A Remembrance of Dr. Fitzhugh Mullan, Social Justice and Health Policy Educator

A pioneer in graduate medical education, social justice, health equity, and health policy, Fitzhugh “Fitz” Mullan, MD, died at the age of 77 at his home in Bethesda, Maryland, on November 29, 2019. Dr. Mullan received his bachelor's degree from Harvard (1964) and his medical degree from the University of Chicago (1968). He completed residency training in pediatrics at Jacobi Hospital and Lincoln Hospital in the Bronx, New York (1971). Dr. Mullan spent much of his career leading state and federal health programs, as the head of the National Health Service Corps, Bureau of Health Professions, Secretary of Health for the state of New Mexico, and as an Assistant Surgeon General. Since 1996, he was a Professor of Health Policy and Management and Pediatrics at the Milken Institute School of Public Health at The George Washington University (GW). Dr. Mullan was a prolific writer and leader who will be sorely missed by the medical education community.

Throughout his career, Dr. Mullan fought for parity in health care for minority groups. His work in health disparities was influenced by early encounters as a medical student in the 1960s working with low-income minority residents of rural Mississippi. These experiences were memorialized in a book he wrote, White Coat, Clenched Fist: The Political Education of an American Physician.¹  Jeffrey Akman, MD, former Vice President for Health Affairs and Dean of the GW School of Medicine and Health Sciences, says the book “became required reading for any medical student interested in community and public health.” Similarly, following many years with the US Public Health Service, Dr. Mullan wrote Plagues and Politics: The Story of the United States Public Health Service,²  another seminal work that is still provided to newly commissioned National Health Service Corps members, according to Candice Chan, MD, MPH, Associate Professor in the Department of Health Policy and Management at GW. Dr. Chan notes, “He was one of the founding editors of the Health Affairs Narrative Matters series, which provides an opportunity for others to bring voice and perspective to health policy issues through personal essays.”

Dr. Mullan will be remembered for his push for race-conscious admission policies to medical schools. An article he wrote that appeared in the New England Journal of Medicine in 2019 highlighted a decline in the matriculation of underrepresented minorities to medical schools despite evidence that minority patients report better care by racially concordant physicians.³  Former dean of the GW School of Medicine, Jim Scott, MD, said his article, “was a call to arms to challenge medical schools, and the Association of American Medical Colleges, to gauge their success, not by the size of their research portfolio or the immensity of their clinical programs, but by their commitment to the health and well-being of the populations they serve. He saw medicine as a call to service and never as a means to personal wealth or prestige.”

Dr. Mullan was not afraid to take a contentious, yet morally just, position. Often, his work turned traditional views of quality upside down. In “The social mission of medical education: ranking the schools” article, he measured and ranked US medical schools based on outcomes in 3 areas: primary care physicians produced, graduates practicing in underserved areas, and class diversity.⁴  The results highlighted the lack of regard for these issues at otherwise prestigious medical schools. In 2005, when he saw physicians trained in Africa and the Caribbean were being lost to wealthy nations, he implored the United States to increase its supply of homegrown physicians. Then, from 2002 to 2012, when more than 30 new medical schools were built in the United States, Dr. Mullan reiterated the importance of reducing excess US graduate medical education positions to reduce the emigration of physicians from underserved nations.⁵  His advocacy for graduate medical education also included efforts to change policy related to the geographic distribution of residency positions, noting that physicians tend to settle near their training sites. Dr. Mullan favored redistributing government-funded residency slots based on the nation's current health care workforce needs. His efforts were rewarded with policymaking successes, such as the Teaching Health Center, community-based venues for training residents, and the National Health Care Workforce Commission legislation that was included in the Affordable Care Act and redistributed unused residency slots to underserved areas.

Dr. Mullan was a committed educator and mentor who made impassioned pleas for educational leaders to address health disparities. While serving as Assistant Surgeon General and Director of the Bureau of Health Professions at the Health Resources and Services Administration, he established a mid-career health professional fellowship to understand federal health programs and policies. More recently, he conceptualized and led residency fellowships for health policy at GW and Kaiser Permanente and he established the Atlantic Fellows for Health Equity for early to mid-career individuals in health equity and leadership. As a founder and Director of the Beyond Flexner Alliance, Dr. Mullan led a national movement focused on advancing a social mission in health professions education. Lawrence “Bopper” Deyton, GW Senior Associate Dean for Clinical Public Health and Murdock Head Professor of Medicine and Health Policy, explained, “The Beyond Flexner movement that [Dr. Mullan] helped catalyze . . . recognized that medical education is failing to create the clinicians we need for the 21st century, and he helped set in motion a movement to rethink how we do that.”

Dean Akman recounted, “Just weeks before his death, Fitz was still imploring all of us to expand our efforts in addressing the ‘social mission' of medicine. He leaves a tremendous legacy that includes legions of students, residents, and physicians who will continue to embody the values, mission, and energy that Fitz brought to his efforts to improve the lives of the underserved.”

In April 2019, The George Washington University Health Workforce Institute was renamed the Fitzhugh Mullan Institute for Health Workforce Equity. May this institute and all other medical training institutions work to achieve Dr. Mullan's messages of equity and training that meets the needs of all, including underserved, populations.