Kevin Grumbach, M.D.
New Medical Schools in the 21st Century: The Challenge of Fulfilling the Mission
UC Riverside has the opportunity to create medical education that addresses the needs of the Inland Empire, and not only make a difference to the region but also define its own measure of success, according to Kevin Grumbach, M.D., professor and chair of Family and Community Medicine at UC San Francisco and chief of Family and Community Medicine at San Francisco General Hospital, who presented a lecture "New Medical Schools in the 21st Century: The Challenge of Fulfilling the Mission" on Feb. 6 on campus.
Dr. Grumbach said that while the campus has a great vision and mission, its other assets are having a community with (1) a great need for better health care and (2) a great potential for responsiveness to innovative medical education leadership. "The university has an opportunity also to learn from the past," he said.
Dr. Grumbach mentioned that the challenges for UCR would be to avoid replicating old models; to cope with a broken health care system; to "maintain the conviction of one's convictions"; and to make a difference in the health of the Inland Empire.
"California is low in its investment in medical education," he said. "A strong case can be made for educating more medical students in California, and it is logical to prioritize low-supply regions as sites for new medical education programs."
California has about 200 active patient-care physicians per 100,000 people — similar to the level for the United States overall. But California "outsources" much of its physician supply production. The state trains 15.8 medical students per 100,000 in the workforce (national average is 28) and provides 26.1 residents per 100,000 in the workforce (national average is 35.9).
Dr. Grumbach made a strong case for universal health coverage. The Inland Empire, he said, has 21.4 percent uninsured adults (19.4 percent in California); 14.3 percent on Medi-Cal (12.1 percent in California). He pointed out that 17.3 percent adults (ages18-64) in the Inland Empire have no regular source of care (15.4 in California); 16.8 percent have delayed or no care (16.2 in California).
"A community-responsive medical education program must address how its graduates will work to overcome access barriers related to insurance status," Dr. Grumbach said. "Physicians from underrepresented minority groups are more likely to practice in underserved areas and care for underserved minority populations.
"The underlying characteristics of students matriculating into medical school are a strong predictor of future practice in underserved communities. A community responsive medical education program should emphasize selection of students with these characteristics, and support them during their medical education."
Dr. Grumbach added that a medical education program with a focused mission can make a difference in career trajectories and promote a commitment to the underserved. "A community-responsive medical education program should infuse a mission of service into its curricula and leadership," he said.
Dr. Grumbach recommended that a community-responsive medical education program value the production of excellent primary care physicians. "A primary care based system is a better performing system and primary-care oriented countries perform better," he said. "Better health is not about better technology, but about what difference it makes to the health care of the people."