New study ranks medical schools on social mission draws criticism

Residency Program Insider, July 6, 2010

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A new study in a recent issue of Annals of Internal Medicine evaluates U.S. medical schools, not on their academic standing, but in their ability to carry out a "social mission."

It's a study touted by its authors as groundbreaking. It's a study denounced by its critics as nothing more than a "limited picture" of medical schools.

Candice Chen, MD, co-author of study, contends it is important because it reveals outcomes of a medical education following graduation, in the context of social service, which she says is hardly measured in academic circles. With a primary care shortage, as well as greater disparities in patient populations, focusing on these issues is becoming more relevant, Chen says.

"There's such a difference between the top 20 and the bottom 20, for instance, in how many primary care physicians they graduate," Chen says. "We're not trying to berate any of the medical schools, we're just saying that in terms of social services, some schools are more successful than others, and others should learn from them."

The study found:

  • Public medical schools graduated higher proportions of primary care physicians than their private school counterparts.
  • Schools with substantial National Institutes of Health research funding generally produced fewer primary care physicians, and those in underserved areas.
  • Schools in the Northeast generally performed poorly in the social mission category.
  • Historically black schools had the highest social mission.

The researchers reviewed records of 60,043 physicians who graduated from 1999 to 2001 and completed all types of residency. The study included an analysis of data from the American Medical Association, and data on race and ethnicity in medical schools from the Association of Medical Colleges, and the Association of American Colleges of Osteopathic Medicine.

The researchers then constructed a social mission score to summarize overall performance of the country's 141 medical schools in producing graduates who practice primary care, worked in areas with a federally designated shortage of health professionals and belonged to underrepresented minority groups. In some cases, some schools are better in certain categories, but still lagged behind in overall social mission scores because of their performance in other areas.

Not everyone is happy with the study, saying that it fails to reveal the full scope of a medical education in the U.S. Others believe the information is outdated.

The American Association of Medical Colleges issued a statement denouncing the study, noting: "Like other attempts at ranking medical schools, this study falls short. By defining 'societal mission' and 'primary care' so narrowly, it provides a very limited picture of medical education's many contributions to society in the U.S. and around the world. And that serves no one well."

The study "presents a limited picture of how medical schools serve society's needs through their integrated missions of education, research, and patient care," the AAMC adds. "While producing primary care physicians, ensuring more diversity in the physician workforce, and encouraging more doctors to practice in underserved areas are important parts of that mission, they are not the only components."

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