Medical schools aim to grow rural doctors

A cotton field lies across from the double-wide trailer where family physician Tony Islas, MD, works. In the distance is the Rio Grande.

West Texas is a dusty, flat country, and El Paso is no exception. Here, Dr. Islas oversees four clinics run by Texas Tech University in communities along the border called colonias. These unincorporated towns, hacked out of the desert by residents, are built without running water, electricity and sewage systems. Trailer home roofs are dotted with tires to keep them from rattling in the wind.

El Paso County has 107 physicians per 100,000 people, according to the Texas Medical Assn., less than half the national average. This shortage of physicians covers most of West Texas, but it's most extreme along the hundreds of border miles that snake their way down to the Gulf of Mexico.

One of the reasons for the striking shortage, Dr. Islas says, is the brown factor. Everything here is brown: the people, the food, the landscape.

Outsiders face culture shock when they arrive. Physicians find that many of their patients speak little English and don't have health insurance. Medicaid and Medicare reimbursements are lower than in areas with higher costs of living.

This is the place Texas Tech University is building a new medical school. A shortage of physicians and lack of access to health care in this border area has provided the political will to spend millions of state dollars to remedy these woes.

Across the country, public pressure to resolve physician shortages in underserved areas is driving legislators to act. Armed with promises of state funding, medical schools are responding in a variety of ways.

One common theme is the idea that graduates of medical schools in underserved communities will stay for residency and ultimately to practice. They also hope these programs will inspire more Hispanics, blacks and other local residents to apply.

Studies show that residents often set up practice in the same place they do their postgraduate training. The tie to medical school is less strong, but there is some evidence that physicians from rural areas are more likely to practice in rural settings. Likewise, underrepresented minorities are more likely to practice in minority communities.

Ed Salsberg, director of the Assn. of American Medical Colleges' Center for Workforce Studies, said that if capacity is added to medical education, it makes sense to do it where there are fewer physicians.

In Texas, the El Paso school is expected to reach out to the burgeoning Hispanic population, recruiting students from the community as well as training nonlocals in hopes they'll stay. The Medical College of Georgia School of Medicine hopes the same as it establishes a clinical campus in rural southwest Georgia, which has a large black population.

Three years ago in Florida, a new medical school opened focused on raising the number of primary care physicians for small communities. Now, pressure from rapid population growth and an aging physician work force have two state schools seeking state approval to create medical schools. A third, Florida Atlantic University, has landed funding to train first- and second-year students who will then complete their third and fourth years at the University of Miami School of Medicine, expanding Miami's medical class.

Osteopathic schools also are expanding. Pennsylvania's Lake Erie College of Osteopathic Medicine is opening a branch in Bradenton, Fla. Touro University College of Osteopathic Medicine in California has plans for a branch in Las Vegas, and Philadelphia College of Osteopathic Medicine has its sights on a campus in Atlanta.

Homegrown docs

Back in El Paso, Dr. Islas said the new school is desperately needed.

"The medical school is a godsend for this area," he said. "The culture of the border is an intermingling of Mexican-American culture and the culture of poverty, and it's an art to learn to work with patients here."

Dr. Islas was born and raised in El Paso. He says having a school here would make it easier to find homegrown doctors and get more U.S. medical students excited about doing postgraduate training in El Paso.

Dr. Islas is a graduate of Texas Tech University Health Sciences Center School of Medicine in Lubbock, Texas.

"Lubbock is not a place that would naturally attract a lot of people," he said. "It's flat, mostly farmland and has a cowboy culture, but they've developed an amazing medical center. One of the strengths of Lubbock is that the city truly embraces its students."

Student spouses get some help finding jobs, and families are directed to good day care and schools for their children.

"When it comes to year four and the student graduates and chooses a residency, the kids are in school, the spouse has a job and they stay," he said. "They've been able to retain an amazing amount of American grads, and that has built the medical complex in Lubbock. We think we have the ability to do the same thing in El Paso."

M. Roy Wilson, MD, president of Texas Tech University Health Sciences Center, agreed.

"There is a shortage of physicians in Texas, and that area particularly has an extreme shortage of physicians, which applies to the border regions all the way down to southern Texas. ... The thinking is, if we can get some of the people who live in the area to go to school there, they're more likely to stay. And we'll get a lot more diverse groups, particularly Hispanics, if we have a medical school there."

Besides being a needed economic driver for the region, the school will emphasize research on what Dr. Islas calls the border apocalypse: diabetes, hypertension, obesity and depression.

Dr. Wilson pegged construction costs at $85 million, with another $25 million needed to get the labs running and recruit faculty. The state will pay to operate the school, and Dr. Wilson did not have an estimate for that cost.

Texas Tech in El Paso already has third- and fourth-year medical students doing clinical rotations there, and the hospitals have established residencies.

If all goes smoothly, a first class of 60 students will start in 2007-08. Eventually, school officials hope to admit 80 first-year students annually.