What is the social mission for medical schools?
September 15th, 2010
10:43 AM ET

What is the social mission for medical schools?

What exactly is the mission of a medical school? Is it to train the best and smartest doctors? Is to tend to our nation’s health? Is it to further medical knowledge?

Go to the website of just about any medical school and you will see roughly the same “three-pillars” message from the dean, or the chairman, or the residency program director. Every medical school stresses their commitment to the triumvirate of education, research, and patient-care.

An interesting analysis of the “social mission” of medical schools comes in the Annals of Internal Medicine. The researchers created their own three-pronged metric that measures three areas that are currently lagging in medicine: physicians working in primary care, physicians working in medically underserved regions, and physicians from minority groups.

The researchers looked at 60,000 medical students who graduated between 1999-2001 and calculated the percentage of who fell into these three categories. Essentially they added these values together to create a “social mission score.”

They ranked all 141 American medical schools, and though there wasn’t space to list all 141 in the article, they did print the top 20 and the bottom 20. Having been a cut-throat medical student once myself, I immediately scanned the scores. I was crushed to find my institution nestled in the bottom 20 (oh, failure!), though we were in excellent company.

Community-based medical schools and public medical schools were prominent in the top 20. The bottom 20 was a whose-who of big-name, big-research institutions (the ones that usually topped the US News & World Report Hospital rankings).

These results were not surprising, but it still stung to find my alma mater prominently posted at the bottom of the list. One of the reasons I’d chosen my medical school—and stayed for residency training, and have continued on as a faculty member—is that the bulk of the medical training is done in an inner-city hospital.

The faculty who work full-time in primary care at our city hospital like to think that we act as role models to our students, that “walking the walk” speaks loudly enough. But apparently not. Only a quarter of our students chose to enter primary care (general internal medicine, family medicine, and pediatrics) in the years covered by the study.

The accompanying editorial pointed out that there are many factors that medical schools cannot influence. Medical schools can do little, for example, about the fact that primary care medicine is packed with aggravation, with lower financial rewards. For many medical students, taking the ROAD—radiology, ophthalmology, anesthesiology, dermatology—is mighty appealing.  Excellent pay, less hassle, more control.

And of course there are some specialty fields that actually do provide primary medical care, particularly OB-GYN, which weren’t included in the study’s definition of primary care.

Despite its limitations, though, the study is a wake-up call to medical educators, medical students, practicing physicians and society in general. While this “social mission” isn’t the only mission of medical schools, it is an important one. Of course we want high-end research to continue in medical schools. Of course we want cutting-edge specialty care to proliferate. But medicine is unique in that it possesses a social mission and it’s clear that as a profession we are falling behind in this area.

The good news is that most medical students are cognizant of this. When I work with students it's clear that the social mission of medicine has meaning for them. It’s more than just lip service or application-essay material. I truly think that the majority of medical students come to this field for the right reasons. The challenge for medical educators is keep that flame alive.

We certainly need to emphasize primary care, since our nation desperately needs legions of more primary-care doctors. There is no need to denigrate specialists, however, because they are also critical to good medical care. But we can emphasize the need for specialists to contribute to the social mission. For those who are not working in underserved areas (which is the majority), medical schools can stress the ethical obligation to providing some care pro bono, or to the uninsured and underinsured patients who have the hardest time getting specialty care.

Increasing the diversity of doctors may be the trickiest aspect of the three pillars of the social mission, since there are economic and academic issues entwined that have roots far deeper than the medical school admissions process.  However, medical schools can make themselves more hospitable places to minorities.  The progress of women in medicine offers both lessons and pitfalls (vastly more women in medicine now, but most in the low pay/prestige fields, and few in upper-echelon positions of power.)

There are many who may quibble about this study, who may say that the “social mission” of medicine is a professional state of mind, not a calculus of minority physicians who do primary care in rural areas.  And there is truth to that: many white, male, Ivy-League cardiologists are extremely ethical, humanitarian, and generous.

But there is something to be said for measures that go against what is most expedient. The truth is, if medicine continues on its current track, it will become harder and harder to find a good primary-care doctor, even if you are a cardiologist yourself.

Danielle Ofri is associate professor of medicine at New York University School of Medicine and editor-in-chief of the Bellevue Literary Review. Her most recent book, “Medicine in Translation: Journeys with My Patients.” is about the care of immigrants and Americans in the U.S. health care system.

