Study in the Annals of Internal Medicine, Provost Responds
This response is from BUMC Provost, BUSM Dean Karen Antman, MD
Yesterday, an article was released in the Annals of Internal Medicine by Mullan, et al., titled, “The Social Mission of Medical Education: Ranking the Schools” that “ranked” on a scale according to the extent to which they graduate doctors who practice primary care, work in underserved areas, and are minorities.
We applaud the attention to primary care, diversity in our medical student population, and in service to underserved populations, but question the author’s arbitrary and very restricted definitions of “Social Mission”. The authors might have chosen to report specifically on the three important parameters but should certainly include service at safety net hospitals within their model.
The accompanying editorial questioned the way the scores were calculated and both the editorial and the American Association of Medical Colleges (AAMC) question the particularly narrow definitions of “Social Mission” used in this ranking.
Boston Medical Center, the largest safety net hospital in New England, is our primary teaching affiliate for BUSM. BUSM students and faculty assist Boston’s neediest and most vulnerable population. The dedication of physicians in emergency medicine, general surgeons, cancer specialists, cardiologists and many other physicians is not considered part of the “social mission” for the purpose of this article.
As the corresponding editorial points out, their metric does not recognize our graduates who now serve as physician faculty at BMC and our affiliated neighborhood health centers and in other regional centers, because Boston is not a designated underserved area (and the Northeast has fewer such designated areas).
We are particularly surprised by our score on underserved minority graduates and on service to underserved patients. Of US Medical Schools we rank at the 75th percentile in the number of African American medical school graduates and at the 85th percentile for Hispanic medical student graduates between 2003 and 2008 (the last year for which statistics are available). Of our current classes, 18-22 percent are underrepresented minorities, far above other schools that were ranked much higher on this metric. We did not focus on diversity only recently. Our 25 year old Early Medical School Selection Program, a partnership between BUSM and 14 historically black undergraduate institutions emphasizes early admissions and curriculum coordination. The editorial agrees that the method for computing this score is problematic.
Forty-one percent of our 2010 graduates are pursuing careers in internal medicine, pediatrics or family medicine. Nevertheless we received a negative score in this parameter.
As noted in today’s Boston Globe article (http://www.boston.com/news/health/blog/2010/06/med_schools_ran.html), we agree with the editorial and the AAMC that “social mission” must be more broadly defined. We feel that at the least “social mission” should include working at safety net hospitals, specialty care of underserved cancer and diabetic patients and those with heart disease. Our emergency room, the largest in New England, treats not only trauma but also provides primary care and is part of the social mission. Certainly graduates who do medical research are also contributing to the social mission. None of these were included in their metrics.
We provide many educational programs to increase the number of underserved high school and college students in the health sciences—MDs and PhDs. Our physicians and students continue to make house calls in the neighborhood and service a Refugee Clinic for immigrants. We provide educational programs for Boston neighborhood youth. The now national Reach Out and Read program began in our pediatric department. We have tens of millions of dollars in health disparities research on Boston University’s Medical Campus.
In responding to the study, John E. Prescott, MD, Chief Academic Officer at the Association of American Medical Colleges, issued the following statement:
I want to bring to your attention a new article which was just released in the Annals of Internal Medicine by Mullan, et al., titled, “The Social Mission of Medical Education: Ranking the Schools.” All, but the newest medical schools, are “ranked” on this new scale according to the extent to which they graduate doctors who practice primary care, work in underserved areas, and are minorities. I wanted to bring this to your attention because you may receive press inquiries about your school’s score. (http://www.annals.org/ subscription required)
There is no doubt that medical schools are deeply committed to fulfilling their social missions, and that producing primary care physicians, a more diverse physician workforce, and graduates that work in underserved areas are important parts of that social mission.
But they are only parts – and like other ranking schemes, this attempted “ranking” on a narrow set of variables presents an inaccurate and limited picture. The fact is medical schools meet society’s health needs in many ways through their integrated missions of medical education, medical research and patient care. A great disservice is done when the impact that medical schools have on communities through their research, outreach programs, care of the uninsured and underinsured is not considered to be of value.
There is an obligation for each medical school to clearly define its social mission and to align that mission with the needs of the local community and the nation as a whole. But as the article’s accompanying editorial notes, a medical school’s societal mission cannot be narrowly defined. To do so presents a skewed view of reality and of medical education’s many societal contributions. And that serves no one well.