Reinforcements for the frontline
Expanded enrollments, new schools could create more primary-care physicians
- April 27, 2012
Dr. David Danner, an osteopathic family physician, is doing well for himself and good for Stuart, a town of about 1,400 people. A 2007 graduate of the Edward Via Virginia College of Osteopathic Medicine (VCOM) in Blacksburg, Danner was recruited by Pioneer Community Hospital, a 25-bed critical access hospital in Patrick County, after he finished his residency in 2010.
It’s no accident that Danner practices primary care in rural Virginia. Since its first class of students graduated in 2007, 53 percent of VCOM’s graduates have entered primary-care residencies, the highest percentage among medical schools in Virginia and the 12th highest in the nation.
“Until VCOM came along, the medical schools here were in the eastern part of the state, and their focus was on specialty care as much as primary care,” says Danner, who grew up in the Appalachian community of Hiddenite, N.C. “VCOM founders said primary care is going to be our focus.”
Danner’s path still is an exception to the rule. The percentage of medical school graduates choosing to practice primary care in Virginia and across the country remains low. Virginia also typically retains fewer than 40 percent of the medical students who are educated here. But the tide may be turning, slowly. The enrollment of medical and osteopathy school students in Virginia is rising, and new schools are on the drawing board at Liberty University and King College. Both have missions similar to VCOM’s, to graduate doctors with an interest in providing primary care in underserved areas.
As the number of graduates in Virginia increases, many, like Danner, may find rural medicine has many attractions.
First of all, the pay for primary care in many rural areas is comparable to that found in metro areas, says Danner. “Rural hospitals know they cannot compete with larger hospitals in terms of attractions, like restaurants and theaters,” he says. “But the money is better than most people think.” Rural hospitals can compete in terms of salary, in part because medical providers in designated underserved areas can charge government payers higher fees.
Danner also has been offered incentives from the state and federal government, like loan payback and loan forgiveness. His schedule includes 4½ days a week at the hospital-owned family health clinic plus one evening a week and one weekend a month staffing the hospital emergency room. He also treats inmates at the jail, serves as team doctor for the high school football team, works as the medical examiner and works one day a month at the free clinic. “Country docs do a little of everything,” Danner says.
18,000 more doctors needed
Virginia could use a lot more country docs, along with more physicians in general. If it survives a Supreme Court ruling in June, federal health-care reform will bring more patients into the insured pool. The Medical Society of Virginia says at least 270,000 previously uninsured Virginians will be covered under Medicaid in 2014, creating a greater demand for primary-care doctors.
In September 2010, the Virginia Healthcare Workforce Data Center, part of the Virginia Board of Health Professions, issued a report showing that Virginia will need more than 18,000 additional physicians by 2030. One of the reasons for that demand is approximately 12,000 current physicians in the baby boomer-age bracket will retire in coming years. In fact, 24 percent of the state’s doctors were 60 or older in 2010. Also, as the state’s population ages, older residents will need more care, says center director Elizabeth Carter.
The center’s study showed that proximity matters in recruiting new physicians. Twenty-two percent of the commonwealth’s doctors in 2010 had graduated from Virginia medical schools and 32 percent completed a residency here, says Justin Crow, a policy and planning specialist with the center. However, almost three-quarters of Virginia’s doctors completed their medical degree, residency or both in Virginia, Maryland, North Carolina or the District of Columbia.
According to the Association of American Medical Colleges, Virginia retains 39.4 percent of physicians who completed their graduate medical training in the state, a retention rate that ranks 38th in the nation. Nearly 40 percent of Virginia medical students are legal residents of another state.
Some of the state’s existing medical schools are expanding enrollments. Those changes, plus the graduates from VCOM and the new Virginia Tech Carilion School of Medicine, are expected to swell the annual number of Virginia medical school graduates to nearly 700 in 2015, up from around 400 in 2010. The two new medical schools now being planned could add another 185 to 225 graduates.
The Virginia Tech Carilion School of Medicine opened in Roanoke in August 2010 with a charter class of 42 students. The school is a public-private partnership between Tech and the Carilion Clinic, a major health-care provider in Southwest Virginia. School officials say the relatively low enrollment is part of its “patient-centered learning” curriculum, which is used by 15 percent of medical schools in the U.S. Under this model, students spend more time working with patients and studying real-life cases. In addition, the school emphasizes medical research, done in partnership with the Virginia Tech Carilion Research Institute, which opened in September 2010.
