Should social justice matter when choosing medical students?

by James Gaulte, MD

Should medical student applicants be chosen less for their demonstrated ability to master large amounts of knowledge and solve problems and more for their social consciousness and desire to push forward with social justice?

That appears to be the suggestion of a panel of experts from the AMA in a project called the Initiative to Transform Medicine (ITM) who believe an altruism deficiency underlies the migration to certain more lucrative medical specializations at the expense of forsaking primary care causing a shortage of primary care doctors.

Duke Cheston gives a good summary and exposition of reasons more convincing than a sudden attack of selfishness, greed and hypertrophied self interest as to why fewer medical students choose primary care. Yes, it does depend to a significant degree on income, but there is more to it.

The suggestion made by the panel that social awareness or social consciousness should be weighed more heavily than ability to master a formidable load of knowledge and problem solving ability in selecting students for primary care residency training reflects a lack of awareness of what is required in primary care and a demeaning characterization of primary care medicine. Often more problem solving skill is demonstrated in sorting out a patients diagnoses from a myriad of often non-specific complaints that is evident in the specialists subsequent handling of the case which arrive in his office with the label already properly applied. Internists were once thought of as being at the top of the problem solving food chain but now those limit their practice to outpatients seem to be considered merely as members of the category of primary care provider.

I believe the shift of medical students from primary care to specialties is due less to some alleged “altruism gap” than to the combination of three other gaps; 1) an income differential gap, 2) a lifestyle differential gap, and 3) a practice hassle

How did the income gap come about? This is a story often told in the medical blogs of the Resource Based Relative Value Scale and the now infamous RUC and the role that once obscure group played in protecting the income of procedure oriented physicians versus those who do not do procedures.

In addition to the altruism deficiency the panel “determined” another weakness of physicians as they are trained today:

Physicians are generally not prepared to be advocates for patients on issues related to social justice (for example, elimination of health care disparities, access to care) and to be citizen leaders inside and outside of the medical profession. This also includes engaging in advocacy on public health issues.

Apparently in the view of this group of self designated experts, one of the many requirements of physician training is to prepare them to work for social justice, which must involve redistribution of wealth. Perhaps lessons in community organizing could be added to the curriculum. I suppose libertarians need not apply. Neither should anyone who thinks Thomas Jefferson had it right when he said,

To take from one because it is thought that his own industry and that of his father’s has acquired too much, in order to spare to others, who, or whose fathers have not exercised equal industry and skill, is to violate arbitrarily the first principle of association — the guarantee to every one of a free exercise of his industry and the fruits acquired by it.

The general philosophical basis of the ITM is the same as that underlying to the creation of The New Medical Professionalism, which seriously weakens the fiduciary duty of the physician and inserts a nebulous duty to society to the physician ‘s obligations.

James Gaulte is an internal medicine physician who blogs at retired doc’s thoughts.

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  • http://doctoringtheevidence.blogspot.com/ Randall S. Bock, M. D.

    bravo and kudos to Doctor James Gaulte.

    First of all doctors (or, in their tadpole-form: medical students ;-) ) should be welcome to have whatever political opinion they choose, not be funneled or channeled into some predilection of a particular power-elite du jour.

    Medical school should be about teaching medicine, and the techniques and science behind it. If and when there are strong compelling political arguments of the day (i.e. always), let’s not presume patients are ignorant, and let’s not presume patients, when they are having (say) their diabetes treated need to hear our political points of view. Certainly if they ask, we are welcome to supply our own opinions but emphasizing that it is merely just that: our own opinions.

    When someday you or I get old (you first please), and need a cataract removed. I hope that the doctor with laser or blade in hand got to that position directly above the waiting eyeball not because of affirmative action, social justice, political opinion, or anything but competence, knowledge, and expertise.

    • J.T. Wenting

      Well said. I want my doctor(s) to be first and foremost proficient.
      Having them “think correctly” is the least of my worries. If people were judged by that in general instead of proficiency I’d long ago have been shot, hanged, or beheaded myself.

