More Medical Schools Needed: Then vs. Now
Reflecting visits to 155 US medical schools, the Flexner Report of 1910 urged high standards for admission and training, and concluded that too many medical schools and physicians existed.1 By 1930 there were only 76 medical schools, but by 1981 there was an upswing to 127.2

As predictions in the early 1990s grew stronger about the glut of physicians in the US, some medical schools closed. Now predictions are moving in the opposite direction. The baby boomers are aging, and the aging are living longer. Meanwhile, many baby boomer physicians are entering retirement.

In a 2005 report, the Association of American Medical Colleges (AAMC) urged institutions to expand medical school classes or to build new schools to increase student enrollments 30% by the year 2015. This increase would avoid an estimated 20% shortfall of physicians in 2020.3 If that shortfall occurs, patients, especially the elderly and poor, will have to wait longer, travel farther, make do with fewer medical services, and present with amplified health problems when they finally do access a physician’s care.

Start-Ups
In Arizona, California, Florida, Michigan, Pennsylvania, Texas, and Virginia, there are plans for or actual start-ups of allopathic medical schools. In The Chronicle of Higher Education Richard A. Cooper, PhD, Professor of Medicine and Senior Fellow in Health Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, reported knowing of “….at least 20 allopathic and osteopathic medical schools that are in various stages of development.”3

Eager to help increase the numbers of physicians in training, the AAMC is lobbying the federal government to lift its cap on the number of residency positions it supports through Medicare.3

Opportunities Opening Up in Academic Medicine
The expansion of medical schools will invariably open up new job opportunities for the under-represented in academic medicine. People from diverse backgrounds who have struggled against the barriers of tradition during their career path may now find more openings available in upper levels of administration and other leadership positions. Fueled by their passion for excellence in medical education, they should be on the alert for new positions opening up as medical training in the US expands. Newly emerging or expanding medical schools will offer the potential for many who want to elevate medical education to the highest of scientific-based ideals, and face challenges with a move into positions of greater breadth and responsibility in medical education. At the same time, academics are awakening to the importance of incorporating the values of the new generation of physicians: balanced work-family-leisure life; integration of technology to increase the efficiency, safety, and quality of medical practice; comprehensive health; creative and research-based approaches to care; strong ethics; and social responsibility that extends beyond US borders.

As a founding dean of one of the new allopathic medical schools, an individual has the opportunity to build a stellar team eager to achieve excellence in meeting the Liaison Committee on Medical Education (LCME) criteria (www.lcme.org). An aspirant from an under-represented group may now have a greater opportunity to become a health science center leader who collaborates with political and university leaders, community groups, patriarchs, matriarchs and influential grass roots citizens to bring supervised medical students and other health students into neighborhood-based clinical sites that provide culturally sensitive, comprehensive medical services and research.

The time has come for people with a different face, demeanor, and style to build academic excellence in medicine. One such person is Deborah German, MD, who has been setting milestones in medical education, first as the assistant and then associate dean of medical education at Duke University Medical Center (1982-98), next as the senior associate dean of medical education at Vanderbilt University School of Medicine (1999-2002), and later (2005-2006) as an AAMC Petersdorf Scholar in Residence where she studied the organizational structure and leadership of major health science center systems.4,5 Her rich administrative experiences in academic and community health settings fueled her vision and passion for her newest appointment as the Founding Dean of the new college of medicine at the University of Central Florida (UCF) in Orlando.4,5 Excited about her appointment, the UCF President John C. Hitt, PhD, described Dr. German as …”the right person to lead us into the future…” 4

Women Leaders in Professional Medical Associations
Some professional medical associations have established a track record of having a female at the helm serving as President. Founded in 1895, the National Medical Association (NMA) elected as its first female president, Edith Irby Jones, MD (1985-86), as its second female president, Vivian W. Pinn, MD (1989-90), as its third female president, Lucille C. Norville Perez, MD (2001-02), followed by L. Natalie Caroll, MD, (2002-03), and now its most recent female president (the 106th) Sandra L. Dadson, MD (2005-06).6,7

