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Managing Editor Scott Harris sharris@aamc.org Staff Writer Elissa Fuchs efuchs@aamc.org

New Facilities, New Partnerships Medical Education Expands

By Whitney L. J. Howell

At first glance, it appears to be a winning combination for the medical profession: aging baby boomers likely to live longer and need more medical attention, and a rising number of qualified students aspiring to attend medical school, with an interest in specializing.

However, all these positives could result in a negative scenario: what some medical industry professionals and officials are defining as a possible physician shortage. A larger elderly population needs more doctors to provide care; a greater population of competent students needs schools; residents need more options for pursuing the specialty they have chosen. Although it is unclear how dire this situation may become, some academic institutions across the country are already plotting ways to address the problem-they are either building new medical schools or are finding new ways to partner with other medical schools in close proximity.

This trend has not caught on in all corners of the nation, but it has made an impact in several areas that are currently underserved by physicians. The task has not been easy, as some universities have discovered, but introducing a new medical school into areas that lack a sufficient amount of doctors to care for the local population has resonated well with some communities.

On the border: filling the gap for a multicultural area

Site of the new research facility and medical school at Texas Tech-El Paso, which broke ground in December 2003. Construction on the new classroom building is scheduled to be completed in the next 18 to 20 months.

For the past 30 years, medical students at Texas Tech University Health Sciences Center (TTUHSC) have received their medical education in two locations. The Lubbock site offered the first two years of classroom instruction, followed by two years of clinical education at a number of locations, including El Paso. TTUHSC serves a landmass larger than all the New England states combined, with the closest neighboring city 300 miles away. This long-distance arrangement has not fared well with El Paso's local residents. With very few medical facilities nearby, easy access to necessary health care is extremely limited.

"It's been a dream in El Paso for the past 30 years to have a four-year medical school here," says Josemanuel de la Rosa, M.D., the regional dean and professor of pediatrics at TTUHSC. Out of the 10 most populous states, he says, Texas has the smallest physician population - and El Paso ranks the lowest of all Texas areas. "Texans are proud, and when you tell them they're dead last, it rubs them the wrong way," he says. So in 1997, area residents decided to lobby for change at the TTU Health Sciences Center.

At first, the community discussed creating a medical school that could concentrate solely on the specific needs unique to the Hispanic community. El Paso's close proximity to the Mexican border made it a prime location to study "border health issues," such as diabetes and infectious diseases that could afflict the Hispanic population. But the idea was abandoned, Dr. de la Rosa says, in favor of a more mainstream institution that will focus certain research initiatives on ethnic issues. The university gave the Texas legislature this description of the proposed school: a border medical school that engages in diversity research with a focus on Hispanic and border health issues.

But the push for a new medical school in El Paso did meet strong opposition in the early stages. Many state officials tried to block the initiative four years ago because they said Texas already had enough medical schools - it currently has eight. "Thank goodness logic and rational science prevailed," Dr. de la Rosa says. "We were able to convince [the legislature] that in El Paso and along the border, there is a physician shortage." In addition, the Texas Medical Association threw its support behind the proposal.

The legislature awarded TTUHSC a $900,000 planning grant in 2000. The money was used to develop a community vision for the medical school, as well as research faculty development in light of the type of school the university wishes to create. In 2003, the legislature gave TTUHSC the final nod for the four-year school and supplied the university with $45 million to construct a classroom building and $2 million to begin recruiting faculty. Overall, TTUHSC has received approximately $100 million for current building renovations, faculty research, and classroom construction.

Even though TTUHSC has substantial funding in its coffers, Dr. de la Rosa says the hard work is far from over. The El Paso medical school will not open its doors for at least another four or five years, and faculty recruitment will not start for another 18 months. The $2 million recruitment grant will be enough only to start the initial faculty development process, he says, but, surprisingly, he has been "overwhelmed by a number of phone calls from faculty members from multiple institutions who are willing to return to El Paso."

