Medical Mastermind Community

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Medical Mastermind Community

The first ideal pipeline-like program for the geographically isolated and financially

disadvantaged.

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Outline

• Quality, affordable health care for all• Medically underserved populations• Physician supply and demand• Distribution of physicians around the US• Efforts to remedy the imbalance• Ideal vs. non-ideal pipeline programs• Grant solutions and future research

www.Medical-Mastermind-Community.com

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Quality, Affordable Health Care For All

http://www.amsa.org/about/


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• This is:– AMSA’s motto– An important humanistic ideal– Professional and ethical obligation

• This is NOT:– A debate on the funding the care


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• Physicians set their own ethical codes• Beurocrats didn’t tell US this is important

• As a group, we need to come up with ways to meet the imbalances that exist.


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Examination of Medically Underserved

• No universal definition exists…– Population densities– Financial income– Student Academic strength– Minority status– Family college background– Population’s general organization– Availability of exclusive privileges


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• The characteristics of those with highest probability of becoming physicians:

• Access to exclusive resources• Most organized• Closest proximity to concentrations of

physicians, income, and population


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Distribution of Physicians in the US

• 20% of US citizens live in rural areas• Only 9% of physicians are rural

• That’s 60 million people in underserved areas!


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Distribution of Physicians in the US• It is a free country and physicians themselves

decide their specialty and practice setting…so far.

• Equality takes priority in an ever-changing legal landscape.

• We must remedy the inequality in health care delivery ourselves or else we risk losing our autonomy.


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Logic for Selecting the Underserved

• N = 20,112 (64% of graduates in 2003-2004 on an AAMC survey)


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• Physicians serve people like themselves…


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• There is not a perfect proportion of applicants that represent the population.

• For example, – Asians apply in proportionally high

numbers.– Blacks apply slightly less– White women apply slightly less white men


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• Physicians serve people like themselves…

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• Applicants don’t represent the population…(minority programs may change this in the future)


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• That’s why there are underserved populations!• Complex Barriers exist:

– Population densities– Financial income– Student Academic strength– Minority status– Family college background– Population’s general organization– Availability of exclusive privileges


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Take home point:

• Underserved applicants serve underserved populations.

• Since the 1960’s the name of the game has been get the underserved into the pipeline.

…but at all costs?

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Take home point:

• AAMC’s AspiringDocs.org

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Ideal vs. Non-Ideal Pipeline Programs

• Merit-based competition in a free market– Increase matriculation of applicants with altruistic,

humanitarian spirit– No discrimination of persons - abolishment of

affirmative action– Equal distribution of quality, affordable care– Make exclusive resources and professional

contacts/mentorship available for everyone: level the playing field: Academically, Geographically, and Financially.


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Efforts to Remedy the Imbalance

• Many attempts to improve imbalances in physician distribution have been made.

• We’re closer to ideal solutions than we’ve ever been before, thanks to prolific research in this area.


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Efforts to Remedy the Imbalance– The Legislative Branch: The Congress of the United

States– The Judicial Branch: The Supreme Court and lower

courts’ rulings– The schools themselves– The state legislatures– Accrediting Bodies: AAMC, AOA, and ACGME – Student Organizations: SNMA – Political Organizations: AMA and AMSA

Let’s not wait for the Executive Branch!


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• Congress:

– $7 billion is spent annually by Medicare to controls physician supply by changing the number of medical residency positions.


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• The Supreme Court’s ruling on affirmative action:

– Grutter vs. Bollinger, 2003 • narrow use• temporary• need to develop race neutral solutions

– Gratz vs. Bollinger, 2003• Automatic point system illegal


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• The Schools

– Debakey High School for Health Prof.• Preps “minorities”• Better because students compete in the free

market for med school, and do well.

• Have to be geographically available to participate.


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• Origin of Magnet Schools like Debakey:


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Efforts to Remedy the Imbalance• The Schools

– Texas A&M Medical School is already race neutral.

• Argue that minorities serve the underserved in increased proportions so less of them are needed - it washes out in the end.

• No data support the outcome that we’re on the right track, but they refuse to violate the constitution.


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To be fair and balanced:


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• The Schools

– Baylor’s Premedical Honors College• Pipeline of minorities enrolled in high school• Condition acceptance to Baylor (72 since 1994)

• Could be found noncompliant with Gantz vs. Bollinger, but Texas State Legislature said the program should be replicated.


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• Texas State Legislature

– Acknowledged Baylor’s Premedical Honors College

– Recommended replicating the program, hopefully simply because it helps the outcome - “Quality, affordable health care for all.”


