Med school will help address shortage of physicians

The inaugural class of 54 students attending the new Western Michigan University Homer Stryker M.D. School of Medicine began their quest to become physicians on Aug. 18, the first to experience the school's team-based learning approach and opportunity to get into the clinic from the beginning of their training.

The medical school is one of three new med schools that have opened at universities in Michigan within the last six years. These schools join three older more established schools.

While six med schools in the state may seem like a lot to some observers, experts say they are glad to see the establishment of new institutions to teach doctors. The schools are needed to address a projected shortage of 90,000 physicians nationwide by 2020.

Dr. John Prescott, chief academic officer at the American Association of Medical Colleges, says one-third of all physicians will be retiring in the next 10 years. He says these retirements coupled with an increased demand for medical services and a generational difference in the number of hours newer physicians are willing to work are among the reasons for the projected shortfall.

"We have 10,000 new baby-boomers hitting retirement age every single day and they are hoping for, and expecting additional, medical services," Prescott says. "We’ve got new people who are eligible for medical care under the Affordable Care Act, and we are graduating physicians today who are working differently than their older counterparts in terms of the number of hours they are going to commit to being on the job."

This trifecta is largely responsible for the establishment in 2008 of Oakland University’s William Beaumont School of Medicine and Central Michigan University’s College of Medicine followed in 2012 by WMU Homer Stryker M.D. School of Medicine. These schools join the University of Michigan Medical School founded in 1848, Wayne State University Medical School founded in 1868, and Michigan State University’s College of Human Medicine founded in 1964.

"Schools have expanded their class size and other schools have been created. What we really need to see are additional Graduate Medical Education positions," Prescott says. "Since 1997 when the balanced budget pact went into effect the federal government has frozen funding for graduate medical education.

"Just as the schools have stepped up now we need more federal funding."

The government in 1997 placed a cap on the number of Medicare-supported residency spots in the United States, a limit tied to the number of residents that teaching hospitals reported in 1996. The cap means that despite a growing number of medical graduates across the country, the same limited number of training slots remain. The freeze is even more challenging for states such as Michigan that recently opened new medical schools, according to an article that appeared in the January/February issue of Michigan Medicine magazine. 

"In the last few years, we have opened three new medical schools: Oakland (University William Beaumont), Western Michigan University and Central Michigan University," says John E. vanSchagen, MD, program director for the GRMED/MSU family medicine residency and associate chair for the Grand Rapids Michigan State University College of Human Medicine department of family medicine. "The remaining traditional schools have all expanded their class sizes dramatically. The bottleneck comes back to GME. We’re coming up on 20 years without an increase in the number of slots that have been available in our state."

Prescott says there are slots available now. He says he thinks medical schools in Michigan have done a very good job of recruiting students, many of whom end up doing their residencies in Michigan. But he says he’s not sure if this trend will continue.

"As we continue to add more medical students and more schools are established, we’re not seeing an increase in the number of slots paid for by the federal government," Prescott says.

Residencies, he says, give students opportunities to explore different specialties and exposure to established physicians who may be potential role models for them.

Dr. Pete Ziemkowski, associate dean for Student Affairs at WMU Homer Stryker M.D. School of Medicine, says he has heard plenty of officials with medical schools discussing the shortage of residency slots and how that gap may be narrowing.

"American graduates have not yet exceeded the number of residency positions available. There are still sufficient residency spots for U.S. graduates," Ziemkowski says. "What’s very competitive and highly sought after are specialty slots."

The reality, he says, is that not every student who wants to specialize in areas such as radiology will be able to do that. Ziemkowski says he we became a primary care physician because he believes in the importance of preventative care. But he says he knows that this is not the right path for every student.

"We can guide and recommend, but we’re not going to push anybody," he says.

Prescott says he originally wanted to be a surgeon and his wife wanted to go into internal medicine. He ended up in emergency medicine and his wife is a radiologist.

The top three specialty choices among medical students are internal medicine, family medicine and pediatrics. Of these, Prescott says internal medicine is the most sought after.

Nationally, more than 500 medical school graduates are already unable to match with a residency annually, according to American Medical Association data. That number is expected to grow as the pool of medical school graduates rises. The value and importance of GME is becoming lost as the federal government focuses on thinning its budget, says Atul Grover, MD, PhD, AAMC chief public policy officer, in the Michigan Medicine article.

"The major problem right now is a climate of deficit reduction in DC where Congress is looking to cut spending and not looking at the long-term need to invest in the workforce," he says.

However, the need to make sure a steady stream of new physicians will be there to replace those retiring physicians is outweighing issues with potential residency shortages.
 
Of the six medical schools in Michigan,  Western Michigan University Homer Stryker M.D. School of Medicine is the only private medical school. Ziemkowski says there was no opportunity to become publicly funded.

The school is a collaboration between WMU and Borgess Health and Bronson Healthcare, Kalamazoo’s two teaching hospitals. It is a private nonprofit corporation supported by private gifts, clinical revenue, research activity, tuition from students, and endowment income. In March, 2011 WMU received a gift of $100 million for the medical school from anonymous donors.

Annual tuition at the medical school is $50,000 for both in-state and out-of-state students. This is higher than both U-of-M and MSU medical schools.

"We are working on developing new scholarships such as merit-based for excellence in a particular area or past experiences and need-based," Ziemkowski says.

With six schools to choose from not to mention those in other states what will make WMU Homer Stryker M.D. School of Medicine attractive for those who want to be doctors?

A family physician by training Ziemkowski says he thinks WMU Homer Stryker M.D. School of Medicine stands out because of its team-based learning approach where students study the material presented during a lecture and actually use it. He says there will be a very early clinical integration.

"Gone are the days when you’d spend two years doing book learning and two years doing clinical study and then you graduate," Ziemkowski says. "Imagine the connections which will be made by a student who studied anatomy on Tuesday morning and made an actual diagnosis on Tuesday and would be in the clinic by Thursday. Simulation plays a big role in this which gives them an opportunity to learn and cement these concepts.

"We have the opportunity to design the medical school we wish we could have attended. We have consistently tried to develop a curriculum that would be appropriate for the future."

To give the school’s students even more of an edge WMU’s Haworth College of Business and the Homer Stryker med school announced in late February that they are offering a dual-degree program that would allow medical students to complete a medical degree and a master's in business administration with a concentration in health care in five years. Typically, medical school takes four years to complete, while it generally takes a full-time student two years to earn an MBA.

WMU officials say the dual-degree program ofers a competitive advantage to medical students, particularly as changes in health-care laws roll out that affect clinical services. Such programs have become a growing trend in recent years, with an estimated 65 medical schools in the U.S. offering an M.D.-MBA program, according to U.S. News and World Report.

Ziemkowski says he’s heard it said that the United States doesn’t have a problem with its economy. It has a healthcare problem.

"We really need to have healthcare and the costs under control," he says. "Having an opportunity for trained physicians to also have a savvy understanding of the system and how it works will only be a benefit."

"There may be individuals who really do want to have those additional business skills to run clinics and deal with changing federal and state legislation and to really organize themselves," Prescott says.

Jane C. Parikh is a freelance reporter and writer with more than 20 years of experience and also is the owner of In So Many Words based in Battle Creek.

Photos by Susan Andress and Western Michigan University Homer Stryker M.D. School of Medicine

A video on the new med school is here.