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 MEDICAL EDUCATION

DOs vs. DOs

Proposed medical school creates rift between osteopathic physicians, UNT

BY KEN ORTOLON Virtu­ "Not only are you

ally everyone agrees threatening to take away
Texas needs more physi­ financial resources from a
cians. The state's physi­ very good school that has
cian-to-population ratio an excellent reputation, by
is well below the na­ doing that you're going to
tional average, and Texas potentially threaten not
has shortages of doctors only the quality of the edu­
in nearly every recog­ cation for all students, but
nized specialty. the long-term availability
Yet a proposal to cre­ of more primary care
ate a new medical school physicians for Texas," said
in the Dallas-Fort Worth Laredo family physician
area is drawing harsh David Garza, DO. "It's no
criticism from at least secret that TCOM gener­
one segment of the med­ ates a disproportionate
ical community. number of primary care
Some osteopathic physicians, many of whom
physicians strongly op­ practice in rural and other
pose a University of underserved areas of
North Texas Health Sci­ Texas," said Dr. Garza, a
ence Center (UNTHSC) member of the Texas Os­
proposal to create an al­ teopathic Medical Associa­
lopathic medical school tion (TOMA) Board of
to share facilities and fac­ Trustees.

ulty with its existing

Both the TOMA board
Texas College of Osteo­ and the TCOM Alumni As­
pathic Medicine (TCOM) sociation Board of Direc­
in Fort Worth. tors oppose the new
UNTHSC officials say school. UNTHSC officials
the proposed allopathic UNTHSC President Scott Ransom, DO, says the proposed MD school
counter that they have re-
medical school has broad will meet the need for more physicians in the Dallas-Fort Worth area. ceived letters from dozens
support from area hospi­ of supportive osteopathic
tals, civic and business physicians who believe it
leaders, and the Tarrant County Medical Society. They be­ will improve TCOM and UNTHSC's ability to train more
lieve it will not only increase the number of new physicians physicians.
trained in Texas, but also attract more research dollars for "I now believe that an MD school working with TCOM
Z UNTHSC and expand clerkship and residency training op­ could provide a healthy partnership," TCOM founder Carl E.
...J
o portunities for both allopathic and osteopathic students Everett, DO, wrote in his letter of support.
U
Z through new partnerships with Fort Worth hospitals.
...J
However, osteopathic physicians are concerned it actually The pros and cons
would drain resources from TCOM. UNTHSC began exploring adding an MD degree program to

