June
17, 2016--The first class of medical students gathered last week to mark the
opening of a branch of the New York Institute of Technology College of
Osteopathic Medicine on the campus of Arkansas State University in Jonesboro.
Starting new branches of medical schools in medically underserved areas is one
way of addressing doctor shortages.
Earlier
this month, dignitaries gathered at Arkansas State University in Jonesboro to
cut the ribbon on a new medical school, only the second in a state with a dire
shortage of doctors.
The
school will greet an incoming class of 115 students in August, but it will not
belong to the state university. The university will work with the private New
York Institute of Technology College of Osteopathic Medicine, which will train
future doctors in a leased building on campus.
The
arrangement is built on the premise that the best way Arkansas can attract and
retain doctors in a state that has among the fewestphysicians per capita and among the unhealthiest residents
is to educate and train them in-state.
The
Arkansas initiative is one of several that states are undertaking to address a
doctor shortage that is going to get worse in much of the nation, especially in
states with large rural areas or high concentrations of minorities.
States
such as Georgia and Texas are increasing their
number of medical residencies under the same premise as Arkansas: the idea that
doctors are more likely to remain in the states where they train.
Many
states offer grants and stipends to medical students and residents willing to
do clinical rotations in parts of their states where doctors are needed most.
Some
states have created branches of their medical schools in underserved areas to
attract doctors and residents to the regions. The University of Kentucky
College of Medicine, for instance, is creating satellite campuses in the
southern and eastern part of the state.
Arkansas,
Kansas and Missouri passed measures in the last two years that enable medical
school graduates to treat patients before completing their residencies.
Almost
all states have embraced telemedicine,
in which doctors use audiovisual technology to treat patients in remote
locations, notably rural areas, from afar. And several states, such as Arizona,
Maine, Maryland, Nevada, Vermont and Washington, have liberalized laws to
enable nurse practitioners and physician assistants to perform some treatment
normally done by doctors.
An Acute Shortage
The
nation is projected to face a shortage of as many as 94,700 physicians by the
year 2025, according to the most recent analysisby the Association of American Medical Colleges
(AAMC), which represents 145 American medical schools and 400 teaching hospitals
and health systems.
And
in 2014, providing the same amount of medical care to underserved areas would
have required as many as 96,200 more physicians, according to the AAMC.
The
shortage is especially dire in parts of the South, with its many rural areas
and minority communities. And in some states, tight budgets and projected
deficits have exacerbated the problem.
In
Louisiana, for example, the state’s ongoing budget troubles are endangering the
future of medical training programs, lawmakers were told earlier this year.
Proposed cuts to hospitals could stem the stream of residents for a generation,
in a state that has a shortage of health care workers and the unhealthiest population
in the nation.
Other
states’ doctor-training programs are cherry-picking some of Louisiana's top
talent, The Associated Press reported last month.
“The
dean of the School of Medicine tells me almost daily he's getting calls from
students saying, 'Is this really where I need to train? Should I stay here or
should I go someplace else?' " Larry Hollier, chancellor of the Louisiana
State University Health Sciences Center in New Orleans, told state senators.
Attracting Medical Residents
Residencies
often are the bottleneck in the physician supply chain.
The
AAMC says that the U.S. has a shortage of several hundred
residency slots as a result of a cap on Medicare spending on graduate-level
medical education.
That’s
why at least 27 states, including Kansas, Missouri, South Carolina and
Texas, offer grants and stipends to medical students and residents willing to
do clinical rotations in parts of their states where doctors are needed most.
Texas
offers a $500 housing and transportation allowance for those training in
underserved areas, for instance. Florida pays medical and nursing students up
to $3,000 for doing clinical rotations in community health centers.
But
other state efforts to provide medical care in underserved areas have been met
with opposition.
The
AAMC, the American Medical Association and the American Association of Colleges
of Osteopathic Medicine opposed the new laws allowing medical school graduates
in Arkansas, Kansas and Missouri to treat patients before finishing their
residencies.
They
argued that medical school alone doesn’t prepare a physician to begin
practicing. For that, they said, graduates still need clinical residency
training.
More Schools, More Students
The
solution to the shortage is producing more doctors, and the nation doing so
gradually.
The
AAMC says medical school enrollment — nearly 87,000 — has
increased 25 percent since 2002.
The
increase is even more pronounced when it comes to doctors practicing
osteopathic medicine, who are trained in separate medical schools and treat
patients more through touch and physical manipulation.
Since
2002, the number of students enrolled in osteopathic medical
school has more than doubled, to nearly 26,000, according to the American
Association of Colleges of Osteopathic Medicine.
Osteopathic
medical schools also have a tradition of locating in underserved areas. And as
the new partnership in Arkansas shows, they will branch out into other states,
often in association with existing universities.
The
Edward Via College of Osteopathic Medicine (VCOM), a nonprofit, opened its
first campus in 2002 on the campus of Virginia Tech University, in southwestern
Virginia. At the time, all three of the state’s medical schools were in the
eastern part of the state.
State
officials and those at Virginia Tech concluded that the VCOM campus would be
the best way to address the severe doctor shortage in that part of the state.
In
recent years, VCOM opened new branches in South Carolina, in partnership with
Wofford College, and in Alabama, with Auburn University as its partner.
This
fall, the nonprofit Burrell College of Osteopathic Medicine will welcome its
first class on the campus of New Mexico State University. The hope is that the
school will bring doctors to underserved southern New Mexico.
The
new partnership in Arkansas, between the public university and the private
medical school, grew out of talks on how to bring more primary care doctors to
the rural and poor Delta region of the state.
Rather
than start its own costly medical school, Arkansas State University concluded
in 2013 that attracting a branch of an osteopathic school would be best because
of osteopathic medicine’s emphasis on primary care and because its schools do
not require large research facilities that are expensive to maintain.
The
medical school will lease the historic, centrally located Wilson Hall on the
university’s campus for about $300,000 a year. Renovations cost $12.6 million,
with each school contributing $2.3 million up front. Arkansas State University
borrowed to cover the rest of the costs, which is expected to be paid back from
rent paid by the medical school.
Jason
Penry, the university vice chancellor, said the new school will recruit
students heavily from Arkansas to increase the chances that graduates will
remain to practice in the state.
Medical
school students will have the same access to the university’s libraries, gyms
and other facilities as other students. And the medical school will be equipped
with technology so that students on the Long Island and Jonesboro campuses can
attend lectures at the other.
“In
a resource-short environment this was a way of bringing decades of experience
in medical education to the state and region in need,” Penry said.
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