The inaugural post of Pattern Analysis described the “new geography” of the 33 medical schools that between 2002 and 2013 had been accredited by either LCME (15) or AOA/COCA (18) to recruit and enroll medical students. The second post raised the question, Where will the clinical faculty necessary to teach the students in these new schools come from? This is a particularly tangled problem because nearly all of these schools have declared their mission to be the training of primary care physicians to practice in underserved rural and urban areas. Yet it is an accepted article of faith, nationally, that there is already an insufficient supply of practicing primary care physicians. Recruiting significant numbers of them to teach in new as well as existing schools of medicine will further reduce the amount of primary care physician time available for patient care.
The interesting issues don’t stop there. An additional 15 allopathic schools have been proposed since the end of December 2011 and 12 “new and developing” osteopathic medical schools currently are listed by AOA/COCA. None of these schools have developed to the point where the accrediting bodies will permit any of them to recruit or accept students. To be sure, many of them are more than mere proposals, and the total number may include a passing fancy (or fantasy) or two. What I try to do here is to identify the purposes and forces driving the proposals and to associate the putative schools with them. That analysis will lend some clarity to the question of whether any of these proposed schools is likely to become an accredited school in a reasonable length of time, say before 2020.
The data analyzed here come mainly from two sources: the AAMC-CAS newsletter assembled and issued by Tony Mazzaschi; and the AOA/COCA report “New and Developing COMs and Campuses” updated through March 31, 2013. These sources were supplemented by my personal knowledge of California, Texas, and Virginia institutions in particular.
Excepting the fact that most of the proposed schools are located in the southern half of the country, there is no national pattern as there is with the newly accredited schools. The latter tend to be located in rural areas, where there is an acknowledged lack of primary care physicians and consequently an underserved population.
On the other hand, the locations of the proposed schools range from “somewhere in Kansas,” to small towns and cities, to a handful of metropolitan centers, to the established campuses of major university systems, some of which have had branch medical school campuses for years. The geographic distribution of the proposed schools looks like a scatter diagram with a correlation coefficient of zero.
An unusual characteristic of two of the proposed allopathic schools (Palm Beach and California Northstate) is that they are for-profit organizations. Although there is at least one for-profit osteopathic school, LCME has never accredited a for-profit school, but is showing these two schools as being in “Applicant Status. “
Proposed Allopathic Schools
University system development of four-year medical schools either de novo or as expansions of branch campuses: University of California System, Merced; University of Colorado System, Colorado Springs; University of Indiana, Evansville; Louisiana State University System, Baton Rouge (with the Pennington Research Institute) and Lafayette (with University of Louisiana); University of Texas System, Austin and Rio Grande (exact location to be determined); and University of Nevada, Las Vegas.
Other than the Louisiana possibilities, which may be trial balloons in a state that already has three allopathic medical schools, and the Nevada proposal made by a Las Vegas physician member of the Board of Regents, the university system proposals are virtual certainties in five years or less. Colorado is funding the development of the Colorado Springs school at the rate of $3 million per year for the next 10 years. At 40, the Evansville branch of Indiana University School of Medicine is well established. The two Texas schools have university system, state government, and strong private-sector support. The University of California, Merced has a rudimentary administrative organization in place and its development will probably move forward more quickly now that the State’s fiscal difficulties seem to be under control.
Private university and college development of four-year schools: California Northstate University, Rancho Cordova, California (for-profit), a Sacramento suburb; Palm Beach Medical College, Palm Beach, Florida (for-profit); Roseman University of Health Sciences, Henderson, Nevada; University of Incarnate Word, San Antonio, Texas; King College, Abingdon, Virginia; “Local Supporters,” Martinsville, Virginia; Shenandoah University, Winchester, Virginia.
This is a basket of unknowns. As noted earlier, LCME has never approved a proprietary school. Two are proposed and in Applicant Status. Henderson, Nevada, is a suburb of Las Vegas where there is a major branch of the University of Nevada Reno School of Medicine (and a proposal to make it a four-year school) and a Touro University College of Osteopathic Medicine. It seems that it would be difficult to shoehorn another four-year school into this milieu, although Las Vegas has become a metropolis of 2 million people.
Virginia has four allopathic and one osteopathic school now. Three more seems like an over-reaction. Carillon (MD) in Roanoke and Edward Via (DO) in Blacksburg are both responses to perceived unmet needs in southwest Virginia that have continued in spite of targeted efforts since the 1970s by the University of Virginia and Virginia Commonwealth University/Medical College of Virginia to increase the number of primary care physicians in the area. East Tennessee State University’s Quillen Medical School (in Johnson City 25 miles south of the Virginia state line) was also a 1970s response to the same problem in the bi-state area. Shenandoah’s proposal is being evaluated for feasibility. In my opinion, the Martinsville proposal will founder. King College is in Applicant Status with the LCME but may affiliate with East Tennessee.
Texas is an extremely wealthy state, but with seven public and one private medical school and two more public schools under development, it seems unlikely that a small sectarian institution like University of the Incarnate Word can develop a private allopathic school in the shadow of the UT system.
Proposed Osteopathic Schools
Traditionally organized institutions of higher education: Larkin University, South Miami, Florida; Indiana Wesleyan University, Kansas; Missouri Southern State University, Joplin, Missouri; Liberty University, Lynchburg, Virginia.
Liberty University has advanced from “Applicant” to “Pre-accreditation Status” and in all probability will add yet another medical school to Virginia’s five accredited institutions in another two to three years. Larkin became an Applicant in January 2013 and Indiana Wesleyan has been an Applicant since 2008. I would bet on Larkin.
Single purpose institutions: Southern California College of Osteopathic Medicine, Los Angeles; Center for Allied Health Nursing Education, Florida; University of St. Augustine for Health Sciences, St. Augustine, Florida; Homer G. Phillips College of Osteopathic Medicine, St. Louis, Missouri; Monmouth College of Osteopathic Medicine, Monmouth County, New Jersey; Southwestern Pennsylvania (College of Osteopathic Medicine?), Beaver, Pennsylvania; Southern Utah College of Osteopathic Medicine, Cedar City, Utah; Wisconsin College of Osteopathic Medicine, Wausau, Wisconsin.
Forecasting the future for this group of institutions is chancy at best. I would be surprised if half of them were accredited within the next three to six years. Monmouth, Cedar City, and Wausau are the most likely to emerge with accreditation.
How Many Is Enough?
Aside from the question of where the faculty will come from, one might also ask whether a 30 percent increase in the number of schools over 2002 is needed or desirable. The accrediting bodies focus only on quality and assiduously avoid the question of numbers, so any answer will have to come from other sources—political, economic, population health, business. Of course, these disparate sources rarely talk to each other and there is no more a coordinated plan for medical education in this country than there is a plan for how health care can be delivered humanely, professionally, and cost effectively to all.
—James E. Lewis, Ph.D., is an independent consultant to departments and schools of medicine, and teaching hospitals. He served as Deputy Dean for Operations and Vice President for Academic Administration, Mount Sinai School of Medicine and Medical Center, and Senior Executive Officer, Department of Medicine, University of Alabama at Birmingham. His monthly column, “Pattern Analysis,” appears on Wing of Zock. He can be reached at email@example.com.