Doctors for the People:
Training Physicians to Work in
Under-served Urban Communities
Sherenne Simon, MPH,
Matthew Anderson, MD, MS,
Pablo Joo, MD
Department of Family & Social
Medicine, Montefiore Medical
Center/Albert Einstein College of
Medicine
Project Aim

Montefiore’s Residency Program in
Social Medicine (RPSM), established in
1970, trains clinicians to work in
underserved communities.

In order to improve our own work we
set about to examine similar programs
which train clinicians to work in
underserved communities.
Why do we need such programs?

Higher Education is funded and organized by
the US ruling class:
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Weill-Cornell Medical School
Charles H. Greenberg Pavilion @ NYH
Belfer Building @ AECOM
Interlocking corporate academic directorships
Medical Students are a very privileged group.
Contextual Factors

Well recognized problem for rural areas

US government has attempted to address
through HRSA, NHSC

Literature on financial incentives and specific
curricular elements

Efforts going on at the undergraduate level:
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High School, College, Post-baccalaureate
Locating Programs

Google Search for websites; Google Scholar
for articles

Snow-balling technique (referrals)

HRSA funded programs (1999-2000) to
promote Primary Care
Literature Review

Inclusion Criteria
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
Medical Schools & Residency Programs
Mission to accept minority/working class students
and/or train for underserved communities
Published literature about program outcomes
Exclusion criteria:
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High School or College enrichment programs
Rural Programs
Traditionally African American Medical Schools
Interviews (phone/email/website)

How and why program was created

How the program is financed and its cost to students

Educational philosophy & curriculum

Recruitment & retention policies

Evaluation methods of graduates long term success
& programmatic success

Relationship to more traditional training programs

Barriers and successes
Medical Schools

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Sophie Davis School of Biomedical
Engineering (CUNY)
Charles R. Drew Program (UCLA)
UC/PRIME programs (5 programs - 1 is rural)
A.T. Still University School of Osteopathic
Medicine (SOMA)
Baylor College (Texas)
Residency Programs (sample)
Arizona
 University of Arizona Family & Community Medicine
California
 UCLA/Harbor Family Medicine Residency
 UCSF/San Francisco General Hospital: Family &
Community Medicine
Florida
 University of Miami/Jackson Memorial Family
Medicine & Community Health
 Miller School of Medicine: Jay Weiss Residency in
Global Health Equity & Internal Medicine. Also at
Jackson Memorial
Residency Programs (sample)
Illinois
 Cook County Internal Medicine Primary Care
Maryland
 Johns Hopkins Bloomberg School of Public
Health, General Preventive Medicine Residency
(PM)
Massachusetts
 U Mass, Worcester: Family Medicine &
Community Health
 Lawrence Family Medicine Residency
Residency Programs (sample)
New York
 Residency Program in Social Medicine (FM,IM,PED)
Washington
 University of Washington, Tacoma Family Medicine
Justifications offered by programs

US population increasingly diverse

Minority/working class students face growing barriers
getting into medical school

Geographical maldistribution of physicians: both
urban & rural

Minority and working class populations have worse
health care access & outcomes (health disparities)
Structure of Programs

Medical school programs typically associated with
traditional MS, but offer enhanced curriculum (ie.
disparities, community health)

Training often occurs in community settings,
particularly community health centers

Service training sites are in underserved areas
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Requirement for research/paper/project/Masters
degree
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Special mentorship
Educational Philosophy

Emphasis on Primary Care

Work in communities, specifically
underserved communities
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Work in Community Health Centers
Recruitment/Retention

Pairing with college-level pipeline programs
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Trainees expected to share program vision of
working in underserved communities
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Special mentorship & assistance
Methods of evaluation within programs

Racial/Ethnic/Class composition of trainees
(or) graduates

Intention vs. actual practice in underserved
communities
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Practice in primary care
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Traditional academic metrics: board scores,
specialization rates; graduates who are faculty
or involved in public health administration
Evaluation Techniques

Use of AAMC survey data on where students intend
to practice
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Measured at 3 time points: MCAT, entrance and exit to
medical school
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AMA master file of clinicians to determine practice
sites of graduates
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HPSA (Health Professional Shortage Areas)
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Follow-up surveys of trainees
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Such surveys are uncommon and cost money
Evaluation:
Charles R. Drew Medical Education Program
Ko M, Edelstein RA, Heslin KC, Rajagopalan S, Wilkerson L, Colburn L, et al. Impact of the University of California, Los
Angeles/Charles R. Drew University medical education program on medical students' intentions to practice in
underserved areas. Acad Med. 2005 Sep;80(9):803-8.
Outcomes
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Programs report high levels of training
minority and/or working class physicians
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High level of work by graduates in primary
care and underserved areas
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Successful academic outcomes
Caveats

Those who make it to medical school are the
“lucky few.”
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Selection bias: Students entering these
programs know what they are getting into
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What are appropriate comparison groups for
these programs?
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These programs are all small, almost
“boutique” programs
Caveats (Contextual issues)

We are losing this battle now….
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Barriers to getting into medical school appear to
have increased since the 1990’s.
Decreasing number of US students choose
primary care.
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These programs rely on funding for Primary
Care training programs (Title VII)
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A mission to serve the underserved does not
currently characterize most of US academic
medicine (neither does an interest in PC)
Conclusions

Successful programs exist that train
clinicians to work in underserved
communities.
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Shared elements
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Mission to serve the underserved (caveat: this
was a selection criteria)
Training in underserved communities.
Community & Primary Care orientation
These findings are similar to those in rural
health programs.
Next Steps/Discussion points

How might this project inform our own work?

What are its broader implications for
academic medical institutions?
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
Is the medical school responsible for the
composition of its classes & the future careers of
its doctors?
What are the broader implications for US
education if professional careers are
unavailable to large sections of the
population?
Thank You
Contacts:
Matthew Anderson, MD, MS
bronxdoc@gmail.com