Category Archives: Medical schools
At its annual meeting and reunion this week in Atlanta, one of the Robert Wood Johnson Foundation’s (RWJF) long-running and highly successful programs is celebrating a milestone: its 30th anniversary.
The Harold Amos Medical Faculty Development Program, formerly known as the Minority Medical Faculty Development Program, works to foster diversity among U.S. medical school faculty. In 2011 it expanded its scope to do the same among dental school faculty.
The program opened its doors in 1983 to its first cohort of eight physicians. That was the beginning of a three-decade commitment to preparing and mentoring individuals underrepresented in academic medicine and science to help them become leaders in those fields.
Today, 200 esteemed alumni later, the program has graduates who are full professors, chairs of departments, leaders of institutes within the National Institutes of Health, and scholars who are known nationally and internationally for their enormously valuable contributions to the fields of biomedical research, clinical investigation, and health services research.
With a primary care provider shortage looming, medical schools are trying a new approach to get physicians into the workforce quickly: condensing medical education from four years to three.
Mercer University (Georgia), Texas Tech University, and New York University offer three-year primary care programs, and will soon be joined by programs in Tennessee, Indiana, University of Wisconsin, East Carolina, and Kentucky, MedPage Today and Fierce Healthcare report.
Most of the schools are shortening or eliminating fourth-year clinical rotations to consolidate their programs, leaving the first three years—which often focus on medical science—untouched.
"We chose to do it on the clinical end rather than [the] basic science end because, as long as Step 1 is [and] as important as it is, our students need to be fully prepared for it,” Betsy Jones, EdD, vice chair of research in Texas Tech's Department of Family Medicine, told MedPage Today. “We didn't make any changes to the curriculum that would threaten our students' ability to do well on [the United States Medical Licensing Examination]. The changes are really at the fourth year level."
A three-year program also saves medical students tuition money, and allows them to earn money in the workforce sooner than in a conventional four-year program, according to Fierce Healthcare.
Richard Rieselbach, MD, is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program and a professor emeritus and health policy consultant for the University of Wisconsin Medical Foundation.
In the last decade, the nation’s community health centers (CHCs) have doubled their capacity. They now provide care for more than 22 million underserved children and adults in every state. But they’re going to need to do it again. By 2019, some 40 million patients will be in need of care.
The United States does not have enough primary care providers to serve these new patients, and our public investment in health professions education—graduate medical education (GME)—is failing to produce the pipeline we need. Medical students are choosing specialties over primary care at an alarming rate, and a policy vacuum keeps the GME program from being held accountable.
An initiative was launched in 2011 that I think holds great promise: the Teaching Health Center Graduate Medical Education initiative. This five-year, $230 million program was funded by the Affordable Care Act and created to increase the number of primary care graduates trained in community settings.
My colleagues and I have proposed a modified and expanded version of this initiative, called “CHAMP” Teaching Health Centers (CHAMP THCs). Our teaching model would pair CHCs with academic medical centers to develop a THC track that would encourage students to graduate in primary care and practice in urban and rural underserved areas.
Graduate Medical Education Funding Is Not Helping Solve Primary Care, Rural Provider Shortages, Study Finds
From 2006 to 2008, 158 of the country’s 759 residency sponsoring institutions and teaching sites did not produce any primary care graduates, according to a study published online last week by Academic Medicine. Less than one-quarter of medical school graduates entered primary care during those years.
The study also found that physician shortages in rural and underserved areas persist; only 4.8 percent of 2006-2008 graduates practice in rural areas. Nearly 200 institutions produced no rural physicians, more than half produced no Health Service Corps graduates, and 283 produced no physicians practicing at Federally Qualified Health Centers or Rural Health Clinics.
Graduate medical education (GME) distribution is uneven, the researchers found, and provides more support to subspecialty programs than to primary care programs. The top 20 primary care producing institutions (where 41 percent of graduates were in primary care) received $292 million in total Medicare GME payments, while the bottom 20 (where only 6.4 percent of graduates were in primary care) received $842 million in these funds.
Underrepresented students considering careers in medicine can talk to mentors and join discussions on the free, web-based mentoring site, DiverseMedicine.org. Launched in August 2012, the site now has 400 active users, American Medical News reports.
High school, college and medical school students can interact with mentors on the site in real time through instant messaging or video chat functions, and learn about admissions testing, residency applications, and more in discussion forums. The site also features podcasts, video lectures and other resources on topics important to aspiring physicians, and a feature that allows students to participate in a mock medical school interview.
“One of the main reasons why there are so few minorities in the field of medicine is because of the mentoring gap. If nobody’s there to tell you how to get into medical school, you’re not going to get in,” Dale O. Okorodudu, MD, the project’s founder, told American Medical News.
A report from the Association of American Medical Colleges (AAMC) documents an overall trend toward increased diversity among students applying to medical school.
AAMC’s Diversity in Medical Education: Facts and Figures 2012 finds that nearly half of the applicants to U.S. medical schools in 2011 were non-White. Whites were the largest group of applicants, followed by Asians. “Compared with 2010, in 2011 the percentage of Hispanic or Latino applicants increased by 5.7 percent and the number of Black or African American applicants grew by 5 percent,” the report says.
But only 2.5 percent of medical school applicants in 2011 were Black men. Twice as many Black women as men applied to medical school that year, creating the biggest gender gap in medical school applicants among all racial or ethnic groups.