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  1. Thor MD PhD

    It should be no surprise that the best medical schools generate the lowest numbers of primary care physicians, these schools in addition to having generally more competitive students cost a significant amount, and unlike undergraduate studies there is a dearth of scholarships for students who don't choose to engage in an MD PhD. The average debt of students that take out loans (notably absent those whose parents can afford to pay for medical school and those who get school paid for as a result of graduate studies) is approximately 200,000 dollars with many students over 275,000 dollars in debt and getting worse with cost of medical school routinely doubling inflation over the last 10 years. So as a recent graduate who has been living on next to nothing for 8 years you are faced with the prospect of choosing a career faced with one that will pay double what the other does the choice is not that difficult. I frankly don't know how a young doctor in family medicine or internal medicine manages to buy a house, a car, save for retirement, in addition to paying student loans which amount to an extra house payment. As a young physician – I can tell you we hear all the speeches, sit through all the talks encouraging primary care, go through all the mentoring sessions, but at the end of the day I can't in good conscience punish my family because the government and the medical system is placing an ever increasing obstacle between physicians and primary care. To expect what are generally the most competitive students in college in a position where they are being asked to make this kind of sacrifice is not sustainable and is becoming even less so as the tuition and fees keep increasing. This is in the face of salaries decreasing in inflation adjusted value, at the current pace even the most dedicated, self-sacrificing of my colleagues are not going to be ABLE to choose primary care as a specialty.

    September 15, 2010 at 12:05 | Report abuse | Reply
    • intern

      Completely agree with Thor. As a fresh grad and new intern, I have about 300K of debt- all from medical school. I will toil for 5 more years before getting a nice paycheck, so that I can start paying off these loans. Many of my classmates are in the same boat. For me salaries played a part in my choice of specialty, although it was probably about 3rd or 4th on the list of reasons that I chose my specialty. While there are some programs to help with loan repayment at this time, who knows when those programs will be cut, leaving docs with a tough time paying their debt. Also, the higher paying fields are often the most competitive, so many of the smartest doctors are shying away from lower paying primary care specialties. You spend a decade of the prime of your life accumulating debt to become a doctor, put up with a lot of BS along the way, yet people expect docs not to be jaded by the time they can actually start earning money. I like to think that I got into the profession for all the right reasons, but somewhere along the way you realize that you don't practive in a vacuum, and that to have a decent home and family, it can be really tough out there, especially in primary care. And they still continue to cut physician reimbursements. I certainly don't want to have to continue to work 70-80 hours a week for the rest of my life just to pay of my debt. At some point, doctors should be intitled to having some sort of a normal life like everyone else.

      September 15, 2010 at 12:28 | Report abuse |
    • UMM

      Oh, cry me a river 'Intern'. Doctors make buttloads of money. Don't act like you are just a working class citizen like everyone else because you are not. Most doctors are overpaid pompous jerks and I can guarantee you are one of them.

      September 15, 2010 at 13:38 | Report abuse |
    • Resident

      Dear UMM, Interns and residents often work 80 hours per week or more (surgeons work 80 hours per week minimum in training). They make on average $50,000. This can last 3-8 years, with the salary only going up $1k-$2k per year, leaving an MD six years out of medical school never having earned more than $65k/year. While working the equivalent of two jobs the entire time, six days per week. Overpaid? Try finding someone to run a cash register for $10/hour, with no sick days and oftentimes no time to use the bathroom or eat uninterrupted, never mind spending overnights in the hospital taking care of ungrateful, entitled (sometimes) sick (always) people, who are oftentimes grumpy and difficult to deal with for good and bad reasons. No, I'm not exaggerating. Next time you see a young doctor under the age of 30, try and remember that he or she is usually a quarter million dollars in the hole just from school loans, and now making $10-15 per hour for the privilege of taking care of you, for 80 nonstop no-time-for-eating hours a week.

      September 15, 2010 at 14:04 | Report abuse |
    • Andy

      UMM, there are very few jobs where you go to school for 8+ years after high school make approximately $42,000 a year to work 80 hrs a week. All the while you have to pay $500-$1000 a month in school loans. And then you have to listen to ignorant people like you who act like all doctors are overpaid.

      September 15, 2010 at 14:04 | Report abuse |

      Oh get off it Andy! I can guarantee you they are ALL overpaid. I bet you think that making 90,000 a year means you are brok eh? Stupid, stupid.

