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Invited Commentaries

The Development of New MD-Granting Medical Schools in the United States in the 21st Century

Whitcomb, Michael E. MD

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doi: 10.1097/ACM.0000000000003048
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Abstract

In 1976, the Secretary of the Department of Health, Education, and Welfare established the Graduate Medical Education National Advisory Committee (GMENAC) for the purpose of obtaining detailed information about the state of the physician workforce in the United States. In its final report,1 which was issued in 1980, GMENAC projected that the country was going to experience a major oversupply of physicians by 1990, due in large part to the increase that had occurred during the previous 2 decades in the number of students enrolled in the country’s medical schools. The increase in medical school enrollment during that time was, to a large extent, the result of federal government programs that provided funding that not only helped to support efforts by existing medical schools to increase their enrollment but also encouraged universities to establish new schools. In that regard, it is worth noting that 40 new MD-granting medical schools were established during the 1960s and 1970s.

As a result of the findings contained in the GMENAC report, no new MD-granting medical schools were established in the United States during the next 2 decades (1980s and 1990s). However, the results of various physician workforce studies conducted during the 1990s indicated that the country was actually going to face a major shortage of physicians in the coming years unless physician supply was increased. In response, in 2000, both the governor and the state legislature in Florida approved a proposal from Florida State University (FSU) to establish a new medical school, and the school enrolled its first class of students in 2001.2 And in 2006, the Association of American Medical Colleges (AAMC) issued a report3 indicating that, to increase the number of medical school graduates to the level needed to avoid a physician shortage in the coming years, enrollment in existing medical schools would have to be increased and new medical schools would have to be established. In addition to the new medical school at FSU, 28 more new MD-granting medical schools have been established in the United States since the AAMC report was issued (List 1). To put the challenges involved in the development of the new schools in perspective, it is important to note that, unlike the situation that existed in the 1960s and 1970s, no federal programs were established to directly support the development of the schools. In this Invited Commentary, I examine some of the characteristics of the new schools established since 2001 and the factors contributing to their development.

List 1
List 1:
MD-Granting Medical Schools Established in the United States in the 21st Century

Factors Contributing to the Development of the New Medical Schools

Major universities played an important role in forming 25 of the 29 new medical schools established since the turn of the 21st century. Public universities were involved in the establishment of 19 of the schools, and private universities were involved in the establishment of 6 of the schools. Two of the 4 schools that were not founded by a major university came about thanks to efforts by individuals who wanted a medical school to be established in a particular community. As a result, The Commonwealth Medical College (now Geisinger Commonwealth School of Medicine) was established in Scranton, Pennsylvania, and the California University of Science and Medicine School of Medicine was established in San Bernardino, California. One of the 2 remaining schools not formed by a major university was established in Pasadena, California, by a major health care system (Kaiser Permanente School of Medicine) and the other was established in Elk Grove, California, by a relatively new for-profit university (California Northstate University College of Medicine).

It is important to understand that for an academic institution or corporate sponsor to establish a new medical school, it must be able to demonstrate to the satisfaction of the Liaison Committee on Medical Education that it has the funds needed to develop and manage the school, as well as access to a site where the school can be located. Various strategies that were employed by sponsoring institutions to meet those critical standards are described in the sections that follow.

Financial resources

Gaining access to the financial resources that were needed to establish a new medical school was one of the major challenges those interested in establishing a new school had to face. In some states, the government was willing to allocate to public universities the funds required to establish a new medical school, while in other states, the government was not willing to do so. Nonetheless, a number of state universities, and a small number of private universities, were able to gain access to the resources they needed to establish a new medical school.

In that regard, it is particularly noteworthy that more than one-half of the major universities that established a new medical school were able to do so in part by gaining access to educational resources that had been developed by existing medical schools. In 6 cases, a university interested in establishing a new medical school was able to acquire and incorporate into the school a clinical branch campus that had been established by an existing school. For example, even though the State of Michigan did not provide additional funding to state universities to establish a new medical school, Central Michigan University and Western Michigan University were able to do so by incorporating clinical branch campuses that had been established by the Michigan State University medical school into their new schools.

