New Prescription: Intensive Care

By Ellie McGrath

A struggling black medical college gets some federal medicine

Over the past century, Meharry Medical College in Nashville has trained 40% of the nation's practicing black doctors and dentists, most of whom have provided health care to the poor. Yet despite this vital contribution, Meharry has been struggling lately to maintain its mission, and even its existence. Over the past decade, the nation's larger and better-known medical schools have adopted affirmative-action admissions policies that have siphoned off some of Meharry's best talent. Hubbard Hospital, Meharry's teaching facility, has been running into heavy debt. Meharry students have not enjoyed access to residencies at two tax-supported Nashville hospitals--a situation attributable to a number of factors, including some community practices and institutional arrangements surviving unexamined from the racist past.

Last year Meharry's woes came to a dramatic head. The American Medical Association and the Association of American Medical Colleges threatened to put Meharry on probation as an accredited school, primarily criticizing the lack of clinical teaching beds for its interns and residents. Meharry officials rushed to upgrade admissions requirements as recommended, but had little success in increasing student access to patients. As a result, last month the probation threat stood, bringing the historic school uncomfortably closer to being out of business.

But help was already on the way. Responding to the recommendations of a White House task force, the U.S. Department of Health and Human Services intervened. In addition to promising to pay off Meharry's $29 million construction loan for Hubbard Hospital, HHS pointedly instructed the U.S. Veterans Administration to expand an affiliation between at least one of the large VA medical centers in the Nashville area and Meharry. Said HHS Secretary Richard Schweiker, in explaining his department's intervention: "Many of Meharry's students have come from disadvantaged economic backgrounds. Its graduates have established a strong record of practicing primary-care medical specialties where they are desperately needed." Federal aid to Meharry follows logically from the Executive order the President signed last September pledging federal support for black institutions of higher learning.

Schweiker's intervention could make the difference. Meharry has had only a limited affiliation with one VA hospital, in Murfreesboro, Tenn., 30 miles from Nashville. Contracts for medical staffing of the Nashville VA hospital have always automatically gone to Vanderbilt University, whose medical school did not graduate its first black M.D. until 1970. (This year 25 of its 418 students are members of minority groups.) Although the VA had a nondiscrimination policy at the time of Vanderbilt's first agreement with the Nashville VA in 1947, exceptions based on "local custom" were used then to segregate black patients and shut out black doctors.

Says Meharry Medical College Administrator Ken Jordan: "What we are facing is the present-day consequences of past practices of segregation." The disparities between the white and black medical schools in Nashville remain striking. Vanderbilt's arrangement with the Nash ville VA not only gives the university control of 485 teaching beds, but generates more than $6 million a year to support 88 residents and 39 faculty members. In addition to all this, Vanderbilt has its own teaching hospital and an affiliation with the city's Metropolitan General Hospital, another tax-supported institution. As a result, Vanderbilt has access to a total of 2,000 teaching beds, compared with only 230 for Meharry, although both schools have approximately the same number of students in clinical training. "It's been a broken record," says Meharry Vice President Dr. C.W. Johnson. "We don't have the patients. We take disadvantaged students and try to teach them with less than an adequate number of faculty members and insufficient bedsides."

With some understandable reluctance, since sharing beds will inevitably reduce the scale of its teaching, Vanderbilt has agreed to sit down with Meharry to discuss giving access to more patients and clinical programs and exploring other ways in which Vanderbilt can help. Says Dr. Roscoe Robinson, Vanderbilt vice chancellor: "Vanderbilt stands to lose more than it will gain, except in terms of good will. We will have to reduce our scope, modify our curriculum and limit class size." Meharry officials believe that there is no "willful, intentional racism" in the university's position. "Color is involved here, but it's green," says Johnson.

Over and above whatever help Vanderbilt eventually provides, Meharry will benefit from a five-year improvement program put in motion by outgoing Interim President Richard Lester, a University of Texas radiologist. Reforms include a plan to attract new faculty physicians and a reduction in the size of the freshman class (to 80 this fall, from 125 in 1980). The latter move is designed to help raise Meharry's average admission test scores to more closely match the level of black students' scores at other medical schools. In addition, Hubbard Hospital has a new director with an ambitious marketing campaign aimed at attracting patients and balancing the budget.

When Dr. Lester stepped down earlier this month, his successor, Dr. David Satcher, a former department chairman at Morehouse College medical school, reflected the general Meharry view that more needs to be done. Said Satcher: "We face a stiff challenge. How do we balance our commitment to admit students other schools are not willing to take a chance on with our commitment to excellence?" Whatever answer he and Meharry find, it and the hoped-for increase in teaching beds will have to satisfy the national accreditation committee. Inspectors will visit Nashville this fall for another look. --By Ellie McGrath. Reported by Anne Constable/Nashville

With reporting by Anne Constable

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