Medical Education is in Growth Phase

by Christina Rogers

Predictions of a physician shortage have set off a spate of new medical school construction nationwide in what health care experts say is the first wave of construction since the early 1980s.

More than a dozen medical schools are now in various planning stages across the country, with many of them — including the one planned by Carilion Clinic and Virginia Tech in Roanoke — scheduled to open within the next five years.

Existing medical schools also are expanding by increasing their class sizes or building new branch campuses, according to the American Association of Medical Colleges.

The recent growth in medical education comes after a nearly 20- year period in which the nation’s number of accredited medical schools stalled at 125 — the result of a long-held policy view that creating more medical programs would lead to a physician glut.

But new demands on the medical community — such as an aging baby- boomer population, the complexity of new medical procedures and the growth of physician subspecialities — have caused many in the field to revise that stance in recent years.

“You had a boom in the ’60s and ’70s for new medical schools. Around the ’80s, there was the perception that we had too many physicians, so the money to start new medical schools dried up,” said Barbara Barzansky, co-secretary for the Liaison Committee for Medical Education, which sanctions U.S. medical schools.

Now, she said, “it’s turned around again with the perception of a physician under-supply.”

School 8th to seek accreditation in 2 years

Florida State University was the first to break the construction dry spell when it opened a new college of medicine in Tallahassee in 2001, paving the way for a new generation of four-year medical colleges.

Then, two years ago, the AAMC came out with a statement calling for a 30 percent increase in enrollment by 2015 — the equivalent of graduating 5,000 more medical doctors annually — both by expanding existing schools and establishing new ones.

“We think that a lot of the growth we’re seeing now is in response to the call,” said Edward Salsberg, director of the AAMC’s Center for Workforce Studies.

Last year alone, the LCME received seven applications for new medical schools.

Three of those schools — in Orlando, Fla.; Miami; and El Paso, Texas — have already received the green light from the accrediting committee to begin enrolling students.

In Roanoke, Carilion and Tech are looking to establish a small, four- or five-year college with an attached research institute near downtown. Plans call for enrolling an inaugural class of about 40 by 2010, roughly the standard starting class size for a new medical school today. The fifth year will consist of a master’s level training in scientific research, but is still under discussion.

In early February, Carilion and Virginia Tech’s proposal became the eighth in the past two years to formally seek accreditation with the LCME.

Most expansion today focuses on allopathic medical colleges, which grant traditional M.D. degrees, although osteopathic schools had a similar building boom in the 1990s, Barzansky said. Doctors of osteopathy are full-fledged physicians, but abide by a different medical philosophy.

“Only recently have people begun to realize that it was a mistake to freeze the educational process,” said Dr. Richard Cooper, a professor of medicine and senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania.

With the pressures of a future physician shortage, communities are anticipating stiffer competition for recruiting doctors and see the new schools as a pipeline to help fill regional work force needs, Cooper said.

Governor: Virginia faces 1,000-physician shortfall

Building a new school also has an economic incentive for some localities, such as more jobs and additional local and state tax revenue, Cooper added.

In the case of Roanoke, Cooper said, when patients leave the region for care at places such as the University of Virginia, “it is basically an economic loss for the community.”

In Virginia, state officials expect the shortage of physicians to be particularly acute because of an already low doctor-to- population ratio. Virginia ranked 21st nationwide in the number of doctors per capita, according to a 2007 health care reform report by the governor’s office.

Right now, the state’s four medical schools graduate 586 new medical doctors each year, but the governor’s office projects a shortfall of about 1,000 physicians in the commonwealth by 2020.

Three other medical schools in Virginia also are planning to enlarge their graduating classes in the next five years.

Virginia Commonwealth University, for example, plans to increase its graduating class size of 184 by one-third, or 66 students, and is seeking $59 million from the state for the construction of a new campus building in Richmond to make those expansions possible, according to state reports.

Eastern Virginia Medical School in Norfolk and the University of Virginia in Charlottesville also intend to add 30 additional slots to each medical school class in coming years, the governor’s 2007 reform report indicated.

Operating costs expected to top $10 million a year

Still, the complexity and costs of building a new medical school can be daunting.

The initial startup investment, including the capital costs for new facilities, can range from about $100 million to $150 million, depending on the size and structure of the program, said Paul Umbach, president and founder of research firm Tripp-Umbach in Pittsburgh.

Carilion and Tech estimate the total investment for their medical campus at $130 million, and are asking the state to cover $59 million of that cost for a joint school and research building.

Then, there’s developing the curriculum, recruiting faculty, raising money and preparing the school for accreditation, said Myra Hurt, an associate dean of research and graduate programs at Florida State University.

“I’m sure I’m leaving out one or two,” said Hurt, who was deeply involved with developing the university’s medical college.

“These are big tasks, especially recruiting the faculty and staff,” she said. “It’s easy to get swallowed up in the massive amounts of work.”

In Roanoke, officials anticipate the school’s cash operating costs will run about $10 million a year.

However, that figure doesn’t include the “fully loaded” costs for the teaching faculty, administrative support and infrastructure. Those details have not been worked out yet, said Dr. Mark Werner, Carilion’s chief medical officer.

The school expects to draw revenue from a combination of tuition, fundraising, Carilion reserves and private investments from Virginia Tech, officials involved in the project said.

Project could lead to local medical ‘constellation’

But more schools in the pipeline also can mean increased competition for faculty, scholarship support and research dollars, Barzansky said.

In particular, funding from the National Institutes of Health, a major monetary backer of medical research, is not growing as fast as it has in the past, she said, which has “a lot of medical schools nervous.”

Some health care experts are also leery that simply increasing the number of doctors won’t mean they’ll be distributed evenly to the places that have the most need.

“Most of the places in the country with the highest number of doctors have the worst access problems,” said Jonathan Weiner, a professor of health care policy and management at Johns Hopkins University. He advocated creating programs or incentives to help assure that graduating medical students stay in the area they are trained.

Officials with Carilion and Tech, however, acknowledged that the medical school alone will have little impact on the local doctor shortage and say their mission is broader than merely trying to fill regional work force gaps by adding more graduates.

“We are looking at this in a comprehensive manner,” said Tech provost Mark McNamee. “Because of the school’s size, it’s not being formed for the purpose of increasing the number of physicians.”

Rather, the medical school and its various components, such as residency programs, medical fellowships and a research institute, altogether are intended to act as a lure, helping draw other health care professionals, including doctors and residents, who want to affiliate with its educational offerings, said Dr. Ed Murphy, Carilion’s chief executive officer.

“It’s all sort of creating a single constellation of stuff that enables us to both train more doctors we can rely on in the future,” he said, “and make this [area] more attractive to doctors who have a lot of choices who want to come here and practice and teach in this environment.”

(c) 2008 Roanoke Times & World News. Provided by ProQuest Information and Learning. All rights Reserved.
Source: Roanoke Times & World News

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