The Harvard Law School Food Law and Policy Clinic (FLPC) released a new report today identifying policy approaches to increase nutrition competency of U.S-trained physicians. Doctoring Our Diets: Policy Tools to Include Nutrition in U.S. Medical Training highlights the current lack of education on diet-related diseases and nutrition that doctors receive over the course of their medical careers. The report illustrates the impact of this knowledge-gap on healthcare costs and patient health, and provides a number of recommendations for federal, state, and non-governmental policymakers to tackle this issue.
Diet is the most significant risk factor for disability and premature death in the United States, and diet-related diseases, such as heart disease, cancer, stroke, and diabetes affect an unprecedented number of Americans. Patients turn to doctors for advice on how to avoid or mitigate these and other health risks arising from poor diet and nutrition. Yet, unbeknownst to patients, many doctors are no more equipped to provide this advice than patients themselves: an average medical student spends less than one percent of total classroom hours learning about food and nutrition, and seventy-three percent of physicians reported that they received no or minimal instruction on nutrition during their medical training. This gap in medical education not only represents a violation of the public trust but a missed opportunity to invest in better population health.
To bridge this divide, Doctoring Our Diet calls for relevant policymakers to take action, recommending specific policy solutions applicable at each stage of medical education. For example, policymakers can condition non-grant funding on the inclusion of nutrition education in medical school programs and residency programs, offer performance-based incentives to medical schools and residency programs that provide a baseline amount of nutrition education, and amend accreditation standards to require baseline competency in nutrition. For each recommendation, the report features a brief feasibility analysis, addressing the benefits and potential challenges associated with implementation.
As one example of the types of policies recommended in Doctoring Our Diet, the report shines a special spotlight on the government’s failure to use existing Medicare funding of GME programs to leverage nutrition education for doctors. Medicare is the single largest contributor of graduate medical education (GME) in the United States, providing $16 billion in 2015. At the same time, Medicare spending accounts for nearly 15 percent of all federal spending. As the prevalence of preventable, but costly, diet-related diseases continues to rise, so too will this percentage: over the next 10 years, Medicare spending is expected to increase from $630 billion to a projected $1.3 trillion—or more than 18% of the federal budget. Doctoring Our Diet explains that requiring Medicare-funded GME programs to educate physicians on nutrition is a logical and necessary approach to mitigating diet-related diseases and saving healthcare costs in the long-term.
This report is a product of FLPC’s ongoing involvement with the Nutrition Education Working Group (NEWG), a group of leaders in nutrition science, education and policy from FLPC, Harvard T.H. Chan School of Public Health, Harvard Medical School, and the Gaples Institute for Integrative Cardiology. FLPC has collaborated with NEWG to raise awareness about the lack of nutrition education provided in medical training, presenting the issue to policymakers, writing comments to the Accreditation Council for Graduate Medical Education (ACGME), and working with various medical boards to add nutrition-focused questions to exams. This initiative represents the latest effort in FLPC’s ongoing commitment to policy development at the intersection of food and health.