Part 2: Chicago's newest medical school is preparing students for AI, prior authorization and the residency match

Two-thirds of physicians use artificial intelligence (AI) daily or weekly in their clinical or administrative work, and 44% say they are somewhat or very likely to leave clinical practice entirely within the next two years, according to Doximity's 2026 Physician Compensation Report, released Aug. 25.

At the Illinois College of Osteopathic Medicine (IllinoisCOM) at The Chicago School, students in the inaugural class of 91 are already using AI to fact-check lectures and build practice board questions and flash cards. They also learn anatomy on plasticized cadavers.

The school, Chicago's first new medical school in nearly a century, opened in July.

John Lucas, D.O., the college's founding dean and chief academic officer, spent about 17 years as an emergency physician and much of his career in graduate medical education, creating residency positions and supervising residency program directors. He said IllinoisCOM built its curriculum around the foundational competencies for undergraduate medical education released in December 2024 by the Association of American Medical Colleges (AAMC), the American Association of Colleges of Osteopathic Medicine (AACOM) and the Accreditation Council for Graduate Medical Education (ACGME).

Michele Nealon, Psy.D., a licensed clinical psychologist, has been president of The Chicago School since 2010.

In the second part of their conversation with Medical Economics, Lucas and Nealon discussed what medical school can teach about the business side of practice, how students are using AI in their training and how the school plans to get graduates to the communities that need them.

Related content: Part 1: How Chicago's first new medical school in nearly a century is training doctors to treat mental and physical health together

Our conversation, lightly edited for length and clarity, follows.

A lot of burnout comes from the way medicine works in the U.S., from the corporatization of medicine to administrative tasks that keep doctors busy all night. How much can school really prepare students for that side of medicine?

Michele Nealon: A lot. They can be prepared a lot for this. Lucas talked about the Mind and Medicine program, but there's also the strategy, the engagement and the intent IllinoisCOM has here to prepare the students.

You can prepare students for the science of medicine. Absolutely, they're doing a fantastic job. I sat in last week on their first research presentations, and I just could not believe the extent and the depth of their learning within 10 weeks. So yes, we teach the science of medicine, and, as Lucas calls them, they're intellectual athletes. They pick up on that very quickly and very well.

You can also teach students the practical realities of practicing medicine. Yes, students need rigorous clinical training, and they get that. They also need to understand stress and workload and the emotional demands, even the realities of the systems within which they work and the responsibility they have in caring for others, and how all of those things affect their well-being.

Oftentimes it's about raising these issues to awareness and attention, and then teaching the ways we know support professionals in managing them. It's almost like you're running a marathon in these professions. You need to be ready, you need to be prepared, there need to be snacks in your pocket to keep you going, and there need to be water stations along the way. These are the skills students are also taught to help them be prepared.

There's an honesty factor here: No medical school can fix systemic challenges in health care. Lucas opened the door on this. There are issues our physicians are dealing with all the time: prior authorization, the documentation burden they have, the reimbursement issues.

Lucas and I are great colleagues as a physician and a psychologist, and we talk about these things all the time, including the loss of self-efficacy when you can't get the reimbursement you know your patient really needs, when you know that if they could get that reimbursement and be cared for, they'd have better health outcomes.

Physicians complete about 40 prior authorizations a week. That takes up 13-plus hours of physician and staff time, and 94% will say that one aspect of their job alone is a major contributor to burnout.

So the team at the College of Osteopathic Medicine is teaching students two things. First is what burnout is. How do you tell it apart from depression, for example? How do you buffer yourself from it?

They talk about burnout as a system problem that needs system solutions. Someday those system solutions will come forward. I'm very optimistic about that.

But in the meantime, many students do start medical school with depression. Not enough get their depression treated, and they also need to understand the difference between burnout and depression, again, something you've written about yourself, Austin.

Depression is a medical condition that needs treatment, and it can really be missed when all of the distress a physician is experiencing is labeled as just burnout. I don't say the word "just" lightly at all, but to separate the two: Burnout and depression are separate things. Label them both accurately. Don't minimize or maximize the impact of either of them alone.

So we need to produce physicians who understand those things and can take care of themselves, with skills and knowledge that are research-based, on how to build that resilience and keep it over the course of a career.

Then we also need to help them be advocates for better systems, because they will know very quickly the human cost of systems that don't work well. We have to remain optimistic that many of our students who go on to become physicians will also work within systems in a way that improves them.

What Lucas and his team have created is a very distinctive opportunity to incorporate all of that perspective and share it with the students, so they can understand whole-person health not only for their patients but for themselves, in a way they can carry throughout the entirety of their careers.

