Wednesday, July 28, 2010

Health Care Reform and Medical School: A Disconnect?

In many previous posts, I’ve written about the need to increase the number of primary care providers if we are to increase access and create a medical home for as many people as possible.

The recent passage of health care reform which intends to provide health insurance for millions of previously uninsured Americans has only accelerated the need to rapidly increase the primary provider pool. And as the Massachusetts reform project proved, if we do not, our Emergency Departments, already over-crowded, will see a two-fold increase in their volumes.

In a recent newspaper article, the significance of this change was highlighted by a recent study ranking medical schools on their “social mission.” Under the study’s definition, each medical school was measured for its ability to turn out an “adequate number” of primary care doctors, including family practitioners and general pediatricians. The study also looked at the number of graduates who worked in underserved areas of the country, including rural clinics and inner-city hospitals. And finally, the study considered the percentage of graduates who were minorities, including African-American, Hispanic, or American Indian.

Using these factors, the 141 physician training medical schools were ranked and overall demonstrated that primary care graduates are not the focus of many of the schools at present. Unfortunately, some of the best medical schools ranked by U.S. News and World Reportannually rank in the 20 schools with the lowest social mission scores.

Hopefully, this study, which undoubtedly will result in some pushback, will stimulate a robust dialogue among the U.S. medical schools, resulting in strategies which will accelerate the number of graduates pursuing primary care careers.

Until this occurs, we will need to support or increase the training and use of nurse practitioners, physician assistants and midwives. Some physicians see these providers as “intruders” on their practices, but this is not the case. Hopefully the combination of more primary care physicians with the other primary care providers I mentioned will minimize the provider shortage that may result from health care reform, making the Massachusetts experience from becoming the national experience.

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