      September 15, 2010 at 14:20 | Report abuse |
    • ..

      I don't see doctors driving 1985 Ford Fiesta's .. do you? Do they rent their homes? Do they never go on vacations?
      Then SHUT UP!

      September 15, 2010 at 14:21 | Report abuse |
    • Student Doc

      Re: Ellipses

      You see a lot of interns and residents driving beaters, and a lot of young docs as well. Once again, before you can start making anything resembling "overpaid" you have to work 80 hours a week 51 weeks a year for a minimum of 2 years.And the 2 year commitment is for GPs.

      Your specialists, are generally training a minimum of 5 years, 80 hours a week, 51-52 weeks a year at an average of $45,000 a year. That's $11 an hour, which is what I made as a grocery store cashier, how many cashiers have 8 years of post high school education?

      September 15, 2010 at 14:31 | Report abuse |
    • Frenemy

      @UMM–With your rash judgment and guarantee of what Intern is like, I'll do the same for you.

      You have no idea about the dedication, effort, and sacrifice it takes to excel for four years in college, go to medical school for 4 more years, and then do a residency for 3-7 years afterward. Do you even realize that that adds up to about 12 years or more of school after high school? You don't know what it's like to do 24 hour shifts at the hospital, or "capped" 80-hour weeks (are you really going to tell your attending doctor that you can't work anymore when he/she asks you to do something when they have full power over your evaluations? No–you keep working), rack up hundreds of thousands of dollars (or "major buttloads", if that term makes more sense to you) just in school debt, and not make a real paycheck until you are into your thirties (do you want to own a house or car or pay for the rest of your life as well? Add those hundreds of thousands on top of the debt that you already have from school).

      Here comes a similar guarantee–most people like you are ignorant.

      September 15, 2010 at 14:44 | Report abuse |
    • FBguy

      To doctors are overpaid:


      Take a look. Average MBA salaries are about 100 grand up to 110k avg at graduation, only pay for two years of graduate school, and can move up quite a bit during career. 4 years of college and 2 year MBA.

      Now think about if you do a primary care specialty in medicine... 160k avg salary, pay for for years of graduate school and then lock yourself into a 40k per year salary for 3-4 more years. Unless you go to the business side of owning a practice or something, that final salary won't go up a ton. 4 years college plus 4 years medical school plus 3-4 years residency.

      Which one would you rather do? Yeah, I'm not going to knock my friends who choose to do medicine too much. They would be stupid if they did it "for the money".

      September 15, 2010 at 15:18 | Report abuse |
    • BJP MD

      I do not think it is possible to convince someone of a person's worth. Those that feel doctors are overpaid cannot be swayed from that position. I would venture to guess that those who complain of a doctor's salary likely make much less. It is the flash of the number that means the most to American's. It is why a professional athlete takes a larger contract in New York, even though the absolute net salary would be greater in Utah. We are obsessed with amounts.

      For argument sake however, let's evaluate the costs: the dollars spent on college/medical school education, the years spent as a trainee(in my case 9 years of residency/fellowship before 80 hour rules at $32K/yr in Chicago), and the fact that we start saving into retirement accounts at advanced ages(37 in my case). The most important money placed in any long term investment, e.g. retirement or college funds, are the early payments; those accrue for the longest time. So yet another area in which physicians must "catch up" after starting practice.

      However, these arguments will never sway one's opinion. My thought is that this is attributable to the fact that many feel that healthcare is a right, not a privilege. As such, they feel their care should be "free". It is disheartening to have patients assume your worth is nothing and voice that opinion. And yet, these same people spend up to $4200/year on frivilous and often hazardous items ($5 pack cigarettes/day = $150/mos, $100/mos cell phone, $100/mos cable-internet) to their health. And yet complain of $20 co-pay or $80/mos in medication bills.

      The reality is that to have a sustainable profession of intellectual people requires a real investment. Otherwise the future doctors will become salespeople, lawyers, MBA's etc. Currently it is only pride getting us out of bed in the middle of the night to fix ruptured aortas or revascularize limbs.

      September 15, 2010 at 17:19 | Report abuse |
    • Eggs

      @ Frenemy: You think you are the only one with a demanding job? Try being a fireman. You do not have the market cornered on hard work so give it a rest.

