11/13/2001 to Family L
While it is important to consider all of the steps that need to be taken to
address the decline in the number of potential family physicians, it is
even more important to consider the priority and timing of such steps. We
must be efficient in our approach. We do not have the luxury of resources
to waste. Indeed many if not all of our sources of funding continue to be
in danger and our aggressive efforts have antagonized many.
We are, perhaps for the first time, in possession of a unique opportunity
to address the needs of underserved peoples and the needs of our own
specialty at the same time.
We owe this to dedicated leaders in Family Medicine for the past 50 and
more years who have given us an excellent start. We now have tens of
thousands of well-trained family physicians who have demonstrated the
ability to serve in a variety of locations and capacities.
We also owe this opportunity to pioneer educator-clinician-researchers such
as Howard Rabinowitz, Roger Rosenblatt, Jack Verby, and Don Pathman; those
who laid the foundations for their works, and dedicated educators such as
Robert Maudlin (RTT) and Jim Stageman (Accelerated Rural Training Program)
who have continued to develop new models to meet the needs of the
underserved in rural areas. Because it does take years before interventions
bear fruit in medical education, there is a need to make educated guesses
and hold course for years before reaping sufficient data. It is time for
not only implementation of successful models, but leaping to the next
steps.
Now more than ever, we know that the candidates for admission to medical
school are the most important consideration. It makes no sense to invest in
medical school or residency programs if there are no or few such candidates
in the pipeline. Some schools have had the luxury of targeted selections.
They can afford to work on later steps. Others will need to start at the
beginning. It makes no sense to set up later programs which will go
unfilled if the pipeline has not been loaded with likely candidates for
such programs.
I have been able to share thoughts and emails with those on the Health
Professions List serve for a number of years. Through these connections I
have become even more aware of how admissions policies not only determine
who gets admitted, these policies act at the college and even high school
level to determine who gets encouraged to pursue premedical studies.
Through my contacts with college faculty and advisors in Nebraska in the
Rural Health Opportunities program, I have been able to see how small
colleges and small college advisors are critical to rural-oriented
admissions. It is my feeling, not documented otherwise, that the success of
the Rabinowitz-Jefferson PSAP program is partly due to the close
relationship between small college advisors and the admissions committee.
If selection bias is bad for some research studies, it is not bad for
selecting the right medical students. Students choosing small colleges have
basically chosen rural locations for the very first decision of their
lives. It would be no surprise that they chose rural again years later,
unless we somehow chase them away.
The first steps to success in any medical education effort to graduate
doctors for underserved rural communities is to establish close and
effective relationships with small colleges in rural locations. Efforts to
identify gifted students at urban colleges are likely to have less effect,
mainly because they have chosen urban locations and are likely to do so in
the future upon graduation from medical training, perhaps because of a
spouse or attitudes they picked up in urban college or medical school or
residency locations. Chadron Health
Career Fair
Immediately the task has become difficult. This is because many if not most
small colleges have faced decades of decline, in finances and reputation.
This has often forced them to make difficult choices, and to reduce
resources that previously were invested in courses and professors for
pre-professional preparation. These courses were an easy target because of
their high cost and the lower numbers of students choosing this area.
Often we know how bad things have become over the decades because of the
outstanding success of a program with minimal investment. In Nebraska two
small colleges have had major boosts in pre-professional education,
admissions, academic excellence and improved finances because students
believed that they could go to these schools and become professionals
rather than taking the usual course of going to the larger urban colleges
(Rural Health
Opportunities Program). It is also important to understand state
policies such as The Continued
Centralization of State Educational Resources and the Impact on the Location of
Young Professionals and
Breeding Young
Professionals and Healthier Rural Communities
There are indications that programs to stem the loss of intellectual
students from a state do not improve the numbers choosing underserved
careers or locations (Missouri, conversations with Hal Williamson). These
students drift out of the state to places like MIT and Stanford anyway,
after the state has invested in their college education. Diffusing these
students to all colleges also does not concentrate efforts on the small
colleges for maximal benefit.
Robert C. Bowman, M.D, Co-Chairman
Rural Medical Educators Group of the National Rural Health Association
UNMC Department of Family Medicine Director of Rural Health Education and
Research
983075 Nebraska Medical Center
Omaha, NE 68198-3075
(402) 559-8873 or fax at -8118
Email: [email protected]
http://www.unmc.edu/Community/ruralmeded/
I am an osteopathic FP director from Portsmouth, OH. My clinic is a little
to the North of town in rural Lucasville. We are fortunate to have a
relatively new state university (Shawnee State) with an excellent science
program. Over the last five years I have gotten involved with their premed
program and have helped better than ten students gain admission to medical
schools - mostly to Ohio University College of Osteopathic Medicine. The
dividends are now paying off, as these very students are beginning to come
through our program, most with an interest in my traditional rotating
internship and FP residency.
I am a definite advocate of recruiting and training locally. We'll see how
it all works out!
Terry A. Johnson, D.O.
Southern Ohio Medical Center.
Bob thank you for your comments re the pipeline. I could not agree more. Recently I have become unusually more aware of the differences between the primary care (FP) doctors and many specialists. Our anesthesia group is in the process of self-destructing primarily because of the narcissistic qualities they have. I should have known it would happen because over the years they have refused to help start IVs or resuscitate babies or supervise nurse anesthetists or participate in medical education or any number of other things that we FP's consider part of our profession.
