AUSTIN — New medical schools are launching across the country to address a projected physician shortage. They’re promising innovative curriculums that let aspiring doctors spend time doing research, working in community health settings, and following the same patients for months.
But they face big obstacles, starting with the challenge of recruiting students and faculty when they’re not yet accredited — and won’t be, even in the best-case scenario, for several years.
An equally big challenge: raising the tens of millions it takes to build and then run a top-tier medical school.
And yet, over the next few years, a crop of medical schools will open on campuses at Washington State University, City University of New York, Seton Hall University, and elsewhere — all in an effort to create a new breed of American doctor.
“What we’re doing is certainly a little bit risky,” said Dr. Clay Johnston, inaugural dean of the University of Texas at Austin Dell Medical School, which will welcome its first class of 50 medical students here this summer.
UT, for example, is building a nine-month research and innovation block into its four-year program, and working with local health authorities to design a reimbursement system that rewards preventive care and long-term value. Dell Medical School is the first MD-training institution in nearly half a century to be built from the ground up at a top-tier US research university.
“Academic medical centers are just reinforcing this broken health care system that pays too little attention to keeping people well,” Johnston said. “We want to produce not just great physicians, but great physicians plus.”
At the University of Nevada, Las Vegas, which is on track to launch its med school in the fall of 2017, student training will involve getting out of the hospital to work at a hospice, a home for developmentally delayed patients, or some other community organization. Plus, students will spend a year at an outpatient clinic where they can follow the same individuals over time, rather than jumping among different specialized clinics each month, as is often the case.
“The students will actually get to know their own patients,” said founding dean Dr. Barbara Atkinson. “They’ll be able to see how you actually treat diabetes over time, not just how you deal with someone hospitalized for a few days, and they’ll be able to follow an entire pregnancy over nine months.”
Meanwhile, at Kaiser Permanente’s new medical school — slated to launch in 2019 in Pasadena, Calif. — organizers are designing a curriculum that emphasizes how doctors can spur behavioral change in their patients and collaborate with neighborhood organizations to shape the health of community.
“There’s no reason to wait until residency for students to learn how to be part of a team,” said Dr. Edward Ellison, executive medical director of Southern California Permanente Medical Group.
“Academic medical centers are just reinforcing this broken health care system.”
Dr. Clay Johnston, dean of the Dell Medical School at UT Austin
Of course, it’s not just a handful of new schools that are designing new approaches to doctor training. Harvard Medical School, for example, revamped its curriculum last year to emphasize critical thinking and give students clinical experience earlier in their education.
“But the new schools do provide a unique opportunity to be a laboratory when they start from scratch,” said Dr. George Thibault, president of the Josiah Macy Jr. Foundation, which supports projects to improve the education of health professionals.
It will, however, take more than an innovative curriculum for these new med schools to compete among the 140-plus other MD-granting institutions in the United States.
Massive fundraising campaigns and acceptance from the local community are needed. And administrators must convince faculty and students to take a chance by enrolling in a school without a proven track record.
Austin, despite being home to more than 50,000 students at its flagship UT campus alone, had long been one of the largest cities in the country without a medical school — so it wasn’t difficult to argue the benefits of one to the UT administration, which is ponying up $25 million in annual funding, plus another $40 million over eight years for faculty recruiting.
Getting the money needed from taxpayers was a harder sell.
In 2012, county voters passed a local proposal to fund the school by raising property taxes, but only after political action committees on both sides spent months lobbying the public.
That tax increase is now helping funnel $35 million a year to the Dell Medical School, and, in turn, UT trainees will provide health services to underserved patients. Federal matching funds are bringing in yet more revenue.
But some of that money is only guaranteed for five years. And the $50 million, 10-year pledge the school received from the Michael & Susan Dell Foundation will run out soon after that. According to Johnston, the medical school is looking to secure other, more long-term sources of funding.
The financial urgency is even more pronounced at UNLV. Last year, Nevada legislators approved $27 million in startup funds — but that’s just a drop in the bucket of the full amount the university needs to get up and running, let alone operate year to year.
“We’re working hard to cultivate donors,” said Atkinson. “But we have a lot more to raise.“
The first development target: finding someone to bankroll a new building. When it opens its doors next year, the UNLV School of Medicine will use a renovated space associated with the university’s dental school until a new facility has been built.
Then there’s the challenge of getting accredited by the Liaison Committee on Medical Education, which oversees medical schools nationally.
UT received its preliminary accreditation last June, but the road to full recognition — a necessary step for students to walk away with MDs after their names — is years long, and can’t happen until the inaugural class of students is in its fourth year. Until then, those aspiring doctors-to-be must trust that the accreditation will pull through.
Similarly, faculty members need to take a leap of faith. “It takes a certain kind of person who really wants to build something,” said Atkinson of the recruitment process at UNLV.
And that something will not be immediately competitive with the likes of Johns Hopkins or Stanford —especially when it comes to research activity, which makes up a large part of most influential rankings of top medical schools in the country.
At UT, Johnston said that federal grant money and publication histories are not part of the criteria he’s using to choose faculty and staff. Instead, the focus will remain on health care delivery and new educational models — and he hopes to find a team that subscribes to the same vision.
“We’re very fortunate to be starting from scratch when we are,” said Johnston. “It would be virtually impossible to do what we’re doing at a school that’s already set in its ways.”
Correction: An earlier version of this story misrepresented aspects of the funding and curriculum for the Dell Medical School at UT Austin.