      September 15, 2010 at 17:20 | Report abuse |
    • Ken

      @Eggs – No one claimed that only physicians work hard. You could make the same argument that a fireman making $42,000 a year has no right to complain when a firefighter in China makes cost-of-living adjusted $12,000 (http://www.worldsalaries.org/china.shtml). Salaries are all relative to where you are and what options are available to you.

      So compare the opportunity cost physicians face - medical students could largely enter into consulting and enter near 6 figure salaries after college, or go into law and earn mid-6 figure salaries after graduate school. Instead, they have a choice whether to make $80,000 up to $500,000. What would you decide to do? And no one needs your pity. Just trying to advance your understanding.

      September 15, 2010 at 18:03 | Report abuse |
  2. Common Misconception

    Go for a D.O. is you want a good primary care physician. Enrollment in DO medical schools is growing very rapidly, and they are taught treatment differently. The schools are generally much less expensive, as well, meaning that doctors aren't forced to choose specializations just so that they can pay off their loans before they die.

    September 15, 2010 at 12:29 | Report abuse | Reply
    • DO Student

      Unfortuantely, this is not true overall. DO schools are just as expensive if not more expensive than many MD schools. There are very few state DO schools which tend to be the cheapest route to getting a medical education. Attending a private medical school or even a state school as an out-of-state resident is extremely expensive (there are a few schools that charge >$50,000 in tuition alone yearly for an out of state student!)

      DO schools do emphasize primary care overall, but you still see the exact same phenomenon with the smartest students going for higher paying specialties.

      September 15, 2010 at 13:13 | Report abuse |
    • Jack

      DO schools are usually more expensive. They are definitely more expensive than state MD schools (DO schools are more on par with private MD schools in terms of cost).

      Although DO schools may focus a bit more on primary care, the same force of debt will push well-scoring, competitive DO students into competitive specialties as well.

      EDIT: What DO Student said. Beat me to it. 🙂

      September 15, 2010 at 13:27 | Report abuse |
  3. nevada md

    As a state medical school professor for more than a decade, and having been in private practice for an equal amount of time, I only agree with a small part of this slanted article. The social mission for medical schools is an attitude and a professional state of mind. Women now make up at least half ( if not most of most) of medical school classes. Minorities in our State are recruited to consider medicine from time they are in high school . It is irresponsible to say that medical schools can be "more hospitable places for minorities." At our school we tried to encourage every student to work hard and treated every student with respect. Scores are color blind, however. Prospective medical students and physicians must put in the work and effort to attain passing scores. Reverse discrimination and diversity for diversity's sake will hurt American health care. The comment that more primary care physicians are needed is true. But after being in school for 12 years (plus) beyond high school no physician wants to be reimbursed 19$ for a routine internal medicine follow up visit for hypertension. Finally, the current system to increase the number of physicians working in underserved areas needs to be improved. The Ob physicians who work in our city in "underserved areas" are for the most part extremely unhappy. They work for significantly less pay, they work many more hours than other private practice Ob docs, and have extremely rigid and restrictive contracts. Many of them state that they feel like indentured servants The social mission/responsibility of medical schools is a complex issue. Promoting diversity, promoting underserved areas of America and encouraging physicians to enter primary care will not fix this issue alone

    September 15, 2010 at 12:49 | Report abuse | Reply
    • Ken

      Excellent point. Medical schools are already admitting a number of students who come from backgrounds that can empathize with the hardships of underserved populations and are motivated to help such areas. But asking even selfless people to sacrifice job satisfaction and family financial security in the current primary care field is not the way to address the lack of physicians entering primary care. Hence the primary care loan forgiveness programs that have started to emerge as little incentives. It's just a tip of the iceberg, but at least it's a tip.

      September 15, 2010 at 18:11 | Report abuse |
  4. Jack

    Agree with nevada, thor and intern. If medical students are supposed to be smart, certainly they will realize that spending more hours in primary care for less pay, no matter how altruistic, will still have an adverse and undesirable effect on the lives of their family members.

    There comes a point where many intelligent, caring, and dedicated students will abandon medical school altogether because it just won't be worth it. That "fuzzy feeling" of helping patients wears off really quickly after about 10 years of post-graduate training, crushing debt, poor reimbursements when it's all over, and the infinitely frustrating cases of patients who refuse to take any ownership of their own health (YES, smoking, drinking, unhealthy eating, being obese, etc. are bad for your health and exercising, eating well, and complying with medical treatments when necessary are GOOD for you!).

