In his JAMA “Viewpoint” article, “Social Mission in Health Professions Education: Beyond Flexner”(1), Fitzhugh Mullan argues that medical schools should be committed to their social mission, which is “…about making health not only better but fairer—more just, reliable, and universal”. This means commitment to reducing health disparities, increasing access to healthcare in both rural and urban underserved communities, and increasing diversity within the health professions. He cites some medical schools as having made significant advances, including Morehouse, Mercer, Florida International University, and the AT Still Mesa Campus. But he also talks about “mainstreaming”, the need for consciousness about, and more important implementation of, social mission in all medical schools.
I believe that the most important measures of a health professions school’s social mission are its outputs, the criteria used by Mullan and colleagues in their seminal 2010 article (2): Are its graduates diverse? Do they practice more in underserved areas? Are they in primary care specialties? Studies show that a well-functioning health system needs at least 40-50% of physicians in primary care; the US is well below 30% and decreasing.
As a safety net dentist, I’m sadly accustomed to my patients telling me that they are in pain. Even in Massachusetts, where most patients are insured and Medicaid provides dental coverage, the vast majority of my patients must wait unconscionably long to finally get a dental appointment, and often have not had reliable access to dental care. Yet the patient telling me this story wasn’t at a dental office – he was at a primary care visit with my preceptor, speaking to me as a first-year medical student.
I chose to enter medical school because I was heartbroken by how the separation of medicine and dentistry harmed my patients. Throughout my medical training, I have only seen even more unaddressed dental need. I have met patients with endocarditis or pneumonia from untreated tooth infections, patients with malnutrition because they can no longer chew, and far too many patients with pain they simply cannot stop. This suffering falls disproportionately on the most vulnerable, including communities of color, older adults, low income people, people with a history of incarceration, people with mental illness or substance use disorder, and rural dwellers.