Christmas gift

On Christmas morning as we were opening presents with our kids and family, I got to thinking about how lucky I am. I really don't know how I got into medical school.

I grew up in a pretty modest home. These days you would have called us poor. At the time I thought we were middle class but, I didn't know that middle class families were not on WIC. But we never went hungry and my mom kept us in clean clothes (though they were rarely new clothes). We lived in several places growing up but my grandparents lived on a farm in rural SW Missouri, so I thought of myself as a country (rural) boy. We didn't have any doctors in my immediate family, although my grandmother was a nurse and my great ,great uncle was a country doc (more about him some other time).

So, how did I get into medical school???

These days my chances would be pretty slim at most medical schools. The vast majority (65%) of our current medical students come from the top quintile of wage-earning families.(1)  From 1997 to 2004, students admitted to medical school with a family income of greater than $100,000 increased over 60%, while those from the middle and lower income quintiles declined. The median income for the parents of a medical student is over $110,000 per year. 59.7% of students' parents make over $100,000. (2)

Many of our students at Kansas come from urban counties. In Kansas that means basically one of five counties/metropolitan areas (KC, Overland Park, Wichita, Topeka, and Lawrence). We have to work very hard to get and keep qualified applicants from small towns and the rural counties. On the 2009 AAMC Matriculant survey, only 2.8% of matriculating students were planning to practice in an area with a population of 2,500 or less.(3)

We have seen an increase in students whose parents are physicians. Some of these are physicians from the community and some are kids of our own faculty. Most medical students' parents have a high level of education. 52% of the fathers of medical students have a graduate degree compared to 12% in the general population. For moms, it is 35% and 10%, respectively. (4)

So what?

Several things in my opinion.
First, as a state school, we have a contract with the state of Kansas. We are the only medical school in Kansas we have to provide doctors for the state. All of the state. Not just the urban/suburban parts of the state.

We also need to produce doctors that look like the population of the state. If all of our students are from the urban counties, they are going to be much more likely to be white or Asian and not underrepresented. If they are all from the highest income brackets, we are neglecting a large part of our population.

And they will be much less likely to practice in the places that we want/need doctors. Rural underserved counties. Urban underserved areas. Primary care practices. Community health centers. Rural health clinics.

Right now we are doing pretty well in this area when you compare us to the rest of the country. The problem is that the rest of the country is doing really badly. So, even though we look good in comparison, we aren't doing that great. A recent analysis done by Fitzhugh Mullan (5),  found that many of the "top" medical schools in the nation did pretty poorly when you measured them on social mission (Vanderbilt #141, Duke #124, Boston U #131, Mayo #103). Social mission is a construct that uses number of primary care physicians produced, graduates practicing in HPSAs, and numbers of underrepresented minorities. KU ranked 5th in the nation on that scale.

We also do pretty good at turning out primary care doctors, at least in Family Medicine. Over the last 10 years (1998-2009 graduating classes), KU and the University of Minnesota were ranked number 1 and 2 when you combine number and percentage of students that graduate and choose a residency in Family Medicine.

But, we have to continue to work hard to maintain what we have. It is a constant struggle to convince people on the admissions committee that we shouldn't just take the students with the highest GPAs. And it is easy for the Dean to say, "we need to raise the MCAT scores of our incoming students". And it is easy to decrease funding for programs that support students from underserved backgrounds.  But those are the battles that have to be fought.  As someone who is really smart told me, "we don't need programs to increase the number of white kids from Johnson County".

References
(1) Bowman B. personal communciation
(2) Jolly P. Diversity of US Medical Students by Parental Income. AAMC Analysis in Brief. 2008;8(1).
(3) AAMC Matriculating Student Questionnaire (MSQ) 2009
(4) Grbic D, et al. Diversity of US Medical Students by Parental Education.  AAMC Analysis in Brief  2010;9(10).
(5) Mullan F, Chen C, Petterson S, Kolsky G, Spagnola M. The Social Mission of Medical Education: Ranking the Schools. Annals Intern Med  2010;152:804-811.