Medical Education: Capitalism's Next Frontier?

Conventional wisdom holds that America faces a growing physician shortage and that one way of responding is by creating new medical schools. Starting a new school is an expensive proposition, which may explain the modest number that have opened in the past decade. But now the private sector may be coming to the rescue by creating proprietary -- or profit-making -- schools to train physicians.

There's a certain irony here in that the birth of modern medicine early in the last century was initiated by the Flexner report on university-based medical education that succeeded by driving a multitude of proprietary schools, all deemed subpar, out of business. In the interim the line has become fuzzier as American students train in schools abroad before doing their residencies here and entering our domestic workforce.

So it isn't terribly surprising that the first new proprietary U.S. medical school, Rocky Vista College of Osteopathic Medicine in Parker, Colorado, which graduated its first class in 2012 and currently has about 600 students, is owned by Yife Tien, whose father founded the American University of the Caribbean Medical School in 1978.

One of the challenges of expanding medical school enrollment is finding residency slots, which provide added experience during the period between when students graduate from medical school and when they can begin practice. Residency slots are funded by the Federal government and a failure to add new ones could create a painful imbalance for today's medical students. Rocky Vista has a five-year Federal grant to fund osteopathic residencies in internal medicine at the nearby Parkview Medical Center.

Now a New Mexico developer is planning a second proprietary osteopathic medical school in Las Cruces, which is a possible solution to the chronic shortage of physicians in rural areas of this poor state. If all goes well it would begin graduating 150 physicians annually in 2020,

Given that New Mexico now has only about 2500 primary care physicians practicing and that
osteopathic physicians tend to skew toward primary care, that could make a big difference if the school lives up to its goals and succeeds in keeping most graduates practicing in New Mexico. The ratio of physicians to population in New Mexico now is less than half the national average.

The Las Cruces proposal has an arrangement to provide residencies for some of its graduates, but the University of New Mexico Health Sciences Center, the only existing medical school in the state, is watching warily and fears an imbalance between medical graduates and residency slots in the state.

The Flexner report in 1910 called the elimination of proprietary medical schools, suggesting they either be closed or merged into universities. It succeeded and the number of American medical schools and graduates was drastically reduced, leading to massive improvement in both medical care and physician income.

Few safe predictions can be made here. One is that if the New Mexico effort succeeds, it will not be the last. Another is some sort of showdown between the perception that America needs more doctors (a hypothesis I and others have repeatedly attempted to debunk) and the growing distrust of for-profit higher education generally.