Could you talk about the curriculum on the business side of medicine? Are students learning things like managing debt, reading and signing a contract and understanding how doctors actually get paid?

John Lucas: Yes. That's actually a great question, and I think it's imperative that we give them the energy to try to change the system while also preparing them to exist in the system as it stands today.

You can't live pie in the sky. They're going to graduate in four years. They're going to be residents working in these systems, and then they're going to be independent physicians. Right now they're learning anatomy and physiology and osteopathic manipulation and all the foundational things, and of course mental health, all the things we need to give them to get there.

But in the course of their training, I have two current health care CEOs, one a physician and one an MBA, who are chomping at the bit to come and talk to our students about the realities of practice. How do we exist in the system? How do you craft your career so that you can actually be productive and engaged for the long term?

These are people who have walked those paths and who are now leaders of enormous hospital organizations. Actually, I lied: It's three of them, all from different organizations.

We're planning on incorporating some of that a little later in the curriculum, in second year, because right now there's nothing for them to do with that information just yet. They're not engaged in that. But as this curriculum evolves, we're going to incorporate those experiences.

Burnout, to some degree, is present when expectations don't match reality, so we have to give them appropriate expectations so that they're not disappointed or frustrated or disillusioned, but really have the resolve to keep that same idea of wanting to make a change.

There's that tension between "This is the real world right now" and "It doesn't have to be that way forever." It's not going to change tomorrow. But you might have a 30-year career. Make it your business to turn the battleship, so to speak. They always say turning a battleship is a very slow business, and that's kind of what we're trying to do in this whole system.

So over the long arc of your career, make a difference, but be prepared to live in the system as it exists, and do everything you can to make sure you're taking care of yourself and providing the best care you can for your patients, given the constraints.

The statistic Nealon quoted earlier about prior authorizations is just obscene. It's crazy that these highly trained physicians taking care of people are spending tens of hours of their lives on this activity.

I actually think that might be where we're headed with AI, because that'll be an AI automation, immediately interpreting these things. Some of the other things we'll see that are going to be good around AI are the use of AI scribes, the acceleration of research protocols and the acceleration of new device and drug development.

AI is getting a lot of press right now: It's going to kill us all, a la James Cameron's "The Terminator" from 1984, which was one of my favorite movies, by the way. I'm a huge Schwarzenegger fan, and I keep saying every time, Schwarzenegger was telling us in '84 that Skynet's coming.

But I think we shouldn't necessarily jump into that engagement of "It's going to destroy the world" without at least engaging on some level with "It could actually make things better." If it's used properly, it has enormous positive potential. If we can hold on to the one and not throw out the other, I think we'll be better off.

I think that will actually resolve a lot of the things physicians currently have to engage in that are dissatisfiers in their lives: the charting, the interaction with the electronic medical record, the enormous amount of time it takes to justify decisions and get therapeutic options for their patients. I think a lot of that stuff is going to continue to be spun up.

It's 2026, so AI has to come up in every conversation. Is it like the old rule that students shouldn't use a calculator in math class, even though they'll have one with them all the time, or is there a deskilling fear? How do you think about AI tools in training? Are students using OpenEvidence or checking ChatGPT, or are they learning to do it the old way?

John Lucas: We try our best to live in the realities of the thing, and AI is here. It's not going anywhere. Students are using it literally every day.

They're fact-checking our lectures. They're using it to create sample board questions, flash cards, learning tools, all of the things I didn't have in medical school and probably would have loved, to be honest. I think those are great.

Ultimately, though, we do have to embrace some of the foundational understanding of how these things came about and how AI was actually educated to do those tasks, which was from human knowledge.

I actually think we have a responsibility as physicians to recognize the parts of our day-to-day tasks that AI does better, and it's hard to admit that, because we want to say we're better than AI at everything. But there are certain realities I think we have to face.

For instance, we know that AI reads an EKG [electrocardiogram] better than humans in almost every case, up to and including cardiologists. It's been shown and demonstrated.

If we know this and we choose not to take advantage of it, we're actually doing our patients a disservice. We're handicapping them based on our abilities as humans by not using that extender, another set of analysis.

If you're lucky and you do a lot of EKGs, you've maybe seen 10,000 in your career. AI has access to millions and can analyze them in seconds. So I think we have to look at that and ask, "Is this producing better care for our patients?"

That being said, AI cannot currently hold a patient's hand. It cannot currently palpate a patient's abdomen, listen to a chest, or look into their eyes and tell them it's going to be OK.

There are human parts that I think osteopathic physicians do especially well, because we believe in hands-on medicine, both diagnostically and therapeutically, and I don't think AI is approaching replacing us in those.