Meanwhile in Richmond, Virginia Commonwealth University is expanding its medical school program. Construction on the McGlothlin Medical Education Center, a $158.6 million, 12-story building, is scheduled for completion next spring. The 200,000-square-foot space will create room for more students. The school currently enrolls about 200 new students a year. That number will increase to 250, eventually raising the school’s overall enrollment to 1,000 students.
The building is named for James W. and Frances G. McGlothlin, who last year made a $25 million donation to the medical school in honor of Dr. Harold F. Young, chairman of the school’s Department of Neurology. Besides expanding the medical school, the building will house the research facilities of the VCU Massey Cancer Center on its top floors.
New schools in the works
While VCU grows, two new medical schools — funded in part by grants from the Virginia Tobacco Indemnification Community Revitalization Commission — are being planned by Liberty University and Bristol, Tenn.-based King College. The schools have set aside some Tobacco Commission money to offer tuition reduction for students from former tobacco-growing counties.
Liberty University will build its osteopathic medical school and school of health sciences on a 17-acre site in Campbell County, not far from Liberty’s Lynchburg campus. (Osteopathic training includes manual medicine, the manipulations of joints and bones.)
The university received a $12 million grant from the Tobacco Commission toward the $40 million anticipated cost of the project. “Any survey or research into the projection of needed physicians in the immediate and intermediate future in the U.S. indicates that the need is growing and is clearly more acute in Virginia’s Southside,” says LU Provost Ronald Godwin.
In February, the medical school hired Dr. Ronnie Martin, an osteopathic doctor, as its dean. He had been a vice dean at VCOM. The Liberty school is on track to open as early as the fall of 2014, enrolling 125 to150 medical students a year. Those graduates could begin practicing in 2020.
Godwin believes that the school can help ease the physician shortage in areas where it is most acutely felt. The salaries of primary-care doctors might not match those of specialists in metropolitan areas, he says, “but Liberty University graduates a high percentage of students who want to go where they are needed to carry out a higher purpose in life than just earning a high income. I expect to see these graduates serve in rural Virginia, other rural areas and even overseas.”
Another proposed school, the King School of Medicine and Health Sciences Center, plans on having 60 to 75 medical students per class when it opens in 2014 on a 28-acre property off Interstate 81 in Abingdon. The $65 million project includes $25 million from the Tobacco Commission. The Health Sciences Center will offer programs in a variety of technical vocational tracks, says King College President Greg Jordan.
Jordan believes that the school can attract medical students who want to practice in rural areas because it is following a proven model called WWAMI. That is the acronym for a 40-year-old program aimed at graduating more primary-care doctors in Washington, Wyoming, Alaska, Montana and Idaho. The participating states help cover the costs of a number of students interested in primary care and rural medicine. More than 60 percent of graduating students during the past 30 years have stayed in the five-state area to practice, and nearly 50 percent of the graduates in the past two decades have pursued primary-care careers. “That program designed a mission and core values that are committed to rural health care. The faculty, research and student recruitment is focused on primary care,” says Gordon.
The King School of Medicine will provide residency and internship opportunities in rural health facilities and physician practices. Already Wellmont Health System, which has hospitals in Norton, Pennington Gap and Big Stone Gap in Southwest Virginia, has offered opportunities for third- and fourth-year medical students to complete internships, clerkships and residency programs. “There’s a high correlation between where doctors practice and where they do their residency,” he says. “On match day [the day that medical students learn their residency assignments], we want to have a significant population of the students say they intend to serve in Southwest or Southside Virginia.”
Jordon notes that the medical school, which has received substantial donations from Abingdon and Washington County, will have a ripple effect in the community. “It creates jobs, improves the local economy and keeps Medicare and Medicaid dollars in Virginia by recirculating health-care dollars in the local economy.”
The ultimate goal of the medical school is to train doctors like Danner, who found his calling in Stuart. He and his wife like the fact that they live near their families. But even more important, Danner can see that he, his two partners and the other family-care physicians in town are making a difference. “We’re busy. We teach a lot of preventive medicine. Here in rural Southwest Virginia, the rates of obesity, smoking and diabetes are high, and so are the risk factors for heart disease,” he says. “In the past, a lot of these people went untreated. Now we’re able to reach them.”