As I have reflected upon this I have realized that those of us who love our profession because of the difference we can make in peoples lives are becoming fewer and fewer and those who look upon medicine as a way to make money are becoming the majority. We in rural medical education don't see it that much because we work with the best and most altruistic students.
Why is this happening? I don't believe it has anything to do with our society as some might think. The events of 9-11 have shown us that heart of America is still the unselfishness and concern for others possessed by Americans. The reason is the wrong people are going to medical school and until that changes medical care for our citizens will never approach what we as medical educators envision as possible.
Do we blame medical school admission committees for this? Maybe in part but my guess is they are not as culpable as we might think. My experience with medical school faculty is that many if not most are really quite altruistic and have the best interests of medicine and patients in mind. What I think is happening is that they have very little choice. That the vast majority of students that apply to medical school do not have the personal characteristics that result in the type of physicians we would like to take care of us or our families, hence the increasing number of physicians that look at medicine primarily as a way to earn high incomes with as much leisure time as possible.
Dr Bowman's remarks are right on. we as medical educators need to somehow work with anyone and everyone who has influence on young people and their choice of career. They are there we just aren't getting them into our profession
[email protected] writes:
>Has anyone done any work about the entry characteristics versus the
>measurable characteristics at, say, the end of the M2, M4 and PGY1 years?
> I think that we, in fact, do something to these young men and women. We
>expose them to high tech, low touch, high frustration medicine. They see
>the cynical aspects and come to believe that they only thing that can
>redeem the years they have put into this is money. I think that we need
>to collect some data about when the change occurs so that we can then
>make changes at the right time in the pipeline. Or maybe we need to
>think about medicine as two different professions...one is technology
>which may pay fairly well but is not the profession of medicine, it is
>linked to technology and only occurs within the confines of a physician
>supervised care plan. And the other is medicine as most of us (and
>family medicine has its share of the cynics as well!) would like medicine
>to be...patient centered. But if we want to be sure that there is caring
>involved then we have to stay in the care of the patient and not simply
>pass them off the to the specialist/technologist of choice. We have to
>be sure that we are co-ordinating that care, providing the caring,
>answering the questions left unanswered by the technician MDs, etc. And
>many in family medicine as well as other specialities are not doing this
>continuity part. Nancy Dickey, MD
Good points! A major issue for us is the low rate of applications from
rural areas. When students do apply from rural areas, they are just as
likely as their urban peers to be accepted, but the application rate
remains stubbornly low, despite nurturing contacts with small feeder
colleges.
When we go back to the high schools, one of the messages we hear is that
math and science are weak at these levels, and many students do not get
the quantitative preparation they need to make it through the college
level prequisites. This is added to the perception among rural youth that
the medical professions are unattainable or unrealistic. They are too
young to be cynical, and too naive to be all that worried about the
financial rewards-which are huge compared to the other rural professions.
we'v e worked on these pipeline issues for many years, with not as much
success as we'd like. we currently have a grant in to a family foundation
to try to graft first year medical students in the WWAMI campuses to the
small feeder high schools, while linking it all to our summer elective
rural clerkship (RUOP). We'll see.
By the way, it is a beautiful rural winter out here in the Okanogan
Highlands, where I'm on a pseudo-sabbatical. We've had 18 inches of snow
in the last 36 hours, with another 10 inches predicted for tonight. I got
the old 1931 Allis-Chalmers Cat fired up and plowed the road-we'll see if
we can keep it open-there are always snow-shoes. And there's a continuing
demand for docs in excellent community-based practices-I've had three job
offers since I got here. Unfortunately, after too many years of city
practice I'm just not competent to handle the acuity that is commonplace
out here.
All the best to all of you.
Roger
Roger A. Rosenblatt MD, MPH
Professor and Vice Chair, Department of Family Medicine
RUOP Director - School of Medicine
Box 354696 - University of Washington School of Medicine
Seattle, WA 98195
RUOP Phone - 206-543-9425; Research Phone - 206-685-1361; UW
Fax-206-616-4768
Okanogan Address(2001-2002): 138 White Rock Road, Okanogan, WA 98840
Okanogan Phone-509-422-0792; Okanogan Fax-509-422-2387
e-mail: [email protected]
I have a special request. In the preparation and distribution of the new
Handbook, please take special care to help the small volume health advisors
as small colleges and colleges with high minority populations. These are
key sources for getting future practitioners for underserved areas.
I do not see many of these health advisors on the list serve. Also when
talking to our admissions folks, the students from such backgrounds often
lack the polish of other candidates. A few visits with small college folks
reveal great needs.
Idea for funding - ask for some grant funds to specifically prepare such a
Handbook thru AAMC and government sources. Be sure to mention that the
purpose of the handbook is to assist such advisors.
Handbook Links - be sure that the areas that are constantly changing, such
as electronic admissions entry, and admissions tests, have fairly permanent
internet links printed.
[email protected]
Education and Career Advice in Rural Communities
For Those Interested in Becoming a Rural Doc, and those helping them
Breeding Young Professionals and Healthier Rural Communities
Education - the entire pipeline