Robert C. Bowman, M.D.
My key concerns involve two areas of medicine. One is the decided lack of leadership ability across the range of medicine. It is my fear that those with leadership ability are going into other professions, such as law and business. This leaves medicine less than effective at the federal, state, and national level. The challenge of facing up to insurance companies, pharmaceutical corporations, and government is great. Medicine has to play a lead role, not a reactive one.
The other area of course is the admissions of those who are "different."
My research indicates that the MCAT, or perhaps more importantly its use, is changing US workforce in ways that are not as good for the nation. My concerns regarding medicine as a distinct personified entity involve not the nerve center and certainly not the processing speed or memory. My concerns regarding the medical organism involve the sensory inputs that give direction and meaning, the ones that shape application and use. We have a way of thinking and of processing information in medicine that is great on content, but undeveloped in application and relevance. MCAT Correlations Urban-Rural Location, Per Capita Income, and Family Medicine
We need more people in medicine that have a broader view, a more global approach. We need people who will stand up to state Medicaid officials and tell them that prescription co-pays may be saving some dollars on prescriptions, but co-pays are risking lives, damaging hearts and minds, increasing ER visits and testing and long term care, inflicting crippling damage upon safety net providers still involved with government programs, and making it more difficult for those with less to become self-supportive and their kids and their kids… We need medical education leaders who will take a leadership role in higher education in a state, telling fellow government leaders that they have ignored K-12 and community college education far too long. This results in increased numbers of Americans who will never fulfill their potential, especially those who could make the most difference for those in the most need. We also need medical educators that will take teaching more seriously, particularly in the clinical years.
The concerns involve not just exclusion of rural doctors, or physicians for underserved areas, or family physicians. This is damaging enough for cost and quality and access. The studies on birth origin also indicate more loss of physicians for general surgery, gynecology, radiology, and other more general specialties. The impact may also be felt upon those most likely to teach medicine. This has become a major concern in medical education, as noted in studies and the Millennium Conferences regarding medical education. Even as we speak, Congress is acting on legislation that might allow more community preceptors to teach, or they might be restricted from teaching. Medicine is becoming more and more dependent upon teachers who are outside the medical centers.
The admissions process is screening out those with a more general focus, as evidenced by the losses of family medicine and rural born students over past decades. The tendency toward teaching is higher in those with a broader focus. When I was involved in an external review at the University of Minnesota, discussions revealed that the specialists with a more general focus in various departments were the ones who provided the bulk of the teaching. With cutbacks, these were noted to be the ones who were "expendable." Those left behind were not as oriented toward teaching or as qualified to teach students.
A persistent myth is that those who don't make the grade teach. As with many persistent myths, there is an element of truth. The truth may indeed be that a broader focus is perceived as weaker, but is more valuable in teaching and in other professions. The weakness perceived may also be a personality characteristic. Family physicians are known to be amiables, as compared to drivers and analytics that are more common in other physicians. Amiables prioritize relationships, as do teachers, counselors, and advisors. It is also the quiet ones who can provide the input that shapes better decision-making in groups, as compared to those who rush in and attempt the first thing that pops into their head. The combination of analytics, drivers, and amiables is useful. The drivers get things done, the analytics make sure it is done well, and the amiables help guide the process and implementation, since relationships are their forte.
I have a proposal regarding addressing both, a special admissions track for some 30% of physicians. This also fits with proposals by Jordan Cohen and Admissions that are different. It also fits with research on Age and Physician Specialty
What if admissions committees were composed of a broader range of individuals beyond basic sciences and even physicians? What if admissions became medical schools seeking the right students rather than students seeking out medicine? What if medical schools had a large group of leaders represented a broad range of society recommending potential physicians who had demonstrated the kinds of leadership and humanistic and other qualities needed? Would medicine be constantly on the defensive as much? Would the maturity level of the students improve? Would physicians gain respect in the eyes of societal leaders? Would we have physicians that were more likely to relate to a broad range of communities, businesses, government, etc., by taking their early career skills and applying a medical training? What would be the impact of these folks, even if only 20% of the entering class, upon the other students? Upon the medical school itself? Service Orientation Characteristics of Rural Interested Students Non-traditional Students
My prediction, based on observations of such students, would be that they would be a royal and necessary pain in the rear and that medicine would greatly improve in the process. Such students have greatly assisted in the development of new medical school outreach programs, new forms of training, entire residency programs, and accelerated family medicine training programs. They have redirected medical schools regarding curriculum, testing, and faculty resources. We would also have the chance to choose more students with counseling, behavioral, and teaching skills.
Many would see finances as the major impediment, but history seems to note that the real problem is lack of willingness to change. There are other methods that would work, beyond just making medicine aware of current deficiencies.
Medicine could be better, if medical education truly wanted to be so. It starts with the preprofessional and admissions.
Short and Sweet on Education and Med Ed
Robert C. Bowman, M.D.