I. U of Miami changes admissions to favor research
II. Deans in NC think primary care problem is fixed
III. FP efforts take a different approach
IV. Community Based Approach to medical education can save tax dollars
V. Research Costly, Not Meeting Needs of Nation
VI. Medical schools resist changes targeting underserved
I. University of Miami School of Medicine begins national recruiting effort - Received 3/12/02 by email and quoted in its entirety:
In a striking departure from previous admissions policies, The University of Miami School of Medicine will begin enrolling up to 35 non-Florida residents in each entering class. This change is effective with the 2002 entering class.
Non-Florida applicants are expected to have a cumulative GPA of at least 3.6 and an MCAT composite score of 30+. All applicants should have a diversity of life experiences and a history of significant patient contact experiences which have had a meaningful impact on their decision to study medicine. Our class size is 150.
The University of Miami School of Medicine-Jackson Memorial Medical Center is the second-busiest medical center in the US and has one of the most diverse patient populations found anywhere. Located on the medical campus are several world-renowned clinical specialty centers, including the Bascom-Palmer Eye Institute, The Miami Project to Cure Spinal Cord
Paralysis-Lois Pope LIFE Center, the Batchelor Children's Research Institute, the Diabetes Research Institute, the Sylvester Comprehensive Cancer Center, and the Ryder Trauma Center.
The School of Medicine has an MD-PhD program, an MD-MPH program, and is currently developing an MD-MBA program to start in the fall of 2003.
For further information about the University of Miami School of Medicine, send email directly to Dr. Robert Hinkley, Associate Dean for Admissions, at: med.admissions@miami.edu
This does not look like an effort to improve the numbers of physicians for underserved populations. The greatest attention is to the research efforts. Diversity is used in a political correct sense to add flavor.
The President of the University has learned her lessons well at her previous post as head of Health and Human Services.
This approach has been the formula for research success at Baylor College of Medicine who also have learned to work with undergraduate and graduate programs at top institutions such as Rice University.
II. At a recent meeting with the Deans in North Carolina, Tom Ricketts, one of the nation's top workforce and shortage area experts, presented information on primary care needs. He was shocked to hear the 4 deans note that they thought that they had fixed the primary care problem. Some shock therapy is in order.
III. Family Practice efforts to address the nation's needs have been limited in funding, but there is great potential. Overall I am not impressed with what FM does with the bulk of its funding, but there is great potential in some efforts at FP programs.
In an effort to find an email address at our Lincoln affiliate, I ran across this link that reminded me that there were other approaches to health care in the nation other than research emphasis:
Pathways to Self-Sufficiency Through Education
The Pathways program offers eligible families an opportunity to develop their family strengths and achieve financial self-sufficiency. Families eligible to participate in the program must make a commitment to achieving self-sufficiency in one to three years. Benefits available to participating families include:
Assisting the family to develop a plan for self-sufficiency
Educational programs and services to help the family achieve their goals
Access to an on-site child development center
Programs and services through the Steven W. Carveth Family Education Center
Rental assistance to qualified families in the "New Heights" Residential Community
Access to medical care and counseling services through the LMEF Family Practice Center.
Enrollment in Pathways is limited to 27 families. Completed applications will be reviewed and considered in the order received. Income restrictions will apply. For more information on the Pathway's Program send an email to nkubes@lmef.org or call Nancy Kubes, Program Director, at (402) 483-4581, Ext. 315. Copyright (C) 1996-2001 Lincoln Medical Education Foundation
(LMEF) All Rights Reserved. Web pages by mrappl@lmef.org
4600 Valley Road, Suite 225, Lincoln, NE 68510
(402) 483-4581 - (402) 483-4184 fax
Lincoln is not alone in its efforts.
IV. The Waco FP residency program has demonstrated that it saves government dollars, as much as 1/3 to 1/2 the cost of public health in McLennan County. The FP program at Waco is integrated as an FQHC and works with the city, county, health department, and both hospitals (Study by Tim Henderson for the National Council of State Legislatures).
Other work by Tim includes the Yellow Book on Health Care in Rural America OTA
and Funding for Graduate Medical Education: The Role of the States
V. Research will continue to cost the nation a great deal and will likely continue to demand more funding. It is important for economic reasons for certain areas of the nation. It is important for national interests, but for people in this country in need of health, the massive research machine has not significantly increased the number of the years or quality.
A prime example is cancer. Despite decades of massive research expenditure, the first year to demonstrate a decrease in cancer mortality was 1995. The data from 1991 - 1995 showed a 2.6% decrease in overall cancer mortality from all sites. The primary reasons noted by Drs. Cole and Rodu were that men decreased their smoking rates 30 years before and there were more preventive efforts in a number of areas. Researchers expected the downtrend to continue for at least 20 years, primarily because of declines in exposures. Data from the Surveillance, Epidemiology, and End Results program and the National Center for Health Statistics, published in Primary Care and Cancer, volume 17 Number 1, 1997.
The research efforts do not mean that research and the underserved are incompatible. Previous research by Rosenblatt noted that they were negatively correlated.
My research notes that the only variables that contribute to the model are the rurality of the state and the % of the class choosing family medicine, no longer does research funding or type of medical school matter. 3/2002
VI. Opinion - Medical schools need to be held accountable through leadership actions, through accreditation restrictions, and through funding restrictions. Medical schools are not likely to change their minds without significant action.
Email: rbowman@unmc.edu
http://www.unmc.edu/Community/ruralmeded/Update 2002 - Iowa now has only about 70% in state medical students, efforts to recruit from outside the state have greatly increased. Since Iowa has the best primary care ratio in the nation, this might be possible, but again, who will replace the rural docs in the state if increased preference for research crowds out those who would choose rural practice?