Newer medical schools created after the birth of family medicine (from 1971 on) have graduated 16 % into rural zip code locations as compared to 10 % for older schools or even schools beginning in the 1960s. Integration of family medicine and primary care and rural medical education into the fabric of the medical school is the only intervention that has worked regarding medical school expansion. The more effective Duluth, PSAP, and similar models remain unreplicated despite decades of success in Distribution of Physicians.
Newer Allopathic Medical Schools - compare older and newer schools for rural location
It is the dawn of a new era for rural health. We rural medical educators find ourselves at the crossroads. We have worked with our institutions to try to put them into paths that would help them meet societal needs, but often find ourselves doing apologetics instead of spending our time implementing the medical education models that we know will work.
We have followed the path of family medicine as far as it will go, but we know that rural communities need doctors who are better suited for rural communities.An Analysis of the Distribution of Accelerated Graduates
Will we choose a new path?
We have watched over the past century as medical education has taken us from preceptorships and proprietorships to gleaming palaces of scientific worship. Medical education has raised all of education to incredible heights, but the larger our schools have begun, the more the poor, the rural, and the disadvantaged have been left behind. Soon increased pressures on all professional schools may make this even more difficult. Character, Color, Admissions, and Physicians
Perhaps no other force has influenced education so much as medical education over the past century. Now that we see those that have been left behind, we still push for higher standards in academics and intellect instead of rallying lower education for broader-based changes. The federal government cheers medical schools on down this maldistribution pathway with promises of more dollars for the National Institutes of Health. Best Vs Brightest
After decades of resisting the influence of those who would manufacture and distribute science, desperate medical schools have joined with these forces wholeheartedly. Breeches of public trust are so enormous as to defy any type of reconciliation in the near future. Although medical institutions will survive, their educational missions may not be able to do so.
Compromises during the process of creating family medicine have created a new series of problems. We have seen deans and chancellors and even leaders in family medicine promise changes that will reverse the maldistribution of physicians. All have received millions in past decades to fulfill this mission, but these dollars have resulted in little if any changes other than a glut of physicians. Compromise in Med Ed: The Current Situation
At gatherings such as these we have shared information about successful models. Clearly these models exist. Clearly they are equal to or superior to existing models. Clearly, they are not accepted or replicated. When established medical leaders fail to adopt a process that can improve medical education and improve the distribution of physicians, it is time to consider other alternatives.
Crossroads: Selections Admissions Package
Intellectual priority with a few tracks to relieve maldistribution vs maldistribution priority
Higher academic standards forcing ever specialized intellectual pursuits in education or involvement in lower education levels elementary through small colleges to attract the kind of individuals who prioritize service in places where service is most needed How To Graduate More Rural Doctors
Crossroads: Accreditation Accreditation and Demands of Rural Practice
Accreditation - Are residents in family medicine Mini-multispecialists held hostage by academic priorities and monthly specialty rotations or skilled ambulatory-based practitioners trained in model clinics that are the top priority of the trainees.
Accreditation - large blocks of rural experiences or limited rural time
Crossroads: Partnerships
Crossroads: Faculty
There are clearly those who need a medical education system with different priorities and outcomes, given the minimum $46 million dollars to start a medical school, it is a great obstacle, but will medical education rally around or will it need examples.
Opportunities and Resources
Status of Rural Health and Rural Medical Education
What should the next generation of medical schools be like?
Failure To Launch - why new schools may not work if birth to admissions issues are not addressed, also Probability of admission tables