March 2010 TEXAS MEDICINE 45

"I now believe that an MD
school working with TeOM
could provide a healthy
partnership."
its Fort Worth campus in November
2008, when the UNT Board of Regents
authorized a study group to evaluate
the likely benefits and liabilities of
such a school.
UNTHSC President Scott Ransom,
DO, says that decision was a response
to interest among Fort Worth commu­
nity leaders. He says there are several
reasons community leaders want the
new school, including what he called a
desperate need for more doctors in the
Dallas-Fort Worth area.
In a resolution supporting the pro­
posed school, the Fort Worth Chamber
of Commerce said rapid population
growth in both Fort Worth and Texas,
"coupled with existing physician short­
ages, have created a critical demand
now and in the future for physicians of
all types, both primary care and spe­
cialists. An allopathic medical school
would supplement the Texas College of
Osteopathic Medicine's provision of
high-quality health care providers and
increase the University of North Texas
Health Science Center's ability to re­
tain physicians in Tarrant County."
Dr. Ransom says there's also a
"pride issue" involved. Fort Worth is
the largest city in the country that does
not have an MD-granting medical
school, he says.
Former Fort Worth Mayor Kenneth
Barr chaired the study group, which in­
cluded representatives of local hospi­
tals, business groups, the Texas
46 TEXAS MEDICINE March 2010
create a more detailed business plan,
Hospital Association, the Texas Med­
ical Association, Tarrant County Med­
ical Society, TOMA, and others. In its
report, presented to the UNT regents in
March 2009, the group concluded that
adding an MD degree program would
help establish additional teaching hos­
pitals to provide clinical education ex­
periences for both MD and DO
students. The panel also said it would
enable expansion and diversity of
graduate medical education (GME)
opportunities in Tarrant County.
The study group added that an MD
school would increase UNTHSC's com­
petitiveness for grant funding, expand
clinical research opportunities, in­
crease the appeal of UNTHSC in re­
cruiting faculty and students, increase
the appeal of Fort Worth and sur­
rounding communities in recruiting
new physicians, and establish a "new
focus of pride" for Fort Worth and its
medical community.
UNTHSC hired consulting firm Price
Waterhouse Coopers to help develop a
business and academic plan for the
new school. That plan, presented to
UNT regents in November 2009, esti­
mated that creating the new MD pro­
gram would cost $25 million in
start-up funding
At that November meeting, the
regents unanimously authorized
UNTHSC officials to move forward
with their plans, but directed them to
focus on four areas, including develop­
ing commitments to TCOM and other
campus programs "to make sure we
protect and secure the future success
for all current programs, schools, and
colleges," Dr. Ransom said.
The regents also instructed officials
at UNTHSC to develop clinical educa­
tion agreements with local hospitals,
and raise the necessary start-up funds.
Once UNTHSC officials address
those issues, they will seek regents' ap­
proval to ask the Texas Legislature to
authorize the new medical school in
201l.
Dr. Ransom says an initial class of
first-year medical students could enroll
as early as fall 2013. Class size likely
would be set at 100 students.
UNTHSC's consultants estimate the
school needs $6.7 million for the initial
planning phase and $14.8 million in
actual start-up costs beyond the ex­
pected tuition revenue and normal for­
mula funding support.
Another $2.7 million would pay for
renovating the existing TCOM class­
room building to house the allopathic
students. TCOM already plans to move
its students into a new 113,000-square­
foot building required by recent in­
creases in its class size.
Dr. Ransom says TCOM and the MD
program can share the newly reno­
vated anatomy laboratory and a clini­
cal skills lab in the new building.
Further, the new MD school would
recruit new faculty to complement ex­
isting UNTHSC faculty from depart­
ments such as anatomy, cell biology,
physiology, obstetrics, and surgery, he
says.
Dr. Ransom said the MD school "will
establish an independent dean suite
that would have a full-time MD school
dean and associate deans for student
affairs, academic affairs, clinical re­
search, finance, and other normal sup­
port personnel, which presents a
relatively limited incremental cost." He
added that the "substantial cost of a
new medical school is facilities and es­
tablishing brand new departments and
service units from scratch. For the most
part, we have the buildings, we have
the service units, and we have a strong

