Academic redlining in medicine

Despite concerted efforts over the past decade to increase diversity in U.S. medical schools, persistent applicant and enrollment gaps remain for students from underrepresented racial and economic backgrounds. To understand these gaps, we propose a new theory of ‘academic redlining’ as a widespread practice in medical schools that systematically excludes students from underrepresented backgrounds from entry into medicine through the nearly universal use of Medical College Admissions Test (MCAT) cutoff scores. In this paper, we provide evidence that academic redlining via the MCAT disenfranchises students from underrepresented backgrounds prior to and during the admissions process due to structural racism, and describe the three core mechanisms that cause medical schools to engage in academic redlining: (1) the pursuit of institutional prestige, (2) market competition and pressure, and (3) market bands. Given the persistent lack of diversity in medicine—which contributes to devastating health care disparities—as medical schools redouble their commitments to diversity, equity, and inclusion, structural alternatives within medical schools’ admissions and education practices are offered to curtail the practice of academic redlining in medical school admissions and medicine.     

Academic approach to academic medicine

Scientific approach to academic medicine crisis would require research to provide evidence for the present state of academic medicine and future actions. The prerequisites for such a research would be clear definitions, appropriate indicators, and measuring instruments. The approach should be holistic, covering tripartite academic medicine activity: education, research, and health care.     

Academic medicine and gender: women in surgical specialities

Scientific advances have always been used as a measure to place societies in the context of developed and developing countries. This circumstance has directly influenced the division among the sexes and among social strata. Traditionally women have been relegated to an inferior status and in some instances their role as active participants in social and economic development has been annulled. In professional spheres, women have reached positions that previously seemed unattainable due to social and cultural limitations imposed by men and sometimes by women themselves. Medical school is currently no longer an obstacle for women to gain entry to, approximately 50% of medical students are women. On the other hand, surgical residences constitute a more complex situation. In order for women to decide to apply to a surgical residence, they have to take into account a variety of factors, among them, the difficulty of joining a male dominated environment where women have to demonstrate they are able and capable of performing sometimes at the expense of having to carry an additional work load. Women admitted to surgical residences will have to face gender discrimination, pregnancy and family responsibilities as well as salary inequities and sometimes even sexual harassment. We aimed to show the circumstances and obstacles that women are confronted with during surgical training and the influence these have in their personal and professional development.     

Academic medicine and quality of medical care

Academic medicine comprises education, research, and medical care, respectively provided by medical schools, research institutions, and teaching hospitals. Thus far, academic medicine has been unsuccessful in establishing, protecting, promoting, and improving the quality of care. Its role in that area should therefore be reconsidered. Quality improvement activities require constant planning and perseverance, explicit standards of good practice, quantitative measurement, and comparison with previous performance or the performance of others. Preparedness and willingness to change attitude, approach, and behavior are pivotal to the success of such activities. Early exposure of medical students to the principles and practices of quality of care improvement would be a starting point for a life long process of experience-based learning that allows physicians to change and improve practice through the application of relevant knowledge and skills. It is essential that changes in graduate and postgraduate education and training be introduced, to improve an understanding of the importance of focusing on the care process from the patient's perspective as well as on the need for interdisciplinary cooperation and team performance as prerequisites for good medical care. Their education should also emphasize the measurement of the quality of delivered care, provide an understanding of the demand of society for accountability and how to meet it, as well as competence in using the principles and practice of quality improvement to provide, document, and improve the quality of care in institutions of academic medicine.     

Academic medicine in a southern African country of Malawi

Academic medicine is usually considered to be a tripartite composition of teaching, research, and health care services delivery or patient care. The meaning of each component varies with interpretation. Developing countries such as Malawi face particular challenges in the field of academic medicine, including research resources, financing, and the brain drain of health human resources. Such constraints contribute to reduced numbers of faculty members, poor remuneration and diminished capabilities for career advancement. Addressing the issues currently plaguing academic medicine will enable this essential and multi-faceted discipline to flourish.     

Reflections on a painful transition: from socialized to insurance medicine in Russia

After the collapse of the Soviet Union in 1991, Russia decided to replace its deeply flawed and under-funded system of socialized medicine by a scheme of health insurance that involved the decentralization of health services and of off-budget financing. Every enterprise would pay 3.6% of its salary fund into a Regional Health Insurance Fund, and the Fund would finance private insurance companies that would compete for clients. The non-working population would have its insurance premiums paid from the budgets of regions or municipalities. The transition from one system to another has been problematic and plagued with a variety of problems not the least of which is that the Russian economic structure is not geared to sustain an insurance system at the present time. The Russian case presents an instructive experiment with the premature introduction of a scheme touted as an "anti-model" to socialized medicine and geared to market and legal arrangements that are, as yet, largely non-existent. Under-funding of health services remains and leads to the polarization of the population into those few who can afford private care, and the vast majority for whom this care is difficult to obtain, or unobtainable. This has ominous political implications.     