In 1982 Johanna Clevenger, MD, became the first Native American female to serve as president of the Association of American Indian Physicians (founded in 1971).7-9 Ten years later Dr. Clevenger served a second term (1992-93), followed six years later by Yvette Roubideaux, MD, MPH (1999-00), Melvina McCabe, MD (2000-01), Joy Dorscher, MD (2005-06), and most recently Susan Sloan, MD (2006-07).7-10 In 1994 Elena Rios, MD, founder of the National Hispanic Medical Association, was its first Latina president.7 The 150th president of the American Medical Association was its first woman president, Nancy W. Dickey, MD (1998-99).11,12

In dentistry the first woman president of the American Dental Association (founded in 1859) was Dr. Geraldine Morrow, elected in 1991; the second woman president (in 2005) was Dr. Kathleen Roth.13 The American Association of Dental Schools (founded in 1923 and renamed the American Dental Education Association in 2000) had Dr. Nancy Goorey as its first woman president in 1977.Almost a decade later Dr. Enid Neidle presided in 1986.14,15

Since its founding in June 1876, the AAMC governing body has been its Executive Council with a Chair (sometimes casually referred to as “president”).16 According to Marian Taliaferro, MSLS, Manager of the AAMC Reference Center and Archives in Washington, DC, the Executive Council formed the Office of (Staff) President in 1969 and appointed John AD Cooper, MD, to the position.16 He served 17 years, followed by Robert Petersdorf, MD (8 years), Jordan Cohen, MD (10 years), and now Darrell Kirch, MD.16 Since the 1980s three Executive Council Chairpersons have been women, Virginia W. Weldon, MD (1985-86), Theresa A. Bischoff, MBA, CPA (2002-03), and N. Lynn Eckhart, MD, DrPH, MPH (2004-05).One Chairperson was African American, Donald E. Wilson, MD (2003-04).16 As people from diverse backgrounds advance in positions of leadership in the AAMC, it is only a matter of time before the possibility of a diverse face and style in the AAMC leadership pipeline leads to the Office of AAMC President.

Looking for Skills in Job Listings
People in academic health interested in leadership positions should look for openings requiring skills in:

1. A vision for superlative medical training and pragmatic steps to advance the quality of medical education,
2. Design of specialty medical and surgical programs,
3. Professional development programs,
4. Innovative curricula,
5. Program evaluation,
6. Construct of standards, procedures and supportive resources impacting people at all levels (from students to faculty to staff),
7. Educational resources including technical skills for state-of-the-art classrooms, libraries and other ancillary services, and organizing excellent clinical teaching sites,
8. Appointing strong standing committees such as for admissions, promotion and tenure, and recognition of outstanding teaching and scholarship (in research),
9. Appointing strong team members for operational details such as finances, information systems, regular horizontal and vertical communication activities, and progressive innovation such as maintaining state-of-the-art programs, technologies, and resource people,

1. Organizing mentors for scholarship advancement,
2. Identifying competitive pilot-study funding,
3. Major strengths in development/fund-raising such as facility in inviting donors, groups, and organizations to provide scholarships, fellowships, endowed chairs and research institutes,
4. Cultural sensitivity and competence,
5. Developing policy statements for national impact on health education and services,
6. Networking with local, regional and national hospital and community groups, and
7. Exchanging innovative medical education and training on an international level.

The new and expanding medical schools provide fertile ground for academics from diverse backgrounds with skills in effective financing; interaction strengths, especially negotiation skills; clear communication and decision-making skills; enthusiasm; and a positive leadership style.

Less May Be Better
Some medical schools have baulked at the recent campaign to expand medical school student positions. Instead, they have promoted increased efficiency. They have insisted that having more physicians does not mean that the underserved, especially in rural areas, will receive better medical care. They add that the trend among today’s physicians for a better balance in their career-personal-family lives may translate into more and healthier physicians, yet may not result in more physician appointment slots for patients.3

A team at Dartmouth Medical School studied effective treatment of their patients. They determined that a ratio of fewer physicians per patient actually led to an equivalent quality of care and fewer unnecessary treatments or procedures.3 As a result, they proposed that more efficient technology, such as using electronic records and medicine-dispensing computer systems, may be a better and less expensive way to increase the availability of health care services.