  • http://medicaleducation.wetpaint.com/ Deirdre

    In Canada, we have introduced the CanMeds Roles, a series of competencies medical students are expected to be developing as part of their medical training. http://rcpsc.medical.org/canmeds/CanMEDS2005/CanMEDS2005_e.pdf
    The Advocate role is largely understood to address some of the concerns brought out in this blog.

  • http://www.chrisjohnsonmd.com Chris Johnson

    I don’t think this is an either/or issue. I spent four years on a medical school admissions committee, and we always had more than enough applicants who were both well qualified and socially aware. I don’t see that changing.

  • http://www.aneurysmsupport.com/ Mike

    On September 18th, 2002 I experienced a ruptured Cerebral Aneurysm on the Anterior Communicating artery. While speaking with the Neurosurgeon about the proposed surgery I asked some surprisingly rational questions considering my physical state at the moment. Among these were where he had trained, how long he had been a surgeon, how many times he had performed this particular surgery, if he was physically up to the surgery at the moment and more than a few others. Not one of these questions involved his political involvement or views or opinion on a variety of social issues that interest me. My only concern, at the time, was his qualifications to perform the surgery with a high probability of a good outcome. While it is always nice to know that your doctor is moral guy who subscribes to a high set of ethics at the moment his qualifications as a surgeon was my only concern.

    • Primary Care Internist

      Well said.

      But why is it more ethical or moral to take the position of equalizing everyone, versus allowing for the personal freedom to choose one’s career path/ specialty? If someone wants to go into ophthalmology to make a lot of money, and also is very technically gifted and knowledgeable, then what’s wrong with that? What’s wrong with rewarding hard work and long training and surviving a very competitive process with money? After all, that’s what every other industry is based on. And that doesn’t mean the ophthalmologist isn’t helping people.

      Why is the person who decides to go into primary care any more (or less) moral or ethical? And if that person decides to be socially/politically active in their practice, what does that have to do with their being a good doctor? If anything, i’d argue that the politics of social engineering and wealth redistribution should stay out of the exam room. Just like religion – doesn’t belong in places like doctors’ offices and schools.

      We already have community advocates, public health experts, politicians, armies of people sitting on a high horse telling everyone how immoral they are, rather than actually doing something productive like using their years of training and expertise treating sick people. What this aging population really needs are more doctors being doctors. I bet these “experts” haven’t actually seen patients in years.

      It is reports like the ITM that so fuel the ire of practicing docs against the AMA, ACP, MSSNY, and almost every other so-called doctors’ organization. The AMA is beyone hope. Maybe MSSNY can re-invent itself with a massive new infusion of youth.

      • Rebecca Hu

        There is nothing moral or ethically wrong with someone who chooses to specialize. Rather it is that US society has a problem where we have too many specialists and not enough people with problems that require these specialists.

  • Vox Rusticus

    This is really nothing more than a leftist political agenda masquerading as “medicine.”

    If a doctor wishes to make a career of public policy, or even engage in advocacy of policies of a particular political bent, that is his right. But pretending that a predisposition to that kind of preference is desirable, and even more so, necessary to a medical student is nothing less than social engineering in the university. Medicine as a profession should not be confused with social work. Leftist political ambitions have no more place in the admissions process than do ultraconservative ideologies.

    Dr. Gaulte is right about the causes of decline in interest in primary care, and it isn’t because medical school classes have a shortage of sheep with a pinkish hue.

  • Vox Rusticus

    I think it is time to call out the “social justice” canard for what it is: a sloppy smear on anyone not slavishly wedded to leftist public policy agendas and economic principles. Anyone take issue with “social justice?” Well, you must be all about anti-social injustice, right?

    • Vox Rusticus

      The unfortunate truth about the “social justice” concept is that it is really a mask of false rectitude and assumed moral superiority of those who hate charity and the spirit of volunteerism. “Social justice” appropriates the mechanisms of public policy, and ultimately force of law on a mission of wealth redistribution dressed up in assumed morality: you must give not because it is in the spirit of love for one’s neighbor but because we say you “owe” your neighbor.

