The social mission of medical schools

Few would argue that it’s the mission of medical schools in the U.S. to produce trained and qualified physicians who can provide needed health care to the American population. But do medical schools have social responsibilities that go beyond this basic mission? Is it also their duty to help meet the need for primary care doctors? Should they be working to help increase the number of minority physicians and the number of physicians in underserved areas?

An intriguing report, published this month in the Annals of Internal Medicine, takes a look at how medical schools stack up on this issue and concludes that not all institutions are equal:

The contribution of medical schools to the social mission of medical education varied substantially. Three historically black colleges had the highest social mission rankings. Public and community-based medical schools had higher social mission scores than private and non-community-based schools. National Institutes of Health funding was inversely associated with social mission scores. Medical schools in the northeastern United States and in more urban areas were less likely to produce primary care physicians and physicians who practice in underserved areas.

Social mission scores were calculated on the basis of data on medical school graduates from 1999 to 2001. The researchers analyzed information such as race and ethnicity, practice location and the percentage of primary care graduates at each medical school, then came up with rankings for 141 allopathic and osteopathic medical schools in the U.S.

Surprise, surprise: Elite Ivy-League and research-oriented schools such as Johns Hopkins and Harvard Medical School fell near the bottom of the list, while lesser-known colleges – Morehouse College in Georgia, Meharry Medical College in Tennessee and Howard University in Washington, D.C., ranked at the top.

Where does the University of Minnesota – a large research institution with an urban campus in Minneapolis and a smaller campus in Duluth – fit into these rankings? Good question. The U of M Medical School was among the top 25 percent of large research institutions in preparing physicians for primary care. The U also was in the top 25 percent for its overall social mission.

The U is among a handful of the larger, research-focused schools that seem to defy the trend, the study’s authors note: “These findings invite questions about what factors influence graduates of these schools to choose primary care and whether those influences might be transferable to other schools.”

It’s one of the first times I’ve seen this kind of data-based analysis to examine how medical schools fare at meeting what could be defined as their responsibility toward society. To be sure, social mission is only one aspect of medical training. It’s also important to prepare physicians for specialties and for research and academia.

The study points out, however, that medical schools cannot afford to shirk their social mission:

Evidence increasingly shows that primary care is associated with improved quality of care and decreased medical costs. However, an insufficient number of primary care physicians has hampered efforts to provide expanded health care access in states, such as Massachusetts, and business groups and insurers have begun to speak out about the need for increased access to primary care.

Rural communities have a chronic shortage of physicians, and federally supported community health centers report major deficits in physician recruitment. African-American, Hispanic and Native-American physicians continue to be severely underrepresented in the U.S. workforce.

The report also takes aim at the prestige factor, noting that national rankings of medical schools “often value research funding, school reputation and student selectivity factors over the actual educational output of each school, particularly regarding the number of graduates who enter primary care, practice in underserved areas, and are underrepresented minorities.”

The authors of the study conclude, “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.”

Predictably, the study has been met with negative reaction. “Political correctness and social missions have now invaded the world of measuring ‘quality’ in medical schools,” a commenter lamented online at the Chronicle of Higher Education. A statement issued by the American Association of Medical Colleges concludes the study “falls short” by defining the role of medical schools too narrowly.

An interview with one of the study’s authors, Dr. Candice Chen of the George Washington School of Public Health and Health Services, sheds more light on how the social-mission rankings can be viewed. Research is important but social mission needs to be valued as well, she argues:

… Medical schools have to play their role too. They have to maximize those changes. And medical schools can make a difference. They can make a difference in terms of their recruitment and admissions practices. They can make a difference in terms of their curriculum. And just in the very culture that they support. Unfortunately, there are schools out there that have no family medicine department, and it’s hard to imagine that a student is going to pick family medicine when they’re not being exposed to a family medicine department within the school. There are definitely things that schools can do, and we look at it as things have to happen across the continuum.

Is this just an academic discussion of no real interest to the public? I don’t think so. Aside from the fact that tax dollars are helping subsidize part of the medical education system, communities have a stake here too. This is a discussion that has been long overdue and should be welcomed, controversy and all.

Photo: Harvard Medical School, courtesy of Wikimedia Commons

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