Such institutions also offer junior academic faculty in medicine the opportunity to multi-task, to mentor and to build auxiliary teams of additional academics who seek fellowships to gain experience in expanding administrative skills. For example, teams may test and implement efficiency designs that may be translated into best practice models. Publications on efficient practices in organizational medicine could be applied to medical schools and hospital systems.

Opportunities for Change Agents
Either way, in an expanding, new or downsizing medical school, potential opportunities are opening up for women, junior faculty, and other under-represented groups of people in academic medicine. These opportunities for strong catalysts, eager to be change agents, may make a significant difference in elevating US medical education to newer, higher standards of medical knowledge and therapeutic care. A door of opportunity that opens for anyone opens for everyone.

References

1. Beck AH. (2004). The Flexner Report and the Standardization of American Medical Education. Brown Medical School, Providence RI JAMA, 291(17):2139-2140.
2. Liaison Committee on Medical Education (Council on Medical Education & Association of American Medical Colleges). (May 2006). LCME Accreditation
3. Guidelines for New and Developing Medical Schools. www.lcme.org. (Accessed 1/23/07)
4. Mangan K. (January 12, 2007). A Growth Spurt for Medical Schools. The Chronicle of Higher Education, Section: Money & Management, 53(19):A27. http://chronicle.com/weekly/v53/i19/19a02701.htm (accessed 1/24/07)
5. News Release. (10/25/06). Deborah German named dean of College of Medicine. http://www.med.ucf.edu/news_releases/2006/oct/102506.htm. (Page 3)(Accessed 2/2/07)
6. Evelyn T. (10/25/06). Deborah German named first dean of UCF College of Medicine. http://neighbors.ucf.edu/UCFnews/index. (Accessed 2/2/07)
7. National Medical Association (NMA) web site. http://www.nmanet.org/index.php/nma_sub/history (Accessed 2/2/07)
8. Women of Color as Leaders in Public Health and Health Policy Conference. (1/9-10/03). Washington DC. http://www.mfdp.med.harvard.edu/woc/timeline/index.htm. (Accessed 2/2/07)
9. American Indian Health Resources: Non-governmental resources. Association of American Indian Physicians. (Page 2). http://www.ldb.org/vl/geo/america/indi_hn.htm. (Accessed 2/2/07)
10. Association of American Indian Physicians. (AAIP). http://www.aaip.org/about/history.htm. (Accessed 2/2/07)
11. Association of American Indian Physicians. (AAIP). http://www.aaip.org/about/exec_board.htm. (Accessed 2/2/07)
12. Nancy W. Dickey, MD, President, Health Science Center and Vice Chancellor for Health Affairs, Texas A & M System. http://www.tamhsc.edu/about/exec/dickey.php?print=1 (accessed 9/28/06)
13. Sgammato J. (June 1998). The new AMA president answers your questions. Family Practice Management, 5(6), p1-7. http://www.aafp.org/fpm/980600fm/dickey.html. (Accessed 2/1/07)
14. American Dental Association (ADA). http://www.ada.org/ada/about/history. (Accessed 2/11/07): ADA History; ADA Timeline.
15. Sinkford JC, Valachovic RW, Harrison S. (January 2003). Advancement of women in dental education: Trends and strategies. J Dental Educ, 67(1)z:79-83.
16. American Dental Education Association (ADEA). http://www.adea.org (Accessed 2/11/07)
17. Email and telephone correspondence with Marian Taliaferro, MSLS, Manager, AAMC Reference Center and Archives in Washington DC. referencing With One Voice: The Association of American Medical Colleges, 1876-2002 (AAMC-published monograph and photo display of past AAMC Executive Council leaders). (1/24/07; 2/1/07; 2/13/07).