      It is a mask for tyranny, nothing less.

    • http://doctoringtheevidence.blogspot.com/ Randall S. Bock, M. D.

      Ironically, just earlier today, I was reading a great post by Thomas Sowell: Using words to confuse , wherein he touches on the concept that “social justice” may be neither very socially redeeming, nor very just.

      Here are his words on this point, somewhat redacted, “Warm, fuzzy words and phrases have an enormous advantage in politics. None has had such a long run of political success as “social justice.” The idea cannot be refuted because it has no specific meaning. Fighting it would be like trying to punch the fog. No wonder “social justice” has been such a political success for more than a century… There is a strong sense that it is simply not right – that it is unjust – that some people are so much better off than others…. Is the person who has spent years in school goofing off, acting up or fighting – squandering …dollars …spent on his education – supposed to end up with his income aligned with that of the person who spent those same years studying to acquire knowledge and skills that would later be valuable to himself and to society at large?”

      • http://Www.Twitter.com/alicearobertson Alice

        Isn’t Sowell brilliant? Does anyone know the details and credentials of this panel that allows them to place themselves as the Knights of Altruism? Although, it is a lofty goal…..so I would not want to throw the baby out with the bath water…..it just seems a bit, possibly, ironic that a panel is desiring the impossible…..the ability to see inside the metaphorical intangible human heart……I’m telling’ ya’ some of these docs think they can walk on water….well…..they want us to think they can! *wink*

  • SmartDoc

    Medical school admissions based on corrupt “progressive” ideological purity, combined with ethnic, sexual, racial and other quotas, makes for third world medical care.

    Which is what ObamaCare is all about anyway,

    • http://www.aneurysmsupport.com/ Mike

      I agree. At the rate we are heading how long will it be before we adopt practices like in the old Soviet Union and “Political Reliability” is the number one prerequisite for anything a person wants to pursue.

    • http://doctoringtheevidence.blogspot.com/ Randall S. Bock, M. D.

      I’m with you on this. I like (actually don’t like) have the “progressives” take the moral high ground via word-coinage, in this case “social justice”, in other cases “affirmative action”, when one actually refers to predetermining outcomes based on socioeconomic standing or on race (respectively).

  • imdoc

    I have yet to hear a working definition of “social justice”. Such words are just code for a liberal progressive agenda in which some committee, made up of the self-appointed “really smart people” will be the thought police for we the unenlightened masses. How better to enforce inevitable rationing of care? The first step is destruction of the duty of a doctor to an individual and supplant that with the doctor as dutiful minion to “society”.

  • Dr. J

    I will point out that Libertarianism is not immoral and does not preclude a person from acting charitably and nobly towards other humans. Excellent doctors can have any number of personal belief systems. To argue that physicians must only be of a certain and single socio-political view is the same as arguing that they should only be a single race, religion or sex; that is it is discriminatory and limits the health and growth of our profession.
    As someone who has a Libertarian viewpoint I fully support this groups right to voice their opinion (misguided and pig-headed though it is) as an issue of free speech. I also hope that the first med school candidate who voices a Libertarian view point and is turned away brings a lawsuit against the AMA for discrimination based on political affiliation and wins a verdict for all their lost future earnings as an MD.
    Perhaps the AMA needs a reminder that free speech is not just for those who have the same philosophy as you…

    • http://medicaleducation.wetpaint.com/ Deirdre

      Here, here! I have been appalled at the political rhetoric about a medical issue. We need doctors with a variety of skills. Understanding social justice issues increases critical thinking = improvement in medical error avoidance and increased advocacy for poorly understood medical issues, such as high rates of diabetes and heart disease in certain populations.

    • http://Www.Twitter.com/alicearobertson Alice

      Good post! Take note…..the public schools are having a hard time just focusing on an education……I call it The Dewey Express…..so keep fighting the thought police. Let the medical schools educate, and let the patient decide what doctor is empathetic……gosh…why am I trembling? Ha! Lest they turn to pre-programmed robots treating us….or even more scary…..more inefficient government employees. Egads…..

