09 July 2010
(NNPA) - As the nation's healthcare system braces for an influx of newly insured patients, a new study published in the June 15 issue of 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 based on their ability to meet a social mission, reveals glaring differences among institutions with regard to their production of physicians who practice primary care, work in underserved areas, and are minorities.
The George Washington University study of 141 U.S. medical schools found that historically Black medical schools had the highest social mission rankings. In a Top 20 list of medical schools with the highest social mission rankings, Morehouse College, Meharry Medical College and Howard University ranking first, second and third respectively. Many of the institutions generally considered to be the most prestigious medical schools did not even make the Top 20 list.
In fact, many of the nation's most prestigious medical schools - including Duke University, Stanford University, Johns Hopkins University, Boston University and Columbia University - finished in the Bottom 20.
The study also found that:
* Medical schools in the Northeast generally performed poorly on all three measures and, as such, had the lowest regional social mission scores.
* Public medical schools graduated higher proportions of primary-care physicians than their private counterparts.
* 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.
* 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 makeup of the U.S. physician workforce. "Where doctors choose to work, and what specialty they select, are heavily influenced by medical school," lead author Fitzhugh Mullan, MD, a professor of health policy at George Washington University, said. "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 Top 20 schools with the highest social mission scores are:
Morehouse College; Meharry Medical College; Howard University; Wright State University Boonshoft School of Medicine; University of Kansas; Michigan State University; East Carolina University Brody School of Medicine; University of South Alabama, Ponce Medical College; University of Iowa Carver College of Medicine; Oregon Health & Sciences University; East Tennessee State Univ. Quillen College of Medicine; University of Mississippi; University of Kentucky; Southern Illinois University; Marshall University; Joan C. Edwards University; University of Massachusetts Medical School Worcester; University of Illinois; University of New Mexico; and University of Wisconsin.
The 20 schools with the lowest social mission scores are: Johns Hopkins University; Stanford University; Duke University; Texas A&M University; Columbia University; Albany Medical College, Columbia University; Medical College of Wisconsin; University of Pennsylvania; Loyola University Stritch School of Medicine; Boston University; Albert Einstein College of Medicine of Yeshiva University; Stony Brook University; Thomas Jefferson University; Uniformed Services University of the Health Sciences; University of Medicine & Dentistry of New Jersey; New York University; University of California Irvine; Northwestern University Feinberg School of Medicine; University of Texas Southwestern Medical Center; and Vanderbilt University.
The authors of the study noted 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." *