For decades, training for medical students has revolved around a large academic institution and a central university hospital, but that model might give way to different ways of doing things in California, as new medical schools look to trim costs and diversify student experiences.
“There are new models out there,” said John Prescott, chief academic officer for the Association of American Medical Colleges. “Medical schools are incredibly expensive, and it can be a daunting task to make sure you have enough funds to put together a quality medical program.”
The traditional concept of having a large medical school building on campus, along with a teaching hospital where students spend many of their waking hours is being updated, with more focus on training students in a variety of settings, from clinics and physician practices to large hospitals.
Two University of California schools — UC-Merced and UC-Riverside — already are working toward a new vision for medical schools. Both universities have turned to partnerships and new teaching models to circumvent a daunting economic climate.
“We’re going to have to look for ways to collaborate and keep our costs under control, and I think that’s true for most people who are approaching higher education at this point,” said David Hosley, interim vice chancellor for university relations at UC-Merced. “We’re looking at a sea change in the way state universities in California are financed.”
In the near term, a medical school at UC-Riverside is expected to open by 2013. In the longer term, there are plans to open a medical school at UC-Merced, a relatively young educational institution that opened in 2005.
“When we develop a satellite campus and when we develop a freestanding medical school is entirely dependent upon philanthropy and state funding,” said Frederick Meyers, executive associate dean of the UC-Davis School of Medicine and executive director of medical school planning at UC-Merced. “Our vision is not of a traditional medical school.”
He explained that there will be an anchor hospital of some kind, but students also will train in other locations in the Central Valley.
UC-Riverside began planning its medical school nearly a decade ago. This year, the university encountered a stumbling block when the state budget cut funding for its medical school. As a result, the university was refused accreditation by the Liaison Committee on Medical Education, which cited a lack of a “sufficient financial resources” as the primary reason for denying the application.
The university has the buildings, the faculty and the senior leadership to run the school; it just lacks the funding, said G. Richard Olds, dean of UC-Riverside’s School of Medicine.
Last week, the Desert Healthcare District approved a five-year, $5 million grant for UC-Riverside’s proposed medical school and a $4.9 million grant for a health and wellness center in Desert Hot Springs. The UC-Riverside grant will be used to hire primary care doctors in the region and establish a telemedicine system.
Looking to the Future
Given the state’s budget crisis, medical schools are facing a new reality.
At the moment, Olds is seeking private sources to replace the funding that was cut from the state budget. UC-Riverside has asked the Desert Healthcare District for a pledge of $1 million per year for 12 years for the medical school.
At UC-Merced, “It is unlikely in this economic atmosphere to get much help from the state or the federal government,” Hosley said. “We’re trying to wrap our arms around the cost. The ballpark figure might be $500 million to get started, and after it matures, the annual costs are similar, so UC-Merced’s leadership would like to be innovative about its approach to medical education.”
Forging partnerships with collaborators and outpatient teaching platforms could become the new normal for medical school education.
UC-Riverside has had a 30-year relationship with UCLA, through its “two-plus-two” Thomas Haider Program in Biomedical Sciences, a medical education program. UC-Merced recently partnered with UC-Davis and UCSF-Fresno for itsÂ Program in Medical Education, or PRIME, considered an interim step toward having a medical school.
In UC-Riverside’s program, students spend two years taking classes at the Riverside campus and two years at UCLA’s training hospital. Rather than building a university hospital, UC-Riverside plans to use a community-based model to train its students, a measure that should help ease financial pressures.
Overall, operating the medical school will cost an estimated $15 million annually, Olds said.
Instead of a university hospital, UC-Riverside plans to develop an outpatient teaching platform. Students would be trained at a variety of sites throughout the county, such as at the county’s federally qualified health centers and possibly at the Desert Regional Medical Center in the Coachella Valley.
The Association of American Medical Colleges’ Prescott said such models have been used elsewhere — in West Virginia, for instance — and have had a great deal of success.
“A lot of medical care takes place outside of a hospital setting,” Prescott said. “I don’t believe a medical student could get all their education in an outpatient setting, but certainly a lot of it could occur in an outpatient environment.”
Olds believes doctors are better served training in outpatient medical settings where students can be exposed to learning more about disease prevention and promoting wellness, not just treating illness.
“If you’re going to build a new medical school, why would you build it like old medical schools?” Olds asked. “It’s an opportunity to try things differently.”
Physician Shortages and Regional Disparities
Another factor influencing the development of new medical schools is a lack of trained physicians, particularly in rural areas. Both California and the nation are facing a shortage of doctors.
One way to produce more physicians is to open more medical schools, but that is an expensive proposition. Currently, California has eight not-for-profit medical schools, and there are plans to add at least two more.
In addition, both the Central Valley and Inland Empire face a “misdistribution” of physicians. Doctors tend to settle in urban centers on the coast — such as Los Angeles, San Diego and San Francisco — leaving the more rural, inland regions with a physician deficit.
Both the regions have had particular trouble attracting and retaining physicians, which has given rise to the idea of recruiting local students who will be more likely to stay in the region after they complete their training, experts said.
UC-Merced recently added an application component for local residents as part of its admissions criteria. Four of the five medical students accepted into its newly launched UC-Merced San Joaquin Valley PRIME with UC-Davis and UCSF-Fresno are from the San Joaquin Valley. The fifth is from Salinas. All have a commitment to working with underserved populations, Meyers said.
UC-Riverside also plans to give weight to applicants’ residence inÂ its application process, Olds said.
“We need doctors who will stay in our communities and take care of the underserved populations of our country,” Olds said. “We plan to give a competitive edge to our own students.”
The physician shortage in the Central Valley and Inland Empire has been a problem for years, experts said. Physicians tend to come from and go to school in urban areas. In addition, the Central Valley and the Inland Empire have low rates of high school students heading for college. But the population in both regions has been rapidly increasing.
“We are outpacing the coastal areas now in terms of population growth and the population most at risk is going to be growing the fastest,” Hosley said. “There will be huge challenges for medical care in the next few decades. That’s why I feel a certain amount of urgency in making progress to address the shortage of physicians.”
In addition, the state has too few medical school slots and an aging physician population. In Inland Southern California, 40% of the doctors are age 55 or older, Olds said.
“We have a big problem,” Olds said. “Our state is growing in population, we are training too few physicians and almost two-thirds of our physicians are going to retire soon.”
By 2025, the shortage of health professionals is expected to be even greater, with an estimated one million vacant jobs in the state — 200,000 of them in the Central Valley, Hosley said.
“UC-Merced is thinking about making a contribution to the totality of the need and not just the shortage of physicians,” Hosley said.