The Milwaukee Community Journal’s Yearlong Health Focus
Washington, DC – As the health system girds for an influx of newly insured patients, a new study in the June 15 Annals of Internal Medicine examines the record of the nation’s medical schools in graduating physicians to meet this new public need.
The study, the first to score all U.S. medical schools on their ability to meet a social mission, shows wide variations among institutions in their production of physicians who practice primary care, work in underserved areas, and are minorities.
Key findings from the George Washington University study of 141 medical schools:
Public medical schools graduated higher proportions of primary care physicians than their private counterparts did.
Schools with substantial National Institutes of Health research funding generally produced fewer primary care physicians and physicians practicing in underserved areas, and thus had lower social mission scores overall.
Several large research institutions (notably the University of Minnesota and University of Washington) defied this trend, ranking in the top quartile for overall social mission score.
Historically black schools had the highest social mission rankings.
Osteopathic schools produced more primary care physicians than allopathic schools but trained fewer minorities.
Schools in progressively smaller cities produced more primary care physicians and physicians who practiced in underserved communities but graduated fewer minorities.
With medical schools expanding for the first time in over 30 years, the findings bring attention to the role that medical schools play in determining the make-up of the U.S. physician workforce.
“Where doctors choose to work, and what specialty they select, are heavily influenced by medical school,” says lead author Fitzhugh Mullan, MD, a professor of health policy at George Washington University.
“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,” he says. The study was funded with a grant from the Josiah Macy, Jr. Foundation.
To determine the true outcomes of medical education rather than the intermediate preferences of medical students and residents, Mullan and his team studied physicians in practice after the completion of all training and national obligations (such as military service or National Health Service Corps placements).
The researchers examined data from medical school graduates from 1999 to 2001, which provided a very different picture than previous studies.
Previous analyses, such as the popular U.S. News & World Report rankings, have relied on the initial residency selection or reported specialty preference of students.
The George Washington University study pinpoints where graduates are and what type of medicine they actually practice.
The study provides a real-time and real-place report on the actual career selections of medical school graduates and the health care they currently provide.
The 20 schools with the highest social mission scores (ranked from highest to lowest):
1. Morehouse College
2. Meharry Medical College
3. Howard University
4. Wright State University
Boonshoft School of Medicine
5. University of Kansas
6. Michigan State University
7. East Carolina University
Brody School of Medicine
8. University of South
Alabama, Ponce Medical College
9. University of Iowa Carver
College of Medicine
10. Oregon Health &
11. East Tennessee State University Quillen College of Medicine
12. University of Mississippi
13. University of Kentucky
14. Southern Illinois University
15. Marshall University
16. Joan C. Edwards University
17. University of Massachusetts
Medical School Worcester
18. University of Illinois
19. University of New Mexico
20. University of Wisconsin
The 20 schools with the lowest
social mission scores
(ranked from highest to lowest):
122. Johns Hopkins University
123. Stanford University
124. Duke University
125. Texas A&M University
126. Columbia University
127. Albany Medical College,
128. Medical College
129. University of Pennsylvania
130. Loyola University
Stritch School of Medicine
131. Boston University
132. Albert Einstein College of
Medicine of Yeshiva University
133. Stony Brook University
134. Thomas Jefferson University
135. Uniformed Services
University of the Health Sciences
136. University of Medicine
& Dentistry of New Jersey
137. New York University
138. University of California Irvine
139. Northwestern University Feinberg School of Medicine
140. University of Texas Southwestern Medical Center
141. Vanderbilt University
The authors note that these findings are important in the context of U.S. health care today.
“The social mission of medicine and medical education should be important to everyone.
It isn’t just about rural areas or just about poor people, it’s about the entire fabric of how we deliver care,” says Mullan.
“As patients are insured through health reform, the first place they will go is the primary care office.
Medical schools need to be mindful of the nation’s requirements 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.”
“The Social Mission of Medication Education: Ranking the Schools” is published in the June 15, 2010, Annals of Internal Medicine.
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