Joe Scherger has been relieved of duties as the Dean of Florida State. FSU's new school has an emphasis on rural, minority, geriatrics, and underserved. FSU's leadership cited disagreements about student preparation (board exams, diagnostic skills) and outside duties.  http://www.tallahassee.com/mld/democrat/news/local/5053263.htm Incoming dean Ocie Harris is well-qualified and experienced and dedicated to the needs of the state and the school will continue on course, but more challenges remain.

The picture does not look good for the upcoming LCME accreditation visit in April for FSU. Why now, instead of after this key step only days away?

While I hurt for Joe and for those close to him, the question in my mind is, do those in higher education get it?

Do they understand the needs of our country, particularly in underserved areas?

Do they understand the power of medical education to stimulate change and improvements in high school and college education?

Flexner understood this, and urban high schools and colleges paid attention. The reforms in education 100 years ago were a result of this. He was also saddened at the maldistribution that quickly developed, likely a result of schools and education left behind with little resources and a poor understanding of how the game had changed. Now that we understand who has been left behind, those schools that have rural, minority, and lower socioeconomic kids, we understand that this is the reason for maldistribution of physicians as well as education, economics, and other areas. Flexner’s Impact on American Medicine

Do we understand this in family medicine?

I think many of us do, particularly those like Joe who have served in underserved areas. I think that there are others, even family medicine leaders who have served in such areas, that have forgotten this.

Can we get the nation to grasp this concept and how family physician-leaders can help in this effort? The question is no longer about what to do and who can lead the effort, it is about political will and trust and meeting the needs of the nation instead of board tests and accreditation.

What does this mean for family medicine, or for all who prioritize service over basic sciences or research or other areas?

Scherger has not been alone in this kind of situation. He was noted widely to be an excellent choice. Granted he was active nationally, but this was known prior to selection. Few have doubted the quality of those he has chosen to work with him.  http://med.fsu.edu/news/newdean.asp

Bob Rakel was wooed by Baylor to become Chair of Family Medicine. He also lobbied for a high position, perhaps 3rd or 4th, and promotions and tenure placement. Bob practiced 40 - 50% of the time. You could not ask for a better clinician and many in high positions at Baylor came to him. Bob did many national things with textbooks, video, consulting. He was promised 21 FTE of faculty. As the number 15 faculty on the way to 21, I had to find a new position in a short time. Somehow graduate funding disappeared, promises were not kept, and Bob's position was changed.  To my knowledge Bob has been a trooper through all of this.

Jeff Susman was a top choice as a dean in all aspects for the Duluth School, but the school chose an internal candidate from a basic science background who was an outstanding teacher. This came after efforts to expand to a 4 year school failed.

The WWAMI positions for provost and deans focus greatly on the basic sciences and obtaining extramural funding. http://www.ruralmedicaleducation.org/position.htm. Although there are family physicians that can work in these areas, but an outreach network would benefit from the direction of a family physician that has learned to work broadly for state and regional needs.

I currently do not know how other FP deans, provosts, presidents, are doing. Nancy Dickey is at A & M, but suspect she is doing well. Also Ann Jobe is at Mercer. Aussie Roger Strasser has his hands full at the new North Ontario school, a situation with probably less political support than Florida State. Given FSU's problems with the LCME and the LCME lack of understanding regarding meeting the needs of underserved areas, I suspect that he spends more than a few moments pondering this obstacle.

Preparing students for the challenges of medicine is a difficult task. One not made easy by accrediting bodies, especially for deans or schools that hope to focus on the preparation of those for primary care in underserved areas. It is a constant battle for admitting the right students and striking the right balance between accreditation and actual education/training/preparation for a real career in medicine. The schools above (except for my alma mater of Baylor) represent many of family medicine's best chances for leadership, yet problems remain.

I think the case is being made that the nation needs a new kind of medical school that uses all 7 years of medical school and residency to prepare family physicians for practice. The closer we come to this model in places such as Nebraska where efforts penetrate all years of training (selections, integrated clinical small groups x 2 yrs, M-1 3 wk rural, M-3 2 month rural, accelerated rural and rural training track), the better we train family physicians. All of the faculty would focus on teaching and service. I think that allopathic schools have shown that they are not the appropriate choice for this kind of school. Nor do they deserve our efforts to keep medical education relevant for students, families, communities, and the underserved.

Osteopathic medical education comes much closer to this focus, and has answered this call consistently. Granted osteopathic schools and graduate education have their own problems, but it is time to consider some major changes. This does not mean we should abandon allopathic schools entirely. It does mean that we should quit rescuing allopathic medical education from the consequences of losing touch with patients, communities, and the underserved. They have given us little respect or leadership opportunities and then there are the threats to close programs and departments, etc. We should focus on schools that truly do meet the needs of families, communities, the underserved, the nation, and medical students in the present and future.

Robert C. Bowman, M.D.

rcbowman@atsu.edu

www.ruralmedicaleducation.org - home page of this site

Leadership Factors in Developing Rural Medical Education

Academic Leaders Deans Organizations

Maybe we should go for legislative positions over deanships see Andy Nichols

Rural Medical Schools: A Different Kind of Education