The Medical Education Futures Study Blog

Last week the Medicare Payment Advisory Commission (MedPAC) held a panel discussion on medical education’s role in training physicians for the 21st century.  Thomas Dean, a family practitioner and MedPAC commissioner, noted that minorities and individuals from rural areas have a greater likelihood of returning to and serving those communities after their medical training and stressed the need to recruit more primary care doctors and doctors interested in practicing in rural areas.  Also last week, the Urban Institute held a forum on Medical Homelessness and the Role of the Academic Medical Center.  The panelists emphasized the need for greater numbers of and value on primary care physicians, and that a robust primary care workforce is critical to the success of the medical home model.

When asked for solutions to address the impact of who is admitted to medical school, the panelists stressed the importance of incentivizing family practice and sending a clearer message that primary care doctors are valued.  While these are necessary fixes to the current problem, they do not constitute the whole of what needs to be done.  Medical schools play a pivotal and influential role as well.

Two clear messages emerged from the recent briefings.  One, primary care and rural medicine are in great need of attention.  Two, now is the time to examine how we can address these issues at the undergraduate and graduate medical education level, specifically at the point of admission.

Robert Bowman of A T Still School of Osteopathic Medicine pointed out in a recent blog discussion that the MCAT fails to predict who will perform better or worse in medical school and that greater attention needs to be paid to more comprehensive admissions processes.  Innovative programs give hope that there are solutions to this dilemma. The Northern Ontario School of Medicine (NOSM), established in 2005, is committed to engaging the surrounding communities in the education process, and medical students spend time studying in Aboriginal, small rural as well as larger urban communities.  Furthermore, their admissions requirements part from the traditional model – they do not require the MCAT and they aim for a class profile that reflects the demographics of the Northern Ontario population.  Sophie Davis is a U.S. school with another innovative model – they offer a combined BS/MD degree, recruit from underserved areas and they also have no MCAT requirement.

With the recent forums and briefings, it is encouraging to see attention being paid to these important issues facing the health care system, primary care and rural medicine.  But attention is not enough – now is the time for action and change in undergraduate and graduate medical education.  True, admissions processes have been successful in selecting and producing top quality physicians for our nation’s workforce for decades.  But as Robert Sternberg recently pointed out in a recent article in Academic Medicine, U.S. medical school admissions methods are archaic.  The dearth of primary care physicians and the large numbers of medically underserved areas are issues quickly gaining attention in the public and with legislators.  While payment reform and a shift in values are important first steps, it is time to update school admissions policies to produce the physicians needed for the 21st century.