You can’t tell by looking which med students at Mount Sinai were traditional pre-meds in college and which weren’t. And that’s exactly the point.

Most of the class majored in biology or chemistry or some other “hard” science; crammed for the MCAT (the Medical College Admissions Test) and did well at both.

But a growing percentage came through Mount Sinai’s “Hu-Med” program, which stands for Humanities in Medicine. They majored in things like English, history or medieval studies. And they didn’t even take the MCAT because Mount Sinai guaranteed them admission after their sophomore year of college.

Adding students who are educated in more than science to the mix is a serious philosophy at Mount Sinai.

David Muller is Mount Sinai’s Dean for Medical Education.  One full wall of his cluttered office is a massive whiteboard almost totally full with to-do tasks and memorable quotes. One reads: “Science is the foundation of an excellent medical education, but a well-rounded humanist is best suited to make the most of that education.”

The Hu-Med program dates back to 1987, when then-Dean Nathan Kase wanted to do something about what had become known as “pre-med syndrome.” That’s the idea that the drive for straight As and high test scores was actually producing sub-par doctors. Students were too single-minded.

Kase “really had a firm belief that you couldn’t be a good doctor and a well-rounded doctor and relate to patients and communicate with them unless you really had a good grounding in the liberal arts,” says Muller.   

So the medical school began accepting humanities majors from a handful of top-flight liberal arts schools after their second year of college. They continue to follow their non-scientific interests for the remainder of their college careers.

Mount Sinai takes care of teaching them the science they need during the summers. It’s often not the science studied in pre-med programs.

The current required pre-med sciences – including basic chemistry, physics, and calculus – date from the early 1900s, when an educator named Abraham Flexner revolutionized medical school by turning it into a truly scientific endeavor.

But those core science courses haven’t changed much since Flexner, Muller says, while science has.

“The science for 1910 is only nominally relevant today; yet that’s the filter through which everyone has to come,” he said.

And it often weeds out people who could make excellent practitioners. Too frequently, he says, “if you can’t get an A minus in organic chemistry, you’re not going to be a doctor.”

Such artificial barriers “exclude people from medical school that we desperately need,” he says.

Studies have shown that the Humanities in Medicine students are just as successful in med school as any other student. And they are slightly more likely to choose primary care or psychiatry as a specialty – both areas where more physicians are needed.

At a recent end-of-year party thrown by the students for professors and administrators, even the teachers had trouble remembering who was a “Hu-Med” and who wasn’t.

Take Virginia Flatow, for instance. She’s a second-year student from New York. She majored in psychology at Bates College in Maine. Because she was also on the debate team, which meant lots of travelling to tournaments, she says she never would have been able to follow the classical pre-med track.

“There are very few courses – maybe I can think of one off the top of my head – where doing a lot of science in college helps you,” she says. “The rest of it is just a matter of how well do you study.”

Flatow agrees with a growing number of medical educators, for example, that organic chemistry is irrelevant for medical school. And that its difficulty discourages many students.

“I know so many people who took one semester of organic chemistry [and] dropped pre-med,” she said. “My brother was one of them.”

John Rhee, another second-year Hu-Med student, majored in public policy at Cornell. He was thinking about going into hotel management, but he decided to become a doctor after taking a summer job at a hospice.

“The experience was so deep for me,” he said, “partnering with a patient through end-of-life care.”

Keith Love, a first-year Hu-Med from Colby College in Maine, said he originally gave himself a “zero percent chance” of going to medical school. He studied environmental science and anthropology in college, and still escapes Manhattan some early mornings to go birding. But, eventually, as he thought about how he wanted to make a difference with his career, he realized, “it was medicine.”

These non-traditional students also serve yet another role – they round out what could otherwise be a class full of science wonks.

“I think the cross fertilization of ideas that goes on between people of an exclusive science background – ultimately everyone benefits from it,” said Harsh Chawla, a third year student from Danville, California. He did the traditional pre-med program – majoring in biology at University of Southern California.

The effort has worked so well, in fact, that Mt. Sinai is expanding it, opening it to students in any major from any college or university. Eventually half the class will be admitted from a slightly reconfigured program, which goes by the new name “Flex-med.”

Back in his office, Muller shows visitors his commanding view of the East River and East Harlem, “which is sort of the core community we serve as a medical school.”