“We have a major, major problem in this country,” Marc Nivet, EdD, AAMC’s chief diversity officer, told American Medical News. “There is just simply an enormous amount of indisputable evidence that we’re not intervening as effectively as we’d like as a society to increase the talent pool of African-Americans who are capable of taking advantage of the science curricula available up and down the pipeline.”
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
The Harold Amos Medical Faculty Development Program
is on the verge of a milestone: it will observe its 30th anniversary this year. In 2012, the program achieved another notable distinction, as a third alumnus was selected to lead an institute at the National Institutes of Health: Gary Gibbons, MD, (’88) is now director of the National Heart, Lung, and Blood Institute (NHLBI). He joined Griffin Rogers, MD, MACP, (’83) Director of the National Institute of Diabetes and Digestive and Kidney Diseases; and Roderic Pettigrew, MD, PhD, (’83) Director of the National Institute of Biomedical Imaging and Bioengineering.
Formerly known as the Minority Medical Faculty Development Program, the Harold Amos Medical Faculty Development Program (AFMDP) was created to increase the number of faculty from historically disadvantaged backgrounds who can achieve senior rank in academic medicine or dentistry, and who will encourage and foster the development of succeeding classes of such physicians and dentists. AFMDP offers four-year postdoctoral research awards to historically disadvantaged physicians and dentists who are committed to developing careers in academic medicine and to serving as role models for students and faculty of similar background.
Practices that work within a particular framework of goals and priorities can become engrained in the work of institutions. But what happens when the framework shifts? Regular review of practices and the assumptions that support them offers one of the best opportunities to enhance diversity and inclusion, which can in turn improve the effective results of Scholar and Fellow programs.
The Robert Wood Johnson Foundation (RWJF) Diversity Matters Podcast Series features host Jacinta Gauda in conversation with leaders and subject matter experts on practical ways to support diversity and inclusion. In the podcast, available now, W. David Brunson, DDS, Senior Director of the Policy Center for Access, Diversity, and Inclusion of the American Dental Education Association (ADEA), and Marc Nivet, EdD, Chief Diversity Officer, Association of American Medical Colleges (AAMC), discuss the practice of holistic review.
Increasingly adopted by medical and dental schools, holistic review is sometimes misunderstood as affirmative action or as an initiative designed solely to increase diversity. Nivet and Brunson will clear up these misconceptions, and explain what it is and what it is not. Listeners will learn how the practice evolved, how it is applied equitably across the entire applicant pool, and how it aligns admissions policies, processes, and criteria with institution-specific goals. Nivet and Brunson will also describe ADEA- and AAMC-sponsored workshops in which admissions deans, staff, and committee members learn how to integrate holistic review into their admission processes.
Holistic review can help institutions to achieve the true culture of diversity and inclusion that they will need if they are to effectively address the nation’s challenges in health and health care.
Visit the Diversity Matters Community to download podcasts and summaries for practices that are working to increase representation in health and health care.
Two new studies show the nation’s younger primary care physicians may find it hard to recover from their medical school debt.
Primary care physicians who graduate with a median amount of debt and have a salary that is typical for the field can pay off their debt within 10 years, even if they live in a high cost residential area, according to a study from researchers at Boston University and the American Association of Medical Colleges, published in Academic Medicine. But young primary care doctors with debt that is above average—$200,000 or more—may have to employ “trade-offs and compromises” to support their repayment. These may include: extended repayment plans, increasing the interest repaid and the number of repayment years, living in a lower-cost area, or joining a federal loan forgiveness program that requires a service obligation such as practicing in a medically underserved area.
There are more sobering statistics for primary care doctors: a study in the Journal of the American Medical Association finds their earnings have grown more slowly than the salaries of other health care professionals. From 1987 to 2010, the average doctor’s earnings grew 9.6 percent; pharmacists’ earnings increased by 44 percent, and dentists earnings grew by 23 percent.
“It is possible that there are some specialties that have done extremely well in the past 10 or 15 years,” Amitabh Chandra, PhD, study co-author and Robert Wood Johnson Foundation Health & Society Scholars program faculty member at Harvard University, told Reuters Health. The slow growth for doctors—compared to other medical professions—is most likely due to lagging salaries of primary care physicians, he said. "If as a country we want more people to go into primary care, this anemic, jaundiced earnings growth is not going to be a motivator to get people to join primary care.”
What do you think? Should more be done to help medical students who go into primary care lower or repay their debt? Are slow-growing salaries a deterrent for medical students to enter this field? Register below to leave a comment.
New data from the Association of American Medical Colleges (AAMC) finds a 3.1 percent increase in the number of students applying to medical school this year. First-time applicants also increased (3.4 percent), which helped bring first-time enrollment at the nation’s medical schools up to an all-time high.
AAMC’s enrollment and applicant data also finds that this year’s entering class of medical students is more diverse than last year. There was an increase in applications and enrollees in all major racial and ethnic groups, and record high numbers for African American and Latino students.
If this year’s trends continue, medical schools are on track to increase total enrollment 30 percent by 2016, AAMC says.
“Medicine continues to be a very attractive career choice for our nation’s best and brightest,” Darrell G. Kirch, MD, AAMC president and CEO, said in a news release. “Given the urgent need our nation has for more doctors to care for our growing and aging population, we are extremely pleased with the continued growth in size and diversity of this year’s entering class of medical students.”