  • jenga

    This push is so laughable. It is easy to see what the advocates ultimately are after. Maggie Maher has discussed this topic alot and the bottom line is they want medical schools to accept Liberal Democrats. They dress it up however they want and throw in their buzzwords demographics, primary care, social justice. It has nothing to do with ability. Hell that gets in the way. It’s an argument that anyone with half a brain can see right through. They might as well cut to the chase and require committees to ask party affiliation and how they feel about taxes, gun control and abortion, because that is what they ultimately want. They want more Sonia Sotomayor MDs and less James Andrews MD.

  • Rebecca Hu

    Sorry, but I think you’re being overly dramatic and ignoring your original question.

    There are problems with today’s medical schools and medical care and there is a BIG problem if there are too many specialists for the types of problems that our society has.

    There is a problem with our society and medical schools if doctors are not aware of the various health disparities and then not treating/targeting certain groups of patients and utilizing preventative practices.

    There is a problem if after medical school, providers no longer feel that they need to learn anything or worst yet, feel that they know everything and that learning is not a constant life-long learning process.

    There is a problem with today’s providers and medical schools if they do not understand the cross-cultural barriers and thus, have communication and cooperation issues. Read Anne Fadiman’s “The Spirit Catches You and You Fall Down” for a story about culture clashes and medicine.

    Personally, would you want a compassionate provider that actually cared about helping you achieve a long healthy life? Or someone that dehumanizes you as a patient, treats you as an object, and sees your body as a machine with a problem needed to be fixed and then everything is good to go?

    It might be a good idea to figure out how to tackle these problems and while you do want strong problem solvers as doctors, it might be also be a good idea to encourage those who are aware of the above to apply to medical school as well.

    I am not advocating that students be solely admitted for their “awareness” of issues, but rather that, it should become part of the criteria especially as medical schools today have so much on their plate such that they are unable to incorporate “ethics” and “culture awareness” classes onto their list of requirements for their students and thus shifts this responsibility onto undergraduates universities, who may be more able to provide these classes.

    • Primary Care Internist

      What does the disparity between specialists and PCPs have to do with cultural awareness or ethical principles?

      I think little or nothing.

    • Residentphysician

      Surprisingly, I haven’t dealt with one hmong patient while being a resident. What has actually helped me the most is my large historical interest in ww2 and the Vietnam war that has allowed me to connect with and respect these individuals. Meanwhile, my liberal friends just don’t get it when it comes to these people. Maybe you should have to be pro military to be a doctor. Seems more reasonable that what you advocate.

    • Dan

      “…treating/targeting certain groups of patients and utilizing preventative practices”
      That’s just good medicine, not social justice. See isosorbide dinitrate.

      “…too many specialists for the types of problems that our society has”
      There aren’t too many specialists, just not enough generalists

      “providers no longer feel that they need to learn anything or worst yet, feel that they know everything and that learning is not a constant life-long learning process.”
      Do you really believe this goes on with any frequency? Really?

      “Or someone that dehumanizes you as a patient, treats you as an object… ”
      This is not a problem of social consciousness, but of being a mean SOB.

      “so much on their plate such that they are unable to incorporate “ethics” and “culture awareness” classes onto their list of requirements”
      Nearly every school teaches ethics and some cultural mumbo jumbo.

      Have you ever actually taken a cultural awareness class? Complete bunk. Frank communication with the individual trumps stereotyping every time.

    • joe

      I am a specialist Rebecca and I have a plethora of patients. I have yet to meet an internist or FP interested in giving onc chemo. Is there a shortage of internists and FP…no doubt? But don’t assume there is an oversupply of specialists, because in my field that just isn’t true.

  • http://hms.harvard.edu/admissions/default.asp?page=pathway Rebecca Hu

    Has anyone seen Harvard Medical School’s New Pathway MD Program?

  • Vox Rusticus

    Rebecca Hu, you are making talking points for the ITM group.

