Medical school rankings are a means, not an end

Two weeks ago, I asked, "Where will new primary care docs come from?" A group of researchers from George Washington University has provided an answer in this week's issue of the Annals of Internal Medicine. In response to the U.S. News and World Report rankings of medical schools, which place a high value on research funding and reputation, Dr. Fitzhugh Mullan and colleagues at the Medical Education Futures Study devised a "social mission" ranking score consisting of the percentage of graduates from 1999 through 2001 who currently practice primary care medicine; who work in federally-designated health professional shortage areas; and who are underrepresented minorites.

The result of applying this score was that the U.S. News rankings have been turned virtually upside down, with publicly funded and otherwise unheralded schools dominating selective private schools. The study's "social mission" criteria that have already come under fire from officials at multiple lower-ranked institutions, including New York University (where I completed medical school) and Johns Hopkins University (where I am a part-time instructor and public health graduate student). Their criticisms have some merit. Primary care physicians aren't the only providers of health care for urban underserved populations, and graduating more underrepresented minorities won't automatically translate into better care for minority populations.

On the other hand, I commend Dr. Mullan and colleagues for shining a light on a dark truth that isn't well known outside of medicine: at the "top" medical schools, physicians are subtly and not-so-subtly discouraged from pursuing careers in primary care fields such as family medicine (I was no exception) and encouraged to go into higher-paid, more "prestigious" subspecialty fields. And right now, the U.S. doesn't need more subspecialty physicians - it needs primary care physicians, it needs physicians willing to practice in areas where doctors are scarce, and it needs more physicians of color who identify with and are willing to serve their communities.

Rankings are a means, not an end. It remains to be seen if this study will do more than just cause a short-lived media controversy and actually lead medical school deans to think seriously about new strategies to recruit and nurture students who will meet the social mission needs of this country. For the sake of your health and mine, let's hope that it does.