Medical Schools Work to Expand: If We Build It,
Will They Come?
Nov.–Dec. 2006
Responding to a growing sense of urgency over the potential shortage of physicians in the coming years, a number of medical schools across the country are pursuing innovative approaches to increase their enrollment levels.
The AAMC surveyed the 125 U.S. allopathic medical school deans regarding their expansion plans. Of the 116 who responded, 40 percent indicated they had already increased their enrollment or “definitely” or “probably” planned to, with another 16 percent saying that they “possibly” would do so. But those increases alone may still not be enough to meet the growing demand for doctors in the next few decades; current efforts are projected to boost enrollment by only about 9 to 12 percent between 2005 and 2015.
Many of these schools are in states like Kentucky, Texas, and Oregon, which are confronting physician shortages. “We are desperately short of general surgeons, primary care doctors, and OB-GYNs,” said Michael Karpf, M.D., executive vice president for health affairs at the University of Kentucky School of Medicine and chair of the AAMC Advisory Panel on Health Care. “Training more physicians is a critical issue here.” The university has already added 10 new slots for incoming students, boosting its overall enrollment by 10 percent, and Karpf says that he expects to begin discussions with senior faculty soon regarding an additional 10 percent enrollment increase.
Other states face concerns about the lack of medical school opportunities for residents. This is particularly true for states that have grown rapidly over the past several decades. As a result, some states are not just boosting medical school enrollment – they are adding schools. New allopathic medical schools or branch campuses are planned or under consideration in at least seven states and Puerto Rico. Florida is considering two new schools. In New Jersey, plans are being developed to convert a Camden clinical campus into a four-year medical school in the University of Medicine and Dentistry-New Jersey system.
“The number of physicians trained in Oregon is half the national average,” said Joseph Robertson, M.D., dean of Oregon Health and Science University (OHSU). “Last year, for the first time, we showed an actual drop in the number of physicians per capita. By 2015, we are projecting a significant workforce shortage in almost every specialty.” To head off a potential crisis, OHSU has already added 20 slots between 2002 and 2006, going from 100 to 120 matriculants, and hopes to add another campus in Eugene, which will allow it to increase its enrollment by an additional 40 students.
A new partnership with the University of Oregon and Peace Health, the largest health system between Portland and San Francisco, will allow OHSU to reduce capital needs and increase its number of students much more quickly than if it had to build a whole new facility. “It’s very much a convergence of resources,” Robertson said. “Fortuitously, Peace Health and the University of Oregon are located right across the street from each other. The university can provide faculty and facilities for basic science instruction, and Peace can provide clinical rotation sites.”
Fourth-year students will be placed at the Eugene location in the fall of 2006 for electives, with third-year students added in the fall of 2007 and first-years on site by the fall of 2008. “Placing first-year students on campus is contingent on obtaining additional support from the legislature,” Robertson cautioned. “We’ll need support by next spring if we are to place members of a first-year class there 18 months later. The case is so compelling that I’m relatively optimistic that we’ll be successful.” Because of a systems-based continuity curriculum that OHSU wants to keep intact, all second-year students will continue to be taught at the main campus. If the Eugene model succeeds, Robertson would like to replicate it elsewhere, and has already initiated discussions with Oregon State University, based in Corvallis.
Texas medical educators are taking a slightly different approach. Since January 2003, Texas A&M Health Science Center College of Medicine, the smallest medical school in the state, has increased its enrollment from 54 to 85 students per class. In January, the state’s Board of Regents authorized the school to more than double that figure, expanding enrollment to 200 students per class, in an incremental fashion in accordance with LCME guidelines. The school plans to start by boosting the 2007 incoming first-year class to 100 students and then ramping up by 20 students per year.
This poses a facilities challenge for the school, which has a “two plus two” system: first- and second-year students pursue preclinical studies at one campus in College Station, while third- and fourth-year students do clinical rotations in Temple, 20 miles away. To accommodate the new students, Texas A&M plans to turn both into four-year programs. “We have one medical school with one curriculum, but we’re going to have two four-year campuses, as well as additional clinical campuses in other communities like Corpus Christi as we grow bigger,” said Chris Colenda, M.D., M.P.H., dean of the medical school.
Like Oregon, Texas A&M requires state funding to help make this vision a reality. “We need support for a new biomedical sciences lab and additional educational space, for example,” Colenda said. “We’ve already initiated the legislative process necessary to have the state help us with our building program, and we’re moving forward with the expectation that this will be successful.”
But enrollment increases confined to just a few states will not be enough to alleviate a growing national problem, said Ed Salsberg, director of the AAMC’s Center for Workforce Studies. In recommending a 15 percent medical school enrollment increase in February of 2005, the AAMC urged that the increase be concentrated in areas of the country where population growth and other factors are likely to make shortages particularly acute.
Now, at its upcoming June meeting, the AAMC’s Executive Council will consider endorsing an AAMC position statement that allopathic medical schools should increase overall enrollment by 30 percent over the next decade. The new proposed association policy calls for all members, regardless of location, to consider enrollment increases. (NOTE: Since the publication of this article, the AAMC posted the aforementioned position statement to their website. This statement can be found at www.aamc.org/workforce/workforceposition.pdf.)
Under current levels of growth, the physician-to-population ratio will peak in about 2016 — the year that the baby boom generation, with record numbers of individuals and high expectations for its medical care, begins to turn 70. This is a recipe for health care disaster, said Salsberg. “We will also be facing growing physician retirements at the same time that the population most in need of health care is growing.”
In fact, even with a 30 percent increase in enrollment that would result in an additional 4,700 new medical school graduates a year, the physician-to-population ratio in the United States will still decline by 2020. From 1980 to 2005, the country’s population grew by more than 30 percent to 69 million. During this time, while allopathic medical school enrollment was flat, the number of allopathic first-year students per 100,000 population fell from 7.3 to 5.8 per 100,000 population; even with a 30 percent increase, the number will rise only 6.4 per 100,000 by 2020.
“A 30 percent increase will only add about 5,000 new graduates a year, which is about half of 1 percent, when the U.S. population is growing at a more rapid rate annually. To meet the future health care needs of Americans, this recommendation is actually a modest one,” Salsberg said.
Despite the evident challenges involved – such as scholarship availability, costs of expansion, and limited classroom and laboratory space – many medical school deans and other executives are strongly supportive of the proposed 30 percent increase. “Our academic community is a data-driven organization, and the data is really pretty compelling,” said Karpf. “Workforce shortages aren’t just looming in the distant future; they’re right on the horizon.”
One size does not fit all when it comes to workforce expansion, agreed both Colenda and Robertson – who heartily endorse the AAMC’s workforce proposal. “There will no doubt be a degree of heterogeneity across the country as we pursue these goals,” Colenda said. “But the AAMC’s workforce projections of need and supply are the best estimate that we have, and I think they make strong policy sense.”
Source: AAMC Reporter, April 2006 – By Gina Shaw, Special to the Reporter; www.aamc.org.
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