    Evidently you think a medical student shouldn’t be able to choose a specialization based on his own interest alone; somehow that choice also should reflect some broader agenda, possibly one that may be alien to the individual’s wishes. (It seems the group’s intent is to turn the medical school application process into a screening tool to select for those inclined to agree with that plan, and presumably against those who disagree.) Sorry, but that places you among the thought police–good things will only go to those with “good” thoughts.

    I don’t need to peruse your reading list to understand exactly the thing you are advocating. No argument will get you out from the reality of what you or this group is advocating: to hijack the academic application process and apply a left of center litmus test to applicants. Those who don’t agree need not apply. No need for drama when the canard is exposed.

    Who ever equated the need for postgraduate professional learning with the willingness to adopt the leftist progressive agenda as if it were a given? You sure seem to.

    The choice is not between someone who is a leftist agenda sympathizer, which you conflate above with being “sympathetic” and being a cold reductionist: that is dishonest argument and a false dichotomy. Personally, I want a doctor who knows and understands medicine; not someone who was selected possibly against another better qualified because of a particular political bent.

    Being a liberal agenda sympathizer does not make you perforce a “strong problem solver.” You are conflating these two vague notions without any proof. Have you got any? Or is your claim another effort to color those with contrary opinions as “weak” problem solvers, the kind one shouldn’t want in medical school anyway?

    If nothing else, your post is a good example of the backhanded techniques of the proponents of liberal litmus testing like to use to tar their opposition: assume moral superiority, debase the opposition, muddy the definitions, and
    pretend that the problem to be “solved” is whatever takes you to the political end you seek.

    Stalin would approve.

  • Mark

    “The suggestion made by the panel that social awareness or social consciousness should be weighed more heavily than ability to master a formidable load of knowledge and problem solving ability”

    If that it what it takes to get into medical school, why do you think the people who have the “ability to master a formidable load of knowledge and problem solving ability” won’t figure out how to fake or display that? My cohort fought and competed for A’s in all those science classes for 4 years, studied 1,000 to 2,000 hours for the MCAT, and jumped through all the other hoops to get into medical school. We’ll figure out and crush any test or criteria you can come up with.

    • crocoduck

      Mark, you hit the nail on the head. Even if it were universally accepted that medical schools must include a measure of “social justice” in the application process, such a measure would need to be qualified and quantified. Therein lies the problem. It is wholly impossible to judge intent in the context of the medical school application process. In other words, as you said, those who desire to get into medical school will jump through the necessary hoops, regardless.

  • Marc Gorayeb, MD

    Promoters of this agenda are required to assume that there is a bottomless pool of critical thinkers from which to select our future physicians; therefore we can select members of that pool that are also culturally and socially sensitive.

    This is a false assumption. One that allows the social engineers among us to exercise power and control over the political makeup of our profession.

  • ninguem

    I tend to find the students who make the most noise about “social justice” are the very ones who end up in the most lucrative non-patient-contact specialties.

    • Primary Care Internist

      exactly. rad-onc and anesthesia was the field adopted by two of my most socially “sensitive” classmates. I think the anesthesiologist has since married a financial maven and given up practicing anesthesia.

  • http://www.chrisjohnsonmd.com Chris Johnson

    Salary disparities certainly are a big reason for the skewed specialty choices of medical students. But, since most face huge debt on graduation, how can they not be? Sure, paying primary care physicians more would help. But letting physicians begin their career without the equivalent of a large mortgage would do far more to encourage career choice based on personal traits and not economics.

    But I think the main reason students don’t choose primary care isn’t the salary differential — it’s the work environment differential. When they take a rotation with an actual primary care doc, they see hectic, chaotic days in which a large portion of the physician’s time is spent dealing with hassles from third party payers and the like. I’m a subspecialist myself, and I just don’t face that stuff constantly like they do.

    Structure the incentives differently, and the result would be more primary care physicians.

  • Becky D.O.

    It’s no wonder the AMA is hemorrhaging members!

  • http://www.chrisjohnsonmd.com Chris Johnson

    Does anyone have a link to this AMA initiative? I’ve consulted Dr. Google and come up blank. Searching the AMA site also doesn’t give me anything about it.

