- St. George's University President and CEO G. Richard Olds says the U.S. doesn't have a doctor shortage problem, it has a distribution problem — and medical schools are largely to blame. The U.S. medical school system, he said in a recent conversation, recruits primarily wealthy applicants who don't represent the population of the country, and who aren't going to work in the areas of highest need.
- Not only is recruitment a problem, said Olds, but there's a structural disincentive for medical school students to pursue family medicine, geriatrics and other high-needs tracks, because medical school faculty members "beat it out of them" thanks to a bias toward academic medicine and specialization.
- The third issue area Olds identified was the structure of residency programs: Most are housed in large, urban centers and in hospitals, which runs counter to the fact that most of patient care actually happens in out-patient environments. Exposing students to these environments during their residency programs — and housing those residency programs in areas where there are severe shortages of doctors, like inner city and rural communities — is key to getting more students to pursue these areas.
According to Olds, 40% of the decision regarding where doctors practice is based on where they come from, and another 40-50% is based on where they complete their residency. So it only makes sense that for the medical profession to serve underserved communities, medical schools have to do a better job of recruiting from those communities and place residency programs in those same communities. There is what Olds calls a "fallacy of grade point averages and standardized test scores" which many medical school reviewers fall into that perpetuates the cycle of only admitting students from wealthy families who can "manipulate" the meritocracy system by affording the best tutors. But there's nothing that says these factors are good indicators of who would make a good doctor, only "a floor criteria to see who was equipped to handle the rigors of medical school," he said. "I would add my ability to talk to people is at least as important as my grade in organic chemistry," he added, making the case for medical schools to reconsider the traditional pre-med core to include more liberal arts majors.
The conversations Olds is having about the real value of meritocracy and how it does a disservice to the nation as a whole, along with discussions of how higher education perpetuates inequalities through its outdated systems of recruitment and evaluation to the detriment of the general welfare are those being had across the higher education landscape. So how does a system which was never created to be inclusive shift gears to realize "we are doing a really inefficient job of serving our country" — and with "a lot of federal dollars at stake"?
Olds credits a global immersive background for helping him to adopt a perspective that is more community focused. And in many ways, university heads across the country can do a better job of focusing on the community as a whole. Often, institutions will host community events or global symposia but assume they are there to teach and share and thus de-value the experiences of those members of the community. Similarly, perspectives of individuals on campus who are not of the dominant culture are often trivialized, when there is much more to be gleaned from a more inclusive, less arrogant approach to education.