When it comes to producing primary care physicians, encouraging them to practice in underserved areas, and recruiting and educating minority physicians, U.S. medical schools vary greatly in fulfilling the "social mission" of medical education. That's the message of a first-ever study from George Washington University, or GWU, in Washington, D.C., that ranks the nation's medical schools according to how well they perform that mission.
The study(www.annals.org) was published in the June 15 Annals of Internal Medicine. According to a June 14 press release from GWU's School of Public Health and Health Services, key findings from the study of 141 medical schools include
- historically black medical schools -- Morehouse College in Atlanta, Meharry Medical College in Nashville and Howard University in Washington, D.C. -- had the highest social mission rankings;
- public and community-based medical schools graduated higher proportions of primary care physicians than did private and noncommunity-based schools;
- schools in progressively smaller cities produced more primary care physicians and physicians who practiced in underserved communities, but they graduated fewer minorities;
- osteopathic schools produced more primary care physicians than did allopathic schools, but also trained fewer minorities;
- for the most part, schools with substantial NIH research funding produced fewer primary care physicians and physicians who went on to practice in underserved areas and had lower overall social mission scores; and
- schools in the Northeast performed poorly on all three goals and had the lowest social mission scores of any region in the country.
"Where doctors choose to work, and what specialty they select, are heavily influenced by medical school," said lead author Fitzhugh Mullan, M.D., a GWU professor of health policy, in the press release. "By recruiting minority students and prioritizing the training of primary care physicians and promoting practice in underserved areas, medical schools will help deliver the health care that Americans desperately need."
The researchers examined data from more than 60,000 physicians who graduated from U.S. allopathic and osteopathic medical schools between 1999 and 2001. The data came from the AMA Physician Masterfile, the Association of American Medical Colleges and the Association of American Colleges of Osteopathic Medicine.
According to the press release, the research team studied physicians in practice after they had completed all training and subsequent obligations, such as serving in the National Health Service Corps or the armed forces, to pinpoint their actual career selections.
To compute the social mission score, the team measured the percentage of each school's graduates in three categories: those who practice primary care -- defined as family medicine, general internal medicine, general pediatrics or internal medicine-pediatrics; those who work in health professional shortage areas; and those who are members of underrepresented minorities, such as black, Hispanic and Native American.
According to the study, the South, the West and the Midwest had positive social mission scores, while the Northeast had negative scores. Western schools produced more primary care physicians and Southern schools produced more physicians who practiced in underserved areas.
More than 28,000 community members have benefited from a number of community service activities performed by medical students in campus-based family medicine interest groups, or FMIGs, across the nation.
According to a recent survey, FMIG members participated in AAFP-sponsored Tar Wars tobacco prevention programs, AAFP-sponsored Americans in Motion fitness programs, community health fairs, student-run free health clinics, primary care weeks and community- or school-based wellness education programs.
FMIG members were involved in other community activities, as well, including a Ronald McDonald House for families of children being treated for serious illness, home visits, food drives, vaccine clinics, and walks/runs/5Ks.
The 2009-10 survey indicated that almost 6,500 medical students from 53 FMIGs participated in community service activities. Of all the activities, the student-run free health clinics benefited the largest number of community members.
Texas AFP EVP Tom Banning said he was not surprised that none of the eight medical schools in Texas placed high in social mission scores. In fact, the majority were in the bottom quartile, he said.
"For a long time, we've been tracking Texas medical students going into family medicine, and this study confirms our findings that fewer Texas students are pursuing careers in primary care."
He said, however, that some medical schools are headed in the right direction, including Texas Tech University Health Sciences Center School of Medicine in Lubbock and Texas College of Osteopathic Medicine at the University of North Texas Health Science Center in Fort Worth. Texas Tech, for example, has started a Family Medicine Accelerated Track that allows selected students to complete medical school in three years.
"They're doing some innovative things to boost the supply line of family physicians, and they emphasize recruiting students from the West Texas community that are likely to come back and practice in that community," Banning said, adding that more such initiatives are needed.
"When you look at publicly funded, taxpayer-supported medical schools, we need to have a discussion about the responsibility those medical schools have to produce the workforce we need," he said.
According to the study, the findings suggest that "initiatives at the medical school level could increase the proportion of physicians who practice primary care, work in underserved areas and are underrepresented minorities."
Such initiatives could include a focus on recruiting and training underrepresented minorities, enhanced support for medical education at the state level, more explicit commitments by medical schools to educate physicians who will meet community needs, and developing branch campuses of existing schools in less urban areas.
"As patients are insured through health reform, the first place they will go is the primary care office," Mullan said in the press release. "Medical schools need to be mindful of the nation's requirement for primary care, for doctors prepared to work in underserved communities and for minority physicians to help meet the growing and changing needs of the country."