthcare institutions increasingly outsource operational functions. Many hospital systems now contract external vendors for revenue cycle management, financial operations, and information technology services — decisions that demand a sophisticated understanding of healthcare’s interconnected nature.
Several major health networks, including Allina Health, Inova Health, and Northern Light Health, have recently shifted thousands of staff positions to service providers such as Optum and Kyndryl. These strategic realignments require leadership with dual expertise in clinical practice and broader healthcare ecosystem dynamics.
Hospital executives face increasingly complex determinations about which functions to keep in-house versus outsource. Healthcare sector specialist Tina Wheeler from Deloitte observes that “Hospitals need to figure out, health systems in particular, and maybe even payers… what they’re good at? And what areas they would want to consider outsourcing?”
Without proper training in health systems science, future healthcare leaders may struggle to evaluate these outsourcing decisions, potentially compromising quality of care, community relationships, and patient satisfaction. As Lieto asserts, “We cannot reform and improve the U.S. [healthcare] system without reforming the way undergraduate medical education is taught.”
