How to train doctors who will care for the underserved

An analysis of the mission statements for every American medical school reveals a recipe for producing doctors who will provide primary care to communities in need.

Many students begin medical school idealistically, with a desire to become primary care doctors who care for patients from underserved populations. Some change their minds during medical school.

Chris Morley, PhD

Chris Morley, PhD

“We know from our own studies and those of others that idealism appears to trail off as medical students become more worried about debt, lifestyle and the prestige of their career path and specialty,” says Chris Morley, PhD, interim chair of public health and preventive medicine at Upstate, vice chair for research in family medicine, and lead author of the study about mission statements published last year in the journal Family Medicine.

For his research, Morley assembled a panel of about three dozen medical school leaders, administrators, professors, researchers and students who read and rated the public mission statement of each medical school in the U.S. Then the research team looked at the percent of graduates from each medical school who go on to specialize in primary care, in designated health professional shortage areas, or with medically underserved populations.  They found that schools that specify something about caring for the underserved in their reason for existence are the ones that produce the most doctors who go into primary care or practice in underserved communities.

Morley says medical schools are not producing enough primary care doctors to replace those who are retiring, because so many new doctors – for a variety of reasons – choose  specialties other than family or internal medicine, obstetrics and pediatrics.

What can be done?

“Medical schools as institutions can be introspective and think about their culture and the messages they give to students,” Morley says.

At Upstate, in addition to being the public teaching hospital for 17 counties, a number of programs are designed to attract students who will be devoted to providing primary care in underserved areas. One focuses on rural medicine, and another combines a master’s of public health with a medical degree. Upstate offers distance learning for practitioners who care for underserved populations, and the regional branch campus in Binghamton focuses mostly on primary care. Upstate also offers training for physician assistants and nurse practitioners, health professions that have a strong focus on primary care.

What is primary care?

Primary care is comprehensive first contact and continuing medical care, as provided by physicians such as pediatricians, obstetricians and family and internal medicine specialists. Nurse practitioners and physician assistants may also provide primary care.

This article appears in the spring 2016 issue of Upstate Health magazine.

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