The Next Frontier For Elite Med Schools: Primary Care

Johns Hopkins, Yale, Harvard, Columbia and Cornell. What do these medical schools have in common?

Beyond their first-rate reputations, they're also on the short list of top U.S. med schools that don't have departments of family medicine. Elite schools have long focused on training specialists and researchers, but with the federal health law's emphasis on primary care, some schools are looking harder at family medicine.

Until this year, for example, the Mount Sinai School of Medicine in New York had neither a department nor any family physicians on staff. Students like Demetri Blanas, 26, who were interested in becoming family doctors found little support. For the first three years of school, his training focused almost exclusively on taking care of extremely ill patients in the hospital.

"I want to spend my career keeping people healthy rather than trying to bring them back from a very serious illness," Blanas says. "I think it is what society needs right now, and that is important to me."

Blanas says many of his professors discouraged him from going into primary care, telling him it was too much work, the pay was lousy, the job was boring, and it simply wasn't as intellectually rigorous as being a specialist.

Mount Sinai ranks among the bottom 20 medical schools in the country when it come to the number of primary care doctors it graduates. But that may soon change. In June, Mount Sinai started a new department of family medicine.

Dr. Dennis Charney, dean of the medical school, says the new department represents a fundamental change in Mount Sinai's mission.

"We want to be one of the leading medical schools that educates the next generation of primary care doctors," he says.

The new family physicians on faculty will teach students in all four years of medical school.

The department grew out of a new partnership between Mount Sinai and the Institute for Family Health, a network of 30 community health clinics across New York.

Health systems are eyeing partnerships like this one, between hospitals and primary care groups, as a smart bet for the future. Under the federal health law, the government will offer bonuses to places that give patients better care for less money. To do that, many health systems are bolstering primary care services to manage chronic conditions and prevent hospitalizations.

Neil Calman, president and CEO of the institute, was intrigued by Mount Sinai's partnership offer from the start. But he was also skeptical.

"It's pretty hard to have a family medicine-based organization in a hospital and a medical school that doesn't have a department and doesn't recognize it as a specialty," he says.

So Mount Sinai worked with Calman to start a department, signing institute doctors onto the faculty.

"It seemed like a natural marriage," Calman says.

"I think people are finally realizing that the country will be bankrupt if we continue to admit people and readmit people for conditions that could be prevented with good primary care," Calman says.

It is a realization he has been waiting awaiting for the past 30 years.

"I went into family medicine believing that was exactly what the country needed," he says. "Unfortunately, it's taken a little longer for everybody else to realize that than I expected."

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