Specifically, Generalizing Matters
Although there is much debate about one of the major reasons why large numbers of Americans have limited health care--because of restrictions on health insurance--there is another less obvious reason: the tendency for physicians to practice in affluent urban and suburban areas. This creates barriers to care for people living in rural and inner-city areas.
The dearth of physicians where they are most needed is largely due to the career choices of U.S. medical school graduates. But these choices can be influenced by private and public incentives that encourage medical students to study general medicine; studies show that family physicians are much more likely practice in underserved areas than are specialist physicians.
The Charles R. Drew University of Medicine and Science in Los Angeles’ Watts-Willowbrook area is an excellent example of a training facility that provides incentives for medical students to become family physicians. Their commendable track record is why the program deserves more financial and moral support than it currently is getting.
When the Council on Graduate Medical Education studied physician distribution, it found that more than 80% of the graduates from Drew chose family practice or general medicine as their area of post-graduate study, and more than 83% of the residents who went through the Department of Family Medicine’s residency program stayed and worked in medically underserved areas, particularly South-Central Los Angeles. This meets the original mandate of the university: to train primary care practitioners to provide care to underserved populations.
These statistics surpass figures from some of the country’s most widely known and respected residency training programs for physicians that specifically focus on the urban underserved. The family practice residency program at San Francisco General Hospital, for example, found that 49% of its graduates in 1994 were working in medically underserved areas or in a public clinic caring for low-income patients.
Despite its record of success, Drew has not sufficiently promoted the Family Practice Program, nor has it been provided substantial financial support. Of the university’s 13 post-graduate departments, family practice’s funding ranks 12th. It gets less than $200,000 from the university, and most of that goes toward salaries.
A recent study of training programs found that those with clear mission statements to produce health professionals to serve underserved communities, and those that conducted training in underserved settings, were more likely to have substantial proportions of their graduates practicing in shortage areas.
As insurance programs force more people to rely on primary care, family physicians and general specialists will be on the front line of medical care. The need for these kinds of doctors will inevitably increase in all areas of the country.
Centers such as Drew’s should be the foundation of future efforts to improve services to inner-city populations and to bring more physicians to these communities. That’s why Drew should take a closer look at its family practice program and clinics, praise and nurture their successes, and increase the services they provide. The program has proven it is possible to provide high quality care to a complex and medically underserved population. It deserves all the financial and moral support the university can muster.