    September 15, 2010 at 13:19 | Report abuse | Reply
    • Jock

      Part of what you are saying is true. Also doctors need to stop BLAMING patients all the time for their issues. There are many of us who do NOT smoke, do NOT drink, and do NOT take illegal drugs. I exersize, eat healthy, and have a generally happy family life. Does that prevent me from having chronic pain? No. Some people are just sick. That is the way life is. You can do everything right and still have a debilitation condition. So please, STOP always blaming the patient. Yes, some are to blame but many are not. We do not live in bubbles. THe crap they put in our food, water, and air supply is mostly to blame for many conditions and that just cannot be helped.

      September 15, 2010 at 13:48 | Report abuse |
    • Michelle

      So doc, what about a patient like me? I'm 30 years old, I eat right (seriously, I do), exercise at least five times per week (running, weight-lifting, swimming), take vitamin supplements as prescribed, I'm sexually monogamous with a disease-free spouse, I don't smoke, barely drink, don't do drugs, and I STILL have health problems. I apologize for my cystic ovaries and fibroid-ridden uterus. I clearly did that on purpose. I'm sorry that my joints swell and ache because my immune system causes occasional friendly-fire incidents. I'm sorry I had pneumonia when I was in the Army and my lungs give me trouble when I get sick.

      Clearly, I'm doing this to make YOUR life difficult.

      September 16, 2010 at 10:14 | Report abuse |
    • Jack

      Goodness people, I simply was stating that the warm feeling of helping people (which apparently should be the only drive for people to want to go into medicine because anyone who hopes to make a living after so much training and effort will be harangued) fades quickly when faced with the realities of actual practice. Bottom line: the people of the US, as a whole, are getting fatter and fatter. There are far too many people in the US that don't care about their health, and expect someone else to magically make everything better (and all too often don't want to pay for it). Take a trip to the local hospital or ED and you'll find it is disproportionately full of people who don't make very many efforts to take care of themselves. A whole lot could be done in terms of general health and medical costs if people would just take some ownership of their health and do things that would keep them healthy!

      Now, Jock and Michelle, before you jump all over me, it's people like YOU that make the warm, fuzzy feelings possible! You're doing what you can to be healthy, and I'm glad as can be to join with you as a team to help you continue to be healthy in the face of so many illnesses and disease processes that unfotunately can happen to anyone. I just wish more people would make the effort to try and do the same, yet every day I'm reminded of how many people choose not to.

      September 16, 2010 at 10:54 | Report abuse |
  5. Nurse Practitioner

    As a nurse practitioner for more than 15 years in primary care, I can say that the niche for advanced practice providers (Nurse Practitioners and Physician Assistants) is definitely in primary care. I prefer to see a NP or PA when choosing my own health care. I get more time and attention, more explanation of my health options and outstanding consideration of my own foibles. In caring for may patients, I try to consider the whole family in offering services and treatment. I have seen the results of time cutting, adding more patients to the schedule than time can permit, and separating out what problems to treat and what need to come back another day. Nurse Practitioners are one of the most studied groups of health care providers, and routinely provide excellent care, have excellent outcomes, and outstanding patient satisfaction. I am proud to provide care in a rural community, along with my NP and MD colleagues.

    September 15, 2010 at 13:23 | Report abuse | Reply
    • Physician Assistant

      I am a physician assistant in primary care, and I agree with most of what you said. Our occupations were created to serve in a primary care capacity. Physician assistants in particular started as a career for medics returning from Vietnam that were then trained in primary care to serve in rural communities. I love primary care and the variety I see every day.

      However, there is a trend in PAs (who are not specialty trained, like NPs) to choose specializations after graduation– much like more MDs are choosing specialties. In my class of 33, a total of seven students went into primary care. Thirteen went into ER, ten into Ortho/surg, and the remaining are in derm, GI, and neurology. While most chose based on their interest, nearly every student cited pay as a factor in their decision– and we only have 100-150K in loans. Double that amount, plus double or triple the schooling, and I completely understand why docs choose specialties.

      September 15, 2010 at 15:09 | Report abuse |
  6. Anna

    One thing they fail to teach doctors in medical school is bedside manner.

