I recently gave a “State of the Department” report to the Executive Committee of the College of Medicine. I took over as Chair in 2005 and have attempted to create a training environment that would facilitate entry of students into a primary care practice with a focus on rural and underserved Alabama. The template we are working off of is above.We’ve not done very well in the 4 years since I became Chair. Only 5% of the students have gone into Family Mediicne and those going into Internal Medicine and Pediatrics have mostly left the state. In the course of the discussion, the non-Family Physician faculty became very defensive and felt that they should not be asked to take responsibility for an outcome that they were unable to influence. In addition, they felt that test scores were an outcome that they should be able to influence and rural students would have trouble keeping up with our current students.
Fortunately, the National Rural Health Association is working on a position paper to counter this argument. In it, they point out that “Medical education programs that include a focus on attracting practitioners to rural settings offer both recruiting and retention benefits to rural communities. In one study, six medical schools that made an explicit commitment to increasing the rural physician supply, that had a defined cohort of students, and that offered a focused rural admissions process or an extended rural clinical curriculum placed an average of 57% of their graduates in rural areas (compared to a 3% of medical students who report intending to practice in rural areas and the 9% of physicians who currently work in rural areas) and, of the two schools for which statistics were available, 79% and 87% of these physicians were still practicing in rural communities from 1 to 20 years after graduation. Implementing similar strategies for 10 students a year in the 125 United States allopathic medical schools would conservatively create an estimated 1139 physicians in rural practice, more than double the numbers expected without these strategies in place.”
This study does not mention test scores but it has been my experience that the NBME exams measure one clinical competency (medical knowledge) and do it on a threshold basis (can you make the minimum on the exam). Maybe we need to assess medical schools differently…
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February 8, 2010 at 4:34 pm
Joshua Freeman
Very well-written piece. Of course, getting students to enter rural practice and family medicine (the latter almost a requirement for the former) is a challenge in every state, not just Alabama or my state of Kansas. I recently spoke with a reporter about what the “Governor” could do about it, and was forced to admit it was pretty limited. The changes need to occur in the absurd reimbursement system, as well as in attitudes among medical school faculty (which you document). We need to produce — and therefore accept into medical school — doctors who look like the patients who don’t have doctors (the ones who do already have doctors). PCMH is a good effort; I think more work on Health Extensions programs, for supporting rural practices, supporting health awareness and infrastructure in rural communities, and increasing pipeline of rural youth into health careers — is also very important. As it is a national problem there should be federal support for addressing it, although the solutions (other than reimbursement reform) might be best done more locally, or at the state level.
February 8, 2010 at 4:47 pm
Dr P
Interestingly, in states where the practice and training milieu has improved, it has been policy makers who have taken the lead. In effect, the governor can make a differece both by changing Medicaid reimbursement (carrot) and threatening funding for medical education (stick).
May 16, 2010 at 4:56 pm
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