SIU School of Medicine has “become a major force in health care throughout central and southern Illinois.”
PRIMARY CARE SIU Ranking: #16
In 1970, a medical school was built among the corn fields, imbued with bright, new-fangled ideas about teaching students and caring for patients based on the needs of the local population.
Forty years later, that mission shines brighter than ever, and SIU School of Medicine has been recognized for its accomplishments in an intriguing way. A study published in Annals of Internal Medicine (Vol. 152:12) has ranked SIU as one of the top medical schools in the United States for its efforts to meet the “social mission” of medical education.
In the study, funded by the Josiah Macy, Jr. Foundation, lead author Fitzhugh Mullan, M.D., of George Washington University defines “social mission” through three primary measures: graduates practicing primary care (family medicine, general internal medicine, and general pediatrics), those working in underserved areas, and graduates from groups traditionally underrepresented in medicine. The rankings were based on answers from a survey of 60,000 U. S. medical school graduates who graduated in the years 1999-2001. The study found “substantial variation” in medical schools’ social mission achievements.
Combining the three social mission factors, SIU ranked 15th out of 140 medical schools. SIU also was the top-ranked school in Illinois for that combined definition. Pair the scores of primary care and health professional shortage areas, and SIU scores even higher, taking the number three spot behind the University of South Alabama and the University of Mississippi.
“I’m extraordinarily proud of this ranking,” says SIU School of Medicine Dean and Provost J. Kevin Dorsey, M.D., Ph.D. “Every individual medical school has its special talents and mission. These components of the social mission are part of the reason this School was created. They’re embedded in our culture. This ranking is a validation of who we are and what we do.”
The authors of the study suggest that schools meeting a social mission are producing “the most well-prepared practitioners for primary care and for the care of minority or underserved populations.” A close look at the three factors shows SIU has been meeting the social mission since we began.
SIU Ranking: #16
The years of the study (1999-2001) marked a critical time in primary care, says Jerry Kruse, M.D., chair of the SIU Department of Family & Community Medicine. About 32 percent of graduates nationwide entered primary care specialties during those years, according to a draft of the report from The Council on Graduate Medical Education (COGME). The social mission study found that SIU ranked 13 points above that average with total of 45 percent of SIU graduates (1999-2001) who pursued primary care residencies. Since then, the percentage of generalists nationwide has declined. Among graduates from US medical schools from 2005 to 2010, only 16 percent plan careers in primary care. Over the last 10 Match Days, however, an average of 44 percent of SIU School of Medicine senior students has entered a residency in family medicine, internal medicine, or pediatrics. But Dr. Kruse points out that many of those graduates who start post-graduate training primary care later turn to specialties or subspecialties for their practices. The Association of American Medical Colleges reports that by 2015, the shortage of primary care professionals will amount to 21,000. As the general population and current primary care physicians grow older, by 2025 an estimated 40,000 primary care professionals will be needed.
The shortage means that chronic care — which studies have found keep people healthier over time — is in danger. “Institutional leaders need to become national advocates to make primary care a more joyous practice and one that’s more reasonably compensated,” says Dr. Kruse, a member of COGME. The COGME draft advocates a balance of at least 40 percent of the physician work forces as primary care physicians to produce the best health-care outcomes.
Working to reverse the decline, Dr. Kruse notes that “SIU School of Medicine stands out as a shining example of a medical school that is meeting the primary health care needs of the region. Over the School’s 40 years, so many holes have been filled, particularly in central, west and southern Illinois.” Today, nearly 400 graduates are practicing primary care in Illinois and retain a strong connection with SIU School of Medicine. “Our graduates link the citizens they serve with the faculty in Springfield,” says Associate Provost Phillip Davis, Ph.D. “They are familiar with SIU’s sophisticated resources for excellent patient care. The expanded network of primary care physicians connects patients with the tertiary services available at SIU.”
SIU Trustee Keith Sanders hopes that SIU School of Medicine will continue its emphasis on graduating primary care physicians. “Those graduates of the medical school make a huge difference,” he says. “They are not fully appreciated in a scheme that rewards specialties.”
In September 2010, the Springfield Family Medicine Residency Training Program received a federal grant to add two additional primary care residents each year, helping provide more access to rural and underserved areas.
SIU Ranking: #5
The social mission study found that public schools like SIU produce “higher proportions of primary care physicians” and that their graduates are “more responsive to the population.” The study found that a total of 46 percent of SIU graduates (1999-2001) practice in Health Professional Shortage Areas (HPSAs), ranking SIU fifth among the 140 medical schools in the nation.
SIU has striven to be responsive to central and southern Illinois and help keep the physician supply constant. Almost half of all graduates are practicing medicine in the Land of Lincoln. “Our graduates in practice have changed the physician power in downstate Illinois,” Dr. Davis notes. Studies show that physicians from rural areas are more likely to choose family medicine. Sixty percent of SIU medical students come from hometowns of 25,000 or fewer residents.
Larry Jones, M.D., class of ’76, was one of those students from a small town: Harrisburg, Illinois. “When I was growing up, health care was very scattered. I remember having to travel to other towns for health care.” An alumnus of the School’s charter class, he returned to Harrisburg in 1979 to start his family practice. “In southern Illinois we had a problem of the aging physician population. Back then, the next youngest family physician in our area was 50 years old. But SIU has helped address that problem.” Thirty-one years after he began his practice, Dr. Jones’ flourishing clinic includes nine primary care physicians, half of them in their 30s. Six are graduates of SIU School of Medicine.
For 30 years, the SIU family practice clerkship program in dozens of small towns along with the family practice residencies in Carbondale, Quincy and Decatur have shown medical students and residents that they can maintain a thriving practice and quality lifestyle in medically underserved areas.