  • Jenga

    This push has nothing to do with primary care and specialists. It’s about getting who they want in the classrooms. They are fully aware that the government funds residency positions. If they wanted less specialists they could do so tomorrow by cutting the funding for specialty positions. They are doomed to failure though, in my experience teaching students and residents those that voice such views considered “social justice” are the first to watch the clock looking for the 80 hour limit and most likely to depend on their classmates to bail them out. Such views are an easy disguise for secretly only caring about themselves. If they want to do this, I say bring it on. It is still my choice to give them the knife or not.

  • Doc Gooden

    Dr. Johnson, you need to brush up on your “Googling” skills. It took me all of three seconds to come up with reference. It’s understandable, though, considering the reference bears little resemblance to the above post. How exactly did Sarah Palin get a post submitted to this site? I guess if you can turn end-of-life-counciling services into death panels, you can turn a rather benign and unoriginal initiative of the AMA to recruit docs who interact better with people into a political conspiracy to load medicine with “lefties” who will gladly becoming public servants under a single-payer system.

    Here is the link:
    http://www.ama-assn.org/ama1/pub/upload/mm/40/behavioral-competencies-medical-students.pdf

    Read it for yourself and decide if there’s anything sinister in this recommendation. BTW, it doesn’t mention the phrase “social justice” once. To convince you that this is, in fact, the initiative the blogger is referring to despite the stark contrasts, check out the wording in the opening statement, specifically the reference to ‘gap’ (i.e deficiency) in the med school admissions process and traits like ‘altruism’.

    “Adequate evaluation of desirable behavioral competencies,
    such as altruism, motivation for medicine, dedication, and
    intellectual curiosity, is a key gap in the current medical
    school admissions process. To enhance the assessment
    of applicants on all desirable characteristics (cognitive
    as well as behavioral competencies), the American
    Medical Association (AMA), in collaboration with the
    Association of American Medical Colleges (AAMC), held a
    conference in 2009 that led to recommendations developed
    specifically for three influential groups in the medical
    school admissions process: medical schools, admissions
    committees, and the medical education community.
    issued in 2007, the AMA called for “Apportion[ing]
    more weight in admissions decisions to characteristics
    of applicants that predict success in the interpersonal
    domains of medicine.” Similarly, the goal of the AAMC’s
    current admissions initiatives is “to improve the selection
    process to create a diverse, capable, and caring physician
    workforce for the 21st century.”

    A diverse, capable and caring workforce! What nerve! Let’s all turn of the Glenn Beck, dial down the paranoid inflammatory rhetoric and restore some sanity to a legitimate debate. For the record, I graduated college two decades ago and they were talking about this so it’s nothing earth-shattering.

  • Doc Gooden

    More Googling Success! The quote in the blog post referring to social justice is actually from an earlier Conference in 2005, quoted by a committee of the 2009 Conference specifically with regard to the issue of public health education in the medical school curriculum. Here’s the reference from the 2009 Public Health section of the ITME committee on optimizing the medical education learning environment (that’s a mouthful).

    http://www.ama-assn.org/ama1/pub/upload/mm/377/cme-report-11a-09.pdf

    This is a key point because Dr. Gaulte makes the disingenuous (that’s generous) connection between the above quote and the medical school admissions recommendations (which I previously linked to and which do not refer to social justice). The reference to social justice is only in the context of teaching public health to medical students, not in assessing them for admission.

    I encourage Dr. Gaulte to clarify the above statements and provide proper context when offering primary sources to advance an argument.

    • http://mdredux.blogspot.com james gaulte

      Doc Gooden,The link you reference in your first comment does not mention social justice as you stated.This link does..
      http://www.ama-assn.org/ama1/pub/upload/mm/377/itme-final.pdf
      On pg 15 of Phrase 3: Program Implementation the authors say in the context of what needs to be improved that “physician generally are not prepared to be advocates for patients on issue of social justice” . This observation occurs several times in the various elements of the Initiative not just in the context of recommendations regarding the teaching of public health.
      The same general theme is expressed again when the report says “Physicians are prepared to do what they believe is best for individual patients.they are not,however,equally well prepared to participate in ethical and political discussions about the allocation of health care resources.