In 3 other cases, a university was able to convert a 4-year branch campus of an existing school into a separately accredited medical school. The 4-year branch campus of the University of Illinois College of Medicine in Chicago was located on the main campus of the University of Illinois at Urbana–Champaign, the 4-year branch campus of the University of Miami in Florida was located on the main campus of Florida Atlantic University in Boca Raton, and the 4-year branch campus of the University of Arizona’s medical school in Tucson was located in Phoenix. Each of the branch campuses became a separate medical school on the campus where it was located. Thus, when the University of Arizona’s branch campus in Phoenix was converted to a new, separately accredited medical school, it became the second fully accredited medical school within the University of Arizona system. Similarly, 2 other university systems established second medical schools where a clinical branch campus of an existing medical school was located: the University of South Carolina in Columbia, South Carolina, and the Texas Tech University Health Sciences Center in Lubbock, Texas.

It is particularly important to note that 7 of the new medical schools were established as the result of the development of a partnership agreement between a major university that wished to form a medical school and a major health care system that wished to have a leadership role in an academic medical center (Virginia Tech University and Carilion Clinic, Rowan University and Cooper Health System, Hofstra University and North Shore-Long Island Jewish Health System, Seton Hall University and Hackensack Meridian Health, University of Illinois at Urbana–Champaign and Carle Foundation, University of South Carolina and Greenville Health System, Oakland University and Beaumont Health). In each case, the health care system was willing to provide funds to support the development of the school provided that the system was designated as the primary clinical affiliate of the medical school and, importantly, that the name of the system was included as part of the name of the new medical school. It is also important to note that one major health care system established its own medical school (Kaiser Permanente School of Medicine) and another (Geisinger Health System) assumed ownership of one of the new medical schools that was experiencing major financial challenges (The Commonwealth Medical College).

Location of a new school

Ever since the Flexner Report was published in 1910, there has been a general belief within the medical education community that medical schools should be located on the campus of the school’s sponsoring university. However, due to expansion of university campuses over the years, identifying a location on the campus where a new medical school could be established has become a major challenge that universities had to address to establish a medical school. As a result, a number of the existing medical schools are present on sites that are not located within the sponsoring university’s main campus.

In that regard, it is particularly important to note that in several of the cases in which the medical school developed as a result of a partnership between a university and a health system, the school was located on the main campus of the health care system. And in several of those cases, the campus where the school was located existed in a city some distance from the city where the university campus is located. The Virginia Tech Carilion School of Medicine was the first of the new medical schools established in this way as a result of an agreement between Virginia Tech University, located in Blacksburg, Virginia, and the Carilion Clinic, located almost 40 miles away in Roanoke, Virginia. The medical school was established as a 501c3 corporate institution with an understanding that the school would be fully integrated into the university when the Commonwealth of Virginia was willing for that to happen. It is noteworthy that the medical school continues to be located on the Carilion campus even though the school is now fully integrated into the university.

Four of the new schools located in major metropolitan areas are present on parcels of land that had been established as biomedical development zones by local governments or private developers. The University of Central Florida College of Medicine is located on a major biomedical campus in Lake Nona, a suburb of Orlando; the University of Arizona College of Medicine–Phoenix is located on a campus in downtown Phoenix; the Washington State University Elson S. Floyd College of Medicine is located on a health campus in downtown Spokane; and the University of Nevada, Las Vegas School of Medicine is located on a campus in Northern Las Vegas. In those cases, government officials aided in establishing new schools in response to the results of studies showing that the presence of a medical school has a significant economic impact on the community where the school is located, as well as enhancing the kind of medical care available to the local population.

Finally, the location of 2 of the new schools was determined by actions taken by state government and university system officials to establish a medical school in an area of the state that they had determined to need a medical school. In New Jersey, the governor led the effort advanced by a member of the state legislature to establish a medical school in the southern area of the state that did not have a medical school. The action led to the establishment of the Cooper Medical School of Rowan University in Camden, New Jersey. In Texas, the leadership of the University of Texas System made a special effort to be able to establish a new medical school in the Rio Grande Valley at a newly established university (The University of Texas Rio Grande Valley School of Medicine).

