Social mission as a way to train more primary care doctors

Medical schools are traditionally ranked on criteria like research funding and technological innovation. These rankings are highly significant. A place on the US News‘ annual Best Medical School list  is a coveted spot indeed.

So that’s why there was some media attention paid to a recent study from the Annals of Internal Medicine, which ranked medical schools according to their “social mission” — a phrase that defines a school’s commitment to primary care, underserved populations and workforce diversity.

Using this new criterion, some of the traditionally high ranking schools fell significantly.

In other words, schools that received a lot of grant money — thus propping their rankings in US News — did not allocate as many resources to primary care, sullying their social mission score.

As the New York Times’ Pauline Chen writes, “Grant money and the security it affords individuals and institutions drive institutions to emphasize research, sometimes at the expense of other urgent but less lucrative endeavors.”

With the primary care shortage at the forefront, and surely to get worse as health reform covers millions more Americans, it’s time to give schools the incentive to churn out more primary care doctors.

Maybe US News can incorporate a variation of the “social mission” into their rankings, for instance. Knowing how important these lists are to schools, it could be an impetus to divert more money to primary care training programs.

Furthermore, the ACP’s Bob Doherty suggests that politicians take notice if schools don’t: “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?”

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  • Vox Rusticus

    Since when to schools churn out anything except graduates? The idea that you can create an arbitrary re-rating scheme to make some new ranking list that conforms to a truly nebulous notion of “social mission” (we suppose, who can say what separates one institution’s quantity of social mission-liness from that of another) and then rank them begs the question “to what purpose?” Partisan political purposes it would seem.

    Is the fact that a “social mission” standard is met supposed to change what applicants would want from a particular medical school? Is it meant to cause an applicant to hold a particular school is greater or lesser esteem than another?

    “Social mission” is a code for what? Percentages of graduates choosing primary care residencies? Percentages of the institutional budget devoted to charity care? Quantity of time required during clinical years to be spent in low-income patient serving outpatient services?

    This seems more than a little misguided. It sort of assumes that the medical school can change where its graduates choose to go for residency simply because of the flavor of the sentiments of its faculty, as if the overall practice climate that presently discourages doctors already in primary care has no bearing on those choices where and in what field to do residency. That is infantile, magical thinking. We ought to give medical students more credit for their capacities for native intelligence and deductive reasoning than to presume that you can force more of them into primary care (than otherwise want to) in face of evidence that primary care is manifestly a poor deal, that pays relatively poorly and where its practitioners are undervalued and treated accordingly.

    You can’t fix a perceived undersupply of primary care practitioners by hanging a new rating chart of medical school rankings. The lack of interest in primary care amongst medical school graduates will not be changed by elevating one medical school’s ranking over another. The lack of interest is a result of extreme economic disincentives to practice in those primary care fields, and that will not be changed one bit by this ridiculous and transparent window dressing.

  • Dr. Mary Johnson

    What Vox said. Squared.

    No one (particularly no one in the Obama administration) is looking at this problem realistically – or talking/listening to those of us who have been there and done that and gotten hosed.

    “Window dressing” is a good description.

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