AAMC Reporter: February 2007

The Regional Medical Campus: Best Route to Expansion?

The University of Kansas School of Medicine-Wichita

How can medical schools increase student capacity by up to 50 percent or more, fairly quickly, while maintaining or even improving the quality of the educational experience they deliver?

With baby boomers aging and a physician shortage projected to occur within a decade, it is a question more and more schools are posing. And for many of them, the answer is the same: establish a separate branch or regional campus remote from the central campus.

"AAMC has recently recommended a 30 percent increase in medical school enrollment by 2015," said Bill Mallon, Ed.D., the AAMC's assistant vice president of medical school services and studies.

"Creating new stand-alone medical schools from scratch is difficult due to high start-up costs, accreditation challenges, and state and local politics. Fortunately, existing schools can investigate strategies to help them meet their expansion goals and avoid the possibility of competition," Mallon said.

Theoretically, Mallon noted, the easiest route would be to simply increase class size, and some medical schools are adding the resources necessary to do that without diluting the educational experience.

"Faculty can be hired and buildings built, but for the majority of schools, the limiting factor is local clinical capacity," Mallon said.

"Students need to be trained at hospitals, surrounded by working physicians and real patients, so once you've partnered with every local hospital and added all the slots you can, sending students to hospitals outside the area needs to be considered," Mallon said.

In addition to this outward push, the concept of regional medical campuses is gaining popularity because of the growth of cities with no medical school presence of their own.

"There are 125 medical schools in the U.S. and that hasn't changed a lot in 20 years, whereas population has shifted considerably in many areas of the country," Mallon said.

"Many large cities are very interested in having a medical school and are lobbying their state politicians. For many of them, partnering with an established medical school outside their immediate area can be a faster and less cost- and labor-intensive way to accomplish the goal," Mallon said.

In fact, several of these areas, with their growing populations, are "hospital-rich," and thus very attractive to medical schools in search of new clinical capacity, creating potential for a true win-win in the establishment of a regional campus, Mallon said.

Clinical Campus, Basic Science Campus, or Both?

Indeed, this scenario drives the most common model for regional medical campuses: The main campus opens a branch location and offers it as an alternative venue for third- and fourth-year students to gain clinical experience, taking some of the pressure off the main program and allowing for immediate and sometimes dramatic expansion. In fact, it is quite common for medical schools to gain the ability to educate 40 to 60 additional students each year by establishing a regional campus.

There are other successful models as well. Some schools follow the clinical concept to its fullest extent, offering no clinical training at the main campus and sending all third- and fourth-year students out to one or more remote sites. Others do just the opposite, establishing a regional campus for all or some first- and second-year basic science students, and then bringing everyone back together at the main location for the clinical years. And, more and more, schools are investigating establishing full, four-year remote programs.

"The model one chooses should reflect the relative strengths of all sites," said Paul Mehne, Ph.D., associate dean at UMDNJ-Robert Wood Johnson Medical School at Camden.

"It's a real opportunity to consolidate existing strengths while building new ones. It also gives you an opportunity to offer students a greater variety of experiences. If a main campus is in a big city, a remote campus might for the first time allow students a chance to practice rural medicine, for example. Different campuses also develop different research strengths or unique programs, further expanding the overall med school offering," Mehne said.

In addition to educational models, today's approximately 50 regional medical campuses differ greatly in physical presence. Some start simply and inexpensively by renting a few offices at a hospital or office park. Others have full bricks-and-mortar facilities with complex infrastructure.

"It can be a big and investment-heavy undertaking, but it doesn't have to be. There's no reason why one can't test the waters and start off small," said S. Edwards Dismuke, M.D., dean and professor at University of Kansas School of Medicine-Wichita.

"When the Wichita regional campus started, we originally used offices at a nearby college and eventually grew into our own buildings. Ultimately, as you grow, you'll need the full complement of support services, student affairs, human resources, IT, maintenance, and more.We have more than 200 employees and a $25 million budget now, but that took a while. Across the country you'll find regional medical campuses in all stages of evolution," Dismuke said.

Any medical schools considering the opening of a regional campus should also keep in mind their potential clout as they investigate the possibilities.

"If a medical school approaches a hospital and says, 'We are looking for sites where we can place students for the last two years of their education, and we would like to partner with you,' that can be an extremely attractive proposition," noted John Molidor, Ph.D., community assistant dean at Michigan State University College of Human Medicine-Flint.

"The benefits can be considerable. They can hire their choice of new doctors with minimal recruitment costs. They get the cutting-edge cachet of being an affiliated teaching hospital. And it's true that doctors can learn as much from students as the reverse, so bringing in students tends to rejuvenate and enhance the skills of the entire staff," Molidor said.

Often, this observation translates into flexibility in the allocation of operating costs. According to the latest update of the AAMC's study on regional medical campuses, originally released in 2003, even such basic questions as who pays the regional dean's salary are open to negotiation. About 33 percent of the schools responding reported that medical schools pay the dean, and about 15 percent reported that the hospital pays the dean, about 10 percent split the salary fifty-fifty, with the rest reporting various agreements in between. [Editor's note: The monograph Regional Medical Campuses: Bridging Communities, Enhancing Mission, Expanding Medical Education is available through AAMC Publications.]

Campuses Keep in Touch

Although every regional campus is different, there are some commonalities. For example, many deans point out that each venture owes its success to achieving a campus-wide commitment to the project and maintaining strong relationships across the board.

"If you're thinking about doing this, the very first thing you have to do is get the key decision makers and the key educators around the table," said Molidor. "Everyone needs to understand the situation and get on board. The links between the schools need to be strong from day one."

Jackie Chadwick, M.D., associate dean for clinical affairs, University of Arizona-Phoenix, agreed.

"There needs to be well-articulated buy-in from the main college at the dean's level and at the department levels so they are supportive of the effort," she said.

"The issues we all deal with are the relationship to the mother ship and folding in faculty at the regional campus in a meaningful way so they feel part of the entire medical school. You don't want the site to feel like a foreign legion outpost."

Different schools develop particular ways of enhancing communication and ensuring that separate campuses, although perhaps hundreds of miles apart, nonetheless work together. At Camden, Mehne reported third-year clerkships are led by co-directors at each campus to ensure ongoing, detailed, and consistent communication. At Phoenix, Chadwick's team has added video conferencing links with colleagues at the main campus in Tucson to make communications more personal and effective.

Colleagues Available to Help

Fortunately, these ideas, experiences, and best practices of veteran regional medical school executives are available to those newly making the plunge through the AAMC's Group on Regional Medical Campuses (GRMC).

"The GRMC is made up of chief administrative officers of regional medical campuses," said Joseph A. Keyes, Jr., J.D., AAMC senior vice president and general counsel.

"Through this group, we help foster professional growth and development, and enable the sharing of information and discussing of key issues."

The group meets in person several times a year, often at the AAMC annual meeting, as well as in full gatherings at member campuses. Group members also report being in frequent contact throughout the year.

"If someone has a question on how to do 'A' or 'B' there's generally someone who's tried it somewhere in the country, so you just jump on the phone and get an answer," said Mehne, a long time GRMC member who is finishing a one year term as chairperson. "It's a very helpful and collegial group."

—By Gregg Siegel, special to the Reporter

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