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• GPA 3.25, MCAT 23


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Efforts to Remedy the Imbalance• Accrediting Bodies:

– AAMC - • certifies medical schools that grant MD degrees• Manage medical school application service• Administer the MCAT

– AOA - certifies DO schools

– ACGME - certifies residency programs


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Efforts to Remedy the Imbalance– AAMC:

• Summer Medical and Dental Program• AspiringDocs.org• Health Professions Partnership Initiative -

grant money to fund underrepresented minorities in Georgia

–K-12, Communities, & Undergraduates.


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– Interjection of efficacy:• 5 UC premedical programs• Control group n= 396 , test cohort n=265• Students competed in free market• Statistically significant increase in admission


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• AAMC’s HPPI program:


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• HPPI: levels the playing field

– Good because applicants still compete in the free market

– Limited to Georgia and you have to be physically present to participate.


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• AOA

– What are you doing?

– Go Dr. Bowman!


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Efforts to Remedy the Imbalance• ACGME:

– Have nothing to do with such issues.

– Perhaps the most ideal entity of all.

– They focus on 7 core competencies of physicians and all research has shown that residency graduates perform equally well regardless of their individual background.


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Efforts to Remedy the Imbalance• Student Organizations

• Student National Medical Association

– Good because they are web-based and community organization, therefore they reach a broader audience.

– Only serve people “of color”.


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Efforts to Remedy the Imbalance• Student Organizations

• Student National Medical Association

– Good because they are web-based and community organization, therefore they reach a broader audience.

– Only serve people “of color”.


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Efforts to Remedy the Imbalance• Are we part of the solution here?• What about Gantz vs. Bollinger?


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Efforts to Remedy the Imbalance• Great program, but white people drink

over there…


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Efforts to Remedy the Imbalance• AMA

– Funds scholarships– Health Care Reform lobbying


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Efforts to Remedy the Imbalance• AMSA

– Health Care Reform lobbying– Diversity Education– AMSA Foundation funds programs


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Efforts to Remedy the Imbalance• What can I do solve this problem for my

generation?

• JOIN AMSA!


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Physician Supply and Demand


http://www.aamc.org/workforce/workforceposition.pdf

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Physician Supply and Demand

• In 2006, AAMC recommended 30% increase in medical school enrollment and graduate medical education.

• Notice the year to which their projections cover - 2025.

• Recall that Justice Day O’Conner said affirmative action should end by 2028.


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Grant Solutions and Future Research

• Who should benefit?

– Dr. Robert Bowman, my mentor, suggests that only including underrepresented groups would be noncompliant with the Supreme Court’s ruling in Gratz vs. Bollinger, 2003.

– That would be an automatic, built-in discriminator of persons.


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• Different benefits from including all:

– Underserved: learn organization

– Adequately Served: gain awareness

• Engage both groups in health access projects and service-oriented mentors.


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• What is a mastermind?

• “Coordination of knowledge and effort of two or more people who work toward a definite purpose in a spirit of harmony.”

• “No two minds ever come together without thereby creating a third invisible, intangible force which may be likened to a third mind.”


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– Make exclusive resources available for everyone: level the playing field:

• Academically - strengthen MCAT/USMLE scores• Geographically - remote access to “discourse of

medicine” and professional mentorship• Financially - grant funded solutions


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• Geographic Information Systems can aid delivery of tele-mentoring programs.


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Take Home Point

• Active grant-funded programs use web-based software can be used to assess students.


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Ideal vs. Non-Ideal Pipeline Programs

• Geographical Solution: telementoring


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• Peer projects in medical access: Medical School LIFE Conference

• Academic Strengthening: MCAT and USMLE prep in autonomy-supportive environment

• Professional Contacts: Individualized coaching from physician role models

• Geographical Solution: – Web-based tele-mentoring to reach broad audience

with state-of-the-art learning tools– Snail mail deliver of books and DVD’s for students

without broadband internet access.


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• Emotional Intelligence development and periodic assessment

• Wellness Program: Stress Management development and periodic assessment

• Diversity Awareness Training


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Special Thanks• AMSA• Dr. Robert Bowman• AAMC• AMSA Foundation• Robert Wood Johnson Foundation• National Science Foundation• W.K. Kellogg Foundation• The Rockefeller Foundation


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Special Thanks• Sullivan Commission• Minority Affairs Consortium• AAMC’s Community and Minority Program• National Medical Association• AMA• SNMA• U.S. Public Health Service• Commission to End Health Care Disparities• Institute of Medicine• California Wellness Foundation• JAMPS


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Premedical Institute of Enrichment


The first ideal pipeline-like program for the geographically isolated and financially

disadvantaged.

Medical Mastermind Community

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