Prescription for the doctor shortage

A medical college finds an innovative way to bring physicians to underserved populations

The Association of American Medical Colleges projects that the United States will be short nearly 95,000 doctors within the next 10 years. That shortage is projected to be most acute in Southern states.

In response, private medical schools—even institutions hundreds of miles away—are looking into opening satellite locations on the campuses of public universities.

Barbara Ross-Lee is VP for Health Sciences and Medical Affairs at New York Institute of Technology and  founding dean of NYIT College of Osteopathic Medicine at Arkansas State University. She says the partnership with Arkansas State University will send 115 new doctors into the field each year, most of whom are likely to remain in the South.

The first African-American woman to be appointed dean of an American medical school, Ross-Lee says collaborations like these offer the best chance to fill the looming doctor shortage.

Why there is such a shortage of doctors?

It’s a pipeline issue. The number of young people who are being trained to become physicians has remained at pretty much one level for many years.

It was further complicated in the late ’90s when there was concern that we were going to have an oversupply of physicians. So strategies that were put in place to address that, particularly as it related to residency training, stalled any growth.

And then, within a few years it became clear that, in fact, we didn’t have a potential oversupply. We had a potential undersupply of physicians. From that point on there have been efforts to increase the number of students who are part of the pipeline to become physicians.

But those efforts ran into problems too.

Initially, the existing medical schools attempted to increase their class sizes significantly in order to increase the production. But much of medical education occurs in the clinical setting, so the availability of clinical training also becomes an issue.

You can’t increase the number of students if you don’t have a clinical base to train them in, as far as hospitals and ambulatory care clinics.

Why is the shortage greater in Southern states?

Because they don’t have a major production of physicians. Our ability to attract students into the primary care disciplines has been a challenge all by itself.

That’s why in the Southern states—and to some extent in the Northwest—they don’t have medical schools, so it’s hard for them to supply the physicians they need per capita.

We have found that students tend to stay and practice in areas where they train. Therefore, it’s important to bring the training to the areas that have the most critical needs. That’s what’s happening in Arkansas.

The state has one medical school, and while that one school has been very effective, the need overwhelms its ability to address the physician workforce. So, bringing additional training into Arkansas will make a difference.

That’s where New York Institute of Technology comes in. Is the focus on recruiting local students or bringing outside students to Arkansas?

Our target is to recruit from Arkansas and the Delta region states, mostly because we know those are the students who will stay and practice in those states that are experiencing the greatest shortages.

I would think a lot of people would want to pursue the medical field.

Actually, we clearly have enough applicants. We have a large candidate pool. But, frankly, the issue is there is a lot of debt associated with medical education and it’s a long lead time.

It takes seven years—four years of medical school and three years of residency training—to become a primary care or generalist physician. It takes at least two more years to develop a specialty. That’s a long time for education. So often the students seek out other opportunities and other health profession programs that don’t take as long.

Is there a specialty that is particularly hard-hit?

Every specialty has reported shortages based on the total population that they serve. But the critical need right now is in generalist care because that’s closest to the population that needs to be served.

Primary care physicians are the base of the entire system. Specialists and subspecialists need a broader health care provider base in order to be successful. The primary care physician shortage has become a chronic problem, especially with a growing and aging population, chronic disease, and increased access to care through things like the Affordable Care Act.

How did this partnership between New York Institute of Technology and Arkansas State University come about?

It was initiated by Arkansas State. The state is ranked number 47 or 48 in physician shortage. In terms of residents’ health, it’s estimated to be the second sickest state in the country.

But Arkansas isn’t a rich state, and opening a new medical school is very expensive. They decided to look around and see if they could partner with an existing school. NYIT has a process by which it can establish additional sites to the parent school. We felt that it was an opportunity for us to expand and do a public service.

Is this happening with other schools as well?

There are discussions going on now with some of the state schools in the Northwest, in Idaho and Utah. In New Mexico, they’ve opened a medical school, but it is in collaboration with New Mexico State University.

What’s different about Arkansas State is that it is a partnership between a public institution and a private university. It shows that the state is looking at innovative ways in which to bring education, building a pipeline for a physician workforce.

Partnering with a college or university is the most viable option for creating a workforce in your state when you have a shortage.

So university leaders could help alleviate the doctor shortage—and boost their profile—by partnering with a medical school?

Right. It is extremely expensive to open a medical school if you are starting from scratch and building your own. But if you partner with existing schools, then there is a real opportunity because there are a lot of things that have already been done.

We’re able to focus on education and produce a physician workforce with much less cost. It’s just a matter of finding the right facilities and you can just import a medical education program.

Who claims the students? Are they New York Institute of Technology students or Arkansas State students?

They are NYIT students. We have a landlord/tenant arrangement. Ultimately, Arkansas State provides space and some of the student support services that you need in medical education.

But other than that, it’s a New York Institute of Technology program. All the faculty, all the staff are hired by NYIT. The students are recruited, supervised, graded, evaluated and assessed by NYIT.

You’ve said that, as a young black woman, you were discouraged from pursuing a path in medicine. Is that situation getting better today?

Oh, yes it is getting better. Of course, today we have other social issues that impede a pipeline for minorities. Women, however, have just a wonderful opportunity in medicine that was not available when I started medical school or when I was looking at a career in medicine.

But it’s still a difficult pipeline issue for minorities, in that minorities still, to a large extent, depend on public education for the K12 system, and K12 is failing for minorities all over this country. Their ability to be competitive for positions in medical schools is compromised.

We are still a very fragmented, siloed system of education. Until we can build the bridges between the different levels of education, our current system compromises the opportunities for much of our population, particularly populations that are underserved or underrepresented.

What you are doing has the potential to lead to other interesting partnerships.

We’re doing it in medicine because we have a critical, almost crisis need. That’s an opportunity in the current environment when we need to produce more physicians. This, it seems to me, could be a strategy for all of education and for other professions.

Instead of trying to create a school de novo, we partner with existing institutions. I believe we would be able to strengthen our education system without the major cost that it would take if you did everything from scratch. This is the new world of education.

Tim Goral is senior editor of UB.

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