base of faculty from which to build. We
would need to add faculty and staff in­
crementally to add to these existing in­
frastructure departments to support
the new program and these additional
students."
Follow the money
While start-up expenses may be lower
because of the existing infrastructure,
opponents of the plan say ongoing
costs to train allopathic students are
considerably higher than training os­
teopathic students.
"They say that because they already
have basic science facilities, they al­
ready have teaching facilities, they al­
ready have some faculty that they don't
need to spend as much as some other
schools," said Dallas orthopedic sur­
geon and TOMA President George
Cole, DO. "The reason they do have to
spend that money is because they've
got to be accredited by the Liaison
Committee on Medical Education,
which has extensive requirements for
full-time paid clinical faculty to teach
those students where we (osteopathic
schools] don't." The Commission on
Osteopathic College Accreditation ac­
credits osteopathic schools.
Dr. Cole says Michigan State Univer­
sity has both osteopathic and allo­
pathic schools, and the cost of training
an MD student there is roughly three
times that of a DO student.
Both Dr. Cole and Dr. Garza are
afraid UNTHSC will take resources
away from TCOM to meet those addi­
tional costs. "It can't work financially
without taking resources from TCOM,"
Dr. Cole said.
Some TCOM students also have con­
cerns about potential negative impacts
on their school.
"The students of TCOM welcome
students of this proposed MD program
on our campus and any potential op­
portunities to work together," said
Joanna Gibbons, a member of the Med­
ical Student Government Association.
"However, there are student concerns
that the addition of an MD program
could be at the expense of the potential
to expand and improve our current os­
teopathic school. We are unsure of how
Advertising Directory
such a program could be established on
a campus already expanding to accom­ Advocate, MD Insurance ...... 30
modate the current student load with­ AMA Healthier Life Steps 36
out utilizing resources that would
American Physicians Insurance Co ....... 50
otherwise go towards TCOM students,"
she said. BBVA Compass Bank.. .. . . 10
UNTHSC leaders disagree. Be Wise - Immunize.. . 53
"The $25 million start-up support
Capelo Law Firm.. .. ...... .41
will come from the community and will
prevent any resources being diverted Covenant Medical Group ..... ....... 34
from TCOM or any other campus pro­ Frost Bank .... .. .. 29
gram," Dr. Ransom said. "The new MD
Hard Hats for Little Heads 29
school will not require any additional
resources beyond normal tuition and HEB .. 21
formula dollars when a full four years IASIS Healthcare.. .. ........43
of students are on campus."
Leichter Law ....... 27
If UNTHSC's goal is to train more
physicians, Dr. Garza suggests it simply Lillibridge.. ...35
increase class size at TCOM. But Dr. MDBug ...... 49
Ransom says TCOM already increased
Pfizer Inc. IBC
its class size from roughly 125 three or
four years ago to 186 this year. And, Rx Security. 35
TCOM hopes to increase that further to Sharp & Cobos, P.e. Attorneys at Law .37
230 within two years.
Stillwater National Bank (SNB) 38
Dr. Ransom says 230 students per
class is about the maximum class size Texas Beef Council ... . ....... 6
of any large medical school in the na­ Texas Drug Card .. ....... 24
tion. Because of that, UNTHSC believes
Texas DSHS - End Stage Renal Disease
adding an MD school is more viable
than continued expansion of TCOM. Program ... ......... 23.44
Both Dr. Garza and Dr. Cole say Texas Medical Association
there is widespread concern that the
Knowledge Center.... .. .49
traditions of osteopathic medicine will
be lost if the allopathic school is cre­ Nonphysician Practitioners.. ........ 30
ated. Those traditions include a focus Physician's Benevolent Fund 30
on primary care and prevention, a
Practice Consulting. .. ...... 3
"whole person" approach to medicine
instead of just treating specific symp­ TexMed 2010 . . 14-15
toms or illnesses, extra training in the Texas Medical Association Insurance
musculoskeletal system, and use of os­
Trust .... . BC
teopathic manipulative treatment. The
fact that community leaders seem to Texas Medical Liability Trust... IFC
believe having an allopathic school is Texas Mutual Insurance Company 33
more prestigious than an osteopathic
TEXPAC 37
school already has damaged relation­
ships in the community, Dr. Cole says.
"It's a slap in the Advertise for as little as $25! TMA's Web
face to say we site experiences nearly 320,000 visitor
want an allo­
sessions each month. With this kind of
pathic schooL"
activity, can you afford not to advertise
Even the re­
port of the UNT in TMA's online classifieds? Place and
study group purchase your classified ad now at
cautioned that http://classi fieds. texmed .org.
adding the MD
school could re- David Garza, DO
March 2010 TEXAS MEDICINE 47
"It's a slap in the face to say we
want an allopathic school."
suit in the loss of the traditions of os­
teopathic health care from UNTHSC's
culture.
Opponents also doubt the ability of
Fort Worth-area hospitals to develop