    Take this as a lesson doctors: More and more patients are opting to completely do away with the need for doctors thanks to the abundance of information at our fingertips on the internet, seeing more and more holistic doctors ( that actually treat the whole body and not some copout of just symptoms, and also implementing chinese medicine that has been around for THOUSANDS OF YEARS before pompous white doctors in America.
    Get ready to see less and less patients. Most of you need to wise up and leave your useless egos at the door. Stop patronizing your patients. Listen to them, they know their bodies better than YOU do. Leave your bias prejudiced and sexist comments out of the discussion. Treat each patient as an individual. We do not fit in your preconceived idea of what a particular patient suffering with condition A should look like.
    Oh, and above all, learn some freaking humility. You do NOT know everything. In fact, you know hardly ANYTHING if the very basic rule of bedside manner is disregarded in patient care.

    September 15, 2010 at 13:44 | Report abuse | Reply
    • WestCoast

      Excellent post Anna ! You hit it right on the head.

      September 15, 2010 at 13:49 | Report abuse |
    • redshirtHS

      I'm sorry for whoever wronged you. I can tell it had quite an effect!

      As for less patients, I'm afraid that the whole "health care bill" and the mandated coverage for almost all US Americans will lead to possibly too many patients. It's usually termed a "healthcare/primary care shortage", and a lot of people are worried about it. Sorry to burst your bubble.

      September 15, 2010 at 15:04 | Report abuse |
    • Yup!

      Anna, I agree with most of what you said– many docs today do not have a very appropriate bedside manner. However, I cringe reading "abundance of information at our fingertips on the internet". I am a physician assistant and can't tell you how many times a patient comes to the office with symptoms classical for a sinus infection, demanding a CT and MRI because they read on WebMD that they have a brain tumor. Or the patient with ringworm who came to the office convinced she had lupus, lyme disease, or syphillis. Or the woman with the expanding waistline demanding thyroid replacement therapy after wiping the donut dust off of her shirt (all true stories!).

      Make a list of your symptoms, discuss them with your doctor, but please dont' diagnose yourself by information on the internet. We went to school for this, are trained in this, and although you may have had bad experiences, most doctors know what they are talking about. If you don't like your doctor (or NP or PA), find another.

      September 15, 2010 at 15:14 | Report abuse |
    • Kim

      Please doctors stop making assumptions of one's health based on their ethnicity. This is a complete waste of time. I cannot count how many doctors said I should have this illness and that problem because I was Japanese! Screw you , you bigoted turd! Funny how white people are never the top of the 'list' of most likely to get this or that, except for skin cancer. Illness sees NO color. Treat ME as an individual based on MY lifestyle and MY eating habits. Nothing more.

      September 15, 2010 at 16:47 | Report abuse |
    • Ken

      I bet as a Japanese person you don't have sickle cell anemia. Is that racist? Ethnicity does play a part in some illness predisposition. I think what you meant to write is that a physician should not presume what illness you have because of your ethnicity. But to ignore your ethnicity is not advisable. You are not your father or mother but what diseases they had are relevant to your health.

      And caucasians are more likely to have fibromyalgia, cystic fibrosis, and Ewing's sarcoma. Do you feel better now?

      September 15, 2010 at 19:49 | Report abuse |
  7. LaughedAt

    As a patient with a very odd and complex allergy (gut allergy to wheat) I have been laughed at by so many doctors and paid more than $10K (with insurance I'm afraid) trying to find out if there is anythign I can do to relieve this in any way. I don't like going to doctors- not because I don't want to take care of myself but because I already know the arrogant words that will come from their mouths. Just because a person graduated from medical school does not mean they know everything about the human body- that is proven every day with research.

    September 15, 2010 at 13:59 | Report abuse | Reply
    • Most doctors are arrogant jerks

      I agree with you 100%. They are running scared because they can no longer lie to the American public as they have in the past. People ate up what doctors said and took it as gospel. Now we can see through their BS and know they are nothing more than glorified drug dealers. They are no different than some crack ho in the street peddling poison to you.

      Educate yourself. Purchase health books. Research online. Join online forums for information from REAL PATIENTS with their REAL EXPERIENCES with medications. Not the lies that doctors will tell you to make a buck.

      September 15, 2010 at 14:24 | Report abuse |
    • NYC

      There is also a huge differenc between doctor care here and in Canada. I had wonderful doctors in Canada that were respectful and helpful. Why? Because their salaries were not threatened like they are here. Their government realizes, ( LIKE NUMEROUS OTHER COUNTRIES), that healthcare is a RIGHT of any tax paying legal citizen. Taking care of your citizen's health is number one. People do not lose their houses because of medical bills. They do not have their credits trashed because of medical bills.

      I am seriously considering moving back. What was I thinking?!

      September 15, 2010 at 14:27 | Report abuse |
    • Educated Patient

      The last thing many doctors want is for their patient to be educated. Food allergies is a prime example of this. Have you read the recent propaganda put out in online news forums about food allergies being a SMALL ISSUE? No it is not. They also assume its always kids with allergies. No they are not. Many adults have it. Food allergies can manifest itself with many odd symptoms such as: depression, anxiety, breathing problems, heart palpitations, aches and pains, etc. Doctors do not want you to find the cause of your issue, especially if its a food allergy. Why? Because its a simple fix: cut out the food.
      Instead they want ot give you drug after drug for each symptom while ignoring the root cause which can be a simple food allergy.

      September 15, 2010 at 14:31 | Report abuse |
    • ERfanatic

      Educated Patient and Most Doctors–I'm not sure what kind of doctors you associate with, but as for Docs in the Emergency Department, I implore you to be educated! Please! I don't know what kind of doctor wouldn't want you to be!

      A year or so ago, I would have given anything for patients to be educated about the H1N1 virus, or "Swine Flu". It was a collosal waste of resources when people would come in with the sniffles afraid that they had the swine flu because they had eaten some pork or bacon or whatever.

      Yes, please educate yourself. There really are a lot of valuable resources becoming readily available! It'll open up the beds in the emergency room for real emergencies that unfortunately happen all to often.

      September 15, 2010 at 14:56 | Report abuse |
  8. Student Doc

    There are now schools with a social mission (AT Still a DO school, and Florida International an MD school), that are for their part trying to make an impact on this problem.
    As many have pointed out, medical schools only accept "the best and brightest", and these students will be able to do a cost benefit analysis. The average student comes out of medical school with $180,000 in debt, making $90,000 a year is going to be much less appealing than a specialty.

    September 15, 2010 at 14:04 | Report abuse | Reply
    • Student Doc

      Also, The New York Times published an eerily similar article in June.


      September 15, 2010 at 14:10 | Report abuse |
  9. Academic Radiologist

    Two points not brought up in this article.

    1. Subspecialty medicine is often (not always) much more intellectually challenging and interesting than primary care, and usually also way more high tech. This makes them very attractive to highly motivated students, so it is not just money.

    2. Many of the non-primary care specialties have way poorer hours and work committment than do primary care doctors. Hospitals are open 24/7, and are staffed with subspecialy internists or pediatricians, ED docs, Critical Care physicians, anesthesiologists, and radiologists among others. Primary care docs usually see patients from 8-5 Mon-Fri, with after hours care being done by the ED's. Although most will take phone call (often staffed by nurses, NP's, or PA's), they rarely if ever see patients after hours.

    So the attraction is not easier work. There is usually more money, but the attraction is often due to the work environment and not the extra cash. I can't think of a cardiologist, surgeon, etc who would want to be a primary care doc even at the same pay.

    September 15, 2010 at 14:08 | Report abuse | Reply
  10. Jake

    I don't care if my doctor goes to Duke or Hopkins or Stanford!

    I want a doctor who is black!

    This article is excellent in that it stresses what is really important. The skin color of my doctor!

    September 15, 2010 at 15:19 | Report abuse | Reply
  11. tim

    I have much different slant on this. I work in hospital administration and deal with the costs of healthcare. The "social mission" helps call students into medicine and is reinforced through medical school and in hospitals, but the reality is healthcare getting more expensive every day and even with the upcoming changes, healthcare will continue to get more expensive. One thing not mentioned is the reduction in reimbursements, just because the doc charges you $75 for a visit he/she is lucky to get $20 for the service. Now don't forget about malpractice insurance either. I actually this cost going higher because the acuity of the patients are going to be higher, since they will wait to the last minute, and the need to cut costs are going to open up the docs to more lawsuits because the patients won't have access to highest available care possible. Show any other profession that if you make a mistake, you could have to pay millions of dollars from a single lawsuit.

    September 15, 2010 at 16:32 | Report abuse | Reply
    • Ali

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      August 1, 2012 at 23:51 | Report abuse |
  12. eilis_artis

    My son who is an Emergency Medicine physician who went to an osteopathic medical school with a large female and minority population. He choose an osteopathic school because of its philosophy and emphasis on primary care. Although he originally expressed interest in Family Medicine, he decided against it in favor of EM. He's found that in the current economic climate, the ED functions as the family physician for many people. He has very strong opinions on the state and cost of healthcare today. However, we both agree that insurance companies shouldn't be determining who gets care and who doesn't.