And while he describes his own pre-med training as “cookie cutter,” Muller has done his own share of thinking out of the box. Among other things, he is nationally recognized for helping create the largest academic home-visiting program for patients in the nation.

But what would he have pursued in college had he not headed straight onto the science track?

He thinks for a moment. “Literature, English lit,” he says in a wistful kind of way. “I read voraciously as a kid and that almost came to a complete standstill in college because there was just no time to breathe.”

And can pursuing different interests really make a better doctor? Of that Muller is confident.

“People who look at the same problems through different lenses will make us better in the long run,” he says. “Now can I prove that’s going to be the case?  No, but I’d like to believe that it is.”

This story is part of a reporting partnership between NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

With her children grown and husband nearing retirement, Amy Reynolds was ready to leave behind snowy Flagstaff, Ariz., to travel but she wasn’t ready to give up her nursing career.

She didn’t have to.

For the past three years, Reynolds, 55, has been a travel nurse — working for about three months at a time at hospitals in California, Washington, Texas and Idaho, among other states. Her husband accompanies her on the assignments. “It’s been wonderful,” she said in May after starting a stint in Sacramento. “It’s given us a chance to try out other parts of the country.”

Reynolds is one of thousands of registered nurses who travel the country helping hospitals and other health care facilities in need of experienced, temporary staff.

With an invigorated national economy and millions of people gaining health coverage under the Affordable Care Act, demand for nurses such as Reynolds is at a 20-year high, say industry analysts. That’s meant Reynolds has her pick of hospitals and cities when it’s time for her next assignment. And it’s driven up stock prices of the largest publicly traded travel-nurses companies, including San Diego-based AMN Healthcare Services and Cross Country Healthcare of Boca Raton, Fla.

“We’ve seen a broad uptick in health care employment, which the staffing agencies are riding,” said Randle Reece, an analyst with investment firm Avondale Partners.  He estimates the demand for nurses and other health care personnel is at its highest level since the mid-1990s.

Demand for travel nursing is expected to increase by 10 percent this year “due to declining unemployment which raises demand by increasing commercial admissions to hospitals,” according to Staffing Industry Analysts, a research firm. That trend is expected to accelerate, the report said, because of higher hospital admissions propelled by the health law.

Improved profits—particularly in states that expanded Medicaid—have also made hospitals more amenable to hiring travel nurses to help them keep up with rising admissions, analysts say.

At AMN Healthcare, the nation’s largest travel nurse company, demand for nurses is up significantly in the past year: CEO Susan Salka said orders from many hospitals have doubled or tripled in recent years. Much of the demand is for nurses with experience in intensive care, emergency departments and other specialty areas. “We can’t fill all the jobs that are out there,” she said.

Northside Hospital in Atlanta is among hospitals that have recently increased demand for travel nurses, said David Votta, manager of human resources.  “It’s a love-hate relationship,” he said. From a financial viewpoint, the travel nurses can cost significantly more per hour than regular nurses. But the travel nurses provide a vital role to help the hospital fills gaps in staffing so they can serve more patients.

Northside is using 40 travel nurses at its three hospitals, an increase of about 52 percent since last year. The system employs about 4,000 nurses overall.

Historically, the most common reason why hospitals turn to traveling nurses is seasonal demand, according to a 2011 study by accounting firm KPMG. Nearly half of hospitals surveyed said seasonal influxes in places such as Arizona or Florida, where large numbers of retirees flock every winter, led them to hire traveling nurses.

Though there have been rare reports of travel nurses involved in patient safety problems, a 2012 study by researchers at the University of Pennsylvania published in the Journal of Health Services Research found no link between travel nurses and patient mortality rates. The study examined more than 1.3 million patients and 40,000 nurses in more than 600 hospitals. “Our study showed these nurses could be lifesavers. Hiring temporary nurses can alleviate shortages that could produce higher patient mortality,” said Linda Aiken, director of the university’s Center for Health Outcomes and Policy Research. The study was funded by the National Institutes of Health and the American Staffing Association Foundation.

The staffing companies screen and interview nurses to make sure they are qualified, and some hospitals, such as Northside, also make their own checks. Nurses usually spend a couple days getting orientated to a hospital and its operations before beginning work. They have to be licensed in each state they practice, although about 20 states have reciprocity laws that expedite the process.

