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Medical Schools: Why Do Some Do Primary Care Better?

A new study published in the Annals of Internal Medicine, ACP’s flagship journal, finds that medical schools vary greatly in producing more primary care physicians and getting them into underserved communities.

- “Public schools graduate higher proportions of primary care physicians” than private schools.

- “The 3 historically black colleges and universities with medical schools (Morehouse College, Meharry Medical College, and Howard University) score at the top” in training primary care physicians who then go on to practice in underserved communities. (Click here for an interview with two recent graduates of historically black colleges and with Wayne Riley, MD, FACP, who is the president and CEO of Meharry Medical College in Nashville, Tennessee and a regent of the American College of Physicians.)

- “The level of NIH support that medical schools received was inversely associated with their output of primary care physicians and physicians practicing in underserved areas.”

- Some institutions defy the trend: “Four large research institutions (University of Minnesota, University of Washington, University of California-San Diego, and University of Colorado) are in the top quartile of medical school recipients of NIH funding and of primary care output rankings. In addition, University of Washington and University of Minnesota are in the top quartile for overall social mission score.”

- “Compared with other U.S. regions, the Northeast, with its preponderance of private, traditional, and research-intensive medical schools, had the lowest scores in … [producing] primary care [physicians] and [serving] underserved areas…” Schools in urban areas, in general, scored lower on these dimensions than schools in less populated communities.

(Click here to see how your state’s medical school rank on social mission.)

This study is likely to generate a highly controversial public policy debate.

If politicians want more primary care physicians, especially ones who are committed to practice in under-served communities, they could put more money into programs focused on the recruitment and training of underrepresented minority medical students.

They might increase support for public medical schools over private schools.

They might ask medical schools and grant-making institutions, like NIH, to examine why research funding promotes technical medicine over primary care, and why some schools that receive substantial research funding buck the trend.

They might give preference to building or locating medical schools in less urban communities.

(Related, the Obama administration recently announced an investment of $250 million to support training of more primary clinicians, including $168 million for training more than 500 new primary care physicians by 2015, $32 million for supporting the development of more than 600 new physician assistants, $30 million for encouraging over 600 nursing students to attend school full-time, $15 million for the operation of 10 nurse-managed health clinics, and $5 million for states to expand their primary care workforce by 10 to 25 percent over ten years. ACP released a statement of general support for the administration’s investment in primary care.)

The authors of the Annals study conclude with a challenge:

“Some schools may choose other priorities, but in this time of national reconsideration, it seems appropriate that all schools examine their educational commitment regarding the service needs of their states and the nation. A diverse, equitably distributed physician workforce with a strong primary care base is essential to achieve quality health care that is accessible and affordable, regardless of the nature of any future health care reform.”

If medical schools won’t re-examine their priorities on their own, aren’t they inviting politicians to force change – by shifting funds to schools that have a better primary care track record?

Today’s questions: Do you think medical schools should be accountable for training more primary care physicians? Should politicians shift money to medical schools (public, historically black, less research-oriented, and less urban) with a better primary care track record?

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*


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One Response to “Medical Schools: Why Do Some Do Primary Care Better?”

  1. Ed Pullen says:

    When I graduated from Tufts University School of Medicine as a fairly highly rated student, my advisors response to my announcement that I was going to apply to family medicine residencies was that I could get a “good residency” if I wanted.

    See my post on how to get more students into primary care:

    http://drpullen.com/2010/06/14/how-can-we-encourage-medical-students-to-choose-primary-care/

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