the necessary residency programs
needed to provide postgraduate train­
ing opportunities in Fort Worth.
Texas Health Resources (THR) ap­
parently has earmarked $50 million
over the next five years to develop
graduate medical education programs
at its Harris Methodist Hospital in Fort
Worth, but Dr. Cole says it may be dif­
ficult getting funding for those new
GME slots. He says Medicare GME
funding at Harris Methodist is capped
at three residency slots, meaning the
THR would have to raise funding for
any new slots on its own.
"They can't expand unless they self
fund," he said.
Where's the confidence?
Dr. Cole says osteopathic physicians in
Fort Worth, with the possible exception
ofTCOM faculty, are almost universally
opposed to the new MD school, as are
TCOM alumni.
Dr. Garza says the TCOM Alumni
Association board voted unanimously
to oppose the proposal in February
2009 and again in November 2009. On
both occasions, the board also ap­
proved a vote of no confidence in Dr.
Ransom, said Dr. Garza, the associa­
tion's immediate past president.
The TOMA board passed a motion
to oppose the school in December
2008. The TOMA House of Delegates
ratified that motion in April 2009.
48 TEXAS MEDICINE March 2010
Dr. Ransom responded that
UNTHSC has received more than 100
letters of support from osteopathic
physicians, including many TCOM
alums.
And, the proposal does have support
from the broader medical community
in Tarrant County. In an October 2009
letter to UNT System Chancellor Lee
Jackson, Tarrant CMS President Rex
Hyer, MD, said increasing the physician
supply in the region requires increasing
UNTHSC's undergraduate medical ed­
ucation training capacity, as well as ex­
panding GME opportunities in Fort
Worth.
"By offering an MD program,
UNTHSC will be positioned to partner
with community hospitals that are
preparing to move forward with
ACGME [Accreditation Council for
Graduate Medical Education] resident
programs," Dr. Hyer wrote, adding that
ACGME programs provide flexibility
because they accept both MD and DO
students.
"Several hospitals have looked to
UNTHSC first as a partner and we be­
lieve that allopathic residency pro­
grams will not detract from the
medical school's commitment to osteo­
pathic training but rather advance the
vibrant training environment at
UNTHSC through DO and MD students
working jointly in local clinical training
sites," Dr. Hyer wrote.
Intcl'iln \vor~krol'L:e
study raises scope
concerns
An interim study of the state's current
and long-range health care workforce
needs ordered by Lt. Gov. David Dew­
hurst could open the door for inde­
pendent prescriptive authority for
advanced practice nurses.
Among the lieutenant governor's in­
terim committee charges is a directive
to the Senate Health and Human Ser­
vices Committee to take a broad look at
the state's health care workforce needs.
Lieutenant Governor Dewhurst di­
rected the panel to study the state's
current and long-range need for physi­
cians, nurses, dentists, and other allied
health and long-term care profession­
als. He also told the committee to make
recommendations for ensuring suffi­
cient numbers of health care profes­
sionals, focusing on medically under­
served and rural areas of the state, as
well as the border region.
One element of the interim charge
has raised some concern among TMA
officials. Lieutenant Governor Dew­
hurst asked the Health and Human Ser­
vices Committee to consider health
care delivered by advanced practice
nurses in terms of access, cost, and pa­
tient safety, and include an assessment
of independent prescriptive authority
for advanced practice nurses.
Health and Human Services Com­
mittee staff in January requested TMA
input on the charge. TMA has asked its
Committee on Physician Distribution
and Access to Care for input.
The charge was one of several in­
terim committee assignments issued by
Lieutenant Governor Dewhurst and
House Speaker Joe Strauss (R-San An­
tonio) that deal with medical educa­
tion and workforce issues. The Senate
Finance Committee will monitor the
expenditure of American Resource and
Recovery Act (ARRA) funds. Some $51
million in ARRA funds received by
Texas went into formula funding for
medical education. TMA officials are
concerned that funding might be cut in
the next biennium if the state, as ex­
pected, faces a budget shortfall.
The House Committee on Higher
Education will study current financial
aid programs, tuition and fee exemp­
tion programs, loan repayment pro­
grams, and professional incentive
programs, and evaluate whether assis­ Patient Portal EMR / Practice
tance should be based on need or Clinic Home Page
merit. Lawmakers significantly ex­ Management
panded physician loan repayment pro­ Electronic Labs
grams in 2009. Elecronic Bills / ERA
The House Committee on Licensing
Free Lifetime Support
and Administrative Procedures will No Cost of Ownership
Full Scheduler
study all existing occupational licens­
ing programs and determine the im­
Note Templates
Free Lifetime Upgrades
pact on consumers, competition, and Vaccine IVlanagement
Free Backups
the cost of services. That study likely EPrescribe
could look at physician licensing Free IVlaintenance
through the Texas Medical Board. CCHIT, HIPAA, ARRA No User Fees

