- Larry Bauer, MSW, MEd
One of the things that I’ve always enjoyed about working with and supporting family physicians was the sense that I was helping not only the underdog, but one of the only groups within the house of medicine that could demonstrate its value in terms of improving the health of the population while reducing the cost of care; doing more with less.
I’ve also encountered elitism in medicine as an educator, as a faculty member, as a family member whose relations have encountered elitism and its effects, and as a patient myself. I want the underdog to lead the charge to reform the U.S. health care system. We would all be better off if family medicine and primary care led.
In Dr. Lin's description of remedies to the problem of too few family physicians, I think he left out the critical element. Our nation’s medical schools are becoming a playground for children from families of special means. Research clearly shows that a very disproportionate number of students admitted to our medical schools are from families with high and exceptionally high income expectations.
Children from families with limited means are disproportionately not making it over the hump. We know from 30 years of research that if more children from first generation to college families were admitted into our medical schools, and if those who have been out for a few years (not only a "gap year") were admitted to our medical schools, and if those from rural backgrounds were admitted to our medical schools, we would have more graduates choose family medicine and primary care, and probably general surgery and psychiatry as well.
This literally is the elephant in the room. I find that very few in family medicine and none outside of family medicine are willing to consider this issue.
I was on the forefront when I was on the faculty in the Department of Family and Community Medicine at Penn State University, as we collectively fought to increase family medicine faculty's teaching of students from first year to fourth year. We invest extraordinary faculty time and energy into teaching in most medical schools in the U.S. Family Medicine faculty are stretched thin because they want to increase students’ exposure to family physicians throughout all years of medical school.
But unless we address the core issue - the monolithic socioeconomic backgrounds of the students our medical schools are admitting - all of this additional expenditure of faculty time (which by the way is a very scarce and valuable resource) is not likely to change the picture. It’s time to focus on this issue. This can not be done by Family Medicine alone. It’s going to take a coalition of people within the medical school and in the larger community.
And a comment on AAMC’s response: the issue is not changing the interview process to address the “personal” side of the candidate. The issue is who is being interviewed in the first place. The second issue is who does the selecting. If basic science and non-clinical faculty continue to make up a large proportion of admissions committees, nothing will change.
Larry Bauer is CEO of the Family Medicine Education Consortium.