Thoughts On Medical Schools and Physician Discipline

Summary: Recent articles in the Hartford Courant have pointed the spotlight at a few possibly "defective" medical schools that graduate more than their share of problem physicians. Even though the articles have attempted to cover multiple aspects of medical education and the challenge of maldistribution, there is more to consider, such as the environment of physicians before and after medical school:

It should not take a lot of thinking to realize that various students come from a variety of backgrounds and locations, with various family and neighborhood influences.
Students also go to a wide variety of colleges. You might be surprised to compare medical student applicants by race and where they come from at http://www.aamc.org/data/facts/race.htm
Also hispanic and black graduates tend to go to underserved locations much more often. Same with rural background students. It certainly could follow that contact with underserved populations might have an impact on physicians. see Physician Discipline and Caring for the Underserved

Some reflections on the work:

It is interesting that the data from schools such as Morehouse was not included. Or that schools with high rates of physician discipline such as the U of Mississippi, U of South Carolina, U of Irvine, Oregon, UTMB Galveston, Loma Linda, U South Carolina, Arkansas, Mississippi, and West Virginia did not receive attention.
Eliminating the top 20 "offender medical schools" would also eliminate the top ranked schools for graduating underrepresented minorities, including numbers 1, 2, 3, 4, 6, 26, 29, and 35 on this list. Not to worry however, schools with more underrepresented minorities did not graduate more disciplinary problems in regressions. Graduating physicians for the underserved likely interacts in some elegant ways with issues such as physician discipline.
Why does West Virginia perform so poorly compared with Marshall, from the state state? Could it be that age is a factor in the physicians disciplined? Turns out that there are some differences by the age of the school, particularly for those in urban locations. The older schools, those over 100 yrs in operation, had more problem physicians. Those in the most urban locations in the country had the most problems. Is there something connected with the inner cities that holds the key?
What does the University of Iowa do that perhaps results in the lowest physician discipline rate in the nation, even with one of the largest class sizes? Why would it want to broaden its applicant pool to attract more from outside the state (other than to compete for more MD/PhD and NIH dollars), and potentially harvest a "riskier" group of graduates?
Why are Emory graduates disciplined at a higher rate compared to nearly all schools when Emory has a national reputation, a wealth of funding from research and other areas, a relatively low class size at 124, and a relatively high MCAT average of 10.7? All of these factors should help it have a relatively low rate of disciplinary actions.

This brings us to two key questions

Why focus our attentions on a few medical schools that have devoted themselves to solving some of the most critical problems?
Why not focus attention on the characteristics of all medical schools that are causing problems for patients? see Medical Schools: What Reforms Might Make a Difference

Concerns regarding ranking of State Licensure Boards and Data Reported in Studies of Physician Discipline Actions

States vary greatly in their physician composition by factors such as age, numbers of young doctors in training, changes in population, and more. Some states are retirement grounds for physicians who only rarely see a patient. Some state licensure boards are more active than others. Data on disciplinary actions can also be multiplied as doctors from some schools may have several state licenses, depending on how the data are counted. There are doctors who are more mobile, states with younger physicians, reciprocal actions by state boards that multiply actions, etc. Some states have lots of docs in training, others have lots of docs in retirement.

Robert C. Bowman, M.D.

Medical Schools for the Underserved

Controversy in Medical Education

Physician Discipline and Caring for the Underserved