A novel concept

LITTLE ROCK — WHAT IS this strange new idea that Mike Beebe has had the temerity to introduce into the always delicate matter of just who should be admitted into this state's medical school? No one has dared bring it up before, at least not in public, though doctors have been gossiping about it for ages. And what idea is that? Why, it's-no, it can't be!-it's the notion that admission to medical school should be based on-steel yourself, Gentle Reader-the quality ofthe applicants rather than which part of the state they're from.

Shocking.

Unheard-of.

Heresy!

Talk about time-honored notions, this one has been around for years and years. Since approximately 1967 A.D., seats in the medical school's entering classhave been allotted under a formula which requires that 70 percent of the first 150 students accepted be divided equally among the state's four congressional districts, which amounts to 27 freshmen students per district. It's not quite as complicated as the infield fly rule, but it's complicated enough, more than enough.

As for the quality of the students admitted, that becomes a secondary consideration. The geographical quota must be filled. Call it Affirmative Action for the rural. But no euphemism can hide the injustice of it, or its tendency to put quality second to some other not very relevant "qualification."

Governor Beebe, in his usual, only tentative way when he's approaching some really big issue that could prove politically sensitive, has dared raise the obvious question: Do we want to keep emphasizing geographical diversity, or do we dare risk all on quality? That is, should we base admission to medical school only on-heretical thought!-the record and promise of the prospective medical student? Regardless of where he or she comes from.

It's not just quality that may be compromised by quotas for different parts of the state, but justice. Not to mention confidence-confidence not just in the selection process but in Arkansaseducated physicians. One applicant who was turned down for admission is convinced she would have made it in on the basis of her grade-point average and experience if only she'd been from a different part of the state.

Naturally enough, she sounds bitter. She's also afraid to give her name, sinceshe's re-applied for admission. Which is the kind of fear, justified or not, that any system based on arbitrary discrimination inspires. What it doesn't inspire is confidence in the system. Quotas for entrance to a professional school based on geography seem to have the same deleterious effect as those based on any other arbitrary consideration.

What we have here is an unfair but quite legal system of discrimination based on geography that is as ethically and practicallydubious as those based on color or creed or class. If its aim is to encourage a wide distribution of physicians in the rural parts of the state, it doesn't seem to work well in that regard, either. "We've had the policy for how many years now," notes David Wroten of the Arkansas Medical Society, "and we still have a large shortage of health-care providers in rural areas."

Here's a suggestion from the ranks of the mere laity, if we may be so bold: Let's put quality not only first but consider it only. Let's junk the whole geographicaldiversity business, which seems to work about as well as the rest of the diversity industry.

But then how would we encourage new doctors to settle in those parts of the state where they're needed most? Let's find other ways to do that-by scattering medical residencies around the state, or by subsidizing physicians who choose to practice in rural areas. Surely our physicians, educators and administrators are imaginative enough to come up with any number of ways to provide Arkansas with country doctors of the best quality. The one thing we don't want to do is dilute the quality of the medical field in this state, anywhere in this state. Nor do we want to settle for "qualified" doctors rather than the best we can produce.

Yes, let's work on the terribly important, life-and-death important, question of providing medical care in rural communities. But first let's try our best to ensure that the physicians there are the very best we can produce in Arkansas. Surely that's a difficult enough challenge without complicating it by adding geographical requirements via some hodgepodge of a formula. Let's aim for a freshman class composed of the best applicants the medical school can attract, however our best minds and most seasoned of caregivers define best, which is difficult enough without throwing in some arbitrary requirement about coming from the "right" part of the state.