Robert C. Bowman, M.D.
The early 1960's was a time of great turmoil. Medical education faced some
trying times. Despite this, some medical schools such as Tufts reached out to
the most underserved areas of the nation. Faculty such as Jack Geiger and Count
Gibson worked with local physicians such as Robert Smith and a cast of hundreds
in the community to set up the Mound Bayou
center. This was a model that not only embraced Community Oriented Primary Care
as per Kark and colleagues, it set the tone for Community Driven Medical
education (Community Driven
Approach).
The Community Driven Process
The needs of underserved communities must drive the process of the determination
of health care, and the needs must drive the process of education and training
of health care professionals. This is the best way to address underserved areas
(Underserved - Overview and Models).
Perennials Vs Annuals
Attempts to force health care professionals to go to underserved areas have not
succeeded and are expensive. Permit this analogy. We take students with no roots
in the communities that most need help and after graduation, they are scattered
like seeds in the wind. Where there is good soil and water and support they
grow. Underserved areas are a bit more challenging. The support soil is thinner.
There are often rocks and dry periods. Perennial students come from such areas.
Optimally they continue to train in such areas and maintain a connection. When
they graduate, the are an extension of the roots that they always had. They
don't dry up easily and they withstand challenges. Not always do they do so, but
enough will, and enough will stay, and enough will be more effective in such
areas because of who they are and the dedication that got them there
Perennials vs Annuals.
Admissions Package
Service Orientation
West Virginia Rural Health
Education Partnerships
Rural Health Opportunities
Program
Cycles of Destruction
Without education, health care, social change, and without the development of
young professionals that embrace such areas, it is likely that underserved areas
will spiral downward. Inner city areas will become living hell and rural towns
will cease to function in any sort of organized fashion. Neither will be able to
meet the needs for education, jobs, and services such as health care.
I find it significant that President Kennedy highlighted the futility of military action if the indigenous people were unwilling to make the social, economic, education, and health improvements necessary (Kennedy and Crisis). We must be willing to work as hard or harder to maintain stability in our own crisis areas to allow young professionals and leaders to develop and grow hardy enough to resist the storms ahead.
States or countries that prepare and select students from underserved areas can expect social, economic, and education improvements over succeeding generations. Young professionals support each other and the community (Breeding Young Professionals and Developing Healthier Rural Communities). This is the best way to cure hopelessness and violence in the nation and the world.
Research demonstrates that
Medical
Schools Can Graduate Rural Physicians It takes leadership and political
pressure. The same principle apply to other underserved populations although the
correlations are not as high. They are still significant and the same type or
programs produce the same results.
Cycles of Reconstuction
In emails with Wayne Altman at Tufts, he mentioned that he now has recruited a
preceptor to work with students. His name includes the names Geiger and Gibson
for a reason. He was named after these two men who did so much to create this
model in Mississippi, Jack Geiger and Count Gibson. His parents obviously
respected them and it is likely that some of the reason that he is a physician
is because of this effort (Mound Bayou: Model to
the Nation). We have had other shining examples of physicians who have
overcome many obstacles to become a physician and return to help family,
friends, and neighbors.
Susan LaFleshe Picotte is one such example (Susan
La Flesche Picotte). She was an Omaha Indian who trained back east and
returned to serve her people, other natives, and settlers in the Thurston County
area of Nebraska. She left a lamp on at night so that patients of any color
could see her at any time. She raised the money to fund the first reservation
hospital not built by government funds. She died in 1915 after years of
suffering from an ear disorder, likely caused by too many nights on horseback or
buggy battling the Nebraska winters.
Restoring Economics and Health with Long Term Reinforcing Cycles
We have other examples where students have trained 9 months in rural areas and
then chosen these or similar areas in Minnesota. In turn they train a new
generation of students and then the next cycle and so on. The Rural Physician
Associate Program in Minnesota RPAP came at a
cost of $30 million tax dollars since 1971, but it has delivered over $2 billion
in economic development for rural Minnesota alone. It is perhaps the best
medical education program in the nation by studies and evaluations of residency
program directors, who prize RPAP grads (Verby
Articles). See also By the
numbers: Rural Doctors and Rural Economies
Leadership Role
Medical schools have a leadership role that extends beyond health. The Flexner proposals nearly a century ago reformed college and high school education in this nation Flexner’s Impact on American Medicine. Other medical school programs such as the Rural Health Opportunities Program have had great impact on small colleges, the breeding grounds of young professionals. State education policy tends to act against this (Centralization of State Educational Resources and the Impact on the Location of Young Professionals). Without sacrifice and leadership, it is clear that underserved areas will continue to cycle downward. Having medical school leaders who constantly champion the needs of underserved people in the state, region, or world is a critical part of domestic and foreign policy. By restoring health, the potential for peace is increased and the danger of violence in terrorism is diminished. Ignoring the needs of such peoples is no longer tolerable. (Kennedy and Crisis)
We have had medical leaders such as Jordan Cohen that have pointed out the need for better admissions Cohen Encourages Admissions to Look Beyond MCAT and collaborative efforts (Century of Reform by Cohen). Will his leadership be more effective as measured by implementation and replication.
Role of Primary Care and Family Medicine
Leaders in primary care need to embrace the underserved. They need to support
their colleagues in rural and inner city practice. Research supports the key
role of program directors and rural positions
Leadership Factors. It is important
to support departments of family medicine and faculty who lead underserved
efforts so that they can maintain and expand influence in the medical school.
Rural Chair Position
Academic Leaders Deans and Organizations
also play a major role.
Dedicated efforts can make the difference:
