The Social Mission in Medical School Mission Statements: Associations With Graduate Outcomes

摘要

Background and Objectives: Mission statements of medical schools vary considerably. These statements reflect institutional values and may also be reflected in the outputs of their institutions. The authors explored the relationship between US medical school mission statement content and outcomes in terms of graduate location and specialty choices.Methods: A panel of stakeholders (medical school deans, faculty, medical students, and administrators) completed a Web-based instrument to create a linear scale of social mission content (SMC scale), scoring the degree to which medical school mission statements reflect the social mission of medical education to address inequities. The SMC scale and targeted medical school outputs were analyzed via OLS regression, controlling for allopathic/osteopathic and public/private school designation. The medical school outputs of interest included percent physician output in primary care specialties (family medicine, pediatrics, and general internal medicine), as well as percent physician output in designated Health Professional Shortage Areas (HPSA) and Medically Underserved Areas/Populations (MUA/P).Results: SMC scale was a statistically significant, positive predictor of the percent of physician graduates entering primary care (β=2.526, P=.001). When examining the specialties within primary care, the SMC scale only significantly predicted percent of graduating physicians entering family medicine (β=1.936, P=.003). SMC scale was also a statistically significant predictor of several measures of physician output to work in underserved areas and populations, the strongest of which was the percent of graduating physicians working in MUA/Ps (β=4.256, P≤.01).Conclusions: Mission statements that are diligently utilized by leaders in medical education may produce a higher degree of alignment between institutional structure, ideology, and workforce outcomes.(Fam Med 2015;47(6):427-34.)Graduation from an accredited medical school is a requirement for entry into the medical profession in the United States, and US allopathic and osteopathic institutions are responsible for the education of the vast majority of physicians that care for the health of the US population. The unique position of these medical schools as the gateway to the medical profession, paired with their considerable public financing, demands an accountability among these institutions to be responsive to the health needs of the population.1,2 Many have recently made the case that medical schools should be more socially accountable for the production of physicians who will improve health care access and equity through a focus on primary care and service to underserved areas and populations, such as rural or low-income communities.3-7US allopathic (MD-granting) medical schools have been expanding rapidly over the last decade, since the 2005 Council on Graduate Medical Education (COGME) 16th Report heralding a shortfall in the nation’s physician supply.8 Osteopathic (DO-granting) institutions’ outputs, meanwhile, have nearly tripled since 1995.9 Absent a funded national body to coordinate workforce expansion, however, the association between medical school expansion and population need has, meanwhile, been limited.10 Health insurance expansion provisions of the Patient Protection and Affordable Care Act of 2010 have suggested that a heavy emphasis on primary care workforce expansion is required, as primary care physicians serve as the point of entry to the health care system for many individuals.11,12 However, this increased emphasis on access to primary care is mismatched with the current workforce supply. Only 30% of US physicians practice in primary care, a proportion that falls short of the 40% recommended by the COGME 20th Report advising the US Congress on the minimum proportion required to provide appropriate care to the nation’s diverse, aging and chronically ill population.11,13,14 Only 8.4% of US medical school graduates from June 2