As a profession, medicine has to embrace the parts that are especially human, the parts AI can't encroach on, at least not yet, and look at the things AI does really well as an additional tool. This is a tool to make us better at taking care of our patients. It doesn't mean you're dumb. It doesn't mean you're obsolete.

At the end of the day, most patients really do value the ability to have a personal conversation with somebody who expresses understanding and empathizes.

We live in an incredibly interesting time with this. As I've told Nealon, if we had built this medical school five years ago, we wouldn't be facing these questions in the same way. If we built this medical school five years from now, many of these things would probably have settled out in a certain way.

But we exist in this incredible time of flux, where a tool we might have wanted to incorporate into the curriculum two weeks ago is now obsolete because AI can do things better than it could in that short time. So we're engaged in that. We're living in the now.

We examine the new and the cool, but we also always revert to the foundations and say, you know what? Anatomy is anatomy. We've got plasticized cadavers in our anatomy lab, and you have to know where these nerves go.

And yes, we have AI tools that will help you. You can put on the VR goggles and actually get inside a human heart and look around its chambers. That's amazing.

You can also take them off and look at the real specimen from a human being, and you have to know those things. That hasn't changed, and it won't change as long as we walk the earth with this human anatomy. You've got to learn those things. It's a really fascinating time to be doing what we're doing.

Michele Nealon: Two things to add there. For the fun of it, go ask Claude or ChatGPT. Tell them you have a headache, throw in a bunch of different symptoms and engage in a conversation.

We know people are doing this more and more. They're asking AI, "Hey, I have this symptom. What could it be?" Go through the whole process and spend as much time as you want.

At the end, even AI will say, "I am not a physician. I cannot give you an accurate diagnosis." It depends on what you're asking and what platform you're using, but they will tell you, "I'm not a physician, I don't see you, and I can't assess this. You're best going to a physician. Please don't take my medical advice." Even AI will tell you it cannot replace the physician. So that's one thing.

Second, as educators, and again as psychologists and physicians, we have an ethical responsibility to teach and train our students about their ethical responsibilities, and we do. We let them know what the rules are and what the expectations are.

How do you take any technology, anything, and use it appropriately, ethically and in your patient's favor? It's not to read something as a simple fix. It's how you use it to enhance and elevate what you know and who you are as a physician. That happens in medical school, Austin, and when you want to be a clinical psychologist, and it needs to continue no matter what.

Students need to understand: Here is what's available to you. They find it out anyway. The younger generations especially are plug-and-go. They know this much better than generations before them.

So, as Lucas said, we have to understand it's a tool that's there. We have to understand its contributions as well as its limitations, and we always have to take on the responsibility to ethically train, teach and hold accountable students who have these technologies at their fingertips.

At the end of the road, it's all about patient care and the ethical use of you as a trained professional, with everything that's available to you, for your patient's care.

John Lucas: One of our faculty members is a practicing trauma surgeon, and he's also really into AI and technology. We were talking the other day, and he said, "I had a patient the other week who I was just stumped on." This guy is brilliant.

He said, "I felt like I was missing something, something I hadn't thought about. I used AI to help me think through some of these things, and you know what? It put me onto something I hadn't considered, and it really helped me in the care of that patient."

That's a great use case. That's exactly where we want to get to: a place where we can use this to help us consider things we hadn't already considered and produce great outcomes and better care.

If we can keep it in that space, really maintain the humanity part and still augment the parts of our care process that are helped and aided by this, I think we're going to end up at a net positive. But the reality is nobody really knows, do they? Nobody knows where this is going, and that's what makes it kind of fascinating to be a part of.

Helping with the physician shortage is a big part of the school's mission, and osteopathic medicine has been looked to as part of the solution in a lot of ways. How are you making sure graduates land residency spots and practice in the areas where they're needed most?

John Lucas: Most of my background is in graduate medical education, or residencies. I came out of that space and was responsible for creating a lot of residency positions and supervising the program directors, the people who actually pick the med students for their residency programs.

I think you have two questions in there. One is how we make sure they get residency spots, and the other is how we make sure they end up practicing where they're needed.

The answer to the first one is to keep our eye on the ball, which is training our students to be great residents. We say we are training physicians, but nobody graduates medical school and goes and practices. We are training students to become residents to become physicians, so we have to keep our end user, if you will, in mind.

When we crafted this curriculum, we used the most recent and most agreed-upon outcomes from the governing bodies in medicine. The AAMC, AACOM and ACGME came out with a document on core competencies.

Basically, it said: We, as organizing bodies for essentially all of medicine in the United States, believe nobody should graduate medical school without these core competencies. They should all be really good at these things.

