Education: New Prescription: Intensive Care

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.