Expecting a Surge in U.S. Medical Schools

[Guest guest]

Expecting

a Surge in U.S.

Medical Schools

By ANEMONA HARTOCOLLIS

applied to 30 medical schools

after graduating from the University of Pittsburgh

last year. Twenty-eight said no.

Of the

two that said yes, one had something in common with Mr. : It, too, was

starting out in medicine. He enrolled in the inaugural class of The

Commonwealth Medical College in Scranton,

Pa.

“I

was ecstatic that I had been accepted to a medical school,” Mr.

said, adding that he would have gone for a master’s in bioengineering if

he had not been accepted. “It’s a giant sigh of relief; it secures

your plans for the rest of your life really.”

The

Commonwealth is one of nearly two dozen medical schools that have recently

opened or might open across the country, the most at any time since the 1960s

and ’70s.

These new

schools are seeking to address an imbalance in American medicine that has been

growing for a quarter century. Many bright students were fleeing to offshore

medical schools, or giving up hope entirely, when they could not get into

domestic schools. Meanwhile, American hospitals were

using foreign-trained and foreign-born physicians to fill medical residencies.

During the 1980s and ’90s only one new medical school was established.

“Huge

numbers of qualified American kids were not getting into American medical

schools or going abroad to study,” Dr. Lawrence G. , dean of the

proposed Hofstra

University School of Medicine, in Hempstead, N.Y., which is not yet

recruiting students, said last week. “I think it was a kind of wake-up

call.”

The

proliferation of new schools is also a market response to a rare convergence of

forces: a growing population; the aging of the health-conscious baby-boom

generation; the impending retirement of, by some counts, as many as a third of

current doctors; and the expectation that, the present political climate

notwithstanding, changes in health care policy will eventually bring a tide of

newly insured patients into the American health care system.

If all

the schools being proposed actually opened, they would amount to an 18 percent

increase in the 131 medical schools across the country. (By comparison, there

are 200 law schools approved by the American Bar Association.)

And beyond the new schools, many existing schools are expanding enrollment,

sometimes through branch campuses. While The Commonwealth is an independent

school, many of the other new or proposed schools are affiliated with

established universities, like Hofstra, which is teaming up with North Shore

Long Island Jewish Medical Center; Quinnipiac University in

Hamden, Conn.; the University of

California, Riverside; Central Michigan University; and Rowan University in

Camden, N.J.

Supporters

of the expansion say that having more doctors will improve care, by getting

doctors to urban and rural areas where they are needed, by shifting care to

primary and family practice physicians rather than expensive specialists, and

by reducing long waits for people to see a doctor and get the care they need.

But

skeptics say that although many parts of the country do need more primary care,

American doctors tend to congregate in affluent, urban and suburban areas that

already have a generous supply.

They say

that doctors create demand for their own services, and that nurse

practitioners and physician assistants could fill gaps in medical care at a

lower cost.

“When

you add more physicians to an area, they just add more services, and their

salaries don’t go down anywhere near in proportion to the increased

supply,” said Dr. Goodman, professor of pediatrics at the

Dartmouth Institute

for Health Policy and Clinical Practice and a practicing physician who has

studied work force issues for 20 years. “More care may not be better, but

it certainly is paid for,” Dr. Goodman said.

Many of

the developing medical schools are well aware of such arguments, and are

billing themselves as different from traditional medical schools, more focused

on serving primary care needs in immigrant and disadvantaged communities.

Administrators say that they expect that approach to be buttressed by a shift

in state and federal reimbursements from specialists to primary care doctors.

Riverside

County, an inland area with a diverse population including immigrants and

Native Americans that has expanded rapidly, has a deficit of about 3,000

physicians, according to Dr. G. Olds, founding dean of the University

of California, Riverside School of Medicine.

Riverside has

applied for licensing, the first step toward becoming a medical school, and

hopes to admit its first four-year class in 2012, and to have 400 students by

2016, a typical size for the new crop of schools. Dr. Olds said his educational

focus, building on his background as a tropical disease specialist, would be on

prevention and “wellness.”

“I

think we have to crank out different kinds of doctors,” said Dr. Olds,

who started his new job Feb. 1.

Whether

the demand for new medical schools exists among patients, it clearly exists

among prospective doctors.

Dr. Olds

said that at his former job as chairman of medicine at the Medical

College of Wisconsin, 25 percent of the students came from California. “So

obviously there’s a ton of California

kids trying to get into medical school traveling a long way.”

The Association

of American Medical Colleges, a trade group, has called for a 30 percent

increase in enrollment, or about 5,000 more doctors a year. The

association’s Center for Workforce Studies estimates

that 3,500 more M.D.s will enter graduate training over the next 10 years, roughly

half of the 7,000 international medical school graduates now entering medical

residencies in the United

States every year, according to

Salsberg, director of the center.

At

Quinnipiac, the trustees last month approved plans for a new medical school, to

open in 2013 or 2014, if it passes accreditation. L. Lahey, the university

president, said that the proposed school would build on the university’s

existing health sciences programs, and the hope was to recruit at least some

students who had worked in health care and wanted to become doctors.

“We

certainly think they will be what we tend to call nontraditional students,

older, some minority,” Dr. Lahey said.

Six

developing medical schools, including The Commonwealth, have received preliminary

accreditation, enabling them to begin recruiting students, and six more,

including Riverside,

have begun the application process, according to the Liaison

Committee on Medical Education, which accredits American medical schools.

An additional 11, including Quinnipiac, have announced their intention to apply

for licensing, according to Mr. Salsberg.

Whatever

the expansion may mean for the cost of health care, it is a relief to aspiring

doctors like Mr. , who took tough undergraduate courses and had a busy

extracurricular life of mock trials, robotics and work as an emergency medical

technician. His pre-med adviser told him that with his 3.3 grade-point average,

he should apply only to osteopathic schools, but he persisted, and was admitted

to The Commonwealth and New York Medical College

in Valhalla, N.Y.

He was

one of 1,300 applicants for 60 positions (eventually class size will double) in

the inaugural class at The Commonwealth, according to Dr. M.

D’Alessandri, the president and dean. Mr. has a United States Navy

scholarship, but for his classmates, the school took $20,000 a year off the

tuition, a reduction of about half, as an incentive to take the risk of a new

school.

Given the

pent-up demand, Dr. D’Alessandri said, he was not worried that he might

produce too many doctors for the good of society. “We should worry about

too many lawyers,” he said dryly.

This

article has been revised to reflect the following correction:

Correction: February 17, 2010

A picture caption on Monday with continuation of an article about an increase

in new medical

schools in the country misstated the given name of a student at the Commonwealth Medical

College in Scranton, Pa.

She is Sidari, not .