    September 15, 2010 at 17:50 | Report abuse | Reply
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  13. posranch

    I'm an old fart..... I remember when doctors made house calls. I remember when folks became doctors because they wanted to help sick people. I remember when a doctor would barter for his services, as opposed to refusing treatment because the patient had no cash to lay out. I remember when a doctor would stay in the medical field until he was an old man himself, instead of getting the student loans paid off so that he could retire at 35 or 40 years old. The whole ideology of medical professionals has changed with the American's increased demand for health care.

    September 15, 2010 at 18:21 | Report abuse | Reply
    • Ken

      Yes, the good ol' days of medicine are quite far behind, for better or for worse. I'm not that old myself, but I do work with doctors who remember an era before antibiotics. And they always tell me - do you know why doctors had such great bedside manner in the old days? Because there wasn't anything else they could do for their patients except talk and listen. And patients understood that.

      Now? Physicians just want to treat people. And patients? They just want to get cured. Parents just want antibiotics for their kids. People want the latest cutting-edge medicine they saw advertised on TV. The doctor has changed, but let's not think they changed in a vacuum. Our whole society has changed. Doctors and patients have to adapt to one another, not just one to the other.

      September 15, 2010 at 19:57 | Report abuse |
    • Scutwork

      It's true, back in the day, there was so much less availability of MRIs or CT scans. There was a lot more evaluating with a lot more emphasis on history and physical exam. One could say there was a lot more emphasis on thinking through a diagnosis.

      Nowadays, there's a lot more info to know, and the old days of spending so much time with the patient to diagnose them are gone. To be honest, it's not so much that the doctor's wanted that, but it's just the state we are in. Most patients want that scan or MRI anyway, and those things cost a lot of money. It's a changing medical world–some ways good, and some ways bad. People might comlain about hasty visits or costs, but they also don't die from some of the diseases that they used to.

      September 16, 2010 at 09:18 | Report abuse |
    • Scutwork

      Oh, sorry but I have to say, most doctors are not even close to retiring at 35 or 40. Doctors usually finish their training by about 30-33 and have all those loans everyone's been talking about. At that point they have literally zero saved toward any sort of retirement, as well.

      Basically, even with saving saving saving, there's absolutely no real possibility for me to ever think about retiring at 35-40. I do take your point, though, that some older docs are still working even into their late 70s. It's pretty amazing, actually.

      September 16, 2010 at 09:22 | Report abuse |
  14. erscutmonkey md

    I'm sorry to hear so much antipathy towards physicians. I suspect these are folks that have medical problems that couldn't be fixed by modern medicine (there are quite a few problems we really aren't good at treating, but I'd like to think that we can be compassionate towards everyone.)

    The 'physicians make too much money' argument is pretty silly if you compare physicians to other professionals with similar levels of training. Lifelong earning compared to the number of years of training and the rigor that is involved is pretty low. Most of the nurses I work with have a better lifestyle and more savings than I do. I'm 38, have been in school for most of my life, drive a Corolla, rent an apartment, and have very little in retirement savings.

    As for early retirement, that's absurd. There are a very small number of doctors who are effective businesspeople who make a lot of money, but most work hard for their entire lives.

    Most of the physicians I know don't retire because being a doctor is still the best job in the world, despite all of the crap we get from lawyers, administrators. Worst are the patients that think that medicine should adhere to 'the customer is always right' philosophy. Medicine should not be a business, but it is. You don't give your children what they want, you give them what they need. It sounds paternalistic, but it's true. The reason people come to the ER for their primary care is because they can get in faster, get more tests done, and not have to pay their co-pay up front. And I agree with Scutwork, you can be the best doctor ever, but if you haven't done an x-ray and blood tests many patients just aren't satisfied.

    So, the 'customer is always right' model is actually beating the bedside manner out of physicians, business is chnaging how we deliver care based on how the public wants it (and are willing to pay for it). To say that we're not interested in money is foolish, but most physicians I know are not motivated by money, we just want enough so that we can make our families safe and comfortable.

    September 19, 2010 at 23:31 | Report abuse | Reply
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