Study: Many top-ranked medical schools fail
to meet “social mission”

A study released in late June takes medical schools back to the basics, judging them on a set of criteria that has placed many of the typical top dogs at the bottom of the heap. “The Social Mission of Medical Education: Ranking the Schools,” published in the Annals of Internal Medicine, ranks schools not on academic performance, but on their ability to carry out their responsibility to society.

The authors say that for medical schools to fulfill their basic purpose—to educate physicians to care for the population—they must produce an adequate number of primary care physicians, ensure adequate distribution of physicians to underserved areas, and add a sufficient number of minority physicians to the workforce. Overall performance in these three areas gave the schools their “social mission score.”

The researchers analyzed records from more than 60,000 physicians in active practice who graduated from medical school between 1999 and 2001 and completed residency training. They defined primary care as family medicine, general internal medicine, general pediatrics, and internal medicine pediatrics, and used data from the American Medical Association, the Association of American Medical Colleges, and the Association of American Colleges of Osteopathic Medicine.

With scores compiled, the authors ranked the 141 medical schools. No Texas schools made the top 20 and two fell in the lowest 20. The University of Texas Southwestern Medical Center in Dallas was the second-worst following Vanderbilt University in Nashville, Tenn., and Texas A&M Health Science Center in College Station was the 17th worst.

The Texas schools’ composite social mission scores, from best to worst: the University of North Texas College of Osteopathic Medicine in Fort Worth (55), the University of Texas Medical Branch in Galveston (56), Baylor University College of Medicine in Houston (84), the University of Texas Health Science Center at San Antonio (86), Texas Tech University Health Science Center in Lubbock (114), Texas A&M HSC (125), and UT Southwestern (140).

Three historically black colleges had the highest social mission rankings, and public and community-based medical schools had higher scores than private and non-community-based schools. Also, the schools that received greater amounts of research grants from the National Institutes of Health tended to fare worse, with a few exceptions. Geographically, schools in the northeast and in more urban areas were less likely to produce primary care physicians and physicians who work in underserved areas.

One rationale for the study the authors stress is the rising concern about physician workforce, especially “as citizens and policymakers reconsider the U.S. health care system and seek ‘quality, affordable health care for every American.’” Primary care advocates echo this point. In a June 22 Texas Tribune article on the study, TAFP CEO Tom Banning questioned the responsibility that taxpayer-supported medical schools have to train and recruit the physicians Texas needs. He told the Tribune, “What we need to ask is, should the state be supporting those schools that receive significant outside funding the same as the schools producing doctors who are going to go in and care for Texas patients?”

Detractors were quick to criticize the study’s timeframe, definitions, and societal benefits not included in the criteria. One scathing review came in a statement released by the American Association of Medical Colleges. “Like other attempts at ranking medical schools, this study falls short. By defining ‘societal mission’ and ‘primary care’ so narrowly, it provides a very limited picture of medical education’s many contributions to society in the U.S. and around the world. And that serves no one well.”

The AAMC continued to say that medical schools are producing more primary care physicians, and that other types of physicians like general surgeons, OB-GYNs, and other specialists should have been counted as primary care physicians.

Troy Fiesinger, M.D., faculty member for the Memorial Family Medicine Residency Program in Sugar Land, disagrees. He says that the numbers used in this study are more accurate than other data often cited in the press because they include only actively practicing family physicians, internists, and pediatricians—those “trained to look at all of a patient’s health care needs and ensure they are met,” he says. “To include other specialists in the category of primary care physicians only increases the fragmentation of our health care system that negatively impacts our patients’ health and underestimates the shortage of primary care physicians.”

He continues. “Many of our state’s medical schools clearly value biomedical research—which often generates expensive treatments—and production of specialists over production of primary care physicians and research on more clinically effective and cost-effective treatments for the diseases that impact the majority of Texans.”