Once the school opens, Dr. de la Rosa says, it will accommodate anywhere from 80 to 100 students. How- ever, the university still has not decided how the transfer from a two-year program to a four-year program will affect students enrolled in the school at the time of the switch.

Construction on the new classroom building has already begun. TTUHSC broke ground in December 2003 and expects the structure to be complete within the next 18 months to 20 months. In addition, a community member has donated a 14-acre plot of land adjacent to the university's current medical facilities. It sits in the downtown area, and "shows the legislature that we're serious about building a medical school facility," Dr. de la Rosa says.

Expansion for a five-state program

Not all universities looking to boost their level of medical education are recruiting new faculty or designing new buildings. Instead, they are looking to partner with existing institutions to strengthen and expand their programs at the surrounding community's behest. For example, the populations around the University of Washington and Washington State University (WSU) have push- ed the schools into the early stages of discussing a possible collaboration to broaden UW's WWAMI program (the medical school initiative that includes students from Washington, Wyoming, Alaska, Montana, and Idaho - 27 percent of the U.S. landmass) by establishing greater biomedical research initiatives at WSU's Spokane location.

"It's a grass-roots effort at this point," says Rich Hadley, president and chief executive officer of the Spokane Regional Chamber of Commerce. "It's basically been a dialogue between the chamber and UW." But he adds that he expects more extensive meetings that will produce more concrete plans to take place within the year.

Currently, the WWAMI program is the only medical school serving the previously mentioned states. Each year, according to John Coombs, M.D., associate dean of the UW medical school, between 600 and 700 students apply for the 178 positions available in each class. Students from Washington State fill 110 of those slots; the rest are divided among other state residents.

Hadley says the small class size and large applicant pool are main reasons behind the proposal to extend the program. "They turn away 150 qualified students a year," he says. This, coupled with the number of hospitals in the region and the business climate, has led the community to believe there are not enough doctors graduating from the WWAMI program to satisfy the area's healthcare needs. In fact, Hadley says, the proposal to expand the medical program in Spokane has the support of the newly elected Spokane mayor, Jim West. The chamber and UW representatives have discussed potential ways to expand the WWAMI program and the number of students granted admission, Dr. Coombs says, as well as avenues to provide more opportunities for primary care and specialty students. "There's a variety of expectations surrounding the interest of the medical school," he says. "We want to create a better home for biomedical research and ways to better support healthcare interests in Spokane."

One of the tricks to succeeding will be convincing the Washington legislature that improving the WWAMI program should be a high priority even though the UW medical school recently suffered a substantial cut in funding, Dr. Coombs says.

Other proposals

Across the country, other states and schools have tackled the idea of creating new medical education institutions. While these efforts have not been quite as successful or received quite as much support as TTUHSC and WWAMI, they are still being pursued.

Since last fall, Fresno has been courting the University of California (UC) about the possibility of building a new medical school that would provide a greater physician population for the underserved San Joaquin Valley.

The proposed school, which has captured the support of California Assembly Member Sarah Reyes (D), would likely be constructed near the California State University Fresno campus. The UC system began a study over a year ago to determine the need for and feasibility of a new medical school in the Fresno area.

In addition, the University of Central Florida (UCF) voted last November to begin researching whether it should open a medical school in the Orlando area. If built, it would be the fourth medical school at a publicly funded university in the state.

The UCF study is expected to take over a year to complete, but the school is already facing roadblocks - mainly financial ones. At this point, Florida has a tight state education budget.

Back out West, Arizona State University (ASU) has set aside its long-term goal of developing its own medical school in Phoenix in favor of forming a partnership with the University of Arizona. ASU's new president, Michael Crow, has made this initiative a high priority. By working with the Translational Genomics Research Institute, which already has close ties to both universities, Arizona could quickly strengthen its biotechnology and biomedical works.

Jack Jewett, president of the Arizona Board of Regents and senior vice president of public policy at Tucson Medical Center, supports Crow's decision to push for a partnership rather than stay the course for a new medical school. "It's been a sensitive issue for years with some believing we need two medical schools," he says. "But we'll live to have one truly great medical school in Arizona with this partnership."

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