Cherisse Dillard, a labor and delivery room nurse, has been a traveler for nearly a decade.  In the past few years, she’s worked at hospitals in Chicago, Dallas, Houston, Pensacola and the San Francisco area.

While delivering a baby is relatively standard practice, she said she makes it a practice at each new hospital to talk to doctors and other staff to learn what their preferences are with drugs and other procedures. Dillard, 46, often can negotiate to be off on weekends and a high hourly rate. “When the economy crashed in 2008, hospitals became tight with their budget and it was tough to find jobs, but now it’s back to full swing and there are abundant jobs for travel nurses,” she said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Tanning salons are already under siege – they got taxed by the health law, are newly regulated by the federal government and states, and have become dermatologists’ favorite bad guy. But some policymakers say that’s not enough. Pointing to rising skin cancer rates and increased marketing toward young people, these public health advocates want new national restrictions regarding who can get their indoor tan on.

“It’s time we started treating [tanning beds] just like they are cigarettes. They are carcinogen delivery systems,” said Rep. Rosa DeLauro, D-Conn., at a May 20 Capitol Hill briefing on the dangers of indoor tanning. “We do not allow our children to buy cigarettes, yet the tanning industry continues to target adolescent girls. And this is not unlike what we found with the tobacco industry.”

Experts at the briefing said young women may have vague ideas about the associated risks, but tanning beds are widely available at such low costs that their use is still widespread and contributing to the escalating prevalence of the deadliest form of skin cancer, melanoma. Melanoma rates among young white women have grown by 3 percent every year since 1992.

In response, DeLauro is pushing for a national ban on the use of tanning beds by minors younger than 18.

Melanoma is the most common form of cancer among people between 25 and 29, according to the National Cancer Institute. Just one indoor tanning session increases users’ chances of developing melanoma by 20 percent compared with that of someone who has never tanned indoors. Each additional session during the same year boosts that risk by another 2  percent, according to the Skin Cancer Foundation. And people who use tanning beds 10 or more times in their lifetime have a 34 percent increased chance of melanoma, compared with people who have never had that exposure.

The industry minimizes these findings, though, and maintains that the science behind the numbers isn’t solely focused on indoor tanning-bed outcomes. “The numbers that they have used to rationalize the [public health] decisions are not studies that isolate indoor tanning salons,” said Joe Levy, scientific adviser for the American Suntanning Association, the trade group representing tanning salons. They include categories like home-use and medical-use tanning, which both drive up the statistics, he added.

Still, in response to these and other warning signals, the Food and Drug Administration last year mandated that tanning beds have clear labels informing customers of the risks. Medical groups, including the American Academy of Dermatology, have for years targeted the use of tanning beds. And 43 states already have laws that either ban tanning-bed use to young people or require parental signatures.

Yet public health advocates say the availability of tanning beds near college campuses and marketing toward young people continue to go unchecked.

A 2014 study of 125 top colleges found that 48 percent had tanning facilities either on campus or in off-campus housing, and 14.4 percent allowed campus cash cards to be used for indoor tanning. Off-campus housing buildings often list tanning beds among amenities like cable TV and fitness centers.

And, though not included in this research, there have also been questions about supervision to ensure students who were using the tanning beds were older than age 18, according to Sherry Pagoto, associate professor of medicine at the University of Massachusetts Medical School, who spoke at the briefing.

“They’re [indoor tanning companies] finding young women in these settings and locating themselves near schools,” Pagoto said. She noted companies like Sun Tan City, with 250 salons mostly in Mid-Atlantic and Midwest states, give money to sponsor football games, expand stadiums and provide free tanning to cheerleaders. “They’re finding ways to become part of university life, one way or another.”

Lisa McGovern, executive director of the Prevent Cancer Foundation’s Congressional Families program, said her group is working on a grassroots campaign to reverse this trend by enticing colleges to not allow students to pay for tanning with college debit cards. The University of Pittsburgh and University of Illinois have already agreed.

“If we keep up that pressure, others will follow,” DeLauro said, noting that parents should know if there are free tanning facilities offered to their children in college, and if a university is allowing students to pay for tanning with those cards.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Sweeping proposals disclosed Tuesday would create profit guidelines for private Medicaid plans as well as new standards for the plans’ doctor and hospital networks and rules to coordinate Medicaid insurance more closely with other coverage.