That came out right when we were finalizing our curriculum, so we built it into the curriculum in a real way. I think we were maybe the first, if not one of the very earliest schools, to do that in such a specific way, because we could. We didn't have a curriculum in place that we had to retrofit. We just used it and said, OK, we're going to make sure our students graduate with the tools and the equipment they need to be fantastic residents.

The plan is to give them great clinical experiences in third and fourth year. We have enormously broad and deep partnerships in Chicago and in our core areas around the country to provide them excellent training and exposure to residents, and to equip them to be the best residents they can be.

They're going to be in demand. I have absolutely zero worry that they're going to be in demand, because I know our approach is going to work.

I think what people don't understand is that, nationwide, the problem isn't so much that we can't match people with residencies. Most of them can. It's just that there aren't enough of certain kinds of residencies for everybody who wants that particular thing.

Let's say neurosurgery. I jokingly say there aren't enough neurosurgery residencies in the United States for everybody who wants to be a neurosurgeon, and so the reality is that not everybody who wants to be a neurosurgeon can be a neurosurgeon. Even if they're great students, even if they perform well, even if they're stellar and at the top of their class, there just aren't enough spots.

So part of the skill of getting well-matched and successful residents is making sure they have the right expectations.

When I was in another job, students would come to me and say, "I want to be an ER doc," and it's a reasonably competitive specialty, or certainly was at the time.

We would look at their portfolios, and I would say, "You know what, from what I see here, you're not going to be a great competitive candidate," because I know how residency directors approach these things. They're going to look at certain metrics.

So I would counsel them: Let's go for this, but let's also have a backup. What's going to be your backup? What else can you do?

So part of it is early matching of our student body and their interests to the preparation pathways for the residencies they want, and giving them the best opportunities to get them.

Some people want to do ultracompetitive specialties, so we've got to have some reality there, too, and make sure that if that doesn't work out, we've got a Plan B. That's a hard conversation, but it's one every medical school across the country has with every one of its medical students if it's doing its job.

I jokingly say not everybody gets to be an astronaut. If you want to be an astronaut, not everybody gets to be an astronaut. It's the same in medicine. Not everybody gets to be a neurosurgeon or an ophthalmologist or whatever it is they want to do.

Then on the practice side, how do we get them to practice where they're needed? In many cases, that determination is set before they come.

If students come from small communities, a lot of them will say, "I want to go back to these communities." If they come from an underserved area of Chicago, which a lot of our students do, we want to bring them in and align them with the mission early, so that we know coming into the game that this is where they're bent.

They may change their minds, and we can't do anything about that. They need to pursue the things they feel passionate about. But largely, getting students to go where they're needed can be predetermined by where we get them from, so we look early to align the mission of the school with the personal mission of these students.

We also put them in certain training environments to see what the need is, and we're trying to engender some of that passion as well. Some students may not have realized they have a passion for rural or underserved medicine, so we put them in positions that help them see the need.

These are incredibly empathic and caring students, and sometimes that's enough to generate that interest and love for what they want to do.

So it's a delicate process of trying to align our class with the mission of our school and their personal missions, while also trying to get them in front of the communities and environments that need them.

That's not necessarily entirely in Chicago, but it's amazing, in a city like Chicago, how many communities don't have access to adequate medical care. We have partnerships with some of those communities, and we're sending students into them even now, in what we call early clinical experiences.

They get to come up for air while they're studying biochemistry and remind themselves, "Oh, yeah, this is why I wanted to be a doctor." They get to go into these communities and see medical care, and some of those communities are exactly where it's most needed. So we're trying to expose them to that to kindle some of that interest as well.

Is there anything I didn't ask that you want physicians in the audience to keep in mind?

Michele Nealon: I do have one, and you already opened the door to it with the national shortfall of physicians.

Just to emphasize for your viewers and listeners how serious this is: The current projection is a national shortfall of up to 86,000 physicians by 2036. In Illinois alone, that's over 1,000 primary care physicians by 2030, an increase, I believe, of 12% from when it was measured in 2010. That's a serious issue for all of us.

As well as everything you asked about, this is a social imperative: training the next generation of physicians. This is a workforce development matter, so that's one that's really top of mind for us, Austin.

And as we've been talking about over this past hour, the kind of professional IllinoisCOM is preparing is not only going to help fill that workforce, but in a way that is substantially different from how physicians have been trained before.

Talking about what gets you to work every day, that is a remarkable societal contribution, as well as a professional contribution, that The Chicago School is stepping into.

Related content: Missed the first part of this conversation? Find it here: Part 1: How Chicago's first new medical school in nearly a century is training doctors to treat mental and physical health together