PatChOlrt

Tech seeks LeVIE L U&~ ~ .. _ _ ~\i'l '\

approval for .
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Medical Education (ACGME) has 11/,;/'00,,; O.. e 04, 2009 $rr1itn. R "0 Dec 04, 2009 by Roq'-l~ 5
n·)odJ10 p~ .. ior !:",I.I'I:'" '0'
turned down a request from Texas Tech .,.t
on O(~ : ..
My Groups' CO:~ (J~ :003' O~:C5 .-·n
. r I,::
University Health Sciences Center to
OOc:lOf
create an accelerated residency pro­
gram that would have cut one year off
the time it takes to train family medi­
Limited Time FREE OFFER (800) 985-9091 www.mdbug.com
cine physicians.
Tech officials are now looking to the
Liaison Committee on Medical Educa­
tion (LCME) to approve a new medical
TMA KNOWLEDGE CENTER

degree program with a similar goal.

(800) 880-7955

School officials expected to hear in (512) 370-1550 in Austin

February whether the LCME had ap­ Fax: (512) 370-1634

proved its proposal to create an accel­ 8:15 am-5:15 pm (CT) M-F

erated degree program for medical E-mail: knowledge@texmed.org

students interested in family medicine. www.texmed.org

In the fall of 2008, Tech asked for a

waiver from institutional requirements
to the ACGME to allow the school to
combine the fourth year of medical
II'TExAs
MEDICAL
USOClATION
school with the first year of family
practice residency to cut training time Physicians Caring for Texans
from seven to six years.

March 2010 TEXAS MEDICINE 49

 At a meeting on Feb. 9, 2009, the
ACGME Board of Directors voted to
deny the waiver request, even though
Texas Tech School of Medicine Dean
Steven Berk, MD, says the ACGME's
Family Medicine Residency Review
Committee favored it.
"The request for a waiver was de­
nied on the grounds that the institu­
tional requirement was deemed too
fundamental and important a stan­
dard," Jerry Vasilias, PhD, executive di­
rector for ACGME's residency review
committees for family medicine and
pediatrics, wrote in an April 13, 2009,
e-mail to Dr. Berk.
Dr. Berk says the ACGME decision
made it very clear it was not interested
in accelerated medical training.
"The family medicine accelerated
residency program got turned down
definitely by the ACGME," he said. "In
the end, the board of the ACGME de­
cided that they did not want to open
the floodgates to this type of approach
because we had many other schools
coming along with us that wanted to
do it at the same time."
Tech's proposal was similar to a pilot
project carried out at. a dozen U.S.
medical schools in the early 1990s. Dr.
Berk says the ACGME didn't deny that
those pilots were very successful, but
the organization simply has chosen not
to pursue that approach.
The proposal that Tech submitted to
LCME seeks to achieve a similar goal
by creating a three-year medical degree
program. The degree program would
not need ACGME approval. ACGME ac­
credits residency programs, while
LCME accredits medical schools.
"It's a plan to take medical students
who know they want to go into family
medicine, graduate them within three
years," Dr. Berk said. "LCME doesn't
have a problem with that. There are
schools that graduate people within
three years as long as you meet all the
requirements for graduation."
That would be accomplished by in­
corporating elements of the current
fourth year of medical school into the
first three years. Students would have a
summer experience that would include
some basic science instruction after
their first year instead of being off that
summer, Dr. Berk says.
In the third year, students would do
intensive care unit, neurology, and
other clerkships that normally are part
of the fourth year, Dr. Berk says.
Tech would guarantee students in
the program a full scholarship in their
first year. That, combined with the
elimination of the fourth year, would
mean their medical school debt likely
would be cut in half, Dr. Berk says.
And, Tech also would guarantee
graduates a slot in one of its family
medicine residency programs. •
Ken Ortolan is senior editor or Texas Medicine. You
can reach him by telephone at (800) 880-1300. ext.
1392. or (512) 370-1392; by fax at (512) 370-1629; or
bye-mail at ken.ortolon@texmed.org.

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50 TEXA5 MEDICINE March 2010