“We are taking steps to align how these programs work,” said Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, which proposed the rules.

Privatized Medicaid has grown rapidly as budget-pinched states have responded to commercial insurers’ promise to deliver care for a fixed price. Most beneficiaries of Medicaid — state programs for the poor run partly with federal dollars — now get care through contracted insurers.

The 653-page rule, which also would require states to establish quality ratings for Medicaid plans, constitutes the biggest regulation change to Medicaid managed care in more than a decade. The National Association of Medicaid Directors, a group of state officials, called it a “milestone.”

One proposal would require plans to assume, for rate-setting purposes, that they will spend at least 85 percent of their revenue on medical care.

Such a “medical loss ratio” target is similar to that required under the health law for other plans — but with a key difference. Unlike health plans sold through the law’s online marketplaces and elsewhere, Medicaid plans wouldn’t have to rebate the difference if they spend less than 85 percent.

But states would still “need to take that into account the next year” when they set new rates, thus limiting profits later, said Vikki Wachino, CMS deputy administrator. CMS is a division of the Department of Health and Human Services.

Jeff Myers, CEO of Medicaid Health Plans of America, an industry group, criticized the inclusion of the medical loss ratio standard, which supporters promote as ensuring plans spend a minimum amount on care instead of executive salaries and shareholder profits.

“We don’t believe a nationwide MLR is appropriate,” Myers said. A uniform profit standard across diverse states could limit plans’ ability to spend administrative dollars to fine-tune care coordination and quality, he said.

Generally, however, “we are very supportive of the direction they are going,” he said of CMS. He particularly praised the proposal to better align the Children’s Health Insurance Program, or CHIP, which aids families with children with moderate incomes, with Medicaid.

Led by giants such as UnitedHealthcare, Anthem, Aetna and Centene, private Medicaid plans generated nationwide operating profits of $2.4 billion last year, according to regulatory data compiled by Mark Farrah Associates and analyzed by Kaiser Health News.

Advocates for the poor have complained that HHS’ regulation of Medicaid managed care has lagged behind the industry’s growth. Industry profits have sometimes come at the expense of denied care and inadequate doctor networks, they say.

A study last year by HHS’ inspector general found that half the doctors listed in official plan directors weren’t taking new Medicaid patients. Among doctors who were, one fourth couldn’t see patients for a month.

In Tuesday’s rules CMS proposed new standards for network adequacy that also allow wide flexibility to states. States would have to certify at least annually that Medicaid managed-care patients have sufficient access to doctors and hospitals, based on standards for numbers of medical providers per member, maximum distances required to travel for care and other criteria.

“This latest proposed guidance ensures that health plans and states have the flexibility to structure their programs and benefits to meet the unique health needs of their enrollees,” Dan Durham, interim CEO of America’s Health Insurance Plans, an industry lobby, said in a prepared statement.

Sarah Somers, an attorney with the National Health Law Program, which has long urged updates to federal regulations, praised proposed safeguards for Medicaid members with disabilities and limited English ability.

“The regulations governing network adequacy have some positive aspects,” she added. “But we are concerned that they do not contain the specificity that we recommended.”

The proposal also would establish a quality-rating system, perhaps similar to the star scores assigned to Medicare coverage for seniors, so members could compare plan performance. However Wachino said it was too early to tell what the ratings would look like.

Margaret Murray, CEO of the Association for Community Affiliated Plans, a group of not-for-profit Medicaid companies, said she was disappointed the quality standards wouldn’t apply to traditional Medicaid run by the states as well as private Medicaid plans.

“We think that managed care will come out ahead in that comparison,” she said.

In a victory for industry, the rules also propose to loosen marketing restrictions on insurers that offer Medicaid coverage as well as plans sold through the health-law marketplaces.

Some companies are counting on capturing customers moving from Medicaid to commercial plans or vice versa as the members’ incomes fluctuate. The new regulation would make it easier for insurers to let Medicaid beneficiaries know that the same company sells a plan through the marketplace.

The rules published Tuesday are only proposals. HHS will take comments until late July and issue final rules later.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.