A medical school, by definition, is a professional school, preparing graduates for their future profession. What are we preparing graduates to do? As we debate the future of our health care system, we must decide if physicians are responsible for improving health in a broader sense, or only for diagnosing specific patient problems and prescribing treatments.
Professions come with the expectation that you use your knowledge to improve people’s lives. Medical students prepare for clinical care, but do medical schools teach doctors to advocate for their patients holistically? Are doctors trained to meet the Triple Aim by promoting population health?
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.
Republicans and Democrats in Congress continue to battle over repealing the Affordable Care Act (ACA). Whether ACA is carried out as planned or replaced with something entirely new, our physician workforce is unlikely ready to meet the changing healthcare needs of the nation. Shifts in demographics, the rise of chronic disease, and escalating health care costs are placing new demands on the knowledge and skills of our doctors. Most American medical schools, however, continue to educate their student doctors in the same ways of decades past.The Association of American Medical Colleges predicts a shortage of 35,600 primary care doctors by 2025. We need more primary care physicians and a more diverse workforce, in cities as well as rural communities and formally designated health professional shortage areas. We need a workforce that understands the importance of prevention and is judicious in its use of limited financial resources for health.Medical schools are a key part of the supply pipeline that can help meet the changing health demands of the American people, but are they aligned with the nation’s emerging healthcare needs? Do they even consider themselves part of this essential pipeline?