Dr. H. David Wilson Dean of the UND School of Medicine and Health Sciences

Editor’s Note:

Editor's Note: The UND School of Medicine and Health Sciences (SMHS)-one of the smallest med schools in the country-has made an outsized reputation for its patient-centered curriculum and its family medicine and rural health programs, areas in which UND ranks in the top five among the 125 U.S. medical schools.

To cap this extraordinary track record, med school dean H. David Wilson, M.D., this year becomes "dean of deans" as chair of the Council of Deans at the Association of American Medical Colleges, the first North Dakota dean to hold this prestigious AAMC office. Wilson, a pediatric infectious disease specialist, has been making national waves among med school leaders for several years with his brand of innovative approaches to medical education and family and rural medicine.

In this edition of the Faculty Q&A, Wilson talks with Office of University Relations writer Juan Miguel Pedraza about his AAMC role, how the SMHS fares among its peers, and what the outlook and challenges are for family medicine.

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OUR: Please tell us about your election to the chair of AAMC.

Wilson: No doubt, it's quite an honor. I'm very happy to do it. I've been there for quite a while, so I think that really I was elected because of longevity. I was selected earlier for the AAMC administrative board, where I got a chance to voice some of my views. It's a very prestigious group of deans from around the country, including Harvard, Cornell, Stanford, and the like.

Now, it's a very democratic organization. When I first became dean (at UND) 12 years ago, there was a kind of "Ivy League" clique running the group, including Harvard, Johns Hopkins, etc. Now it's wide open to people from Tennessee, New Mexico, and North Dakota. We're now seen as equals.

OUR: UND in April was recognized by the American Academy of Family Physicians (AAFP) as ranking fourth in the nation for the percentage of grads choosing family medicine as a career. Please put this into perspective and tell us what it means for UND.

Wilson: Well, first let me say that we're exceedingly pleased to be recognized for encouraging students to pursue the specialty of family medicine. This honor reaffirms that our school is doing an exemplary job-better than most other U.S. medical schools-of preparing students who choose to become family physicians.

But let me also point out that family medicine is facing a big challenge-it's a very troubled area at the moment. For the past nine consecutive years, the number of U.S. medical students going into family medicine nationally has dropped.

We continue to succeed at UND, but we've also seen declining numbers of students going into family medicine. Based on a three-year average, 17.4 percent of our graduates have entered an accredited family medicine residency program. This spring, 20 percent of the 55 graduating medical students planned to pursue training in family medicine; the national average is about 8 percent. So we're very proud of the fact that we do a great job in this area. But we're down from about 25 percent a decade ago. Now family physicians account for one-sixth of our grads instead of a quarter.

Family doctors work very hard, and they must master a very large number of skills to responsibly do their job, but they are not compensated to the degree that other specialists, such as cardiologists or surgeons, are. These are all very bright students; those wanting to go into family medicine must ask if they really want to work as hard as they must in order make $150,000 when physicians who specialize can make twice as much or more.

OUR: U.S. News and World Report, in its 2008 Best Graduate Schools edition, again ranked UND among the leading U.S. med schools for its rural medicine program. How does this tie in with your view of medical education, and what do you see ahead for the program?

Wilson: Well, as I've said before, this recognition reaffirms our role as a national leader in the education and training of physicians for rural practice. It's about our commitment to quality, accessible rural health care. Clearly, we're seen as a national model for how medical education and practice can best be carried out in a rural, sparsely populated state. It's also a particular honor for our Rural Assistance Center (RAC), the only one in the entire nation. (Editor's note: Operated through the Center for Rural Health, RAC serves as an international clearinghouse for information on rural health issues; its personnel field requests from every state in the union and several foreign countries.)

I think this ranking also says a lot about community-based medical schools, of which ours is a leader. We're a medical school that does not have an "ivory tower" university hospital.

There are 20 like ours in the country, and I think that there's a recognition that we're a major player, and sometimes the envy of places that have their own major hospitals. Trying to run the whole medical school administration including the hospital is a major burden. Sometimes there's major competition between the hospital and medical education folks.

The fact is, the hospitals have a hard time making money, especially when you consider that they give away so many services. Often they're places that take care of the very worst cases, such as patients with really bad burns, cases where you spend an awful lot of resources, and often they're not compensated. So they frequently run on very tight margins, and often they're in deficit.

OUR: What changes are driving medical education at UND?

Wilson: I think there are a lot of innovative things happening nationally in medical education. There's a lot of forward thinking, but there's also pressure in most medical schools to keep their hospitals full, to make the budget-there, you're between a rock and a hard place because medical teaching takes faculty time.

In many places today, the faculty don't have time for students. Students (in such places) see their attending physicians once a week, and the rest of the time they're taught by interns and residents.

At UND, however, we have the luxury of having practicing physicians who still take the time to teach students, even though there are pressures on them to make their bottom line. That's one of the reasons that we're kind of the envy of many other medical schools.

In general, there's a growing shortage of medical professionals, including physicians. U.S. health care faces a major challenge in this regard. We need more doctors: we've got a growing population and more of it is getting older-and older people require a lot more health care.

The AAMC (the organization whose Council of Deans Wilson will chair this fall) has taken the lead nationally, calling for a 30 percent increase in medical school enrollments. We recently increased our enrollment by 10 percent and we're thinking about whether we should add another 10 spots.

Moreover, physicians today don't want to work 24-7. They don't want to be on call all the time. They're insisting on time away from practice for family and friends. It's a different world from the one I encountered when I got into medicine. Back then, if you asked physicians of my generation which came first, family or medicine, medicine always came first and family second. For today's physician, family is first.

In the long term, I see us continuing to focus on family and rural medicine because they are our niche. Obviously, we're also looking at threat of pandemic bird flu and other potential disasters, but that's where we're at the front of the pack. Our niches in terms of national recognition are medical education-where you don't have to have the biggest class to have the best curriculum-rural health, and family medicine.

We're also developing niches in special areas of research, particularly neuroscience, eating disorders, cancer, and alcoholism. We're a small school, so we have to focus our energies; we can't be all things to all people

I'm very proud of what we've done here. We continue to get accolades about our students from (medical internship and residency programs) places such as Michigan. That tells us we're producing very bright, devoted students.