Some elite medical schools lack family medicine departments

Ten medical schools in the country, including some of the most elite, do not have a department of family medicine, according to a report by STAT.

That includes Harvard Medical School, the world's most famous, the report says, although a group of students, with support from some faculty, is campaigning to change that.

"We call those schools the 'orphan schools,' because they are deficient," John Meigs Jr., M.D., president-elect of the American Academy of Family Physicians (AAFP), says in the article. "They're shortchanging their students and also shortchanging the needs of this country," which faces a major shortage of primary care providers.

Along with Harvard, the AAFP says the schools without family medicine departments are: Columbia, Cornell, George Washington, Johns Hopkins, New York University, Stanford, Vanderbilt, Washington University in St. Louis and Yale. Schools without family medicine departments send fewer graduates into the specialty, according to the AAFP, despite the fact that about 40 percent of primary care visits in the country are to family physicians.

Some Harvard students, including the daughter of the medical school's dean, are calling for a change and say the school's students should have more exposure to family medicine. However, establishing a family medicine department isn't so easy. Jeffrey Flier, the school's dean, says Harvard Medical needs at least three of its affiliated hospitals to create a family medicine department or residency to set up a clinical foundation to support a program. Only one hospital has a residency program and it is affiliated with another medical school.

In 2013, Harvard Medical School offered $2 million in matching funds for an affiliated hospital to create a residency in family medicine, but none of the hospitals took the offer because of the costs involved or because their existing internal medicine and pediatric residencies already met the need, according to the report.

One issue is that doctors who train in internal medicine or pediatrics often pursue subspecialties that pay more, while most who choose family medicine tend to stay in primary care, Kristen Goodell, a family physician at Harvard Medical's Center for Primary Care, told STAT. Short of establishing a family medicine department, she and others at the center are working to form a collaborative of family medicine specialists and students on the Cambridge campus.

The demand for more primary care physicians is certainly there. The Affordable Care Act has created a need with previously uninsured patients seeking physicians to provide them with medical care.

Overall, American medical schools have responded to the looming physician shortage by enrolling and graduating more medical students. However, there are not enough residency positions in the U.S. for all graduates; last year only 26,252 of the 52,860 graduates got matched to a program. 

To tackle the physician shortage, some states have shifted their focus to increase the number of residency positions at hospitals to have more practicing physicians within their borders, FiercePracticeManagement previously reported.

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