Academic promotion and tenure in U.S. family medicine units

The authors interviewed by telephone the heads (or their representatives) of 101 of the 120 family practice units in U.S. medical schools in 1987. Each respondent was asked for his or her personal perceptions of the relative importances of research, teaching, patient care, and administrative activities in the academic promotion process. Respondents were also asked for their views of their units' and institutions' perceptions of the importances of the same four activities in the promotion process, as well as other related questions about promotion and tenure. The findings indicate that there is still a significant incongruence between the value structure of most family practice units and that of their institutions but that many family practice units are beginning to achieve parity of promotion and tenure with other departments in their institutions.     

Academic medicine and managed care: seeking common ground.

The authors report the highlights of a one-day symposium, "Academic Medicine and Managed Care: Seeking Common Ground," sponsored in early 1997 by Tulane University Medical Center. The meeting was held to foster better understanding of the gap between managed care organizations (MCOs) and academic health centers (AHCs) and to define their common ground. There were 62 participants, mainly executives froin AHCs and MCOs, plus government officials and policy researchers interested in the interface of academic medicine and managed care. The participants agreed that there are indeed some common areas in which the two types of organizations can develop programs and interests that serve the missions of both. These include (1) a commitment to high-quality health care, objectively measured by outcomes; (2) issues of "customer service"; (3) certain areas of research (e.g., examining outcomes of medical interventions; measuring cost and cost-effectiveness; measuring quality of care); and (4) preventive medicine, an area in which both AHCs and MCOs are still relatively weak. On the other hand, large elements of AHCs' basic missions of education and research are not seen by MCOs as areas for developing a common agenda. Participants agreed that AHCs must do their best to improve and demonstrate the quality of their care, address the challenges of the market (i.e., take "customer service" seriously), address the issue of how many specialists and how many generalists should be trained, and define the cost of each of their missions. On the other hand, managed care must acknowledge that the missions of AHCs greatly benefit patients and society. Participants agreed that all approaches to AHC-MCO interfaces must be flexible and local, that common ground does exist, and that understanding can grow between these two kinds of organizations if acrimonious exchanges are avoided and serious efforts are made to work together for solutions.     

Academic medicine and the search for meaning and purpose.

The transformation of the health care industry into a marketplace governed by commercialism and free competition challenges the doctrine of medicine as a profession valuing service to the patient above financial reward. Many physicians have become disenchanted with their ability to serve as advocates for and provide care to their patients. Financial success, the measure of the marketplace, has become the dominant standard of measurement or "value" for most academic medical centers (AMCs). Many doctors report their work is less fulfilling. As a result, all three social missions-patient care, teaching, and research-are in jeopardy. The growth of modernism, preeminence of biomedical research, and dominance of a market-driven clinical enterprise will continue to pose challenges to the health care system in the United States. However, AMCs can provide the leadership and serve as the ambassadors through which the health care system can be renewed with a sense of direction and purpose. Renewal must begin with more open discourse about what we value in health care and what kind of medical profession we want to have, to include addressing questions such as: What does it mean to be an academic physician? What gives my work meaning and purpose? This kind of dialogue could easily be built into the medical students' curricula and residency training programs, with the faculty taking the lead.     

Academic ranks and medical schools of underrepresented minority faculty in family medicine departments.

PURPOSE: To examine academic rankings and educational backgrounds of underrepresented minority (URM) family medicine faculty and compare their academic ranks with national trends. The authors also determined the extent to which international and historically black educational institutions contributed URM faculty to family medicine. METHOD: In 1999 questionnaires were sent to 129 family medicine departments asking for academic ranks and educational institutions attended by their URM faculty. Comparisons were made between URM faculty's academic ranks and all family medicine faculty, medical school minority faculty, and medical school faculty. RESULTS: A total of 80% of URM faculty were assistant professors or instructors, and 4.4% were professors. URM family medicine faculty had significantly lower rankings compared with medical school minority faculty and all family medicine faculty. URM family medicine faculty at historically black medical schools were more likely to have received their degrees from historically black undergraduate institutions and medical schools than were URM family medicine faculty at non-historically-black medical schools. CONCLUSIONS: URM family medicine faculty appear to experience a double disadvantage: being minority and working for family medicine departments. Their academic ranks remain far below those of both minority medical school faculty and family medicine faculty, a discouraging finding considering the current shortage of URM faculty in family medicine departments. Historically black medical schools cannot address the shortage alone, so non-historically-black medical schools need to both recruit URM faculty and follow up with appropriate mentoring of those faculty.     

The role of andrology as a field of reproductive medicine in the solution of demographic problems in Russia

Under the conditions of a deepest demographic crisis, which is progressing in Russia and has led to the fact that Russian population diminishes by 1 million each year, the development of andrology should be considered a very important link in the state system of measures taken to increase birth rate. Andrology is an essential field of reproductive medicine and should receive a status of an individual medical specialty. At the same time, andrology should be organically connected with obstetrics and gynecology, which would provide effective diagnostics and treatment of the infertile marriage. It would be baneful and inappropriate to refer to andrology as one of officially recognized medical specialties such as urology, endocrinology, dermatovenerology, surgery, sexology etc. Andrology is a new polydisciplinary and multisectoral medical field requiring multifaceted biological and medical knowledge and special training of doctors; it does not tolerate narrowly specialized professional thinking and acting from a doctor working in this complicated medical field.