Summary

The purpose of this Invited Commentary is primarily to provide an overview of certain key factors that contributed to the development of a number of the new medical schools established in the country since the turn of the century. More detailed information about the new schools is available in a report published by the AAMC,4 and in a series of reports published by the Josiah Macy Jr. Foundation,5–7 that describe the development of the schools. Although it is not possible to be certain as to whether all of the new schools would have been established if the factors noted above had not been involved, it is clear from a review of other information that it probably would not have been possible to establish some of the schools. In that regard, it is important to recognize that some institutions that indicated their intent to establish a new medical school were ultimately unable to do so, largely because they were unable to obtain the resources necessary to do so.

As noted in the introduction, one of the major reasons for establishing the new medical schools was to contribute to the recommended increase in the number of students enrolling in medical schools each year. Since the turn of the century, the number of students entering medical school each year has increased by almost 5,000, and almost one-third of those students have enrolled in the new medical schools. Since the new schools tend to enroll a small number of students in their initial years of existence, it is safe to assume that the number of students being enrolled by the new schools will only increase over time. There is no question that the development of the new schools has made an important contribution to meeting the challenge of increasing physician supply to meet the needs of the population, and the factors noted above have clearly contributed to that outcome.

In that regard, it is also important to note that a number of new DO-granting medical schools have been established since the turn of the century and that a number of medical schools have established 4-year branch campuses. Thus, it is clear that the number of medical school graduates will continue to increase in the coming years. It is already apparent that the increase in the number of students graduating from U.S. medical schools will adversely affect the number of graduates of foreign medical schools who wish to come to the United States for residency training.

Finally, while this Invited Commentary has been focused primarily on the approaches that institutions have employed to establish a new medical school to contribute to the need for increasing physician supply, it is critically important to recognize that the development of the new schools also provides an opportunity for important changes to be made in the nature of the educational programs being provided by the country’s medical schools. When it became clear following the release of the AAMC Statement on the Physician Workforce3 in 2006 that a number of institutions were beginning to consider establishing a new medical school, the Josiah Macy Jr. Foundation sponsored a conference in 2008 that was designed to focus attention on that issue. Indeed, the president of the Macy Foundation made it clear in his introduction to the report summarizing the results of the conference8 that the need to reform medical education is a critical issue that must be addressed by the academic community. In that regard, it will be critically important to monitor the changes being made by the new schools.

References

1. Graduate Medical Education National Advisory Committee. Report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services. Volume 1: Summary. September 30, 1980.Hyattsville, MD: Health Resources Administration (DHHS/PHS), Office of Graduate Medical Education.
2. Hurt MM, Harris JO. Founding a new College of Medicine at Florida State University. Acad Med. 2005;80:973–979.
3. Association of American Medical Colleges. AAMC Statement on the Physician Workforce. 2006.Washington, DC: Association of American Medical Colleges.
4. Association of American Medical Colleges. A Snapshot of the New and Developing Medical Schools in the United States and Canada. 2012.Washington, DC: Association of American Medical Colleges.
5. Whitcomb ME. New and developing medical schools. Motivating Factors, Major Challenges, Planning Strategies. 2009.New York, NY: Josiah Macy Jr. Foundation.
6. Whitcomb ME. New and developing medical schools. Motivating Factors, Major Challenges, Planning Strategies. 2013.New York, NY: Josiah Macy Jr. Foundation.
7. Whitcomb ME. New and developing medical schools. Motivating Factors, Major Challenges, Planning Strategies. 2018.New York, NY: Josiah Macy Jr. Foundation.
8. Hager M, Russell R. Revisiting the Medical School Educational Mission at a Time of Expansion. 2009. New York, NY: Josiah Macy Jr. Foundation; https://macyfoundation.org/assets/reports/publications/macy_medschoolmission_proceedings_06-09.pdf. Accessed October 11, 2019.
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