First lady issues call to action at Hopkins Mrs. Clinton pleads for more doctors in primary care

June 11, 1993|By Michael Ollove | Michael Ollove,Staff Writer

It was the 100th birthday party for the Johns Hopkins School of Medicine, but that didn't prevent the celebrity guest star from dwelling on an area that is not Hopkins' long suit.

First lady Hillary Rodham Clinton told a Hopkins audience yesterday that the nation's medical schools must help correct an "imbalance" that has left the country with a shortage of primary care physicians, the front-line in preventive medicine, and an overabundance of specialists.

"There is no way we can provide universal access . . . and require a benefits package to be available to all Americans that emphasizes primary and preventive health care without a larger supply of primary physicians," said Mrs. Clinton, head of the president's task force on health care reform.

Fewer than one-third of all doctors practice in primary care and only about 15 percent of medical students today say they plan to go into primary care. Many health policy experts say the nation should achieve an even split between specialists and generalists.

The Hopkins medical school, with its heavy emphasis on research and specialties, produces few primary care doctors. According to the American Association of Medical Colleges, Hopkins ranks 117th out of 125 medical schools in the production of doctors who go on to practice in primary care -- generally identified as general internal medicine, general pediatrics and family medicine. Only 14.5 percent of Hopkins medical school graduates go on to primary care.

Mrs. Clinton, though, came not to chide Hopkins, but to praise it. She expressed pleasure over the school's announcement this week that it will require all its students to complete a four-week primary care rotation. Sprinkled throughout her 30-minute address to faculty and alumni were many other compliments as well.

She praised the "magnitude of Johns Hopkins' contributions in medicine and health care" and cited the school's leadership in medical discovery and its commitment to serving the poor of East Baltimore.

She also repeatedly asserted that Hopkins has much to contribute to the national solutions to the health care crisis and frequently sympathized with the centennial audience for the avalanche of paperwork, complex insurance plans and threats of medical malpractice that have made a medical career increasingly irksome.

The Turner Auditorium crowd seemed won over by Mrs. Clinton, greeting her and sending her home to Washington with warm ovations.

It was not Hopkins' first encounter with a first lady. A century ago, the wives of Presidents Cleveland and Harrison helped raise the money that created the medical school. But first they extracted a commitment that women would be admitted on an equal footing with men.

"I'm sure they were roundly criticized for being so aggressive and so assertive in their views," said a smiling Mrs. Clinton.

It was one of the light asides in an otherwise urgent call to arms. The nation's health care debate, Mrs. Clinton said, will say a lot about "what kind of country we are and what kind of country we want to be.

Although she sounded many familiar themes, she tailored her remarks to her medical school audience. And the issue she most emphasized was the need for more primary care physicians, particularly in rural and urban areas.

"The success of health care reform depends in part on our ability to put doctors and health care resources where they are most needed, not simply where they are most profitable," she said, "but that will happen only if incentives that have traditionally gone into medical education to promote specialists now go into medical education to promote generalists."

She suggested that medical schools encouraging generalists might receive more government aid. She also said "students who are willing to go into those areas that our country most dramatically needs" might be entitled to more help with their education debts.

Michael E. Johns, the dean of the Hopkins' medical school and Mrs. Clinton's host, interpreted her remarks as a general prescription rather than one pointed at Hopkins. "She was speaking nationally, for what society needs," Dr. Johns said, noting that Mrs. Clinton also made a strong commitment to fund medical research.

The dean has long asserted that research schools such as Hopkins occupy a special niche in medical education and should not be expected to be factories for primary care doctors.

But Dr. Johns has said medical schools cannot meet the nation's goals for primary care doctors unless generalists are valued more by society, meaning salaries that are not so far below the specialists' and an equal measure of prestige.

"It's not a simple problem of: Do you provide the right kind of medical education," he said.

Mrs. Clinton herself stressed that her reform efforts will fail unless cooperation replaces the wariness that is omnipresent in medicine.

"Specialists are going to have to cooperate with nonspecialists. Doctors are going to have to cooperate with nurses. Hospitals are going to have to cooperate with clinics.

"I had no idea before I got into this," she said to gentle laughter, "how difficult cooperation was."

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