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Jack Geiger had done more than most of my heroes combined when Paul Farmer was still a wink in his mother's eye, but in the early 70's after integrating Case Western, being part of the Harlem renaissance, creating the system of community health centers and doing research with Nobel laureates, he decided to tie it together for yet another act - founding Sophie Davis Medical School.
Sophie Davis is a bustling little school in City University of New York's (CUNY)'s north Harlem campus. In the 30's and the 40's, CUNY was the best public college in the country, providing city residents with educations on par with many of the ivy league schools of the time. My father attended CUNY for a while in the early 60's. In addition to it's tremendous academic history, CUNY has a long tradition of radical student activism around race and class issues, a tradition that it is still strong - some of the best activists of my generation were active there in the 80's and 90's as part of SLAM (The Student Liberation Action Movement) and its predecessor organizations. It was both of these traditions that brought Geiger to CUNY from a position he had taken as the Social Medicine guru at Stony Brook after it became clear that the school [Stony Brook] was struggling with meeting its mission statement of educating primarily primary care doctors.
With the help of my Leg interns, I am working on a project to collect and disseminate social histories of doctors that did truly amazing things. Like everyone else, I am a fan of Farmer's, but it gets disturbing how many folks come to AMSA and to their first struggles with class and race through Tracy Kidder's biography of the man. His solutions to his struggle are unique, and I worry about how many folks who grasp the questions that motivated him see only awnsers in service in the global south, something that is unsustainable and a poor use of their economic and political capital. AMSA's rank and file needs other models to follow, hence this spring project.
[some of the work may later appear here]... With this in mind I had arranged for an audience with Geiger a couple of weeks ago and a chapter visit with my friend Salina's AMSA chapter at the school.
The chapter visit went well, one of the best of the year. We gave a talk on the domestic health care worker shortage and I was amazed by the sharp insightful questions and by the very colorful full house of punky young students. I go to one of the most racially diverse medical schools in the country, but my chapter is nothing like this. Salina is a total rockstar, and I was surprised that most of her chapter matched her energy and they had a strong grasp of public health issues I am still struggling to understand. Also, bizarrely, when I made a joke about cardiologists, no one looked offended, and when I asked what specialties folks were interested in, I got blank stares. Finally, from the back of the room, someone mumbled "we want to do primary care... Moury wants to do geriatrics, does that count?" I kept thinking during the visit that I wished I went to this med school. The meeting with Geiger was also full of surprises.
Geiger was delayed with some family drama and we ultimately had to reschedule, but this was a blessing as we (myself and policy interns Shannon and Stephanie) found ourselves waiting in the care of Geiger's colleague Pyser Edlesack, Sophie Davis's director of field education. Pyser has worked with Jack since the early 70's and he says that Sophie Davis was really Geiger's crowning achievement.
There are a damn lot of problems with access to healthcare in the US among them the problem of a lack of primary care doctors. No one wants to practice primary care. Even at many schools which state their commitment to it, schools like mine or like Stony Brook, it is given short shrift. Family docs never hold administrative rolls, top students are encouraged to go into research, general internists who visit for clinical skills practicum's tell stories about how hard it has gotten, how little it pays. Its gotten to the point that many good students I know who want to do family practice, students whos values I share, go for ER residencies because the work is similar but the pay is better. Among my friends who do family, I feel like they fall into 2 catagories - visionaries and folks who didn't do well enough to make the specialty they wanted. It shouldn't be this way.
ER docs cost way too much. While we have an overall shortage of doctors in the US, the bulk of it is in primary care. Proportionally we have way too many specialists. We import 25% of US residency spots are filled by foreign docs, predominantly primary care spots. Internists, FP's, Psychiatrists. We have the money to insure everyone in the US, but our system is top heavy. Primary care has lost its prestige. How do we restore it? At Sophie Davis they may have found the answer. Pyser explained.
Sophie Davis isn't a true med school. They have partnerships for the clinical years with other schools in the city, Cornell, NYU, Downstate, Dartmouth, ect. The students do a 7 year combined BS/MD. This helps keep costs down, and innovatively keeps the obnoxious parts of medicine, the surgeons and the specialists, off campus and out of the curriculum.
They have relationships with high schools and sometimes even junior highs. They identify promising students who otherwise would never have a shot at medical school, mostly young women and men of color, kids who are likely to stay in their communities. They know the advisors and the teachers, they sift and the cultivate. Not everyone is cut out for medical school and many promising students never make it all the way. But enough do. They make it possible for every student to afford the program, and in return students commit to doing primary care for at least 2 years in an underserved area of New York state.
Once they are in, the curriculum is different too. In addition to the usual required courses in chemistry, anatomy and biology, students have a highly structured curriculum that emphasizes the social determinants of health, population health and early interventions. They study psych and American History and do undergraduate fieldwork studying health systems in their communities. The curriculum is subtle, but effective. Students at Sophie Davis are stoked about doing primary care. They know its importance and their role it. When it comes time to go their two years of service, most of them go back to their own communities to practice.
The students get it.
Around the US, leading academics are chasing the future of medical education in the form of lengthened 5 year medical programs to add an extra year of research, and "primary care focused" schools like Touro School of Osteopathic Medicine prepare to invest in 300 million dollar linear accelerators to focus on rich mens prostates. They've got it all wrong. The future started 35 years ago in a small building in Harlem.
Lets hope they find it in time.
-Dan
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