New medical schools open, but physician shortage concerns persist

The number of residents and fellows also is increasing, but not enough to match the loss of retiring physicians.

By — Posted March 29, 2010

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Not a single allopathic medical school opened its doors during the 1980s and 1990s.

But since 2007, more than a dozen allopathic schools have started the Liaison Committee on Medical Education accreditation process. Another 10 are under discussion, and five osteopathic medical colleges have opened.

The surge in new medical schools is taking place as the Assn. of American Medical Colleges predicts a shortage of at least 125,000 physicians by 2025. Hopes among educators and physician leaders are high that the new schools can help underserved areas and spur local economic growth.

But some experts on work-force issues say new schools are not enough. They say that without more federal funding for residency slots or changes in the doctor payment system, the schools are unlikely to avert an overall work-force shortage or address the undersupply of primary care physicians and general surgeons.

"In the 1980s and 1990s, there was a worry about a surplus of physicians," said Edward Salsberg, director of the AAMC's Center for Workforce Studies. But the association's 2006 call for a 30% increase in medical school enrollment "has been pretty influential, because it sort of gave the stamp of approval to schools that were wondering what they should do."

Many of the new schools' deans say they hope they can help ease the shortage of primary care doctors in their areas.

For example, the Texas Tech University Health Sciences Center Paul L. Foster School of Medicine in El Paso admitted its charter class of 40 students in July 2009. The school's founding dean, Jose Manuel delaRosa, MD, said its priority is supplying physicians to meet the needs of El Paso, the Texas-Mexico border area and rural West Texas. The area's physician supply is less than half the national average of 254 doctors per 100,000 residents, he said.

"We need to recruit [students] from the border and teach them on the border to keep them on the border," Dr. delaRosa said.



The new schools and expansion at existing schools will increase first-year enrollment by 21% in 2013, according to a May 2009 Center for Workforce Studies report. But the Balanced Budget Act of 1997 capped the number of new Medicare-paid residents that each teaching hospital can claim.

The number of residents and fellows increased 8% from 1987 to 2007, according to an AAMC report, but that growth rate will not be enough to match the loss of baby boomer physicians set to retire soon. One in three active physicians is 55 or older, Salsberg said.

The most likely effect of the new schools will be to change the composition of students filling residency slots, said Richard "Buz" Cooper, MD, professor of medicine at the University of Pennsylvania School of Medicine and co-chair of the Council on Physician and Nurse Supply.

The new schools are "necessary but not sufficient," Dr. Cooper said. "We will need more U.S. grads -- we can't continue to depend on [international medical graduates]. But unless graduate medical education is expanded, the new grads will simply replace IMGs, and there will be no increase in supply."

The American Medical Association supports lifting the cap on Medicare-supported residency positions. The Association also favors federal legislative initiatives that would provide new money for graduate medical education.

New schools alone won't solve the primary care shortage, because graduates from these new schools will be no more likely than any other graduates to enter primary care-related residencies, said Robert L. Phillips Jr., MD, MPH.

"The physician income gap that's grown so much in the last 20 years is affecting students' choice of what to go into and also is affecting what residencies are built -- they go where the money is," said Dr. Phillips, vice chair of the Council on Graduate Medical Education and director of the American Academy of Family Physicians' Robert Graham Center: Policy Studies in Family Medicine and Primary Care. "The reason we're not filling the primary care spots is because of the pay differential. And students have more choices of other residencies because of what we've built in the last decade."

New school math

It can cost $100 million to $150 million to start a new medical school -- building facilities, attracting faculty, paying operating expenses -- yet universities say the cost is worth it, said Emery A. Wilson, MD, principal at Lexington, Ky.-based DJW Associates. The medical education consulting firm has advised more than a half dozen universities that are exploring whether to start new medical schools.

"First, there is a need for more physicians, so it's easier to justify the cost of starting a medical school if you're answering a perceived need," Dr. Wilson said. "Second, we have a lot of young people who are interested in going to medical school, and a lot of private schools have 5,000 or more applicants for a class of 100 students."

Attracting applicants has not been a problem for the new schools that have started recruiting or enrolling students.

"The problem is just narrowing it down," said Cynda Ann Johnson, MD, president and founding dean of the Virginia Tech Carilion School of Medicine in Roanoke. Despite lacking full LCME accreditation, nearly 1,700 students applied to be part of the school's charter class of 42 students that begins Aug. 2.

In Florida, first-year student Brittany Moscato was attracted to the University of Central Florida College of Medicine in part by the college's offer of a full four-year scholarship for its charter class. But she also checked to make sure the school's preliminary LCME accreditation status would not hurt her chances of a good residency position.

"A new medical school might not be attractive to some people," Moscato said. "But I have that pioneering spirit, as do all of my classmates. We want to be part of something bigger than ourselves so we can look back and say, 'I helped start that legacy.' "

Another new school is planned for Connecticut. Quinnipiac University announced in late January that it will open a medical school. The university hopes to hire a dean and establish clinical partnerships by this summer, said President John L. Lahey, PhD.

Estimated costs to start the new school will be $75 million, and $35 million will subsidize the school until it is self-funding within a decade, Lahey said. The university is saving money by rehabbing a building it purchased in North Haven, Conn., instead of doing new construction.

"Health is the dominant conversation in this country and, particularly in the primary care areas, there is an acute need for doctors in urban and rural areas," Lahey said. "So we think there's clearly a market for what we're looking at."

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Where the new schools are

Since 2007, more than two dozen medical schools have opened, begun accreditation or started discussions to open -- the biggest surge in decades.

There are 13 allopathic schools in the accreditation process, with at least 10 more in the planning stages. In addition, five new osteopathic schools have opened across the country. Educators and physician leaders hope that the graduates of the new schools will help ease a predicted physician shortage, but they add that more funding and residency positions will be needed to avert future holes in the overall work force.

Sources: American Assn. of Colleges of Osteopathic Medicine; Assn. of American Medical Colleges; news reports; "Institutions with Developing Medical Education Programs that have Applied for Preliminary Accreditation by the LCME," Liaison Committee on Medical Education, March 5 (link)

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External links

"Institutions with Developing Medical Education Programs that have Applied for Preliminary Accreditation by the LCME," Liaison Committee on Medical Education, March 5 (link)

Presentations including "The State of the Physician Workforce: With Medical School Expansion Underway, What's Next?" Assn. of American Medical Colleges Center for Workforce Studies, Nov. 2, 2008 (link)

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