      The blog as I posted it on my web site, in fact had a link to the AMA reference but that did not appear in Kevin re-publication of it.Had it appeared at least two commentators would have saved themselves some time and effort.

      My reading of the Initiative was that the authors were placing at least some emphasis in social justice in the sense of allocation of society’s resources which is a relatively new aspect of the dialogue of medical
      education..The authors placed value on physicians as advocates for social justice and opined that physicians
      were deficit in that regard. More importantly another link that was present in my original posting was also omitted. Here is that link (http:popecenter.org/commentaries/article.html?id+2385)
      In it you will find my reference for several of comments regarding the weight of various factors in admission decisions and what appears to be a trend .This link quotes Dr. Walter Hartwig who gives his views on admissions policies.
      Hopefully with the information from the links that were apparently edited out of my post, my position will be clearer and there will no need to compare my comments to a Glenn Back rant.
      Had I known links critical to my arguments would be deleted I would not have agreed to Kevin’s republication of it.

  • http://www.chrisjohnsonmd.com Chris Johnson

    Thanks for improving my Google-fu. That was really my point — on blog posts like this I like to have a link to the original source so that I can decide for myself what it says.

    As you say, this isn’t new. I was on a medical school admissions committee in the early 1990s and we were talking about it then. Besides, it really is, I think, a false dichotomy: we had plenty of highly qualified applicants who were clearly socially aware. Liberalism is not a personality defect. We even admitted the occasional conservative.

  • Doc Gooden

    Thanks for the clarification, Dr. Gaulte. The post would have been much more useful with references (take note, Kevin). Reading through the linked 2007 report, I didn’t see any reference to the goal of increasing primary care doctors. Was this an inference of yours or is there another reference where this is explicitly discussed in terms of med school admissions or curriculum?

    My Glenn Beck comment referred not to your original post, but to the cacophony of ideological venom spewed by the peanut gallery over such a benign initiative. Like I said, med schools have been pushing liberal arts education and interpersonal skills since I was applying.

    I will take exception to one comment in your post, however. You state that any concept of social justice necessitates a redistribution of wealth. As applied specifically to health care, this need not be true. The paper above refers to social justice only in the context of eliminating disparities in the delivery of care and promoting universal access to affordable health care. These are admirable goals and shared by even the most conservative health reform advocates (check out the mission statement of the conservative Doctors For Patient Care – it’s right in there). The issue at hand is not whether the entire population, no matter who you are or where you live, should have access to affordable health care, but rather how that goal should be achieved. Single payer advocates prefer a top-down government administered solution. Conservative feel that a free-market solution will accomplish this. Either way, both groups would acknowledge that the ultimate goal is universal access to affordable health care. Only a supporter of the status quo would feel otherwise. The commenters immediately jumped on the reference to social justice as an endorsement of progressive policy – but there’s nothing that says social justice can’t be achieved through the free market just as well. I encourage all the commenters to read these references if they still think there’s some grand lefty conspiracy to take over medical education.

    • Kevin

      I added the references in. It was an oversight, and the fault is entirely mine. I apologize for the error.

      Best,
      Kevin

  • http://mdredux.blogspot.com james gaulte

    Doc Gooden
    Thank you for your remarks.The reference which really was the reason for my blog is this one http://popecenter.org/commentaries/article.html?id=2385.It is from the Pope Center and I was made aware of it from John Goodman Health Policy Blog ( As of this writing I still do not see it appearing in Kevin’s version of my blog.).
    To the extent that readers find the Pope Center commentary credible and not hyperbole,I believe they will not be disabused of the notion that there is a leftward shift in the thinking of medical schools regarding admission criteria.While I do not reject the notion of a market solution to universal health care so far everywhere there has been a program to move toward universal care it has been by redistribution.
    While the INTM may not have clearly spelled out their meaning of social justice and perhaps meant only universal health care it seemed to me to be to be part of the general trend towards emphasizing the role of the physician as stewards of society’s resources and minimizing the role as patient advocate that is evident in the New Professionalism and guidelines regarding training of residents in internal medicine.
    The term social justice has been used in many contexts-affordable housing,equal pay for women,affirmation action and almost any circumstance in which alleged undeserved inequalities “call for redress”, to use Rawls’s words.The IMIT authors should have said universal coverage rather than social justice if that is all they intended the term to mean.

