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Sun September 23, 2012
The Next Frontier For Elite Med Schools: Primary Care
Originally published on Sun September 23, 2012 5:51 pm
Johns Hopkins, Yale, Harvard, Columbia and Cornell. What do these medical schools have in common?
Beyond their first-rate reputations, they're also on the short list of top U.S. med schools that don't have departments of family medicine. Elite schools have long focused on training specialists and researchers, but with the federal health law's emphasis on primary care, some schools are looking harder at family medicine.
Until this year, for example, the Mount Sinai School of Medicine in New York had neither a department nor any family physicians on staff. Students like Demetri Blanas, 26, who were interested in becoming family doctors found little support. For the first three years of school, his training focused almost exclusively on taking care of extremely ill patients in the hospital.
"I want to spend my career keeping people healthy rather than trying to bring them back from a very serious illness," Blanas says. "I think it is what society needs right now, and that is important to me."
Blanas says many of his professors discouraged him from going into primary care, telling him it was too much work, the pay was lousy, the job was boring, and it simply wasn't as intellectually rigorous as being a specialist.
Mount Sinai ranks among the bottom 20 medical schools in the country when it come to the number of primary care doctors it graduates. But that may soon change. In June, Mount Sinai started a new department of family medicine.
Dr. Dennis Charney, dean of the medical school, says the new department represents a fundamental change in Mount Sinai's mission.
"We want to be one of the leading medical schools that educates the next generation of primary care doctors," he says.
The new family physicians on faculty will teach students in all four years of medical school.
The department grew out of a new partnership between Mount Sinai and the Institute for Family Health, a network of 30 community health clinics across New York.
Health systems are eyeing partnerships like this one, between hospitals and primary care groups, as a smart bet for the future. Under the federal health law, the government will offer bonuses to places that give patients better care for less money. To do that, many health systems are bolstering primary care services to manage chronic conditions and prevent hospitalizations.
Neil Calman, president and CEO of the institute, was intrigued by Mount Sinai's partnership offer from the start. But he was also skeptical.
"It's pretty hard to have a family medicine-based organization in a hospital and a medical school that doesn't have a department and doesn't recognize it as a specialty," he says.
So Mount Sinai worked with Calman to start a department, signing institute doctors onto the faculty.
"It seemed like a natural marriage," Calman says.
"I think people are finally realizing that the country will be bankrupt if we continue to admit people and readmit people for conditions that could be prevented with good primary care," Calman says.
It is a realization he has been waiting awaiting for the past 30 years.
"I went into family medicine believing that was exactly what the country needed," he says. "Unfortunately, it's taken a little longer for everybody else to realize that than I expected."
JACKI LYDEN, HOST:
Most people who've tried know that it can be tough to get an appointment with a primary care doctor. The good news is that more and more med students are starting to show an interest in family medicine. But the country's top med schools aren't keeping up with the demand. Jenny Gold, with our partner Kaiser Health News, has this story from New York about a school that's trying to change that.
JENNY GOLD, BYLINE: Top-rated medical schools have always focused on specialties and research, not primary care. Schools like Harvard, Yale and Cornell don't even have departments of family medicine. Until recently, Mount Sinai School of Medicine in New York was on that list too. Fourth year med student Demetri Blanas says many of his professors actively discouraged him from going into primary care, with a list of complaints: Too much work. Lousy pay. Boring cases.
DEMETRI BLANAS: It has a big impact over a long period of time when your mentors who are the ones that you're supposed to be learning from don't think that you're making a good career choice.
GOLD: But Mount Sinai is changing. In June, the school started its very own department of family medicine. Dr. Dennis Charney is the school's dean.
DR. DENNIS CHARNEY: This is a fundamental change in expanding primary care at Mount Sinai. So it's a big deal for our institution.
GOLD: The new family physicians on faculty will teach students in all four years of medical school. And students like Blanas will be able to spend more time training in community health clinics like those run by Dr. Neil Calman in New York.
DR. NEIL CALMAN: So we're on the third floor of the Sidney Hillman Health Center, which is one of the Institute for Family Health's 30 primary care sites.
GOLD: Two years ago, the Institute for Family Health decided to build a giant new clinic in Harlem, Mount Sinai's neighborhood. That's when Mount Sinai approached Calman and asked him to partner with the hospital. Calman was intrigued but skeptical.
CALMAN: It's pretty hard to have a family medicine-based organization in a hospital and a medical school that doesn't recognize it as a specialty.
GOLD: So Mount Sinai decided to work with Calman to start a department. It's just the sort of partnership that hospitals across the country see as the future of medicine. That's because the federal health law offers bonuses to health systems that keep people healthy and out of the hospitals. And they do that by ramping up the kind of primary care offered at Calman's clinics.
CALMAN: Here, come look at this. So your blood pressures are controlled, your blood sugar's controlled. You're doing a great job with the medications. And, you know, doing all...
GOLD: Calman has been helping patients manage chronic illnesses like diabetes for the past 30 years. He's optimistic that students at Mount Sinai will want to follow in his footsteps.
CALMAN: I went into family medicine believing that it was exactly what the country needed. Unfortunately, it's taken little longer for everybody to realize that than I expected.
GOLD: Mt Sinai's Dean Charney is also hopeful.
CHARNEY: If you have medical schools like Mount Sinai and Harvard and Yale and Columbia and Penn saying that this is an important part of the future of medicine, there'll be a trickle-down effect to the students who will say, yup, you know, that's what I want to do. I want to be at the vanguard.
GOLD: It's too early to know how many Mount Sinai students will actually pick family medicine this year, but nationally over the past three years, the number of med students who go into family medicine has grown by 20 percent. For NPR News, I'm Jenny Gold. Transcript provided by NPR, Copyright NPR.