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Looking At Medical Schools From A Different Perspective

Joe Cantlupe, for HealthLeaders Media, June 24, 2010

At first glance, you don't quite believe it, when you read the findings of a recent Annals of Internal Medicine study that examined U.S. medical schools for their collective social consciousness: namely, that some of the nation's most prestigious medical schools—Johns Hopkins University, Stanford, Duke, Texas A&M, and Columbia, to name a few—are ranked near the bottom in terms of graduating physicians who continue to work in primary care, or work in underserved areas, or are underrepresented minorities.

The study, "The Social Mission of Medication Education: Ranking the Schools," bills itself as the first to evaluate U.S. medical schools, not on their academic standing, but in their ability to carry out a "social mission."

It's a study touted by its authors as groundbreaking. It's a study denounced by its critics as nothing more than a "limited picture" of medical schools.

Candice Chen, MD, co-author of The George Washington University study, contends it is important because it reveals outcomes of a medical education following graduation, in the context of social service, which she says is hardly measured in academic circles. With a primary care shortage enveloping the country, as well as greater disparities in patient populations, focusing on these issues is becoming more relevant, Chen says.

"There's such a difference between the top 20 and the bottom 20, for instance, in how many primary care physicians they graduate," Chen says. "We're not trying to berate any of the medical schools, we're just saying that in terms of social services, some schools are more successful than others, and others should learn from them."

"Primary care physician output, practice in underserved areas, and a diverse physician workforce have persistently challenged the U.S. health system and medical education," the study states. "This analysis reveals substantial variation in the success of U.S. medical schools in addressing these issues."

It found:

  • Public medical schools graduated higher proportions of primary care physicians than their private school counterparts.
  • Schools with substantial National Institutes of Health research funding generally produced fewer primary care physicians, and those in underserved areas.
  • Schools in the Northeast generally performed poorly in the social mission category.
  • Historically black schools had the highest social mission.

The researchers reviewed records of 60,043 physicians who graduated from 1999 to 2001 and completed all types of residency. The study included an analysis of data from the American Medical Association, and data on race and ethnicity in medical schools from the Association of Medical Colleges, and the Association of American Colleges of Osteopathic Medicine.

The researchers then constructed a social mission score to summarize overall performance of the country's 141 medical schools in producing graduates who practice primary care, worked in areas with a federally designated shortage of health professionals and belonged to underrepresented minority groups. In some cases, some schools are better in certain categories, but still lagged behind in overall social mission scores because of their performance in other areas.

Not everyone is happy with the study, saying that it fails to reveal the full scope of a medical education in the U.S. Others believe the information is outdated.

The American Association of Medical Colleges issued a statement denouncing the study, noting: "Like other attempts at ranking medical schools, this study falls short. By defining 'societal mission' and 'primary care' so narrowly, it provides a very limited picture of medical education's many contributions to society in the U.S. and around the world. And that serves no one well."

The study "presents a limited picture of how medical schools serve society's needs through their integrated missions of education, research, and patient care," the AAMC adds. "While producing primary care physicians, ensuring more diversity in the physician workforce, and encouraging more doctors to practice in underserved areas are important parts of that mission, they are not the only components."

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