“Without SIU School of Medicine, the medical facilities in southern Illinois wouldn’t be near the level we have now,” Dr. Jones says. “While we still have a shortage of primary care physicians, SIU has definitely bolstered the local medical facilities and local economies. Without the medical school, we would have fewer hospitals, fewer small town clinics, and patients would have to travel long distances to access medical care.”
Keith Sanders, 71, a native of Benton, Ill., recalls that health care was “primitive and well below par,” in southern Illinois when he was growing up. Sanders, former faculty at George Washington University in D.C. and vice president for administration and chief operating officer of University of Wisconsin Health System, has been a patient of SIU graduates. “I’ve watched SIU School of Medicine grow from nothing to its current status of national respect. The School has been one of the most significant developments in my home area during last 50 years,” Sanders says. “SIU School of Medicine has immeasurably contributed to the quality of life in southern Illinois. Many people are alive and doing well thanks to the excellence in medical practice in the region today.”
In addition to primary care services, SIU’s Rural Health Initiative (RHI) has helped expand specialty and tertiary care services. Partnering organizations include INET (representing 10 of the most rural counties) and the Illinois Rural Health Association. RHI has worked tirelessly to help attract needed medical professionals to treat children’s mental health, the developmentally disabled and cancer patients, to name just a few.
SIU also has worked to link populations with existing resources. “That’s not the traditional way other medical schools do it,” says Dr. Davis. “With careful coordinating, we don’t have to build new infrastructure and duplicate services.” For example, the SIU Telemedicine network has helped link together all of the downstate critical access hospitals, providing easily accessible clinical activities, continued education, and on-site quality assurance activities. “This is a powerful representation of how we have listened to what the health-care infrastructure needed downstate,” Dr. Davis notes. “Telemedicine helps people communicate so they can be more effective.” SIU’s telemedicine department also has facilitated clinical care opportunities for psychiatry, neurology, pediatric cardiology, dermatology, and post-cardiac surgery.
An editorial in The State Journal-Register wrote, “Not only has the school become enmeshed in the medical community, it has become a major force in health care throughout central and southern Illinois.” (July 13, 2010)
SIU Ranking #124
Although SIU didn’t rank as high at graduating underrepresented minorities during the years 1999-2001, a closer examination shows that SIU School of Medicine has always recognized the need to help underrepresented populations find a career in medicine. SIU School of Medicine created the MEDPREP Program with that mission in 1972, when the medical school was just getting underway. Over the past 40 years, more than 1200 students concluded their participation in MEDPREP — 82 percent are underrepresented minorities. Nearly two thirds of those students were accepted to professional schools, and 93 percent of those accepted went to medical schools, according to Harold Bardo, who has been director of MEDPREP since 1985. “MEDPREP has been a sustained effort that has received strong support from each of the three deans at the School of Medicine, both in good and lean fiscal years. I applaud their efforts.”
Still, MEDPREP students weren’t always coming to SIU School of Medicine. Bringing underrepresented minorities to the medical school became a mission of then-Dean and Provost Carl Getto, M.D., who in 2001 commissioned Wesley Robinson-McNeese, M.D., (a 1986 SIU graduate who also completed MEDPREP) as assistant to the dean for diversity. “Establishing that office was very important,” Dr. McNeese says. “The School of Medicine recognized that it was lagging behind in attracting people from underrepresented minority groups.” Over the past decade, the School has excelled in bringing diversity to SIU School of Medicine. Dr. McNeese has created a system of educational support and counseling for minority students to help them form ties in the community. He also has instituted a Physician Pipeline Preparatory Program (P4), in an effort to help high school students get a peek into the life of medical students and physicians. A minority health elective with the Southern Illinois Healthcare Foundation and a student research program helps bring medical students to cities such as Centreville and East St. Louis, which have high minority populations.
These efforts are working. During the past decade, an average of 14 percent of SIU School of Medicine’s student body has been underrepresented minority students. Among the current 291 students, 18 percent are minorities. More than 100 minority graduates of the medical school are caring for Illinois citizens. “We’ve made so many improvements since the time of the study; we definitely would rank higher if the study were done with more recent graduates,” says Dr. McNeese. “My goal is to have our student body and graduates match the 20 percent of minorities living in the state of Illinois. That segment of the population will appreciate having more choices of physicians from their own ethnicity.”
A BRIGHT FUTURE
The social mission study may indicate a shift in medicine that considers the social conscience. As the study authors note, “Beyond their general education mission, medical schools are expected to have a social mission to train physicians to care for the population as a whole, taking into account such issues as primary care, underserved areas, and workforce diversity.
That is the mission of the medical school.
“I can’t think of very many forces that have had an even nearly equal positive force on the region as SIU School of Medicine,” Sanders says. “The whole university has had enormous force, and the medical school is prominent in that endeavor of service. Rather than being a shining city on a hill where everyone goes, SIU School of Medicine has reached out and improved the quality of medical care in the region.”
Primary care, underserved areas, and minorities: these three issues have encompassed the School’s mission for 40 years. “The study reaffirms that we have the right mission,” Dr. McNeese says. “We just need to keep at it. There is a spirit of innovation here regarding clinical practice, education, and research. We’re not just resting on our laurels.”
Indeed, SIU is synonymous with both social excellence and academic excellence. In 2008, the School received a citation-free accreditation from the Liaison Committee on Medical Education, which also gave SIU five commendations for academic excellence. A recent survey of graduating students found that 98 percent of students were greatly satisfied with their medical education. For SIU, the social mission and educational mission are permanently linked.