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University of Minnesota Medical School does well in new 'social mission' ranking; Mayo not as well

A research team has figured out a metric to score 141 medical schools according to their "social mission," and the University of Minnesota Medical School is in the top quartile at No. 34. The Mayo Clinic is No. 103.

This study isn’t about a medical school’s ability to throw great parties. It’s about the school’s commitment to "train physicians to care for the population as a whole, taking into account such issues as primary care, underserved areas, and workforce," according to the authors.

The study  was published Monday in the Annals of Internal Medicine, a journal of the American College of Physicians.

Researchers looked at percentages of medical school graduates who went into primary care, who work in "health professional shortage areas," and who are under-represented minorities themselves. They relied on 1999-2001 data on more than 60,000 graduates, the most recent "cohort" available that had completed residencies and national service obligations.

Timely study
Given the national health insurance expansion, the study is timely, according to a co-author I interviewed Monday.

"The issues of doctors going into primary care, going into underserved areas and diversity in the health-care work force are really pertinent right now," said co-author Candice Chen, an assistant professor of pediatrics and health policy at George Washington University. "Health-care reform is going to make these issues a lot more pressing ... and primary care is probably one of the areas that’s going to be the most stretched."

Among the findings:

• Public and community-based medical schools scored higher than private and non-community-based schools.

• Schools in the Northeast and in more urban areas were less likely to produce primary care doctors and those who practice in underserved areas.

• National Institutes of Health funding was "inversely associated with social mission scores."

U of M is an exception
But the University of Minnesota and three other major research institutions "defy" the NIH finding.

The U’s medical school is in the top quartile of NIH research grants, but it ranked 14th in the number (45 percent) of primary care doctors it graduated. The U ranked 49th for percentage of minority graduates (5.1 percent) and 86th for physicians practicing in health professional shortage areas (22.6 percent).

"The University of Minnesota is a school that defies the trend, and so we think they should get credit for being able to do both [research, primary care]," Chen said. "But it encourages our other schools (in the ranking) to look at the University of Minnesota and say, ‘Well, how did they do that? How did they both get research dollars and put out high-quality and high-technology research and also put out primary care doctors?’ " 

Rochester, Minn.-based Mayo Clinic, which receives nearly as much NIH money as the U of M according to Chen, ranked 132nd in its output of primary care doctors (23.8 percent of students). Mayo ranked higher than the U for underrepresented medical school students — 16.4 percent for a No. 42 ranking.

Powerhouses in social mission
So, who’s the powerhouse medical school when it comes to social mission? Morehouse College, a historically black school in Georgia, is No. 1. The next two spots also went to historically black colleges. Who’s No. 141? Vanderbilt.

I mentioned that it’s somewhat odd to see lesser-known schools top the likes of Mayo, Harvard (No. 62) and Johns Hopkins (No. 122) in a ranking of medical schools.

"We actually think that that is one of the strengths of the study," said Chen, whose employer ranks No. 110. "Too often, these schools that are really doing the hard work, defying the trends, putting out the primary doctors, putting out the doctors that are willing to go into underserved areas, putting out the minority physicians — they often don’t get credit where credit is due."

The social mission ranking throws a little love their way.

"We’re hopeful it’s a step in the right direction to changing the mind set of the public, of educators, and of legislators to say, 'OK, what do we value in medical schools, really?' "

Is it the good GPAs and high MCAT scores of future doctors, she said, "Or, is it that they’re going to be compassionate, well-rounded, able-to-connect-with-patients doctors, in addition to being bright and scientifically minded?"

UMD’s focus
Sometime ago, I interviewed Dr. Raymond Christensen, assistant dean for rural health at the University of Minnesota Duluth, about the impact of health-care reform on the medical school. The extra need for primary care physicians fits right in with UMD’s mission, he says.

Some of his comments from that interview indicate why the University of Minnesota Medical School system scored high in overall social mission and percentage of primary care doctors. Students spend two years at UMD and two years at the Twin Cities campus.

The medical school tries to select students from small communities in the hope that they’ll be interested in serving as primary care, family and internal medicine physicians in rural areas, where the need is greatest in Minnesota, Christensen said. Once they’re enrolled, however, they can’t just be "conscripted" to those specialties or rural areas, he said.

"They know our mission," he said of students. "They know we harp about it and they know we’re trying to guilt them, too. I’m a rural kid ... my vision has always been to provide access to high-quality rural health care."
 
Part of UMD’s mission is also to train Native Americans who will serve Native American communities.

"So, as I look at our goal to train more family physicians this reform is helpful in that it raises the visibility of family medicine," Christensen said. "The last time we had a lot (family physicians) come in is in the 1990s."

Read the study[pdf] here and check out the appendix [pdf] of the rankings.

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