Plans for Medical School Reignite Workforce Debate - Brief Article

0 Comments | Family Practice News, Nov 1, 2000 | by Greg Borzo

The nation's first new allopathic medical school in 2 decades is preparing to open soon in Florida, a victory for state legislators who pushed it through over the objections of critics who questioned the need for more doctors.

Florida Gov. Jeb Bush signed a bill in June authorizing $50.8 million in funding for the first year of the controversial school at the Florida State University campus in Tallahassee. The school reportedly plans to enroll its first class of 40 students by spring or summer 2001, but it still faces challenges in securing accreditation and recruiting faculty and students.

The school wants to recruit students interested in careers in primary care medicine, geriatrics, and/or service to underserved areas. The university's existing program in medical sciences offers 1 year of medical school to about 30 students who continue their education at the University of Florida, Gainesville.

As part of an unusual curriculum design that eliminates the need for a teaching hospital, 3rd- and 4th-year students will be trained instead at community-based facilities such as physician offices, HMOs, nursing homes, and community hospitals. Enlisting appropriate clinical sites may be a challenge for the school's timetable, said Joseph Keyes, senior vice president of the Association of American Medical Colleges (AAMC).

At press time, the school had not yet applied for accreditation from the AAMC's Liaison Committee on Medical Education (LCME), Mr. Keyes said. All 125 U.S. medical schools are accredited by LCME.

Florida State University officials did not respond to interview requests for this story. LCME's two secretaries were not available for interviews, and the Florida Medical Association declined to comment.

Their reticence may reflect the contentious debate over the need for the new medical school. That argument contributed to the state legislature's decision in June to abolish the Board of Regents governing Florida's university system, according to a knowledgeable source who spoke on the condition of anonymity.

"There were other reasons, too, but the board tried to block the medical school, so some of the legislators in favor of the school led a charge to get rid of the board," he said. By 2003, local boards at each state university will replace the regents.

In recent years, state legislators-some of them FSU alumni-have several times proposed a college of medicine for FSU. But the Board of Regents and others cited Florida's already large physician workforce.

In 1998, Florida had 283 physicians per 100,000 residents, one of the highest ratios in the nation. (The national average is 224 per 100,000.) Yet FSU promotional material claims that the state has only 210 physicians per 100,000 residents. That figure is apparently derived from counting elderly residents more than once, based on the the rationale that elderly residents consume more physician services.

Organized medicine has long maintained that there are enough or perhaps even too many medical schools and physicians nationwide. Many school administrators openly acknowledge this, but none seem willing to close their own schools. Meanwhile, five osteopathic medical colleges have opened in the past 20 years, bringing the total number of such schools to 19.

Many studies have documented a surplus. In 1998, the Pew Health Professions Commission called for school closures to reduce the entering medical school class size by 20%-25% by 2005, from 17,000 students to about 13,000 students.

Yet some experts say it may be time to rethink the issue. Janet Coffman, associate director for workforce policy at the Center for the Health Professions at the University of California, San Francisco, notes that many workforce studies were done when managed care was curtailing demand for physician services. As heavily managed care retreats and the population ages, the demand for physician services is growing slowly.

"I would not say that we need any more medical schools," Ms. Coffman said. "But I am beginning to see some serious discussion" of the topic.

She cited a widely discussed opinion piece by Dr. Fitzhugh Mullan of George Washington University, Washington (N. Engl. J. Med. 343[3]:213-17, 2000). He argned that the education of more medical students could help close the gap between the number of U.S. medical school graduates and the number of residency slots.

About 5,000 graduates of foreign medical schools fill the gap between the number of U.S. graduates and the number of available residencies each year. This "draws talent away from these countries, limits opportunities for young Americans, and results in a medical work force in the United States that is not well matched to the population in terms of culture and language," Dr. Mullan wrote.

In any event, Florida State University does not envision a large school. It plans to reach a maximum enrollment of 120 new students per year by 2005. Together, the state's three existing medical schools at the University of Florida, Gainesville, the University of South Florida, Tampa, and the University of Miami enroll about 350 new students per year.