Morehouse, Howard medical school graduates most likely to work in underserved areas

By Darryl Fears
Washington Post Staff Writer
Monday, June 14, 2010; 8:12 PM

Graduates of medical schools at historically black universities such as Howard and Morehouse are the most likely to practice the kind of medicine needed under the health-care overhaul, according to a study published Monday.

The study in the Annals of Internal Medicine ranked medical schools based on the communities where their graduates worked and whether those doctors practiced primary care. The Morehouse School of Medicine in Atlanta, Howard University College of Medicine in the District and Meharry Medical College in Nashville ranked as the top three, in that order.

Vanderbilt University School of Medicine in Nashville finished at the bottom of the 141 ranked schools, and the Northwestern University-Feinberg School of Medicine was 139. The Johns Hopkins University School of Medicine in Baltimore was ranked 122.

The United States faces a shortage of up to 100,000 primary-care doctors in 2020, six years after the health-care overhaul fully kicks in with more than 35 million newly insured Americans. Yet elite medical schools place a stronger focus on specialized medicine and research, the study said. They also lag in recruiting underrepresented minorities -- Latinos, Native Americans and African Americans -- who tend to fill the openings created by the shortage.

"It's no surprise," said Eve Higginbotham, a senior vice president and dean of health sciences at Howard University. "We've known for a long time that minority students end up working in underserved areas four to five times more than majority students."

Wayne J. Riley, president and chief executive of Meharry Medical College, said the school recruits students with a background in community service and trains them to work in underserved communities. "We're very upfront. When you put the initials M.D. behind your name, it comes with an obligation to serve," Riley said.

But others called the study, "The Social Mission of Medical Education: Ranking the Schools," another attempt to rank universities based on randomly selected criteria. John E. Prescott, chief academic officer of the American Association of Medical Colleges, questioned the study's methodology, saying, "If one focuses only on primary-care physicians, we're missing the boat."

Prescott said there is a need for more physicians of all types. "Some of the most important things that have happened in health care in the United States have come through research."

The study's chief author, Fitzhugh Mullan, said its intention is not to point fingers.

"It allows schools to examine the outcomes of its graduates . . . and how many minorities have gone through their institutions," Mullan said. "Health-care reform has now been enacted. The question is, how do we address it."

The study tracked 6,000 medical students who graduated between 1999 and 2001, the most recent group to have finished college, hospital residencies and obligations, such as working in the National Health Service Corps to pay off student loans, Mullan said.

Nearly 40 percent of Morehouse graduates -- the highest rate recorded -- practiced primary care in areas designated by the federal government as places where doctors were sorely needed. Thirty-three percent of Howard graduates practiced primary care in those areas.

By contrast, 20 percent of Vanderbilt's graduates worked in those areas, according to the study. About 27 percent of Johns Hopkins graduates practiced primary care where they were most needed.

David Nichols, the vice dean at Johns Hopkins medical school, said that the study is important because it "highlights the important role that black medical schools play in U.S. medicine," but he added that Hopkins has changed since 2001. It is starting an Urban Health Residency next month that replaces hospital residency with experience in neighborhood settings such as clinics and health departments.

Northwestern University dean Raymond Study agreed that the study has "very useful data" and lessons for medical academia but said it does not reflect changes since 2001.

"We're in this study as having a 7.9 percent representation of underrepresented minorities, and we've doubled that," Curry said.

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