  • Doc Gooden

    I agree. Not to beat a dead horse, though, I still can’t for the life me find any mention of primary care in any of the IMIT documents. Contrary to what Hartwig asserts, the goal of the IMIT does not seem to be the increase of primary care physicians. It seems as though he has started with an idea that the AMA has this goal in mind and then went to find prior initiatives as evidence of this even though the original intent of those initiatives was far broader. The Pope article also seems to ignore the fact that a more recent, 2009 report has been issued, also not mentioning an increase in primary care docs as a goal. It seems like a small issue but it was the main point of the article. I just can’t find any evidence of it.

  • Charles Cohn

    A young doctor with a large student debt can’t afford to be very altruistic.

  • http://a-robert-malcom.artistwebsites.com/ Robert Malcom

    there is no such thing as ‘social justice’ – it is a collectivist mythology, and the sooner it dies, the better for all -’otherism’ [which is what 'altruism' means] is a slaver’s mindset,whatever euphemisms are used to disguise that – for that is what a slave does, exist for the sake of others, which is what the term means in practice…

  • gzuckier

    Not that I am in the habit of making my physician (or anyone else I do business with) meet a set of Politically Correctness Guidelines, but it is kind of beyond serious doubt at this point that major threats to the health of a large segment of the population come from “social ills” like poverty and attendant problems like malnutrition (yes, even in America, particularly prenatal); which comes back to the question, are medical professionals in the profession of actual health care, or are they just glorified technicians with prescribing rights? And the oft recurring theme among blog responses, that these dang patients are free to be healthy but they just fail to take responsibility for themselves, is disconcerrting from someone who presumably had the many years of analytical education required to get into these highly cerebral fields; is it really likely that at some point in their lives, the teenage single welfare mothers, crack addicts, homeless alcoholics, et al sat down and looked at the steady job suburban house stable family lifestyle and made a rational assessment that the Walmart shopping cart piled high with trash looked more appealing; and since we all were more wise in our decisions, we are justified in the belief that “those people” chose their lot and it’s none of our concern.

  • sharon.a.wander

    There are enough Doctors to go around, Enough Pain Clinics dispencing Oxycontin, percocet etc. Paid for by you the citizen . We need legalized marijuana stores like liquior stores to dispence marijuana, The President of Mexico is pleading with our President and Government to handle the DRUG problem like to end Prohibition by the Government . The Drug seeking patient’s will eventually get the Medical Profession into trouble with the DEA..Our Government did a stupid thing with Whiskey Prohibition and reversed the Law and ending Prohibition,.Our Government can do the same thing with Marijuana and Coccaine,methan,and end illegal drug activities, murder, killings and infecting our children . Our Government can use the tax money. Also we need a national lottery, term limits and a reversal of politics as we now know of it.

  • doctor

    I read the AMA conference summary. Evaluating extracurricular activities, strength of letters of recommendation, and motivation have all been traditionally important aspects of admission to medical school. “Commitment to social justice” seems something different- codewords for opening the door to asking about political views, which is a slippery slope. We are getting this in private practice as well, being required to study “cultural competency” that also becomes a codeword for political views. It’s a shame.

  • http://www.healthscareonline.com Richard Young

    We shouldn’t lose our altruism, but a payment system that expects primary care physicians to continually give away their intellectual work is the underlying reason for the pay disparity.

    RUC is the real culprit. It’s comprised of over 80% ologists, just like the House of Delegates of the AMA. The easiest quick solution is to separate primary care and referral care into different payment pools. The more necessary long-term solution is to blow up the current E/M rules and create payment approaches that actually pay primary care physicians for the time it takes to do their multi-organ system, multi-symptom, multi-chronic disease work.