Americans can always be counted on the do the right thing, after they have exhausted all other possibilities - Winston Churchill
All of the crazy adaptations we seem to go through seem to stem from the fact that medical education is just not a good foundation for primary care education. Many of our efforts in Family Medicine attempt to cover glaring deficiencies in the existing system. This has given us inroads into medicine, but we are not cashing in on these. Also, we tend to rescue medical schools from the fate that they deserve, loss of public trust, loss of funding, etc.
Ask yourself these questions. If we had primary care medical schools instead of the current system:
Would we worry as much about the FP match, program closure, maldistribution of residents, loss of graduates from our states?
Would primary care still get zeroed out every year by the president?
Would we constantly be competing against ourselves and other primary care wannabes?
Would we be distracted by the urge to merge with other "primary care" disciplines instead of determining what primary care should be and how best to do it?
Would the clinical centers where we practices be in dire financial trouble or with a primary care school would all kinds of people (health systems, specialist groups, primary care groups) beat down our door to have our patients, our research, our graduates?
Would we still need a Family L list serve or would we focus on better stuff? Sorry, couldn’t resist.
Would we have so much trouble integrating the clinical, research, behavioral, and education pieces?
Would we have so much difficulty focusing on the needs of our various states or the clinic populations around our training centers?
Would our primary care school deans have to worry about practice plans (the number one cause of job turnover)? Sure we like to make money, but we chose service and patients instead of money when we chose family medicine. Our values are very different. Why not our training?
Would our primary care school be jumping in bed with the same financial resources that medical schools and associations do? Would the annual conference of our discipline look more like a casino operation than an opportunity to grow?
"I tell you the old-fashioned doctor who used to cure you of all illnesses has quite disappeared. Now there are only specialists and they all advertise in the papers." F. Dostoyevsky The Brothers Karamazov 1880 via Joseph Merrill M.D.
Would our primary medical association still be fighting to have residencies in every state and departments in every school? Would it defend the faith more like a guild or trade union or would it concentrate even more on what the best primary care doctors in the world would be in a variety of locations?
Would our efforts overseas look like an attempt to train the elite in an elitist fashion or would be appear to be reaching out to the populations in need?
Would we be worrying as much about maldistribution, retention, recruitment, retraining? Would we hope that the feds didn't discover that all of their investment really didn't result in much progress in these areas?
Would we still be competing for curricular space and earlier clinical involvement for medical education?
Would we still fight to try to prioritize the doctor patient relationship and have doctors who could interview, and listen?
Couldn't we get better candidates who were more into service and communication than intellectual pursuits?
Would we have leaders (like AAMC leaders) wringing their hands about the economically disadvantaged that could not afford to support doctors and hoped to send them some temporary rookie doctors because that is the best that they can do (in return for the ability to charge higher tuition)?
The basic science of medical education is money
Heat is to water as money is to curricular change
John Hickner, M.D.
Wouldn't it be better to have primary care school leaders would understand that health care is a substantial contributor to the economies of rural, inner city urban, and underserved locations. By choosing doctors who came from and want to serve such populations we would be contributing leaders and economic impact to areas that have been sucked dry of such resources for generations.
Isn’t medical education more than just skills:
Medical education is not just a program for building knowledge and skills in its recipients... it is also an experience which creates attitudes and expectations. A. Flexner
These can shape a physician for years or for life. Are today’s medical schools shaping physicians the way we want them to be, for us, for our children, for future generations?
Robert C. Bowman, M.D.
rbowman@unmc.edu
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