Will be presenting at Memphis at the STFM Predoc meeting about Shaping a
Nation with Selections. The seminar asks some basic questions. Indications
are that the physicians that we most need are broadly spread throughout the
population. This is not necessarily those that we choose to cast our nets
for. We do catch the bigger fish, those from parents who are even bigger.

We may even net some of the best physicians, but they manage to slip
through the net to other careers.

When we choose for top colleges and scores,  we get medical students most
highly associated with top levels of income, education, professionals,
population density, and proximity to medical schools.

When we choose medical students by different methods designed to negate
these influences of parents, we get physicians who are more likely to
distribute, improve health access, and represent a much broader segment of
society. These also tend to be family physicians.

The seminar includes some examination of empathy, special admissions,
awareness, and service orientation. It is likely that at least some of
these qualities for physicians are also related to admissions by scores,
rankings, and prestige levels, but in the opposite direction. In other
words, admitting a more and more narrow segment of American society to
become physicians is not a good progression. Important questions need to be
raised and studies done to examine some of our health care costs and
quality problems as a function of the types of physicians that we admit, or
fail to admit. We may find that more than maldistribution is a problem for
elite admissions.

http://www.unmc.edu/Community/ruralmeded/shaping_a_nation_physicians.htm

Robert C. Bowman, M.D.
[log in to unmask]
www.ruralmedicaleducation.org

I once spent some time with maps noting the various toxic conditions
emanating from test wells and the likely sources of contaminants in our
Omaha area.

This tends to keep me from enjoying one of my son's interests, fishing.

In a nearby lake, signs note that only fish of a certain length can be
kept.

Figuring back over the growth of the fish
Figuring the location and what used to be upstream
Figuring in the more recent clean ups with better conditions

You could not eat the younger and safer fish by law. You needed to eat the
ones that had spent the most time in the lake back when the lake was far
more contaminated.

This was of course better for success in the reproduction of the fish, but
perhaps questionable for maximum safety in human reproduction. Fortunately
few are dependent upon this lake for everyday survival.

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