Harvard Medical School didn’t make it into the top 50 in a ranking based on how many primary-care doctors the schools produced and how well they served minority communities. Other top East Coast institutions also fell short.
The study of 141 U.S. medical schools and 60,043 graduates, published today in the Annals of Internal Medicine, focused on what it called the “social mission” of these institutions. It found the top performers were state-run universities and schools originally set up to teach minorities. The three highest-rated schools, including No. 1-ranked Morehouse School of Medicine in Atlanta, were created to educate blacks.
For other, often-quoted rankings, medical schools were judged on how much research they do or on “subjective” faculty opinions, said Fitzhugh Mullan, a study coauthor. While important, these measures don’t gauge a school’s quality in its mission of training doctors to treat people, he said.
“Some schools focus on research and pay less attention to generating doctors that work with the population and are fairly distributed,” said Mullan, a pediatrician and public-health professor at George Washington University, in Washington, where four of the study’s authors are affiliated.
The top three medical schools for research in U.S. News & World Report’s 2010 graduate-school rankings were Harvard in Boston, the University of Pennsylvania School of Medicine in Philadelphia and Johns Hopkins University School of Medicine in Baltimore, in that order. Under the new metric, those three finished 62nd, 122nd and 129th, respectively. George Washington School of Medicine & Health Sciences, in Washington, was 60th.
After Morehouse, the second-ranked school in the study was Meharry Medical College in Nashville, Tennessee, while Howard University College of Medicine in Washington came in third. The lowest-ranked medical schools in the study were Northwestern University Feinberg School of Medicine, in Chicago, University of Texas Southwestern Medical School at Dallas, and Vanderbilt School of Medicine, in Nashville, Tennessee. They show up in 139th, 140th and 141st place.
Other schools ranked include Yale School of Medicine in New Haven, Connecticut, which finished 51st; Dartmouth Medical School in Hanover, New Hampshire, 59th; and Brown University’s Warren Alpert Medical School in Providence, Rhode Island, 66th.
A Harvard spokeswoman, Alyssa C. Kneller, said the medical school “does not comment on rankings, including those generated through this study.” Other schools didn’t respond immediately.
The rankings are based on how many of the schools’ graduates practice in primary care, how many work in what are classified by the government as areas with a shortage of health professionals, and how many belong to minorities that don’t have enough doctors serving them. The study defines that term as blacks, Hispanics and American Indians. Asians aren’t included.
Of Harvard’s graduates surveyed, 23 percent went into primary care, compared with 44 percent at Morehouse. As for graduates practicing in underserved areas, Harvard’s tally was 33 percent and Morehouse’s was 39 percent.
The authors used data collected by the American Medical Association in Chicago, the Association of American Medical Colleges in Washington and the Association of American Colleges of Osteopathic Medicine in Chevy Chase, Maryland.
Those included in the study graduated from 1999 to 2001. The turn-of-the-decade data was chosen because the researchers needed to be able to track doctors after they finished residencies to see where they settled and in what areas they were practicing, Mullan said.
‘People Make Choices’
“Kids come into med school wanting to be primary care doctors and then they change by the end,” said Joe O’Donnell, the senior advising dean at Dartmouth. “People make choices based on values, so if people start to value primary care then more people will choose it. We can hope that health care reform will help to change things.”
Richard Silverman, director of admissions at Yale’s medical school, said social commitment is important to Yale students, and not all the work they do in underserved areas around the world would be captured in a survey like this.
“Many of our graduates may not be primary-care doctors, but they are providing daily care in places like Haiti,” he said. “It would be inaccurate to think Yale is interested only in research.”
The dependence on research dollars at some schools can interfere with their focus on the goal of producing more primary-care doctors, Mullan said. By recruiting more female, minority and older students, the schools could raise their numbers of primary-care doctors, he said. Studies have shown that these students are more likely to pick primary care.
In research-oriented cultures, the “role models” are doctors who have gone into specialties and taken a more scientific route and “students take the lead from what they see,” Mullan said.
“A medical school is the only institution in the country that can grant a diploma to be a physician,” Mullan said. “It’s important for schools to reflect on what role they are playing, and we’re providing them a measure to do that. They may decide that they are content with their current mission, but at least they can examine this with new information.”