World Report

US plans to boost number of medical schools
Several US states are forging ahead with plans to build new medical schools in a bid to increase the number of US-trained physicians and fill gaps in certain specialties. Sharmila Devi reports.
Around 18 new medical schools are planning to open across the USA in the next few years—the biggest expansion of training since the 1970s that proponents hope will reduce what they call a looming crisis in physician shortages but critics say fails to address an irrational distribution of valuable resources. In the absence of any centralised planning, several US states and private institutions have individually embarked on new medical schools. They are spurred by several factors including gaps in primary care, growing use of foreign-born and foreign-trained physicians, the upcoming retirement of nearly a third of doctors in the next decade or so, and the growing needs of the ageing baby-boomer generation. Health-care reform, currently stalled in Congress but subject to a renewed push by President Barack Obama last week, could also add an estimated 30 million newly insured Americans to the system. Six medical schools have received licences or have them under review and another 12 regions were discussing new institutions, which would add to the 131 medical schools currently operating in the USA, said Edward Salsberg, director of the Centre for Workforce Studies at the American Association of Medical Colleges (AAMC), which represents the major teaching hospitals. “It is absolutely ridiculous to suggest we don’t need an increase in medical school enrolment and it’s way overdue”, says Salsberg, who noted that 2500 American students go outside the USA for their training every year. “Even if you think we don’t need more physicians, we have to meet the need for more training of US citizens.” “Over the past 20 years, the number of doctors in relation to the American population has risen by 30%. Yet in many parts of the country, more doctors has simply meant more doctors, not better access for patients, not better communication among a patient’s health care providers, and not better results”, said a New York Times opinion article by Goodman and Shannon Brownlee, a senior research fellow at the New America Foundation, last month. “The truth is that regions with the highest number of doctors per capita tend to deliver lower quality care at a higher cost.” They argued against the call by the AAMC and others to include in any health-care legislation the addition of 15 000 new medical residency slots to the 100 000 residencies that the federal government currently finances. “Increasing the number of doctors would make our health care system worse, not better, because the United States doesn’t actually need more doctors”, they wrote. “What we do need is for primary care to reclaim its central role in the delivery of medicine, to provide the preventive care, chronic disease management and coordination of services that is lacking in so many parts of the country.” However, several of the new medical schools were very much focused on the need for more primary-care doctors and were creating innovative ways to attract students into the specialty. “Research showed some time ago that the biggest predictor of a student choosing a career in primary care was service in the Peace Corps”, says Richard Olds, founding dean of the University of California’s new Riverside School of Medicine, who referred to the US federal volunteer agency. “We need modification of Vol 375 March 6, 2010

“...2500 American students go outside the USA for their training every year.”
The AAMC has called for a 30% increase in enrolment or about 5000 more doctors a year. There are about 774 000 active physicians at present in the USA, says Salsberg. “We have called for an increase that does not meet actual demand because we agree we need to improve the delivery system but not all future needs can be met by redesign. You have to be cautious about thinking the system will be radically redesigned in the near future”, he said. “Around two-thirds of the new schools are being planned at the state level and it’s hard to believe all these states were doing this if they didn’t have convincing evidence of need.” But vocal critics including David Goodman, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA, argue that there is no simple supply-side solution to physician shortages, particularly with the difficulties in filling primary-care jobs, and addressing low levels of pay relative to specialists and fragmented care across the country.

The printed journal includes an image merely for illustration
New York Times/eyevine

First-year medical students at Commonwealth Medical College, Scranton, PA, USA


World Report

recruitment strategies across the board and, at selection, we must make more emphasis on commitment to community.” Riverside hopes to admit its first students by 2012 and to retain most of its graduates within its urban region, which lies some 50 miles east of Los Angeles and was notable for its high diversity, a population that was both growing and ageing, and suffering from a shortage of primarycare doctors, says Olds. Riverside’s strategy was simple in one sense; drawing more students from the local community would make it more likely they would stay and better represent their community. To that end, Riverside encourages its science undergraduates to take part in a programme that mentors and teaches local high school pupils. “We take intelligent high school students with scores that would suggest they have very little chance of entering medical school and put them into study groups to create a pool that we can ultimately draw on for medical school”, he said. “They can’t flunk out and it may take 6 or 7 years of coaching but we’ve been very successful on a small scale. We should be able take any intelligent kid and turn them into a great doctor.” Quinnipiac University, Hamden, CT, USA, also hoped to attract nontraditional students to its new medical school when it opens its doors in 2013 or 2014. “We’ll be different from the established schools in drawing from people already in the health industry”, said John Lahey, president of the university, which trains health professionals including nurses, therapists, and physician assistants. Quinnipiac also works on global health issues in many developing countries, such as Costa Rica, Gabon, and Haiti. “Global health is primary care and we hope by giving our students some experience in these countries it will inspire them to enter this field”, says Lahey. Vol 375 March 6, 2010

“‘Despite the negative press given to generations X and Y, I don’t think most people today entering medicine expect to get rich’.”
health-care revenues, much of it to neighbouring New York, so there was a clear interest in developing local resources, he explains. “While not solving all the problems in primary care, reducing debt will allow students to have more options”, he says. “We suffer from a discontinuous care system and an educational model that’s not integrated in which doctors and nurses only meet at the bedside. We want to change that.” Students at Commonwealth are assigned to a local, multigenerational family whom they follow for 4 years. “Students get to hear all the things that doctors don’t usually hear about, like problems with billing, waiting times, and so on”, says D’Alessandri. Primary care was not the only specialty experiencing shortages, said Lawrence Smith, dean of the Hofstra University School of Medicine, Hempsted, NY, USA, a new school formed with the North Shore-Long Island Jewish Health System that planned to admit its first class next year. “Primary care gets big play but our region is suffering from shortages in obstetricians, general surgeons, psychiatrists—all jobs on the lower side of the pay scale and not seen as

US medical schools are looking at new ways to attract students into primary care

prestigious in terms of lifestyle”, he says. But Smith was optimistic about young people’s sense of altruism and he did not expect the recession to lead to a greater number of students seeking to make money as specialist doctors instead of on Wall Street. “Despite the negative press given to generations X and Y, I don’t think most people today entering medicine expect to get rich”, he says. Although the opening of new medical schools stalled over the past few decades, there had been a rise in new osteopathic institutions but there is still a definite need for an overall increase in physician training, says Stephen Schoenbaum, an executive vice-president at the Commonwealth Fund, a foundation that supports health-system research. “The US for many years has been importing physicians and they now make up about a quarter of the workforce”, he explains. “Opinions about that range from it’s unethical to be taking physicians away from countries that need them more to economic arguments about how it’s less expensive to educate them here”, he says. “Putting aside moral and economic arguments, we have to think about requirements in the US as well as how to increase diversity in the physician workforce.”

Sharmila Devi


Scholarships to attract more students were being offered by the independent Commonwealth Medical College, Scranton, PA, USA, which started classes last year and was set up with financial help from Blue Cross of Northeastern Pennsylvania, a nonprofit insurance company. The college offers US$20 000 a year scholarships for its 4-year courses—in effect cutting fees by half and all the funds are raised locally, says Robert D’Alessandri, president and dean. The state lost nearly $1 billion per year in

The printed journal includes an image merely for illustration

Sign up to vote on this title
UsefulNot useful