Response to 2010 Question of the Year
In 2009, the Pritzker School of Medicine (PSOM) and the University of Chicago Medical Center (UCMC) implemented an innovative program designed to address two important goals: (1) to decrease our graduates' debt and (2) to improve the health of our community. The program entitled REACH (Repayment for Education to Alumni in Community Health) encourages PSOM graduates to practice in federally qualified health centers (FQHCs) or community hospitals in the underserved neighborhoods surrounding the University of Chicago by addressing financial barriers that might deter even the most altruistic young physician from such a choice. The average debt of a PSOM graduate is approximately $160,000. REACH provides a $40,000 yearly stipend from UCMC, in addition to the salary provided through the FQHC or community hospital, for a period of up to four years. REACH also connects alumni participants with the Urban Health Initiative (UHI), a wide-reaching program linking UCMC and community partners to improve the health of Chicago's South Side residents in order to promote bonds between our graduates and our surrounding community, its residents, its health providers, and the research, clinical, and teaching missions of UCMC. In addition to providing clinical care, REACH recipients take on leadership roles in UHI's community-engaged research and teaching programs involving our own medical students.
Historically, while a small number of our students have participated in the National Health Service Corps, the University of Chicago, a research-oriented medical school, has not traditionally matriculated large numbers of students who are prepared to commit to providing primary care in underserved settings. However, through targeted curriculum, including one of the very first required medical school courses on health care disparities1 as well as a requirement for all students to complete a scholarship and discovery project where one of the areas of concentration is a community health track, the University of Chicago now graduates an increasing number of students with a strong interest in public service. The most recent data from the 2009 Graduation Questionnaire demonstrate this as a strong and growing interest. For example, 38% of PSOM graduates (compared with 29% nationally) indicated their intention to locate their practice in an underserved area, with 87% of those responding indicating the likely location being an inner-city community.2
Given the demonstrated impact of our curriculum in encouraging a culture of service, education–service exchange programs which require a commitment on the first day of medical school may not have as broad or as significant an impact for our student population. REACH captures students whose career paths evolve through participation in course work, research, and service learning opportunities during medical school.
REACH differs from loan repayment programs in several important ways. First, the program considers the community's broader health care needs by including both primary care physicians and much-needed specialists in cardiology, nephrology, gastroenterology, and dermatology. Our mission is to encourage practice in underserved communities even among alumni whose specialties of medicine do not typically offer such a pathway. Second, participants in REACH can practice part-time (at least 50%) with a prorated stipend. This option allows participants the flexibility to devote time to leadership positions in their practices, engage in research or teaching, raise children, or devote time to other personal priority areas. Finally, REACH participants practice in a community well known to them from medical school. Because this commitment represents an informed choice, we anticipate that participants are more likely to remain on the South Side of Chicago after completing the REACH program.
REACH began recruiting in spring 2009. One early challenge has been the strong emphasis among local FQHCs and community hospitals on hiring family doctors, not a field chosen by a significant number of our graduates in the past. However, interactions with the UHI and strong interest on the part of PSOM graduates in the REACH program have led to an expansion of FQHC recruiting. Our first REACH recipient (a family medicine physician) began practice in fall 2009, with two additional REACH recipients (a family medicine physician and a primary care pediatrician) joining in fall 2010. Further, the FQHCs have begun to consider their subspecialty needs and are considering creating a shared position for a subspecialist (such as a dermatologist or a cardiologist) at multiple practice locations.
REACH offers a novel approach to addressing two distinct problems—expanding physicians in our underserved South Side community and addressing educational debt of our graduates. It is an innovative model by which academic medical centers can support the health of their communities while providing meaningful assistance to their medical students. The advantages for community, medical school, students, and medical center are potentially transformative.
1Vela MB, Kim KE, Tang H, Chin MH. Innovative health care disparities curriculum for incoming medical students. J Gen Intern Med. 2008;23:1028–1032.
2Association of American Medical Colleges. 2009 Graduation Questionnaire: The University of Chicago Pritzker School of Medicine. Available at: https://services.aamc.org/gqtools
. Accessed April 30, 2010.