AAMC Reporter: June 2009

A Word from the President: "Nurturing the 'Spirit of Service'"

Each year at commencement season, I am impressed by the graduating classes that I address. In particular, I find myself inspired by the values of these new physicians, their commitment to community service, and the innovative ways they reach out to the underserved. Like other members of their generation, they are, as President Barack Obama recently observed, "possessed with that most American of ideas, that people who love their country can change it."

For those of us in academic medicine, it is truly inspiring that the Obama administration has made service a top priority. At a time when one-in-five Americans lives in federally designated health professional shortage areas (HPSAs), when there is increased concern about a shortage of primary care physicians, and when we struggle to address ongoing disparities in care, a renewed national commitment to service is especially welcome news. The question is whether academic medicine is doing everything possible to maximize this commitment as we support new physicians in their journey along the medical education continuum.

As a first and critical step, I believe it is important we understand and accept that the next generation of physicians is comprised of very different people with different aspirations for their personal and professional lives than previous generations. These differences are supported by data showing that both men and women have different expectations about income, flexible work schedules, and professional advancement. According to the 2006 AAMC/American Medical Association Survey of Physicians Under 50, the most important factor to young physicians in a desirable practice is work-life balance (71 percent of respondents). I believe that a key driver of these attitudes is the fact that these new physicians face challenges my generation did much less frequently, from raising children in a two-career family (and for some, caring for elderly parents at the same time), to coping with staggering levels of medical school debt.

Contrary to what I sometimes hear—the claim that the emphasis young doctors place on work-life balance means they do not share the work ethic of previous generations—these professionals impress me as exceptionally oriented toward community service. Between 2002 and 2008, the percentage of medical school applicants that reported medical or clinical community service or volunteer experience increased steadily. And, as our applicant and enrollment data continue to show, following them are several more generations of serviceoriented aspiring doctors.

A key challenge for mentors and medical educators is to nurture this "service spirit," as President Obama refers to it, during medical school. An important initiative in this regard is our Caring for Community Grants Program, which finances new, existing, or short-term community service projects initiated by medical students. Since the program's founding in 2000, over 70 of our member medical schools have received funding for studentinitiated programs such as free clinics, mobile health care vans, and preventive health care counseling.

As these new graduates take their first steps into the professional world, we should redouble our efforts to let them know about the numerous opportunities to serve their country. In addition to helping graduates address debt, these programs offer an exceptional training ground for further developing the competencies they will need as America becomes more culturally diverse and health care more interdisciplinary and team oriented. Many excellent programs come to mind, such as the Indian Health Service, Armed Forces Health Professions Programs, the Department of Veterans Affairs Education Debt Reduction Program, and the U.S. Public Health Service Commissioned Corps (USPHS). (As someone who served in the USPHS for eight years, I can personally attest to the exceptional opportunity this program provides.)

Another important program, which has been receiving increasing attention lately, is the National Health Service Corps (NHSC). For more than 40 years, the NHSC has offered financial support to qualified health professions trainees and practitioners in exchange for their service in a HPSA. Today, at 4,000 strong, the NHSC provides primary medical care to four million Americans in underserved rural and inner-city areas. Over time, this investment has reaped substantial dividends for our ability to address health care disparities. For example, more than 52 percent of NHSC awardees remain in the regions to which they were originally posted for more than 15 years.

Until recently, the perception of the NHSC as a chronically underfunded program (with limited opportunities) has prevented the Corps from realizing its full potential. The Obama administration and Congress, recognizing the vital role of the NHSC as part of health care system and as a service opportunity, provided it with an additional $300 million as part of the economic recovery package. By effectively tripling current levels of NHSC funding, and in turn expanding the areas that qualify as a HPSA, the recovery package will enable the NHSC to greatly increase field strength over the next two years. Along with a proposed 25 percent budget increase for FY 2010, steady and sustainable investments in the NHSC can build upon past success to help ensure the program meets the needs of future service-minded physicians. We have been working with the Health Resources and Services Administration (which oversees the NHSC) on ways to promote these opportunities, and look forward to continuing our discussions.

As the nation experiences a resurgence in national service, the question is not whether new physicians are committed to working as hard as previous generations, but whether previous generations are committed to providing new physicians with sufficient opportunities to serve. In fact, we would be remiss in our responsibilities as medical educators, mentors, and fellow citizens if we did not do our best to support and promote these opportunities. This "service generation," and those that follow, may help others recapture an idealism that has been lost about improving health care for all.

Darrell G. Kirch, M.D., AAMC President and CEO