Remedy for region’s doctor shortfall

With more than half its physicians predicted to retire in the next decade, the Scranton region marshaled hefty local and state support to open a medical school in its own backyard.

The Commonwealth Medical College caters to Pennsylvania residents, reserving at least 70 percent of its spots for them in the hope they will stay local.

In doing so, the region confronted one of health care's most pressing problems: a projected national shortage of 159,300 physicians by 2025, with the greatest impact in rural and other underserved areas, including parts of Philadelphia and South Jersey.

Scranton's college is one of nearly two dozen medical schools that have opened in recent years or are in planning stages around the country. The growth is the industry's largest since the mid-1970s.

Several other schools are in the approval process, including a partnership between Cooper Hospital and Rowan University for one in Camden.

Other schools are expanding. Temple University plans to launch a campus in the Lehigh Valley, and Drexel University is considering expansion to other cities in addition to adding slots in its Philadelphia school.

Factors in the growth are an aging and growing population, the expected retirement of about a third of doctors nationally, and changes in health-care policy that will insure more people.

Nationally, students entering the nation's 132 traditional medical schools and 25 osteopathic schools grew from 19,567 in 2002 to 23,494 last fall, said Edward Salsberg, director of the Association of American Medical Colleges' Center for Workforce Studies.

By 2020, the number of graduates is expected to grow by an additional 7,000 a year, to 27,000, he said.

At the forefront are new schools such as Scranton's Commonwealth, which mounted a swift effort to raise necessary funding.

The community donated more than $28 million to construct a $115 million building, set to open a year from now. Local businesses, doctors, banks, and entrepreneurs such as former Gov. William W. Scranton gave more than $5 million for half-tuition scholarships for the first class of 65 students at the school, which opened its main campus in the fall in a temporary site at Lackawanna College in Scranton. There also are campuses in Wilkes-Barre and Williamsport.

The state - with backing from Gov. Rendell and Senate Minority Leader Robert J. Mellow, who represents Scranton - gave $35 million, and Blue Cross of Northeastern Pennsylvania contributed $70 million toward start-up and construction. With support of eight local banks, the college also obtained a $40 million loan - a major feat for a start-up with no assets.

Local physicians were eager to help.

"You don't have a bureaucracy hierarchy of 100 years of existence that you have to struggle with to change," oncologist Harmar Brereton said. "There's an entrepreneurial spirit and a certain freedom that this medical school engenders."

With Philadelphia already flush with one of the largest concentrations of medical colleges in the country, Temple in August 2011 will open a branch in the Lehigh Valley in partnership with St. Luke's Hospital of Fountain Hill, Pa. It will serve 120 students by its fourth year.

"It will give the Lehigh Valley homegrown doctors," said dean John M. Daly, noting that more than half of Temple's medical students are from Pennsylvania and half remain here to practice.

The Philadelphia College of Osteopathic Medicine - the largest contributor of doctors to the state's workforce and to rural areas in particular - opened a 330-student campus in Georgia in 2005 based on that state's growing population and physician shortage.

Drexel's medical school has grown from 235 first-year students to 260 over five years, dean Richard Homan said. The school is considering expansion, possibly in Lancaster.

And the Cooper Medical School of Rowan University is planning to open in 2012 with a class of 40. Officials are aiming to address a longtime shortage of medical students; New Jersey ranks 31st in medical students per capita.

But some wonder if the expansions will provide more general-practice doctors in underserved locations as intended.

"I'm just not sure A follows B," said Gail Morrison, vice dean of the medical school at the University of Pennsylvania, "especially as long as there is a big discrepancy in pay between specialists and primary-care doctors."

At Penn, only three to five graduates in a class of 160 go into family medicine.

Some experts say the nation doesn't need more physicians; they favor lower-cost nurse practitioners and physician assistants.

Others say a lack of residencies may cripple efforts to turn out more doctors. Residencies in which medical school graduates train total about 25,000 nationwide.

"So we have a situation where the top of the funnel is expanding, but the residency opportunities have not grown proportionately," said Matthew Schure, president and chief executive officer of Philadelphia Osteopathic.

Some assert that more American students will push out some of the 7,000 foreign medical students who graduate annually.

"We think there will be a lot of pressure on foreign graduates," Salsberg said.

Some question whether doctor quality will suffer as more students who may have been rejected for medical school get in. Others doubt it, noting that many qualified students are rejected. Commonwealth's current class scored close to the national average on entrance exams.

"No medical school would ever set up any student for failure or disappointment," said Osteopathic's Schure.

Conceived in 2004, Commonwealth faced virtually no opposition, given the statistics, officials said. The average age of area physicians was over 50. There was only one neurosurgeon, and he was due to retire in a year. The lack of physicians hurt the area economically.

"About a billion dollars in health care leaves the area on an annual basis," said Robert M. D'Alessandri, founding dean and president of Commonwealth.

With its three campuses, Commonwealth considers its 16-county region to stretch west to Clinton County, south to Schuylkill, east to Pike, and north to New York.

It occupies 22,000 square feet at the temporary Scranton site, including a 12-table anatomy lab. The new building will occupy close to a city block and in time enroll 120 per class.

The college is unusual in that it's not affiliated with one university. It operates on a $25 million annual budget and this year received $3.7 million in federal and state research grants. Officials declined to say if it's running in the black.

Commonwealth recruited young faculty members as well as veterans. Medical graduates of the Massachusetts Institute of Technology, Harvard and Yale Universities, and the University of California are on board.

John Arnott, 33, a Wilkes-Barre native who trained and did his postdoctoral work at Temple's medical school, was thrilled to come home.

"It was an opportunity to put my own fingerprints not only on my research but on university policy," he said.

The college has a cadre of 600 area physicians who will volunteer to teach part time. Local obstetrician Hal Davis one afternoon taught students how to give pelvic exams in the simulation lab.

The school has set as a goal of retaining at least half its graduates as Pennsylvania practitioners.

Officials hope to raise scholarships for graduates who commit to work locally for some time, D'Alessandri said.

"This could be basically a loan that would be forgiven once they've completed five years of practice in the region," he said.

Its program, by design, encourages doctors to stay. The private school accepts only U.S. students, and, in its first class, three of every four are Pennsylvanians, a third from the northeastern part.

Local residents have "a big leg up" on admittance, said Paul Katz, vice dean for faculty and clinical affairs.

Doctors who do their residency in the region also are more likely to stay, he said.

The school will look to create more residencies, including those in speciality areas such as obstetrics, gynecology, and behavioral health.

Commonwealth also has a teaching program that it hopes will promote primary care and tie its students to the community.

It matches each student with a local, multigenerational family that has at least one person who suffers from a chronic illness. The student, under the tutelage of a family-care doctor, follows the family's health for four years.

"It's been a really neat experience to see that continuity of care, to see how invested the physician is and also how invested the family is in their physician," said Emily Roe, 23, of Malvern, an aspiring pediatric physician.

The college has a goal of having at least half its students go into family practice.

"This school cultivates respect for primary-care doctors. They really care about teaching doctors to understand the patient as a person," said Stefanie Hallman, 24, a Drexel graduate.

Student Melissa Rader, 23, a Pennsylvania State University graduate from Scranton, wants to stay in Pennsylvania.

"I came here because I am local. . . . It was on a personal level for me," she said.

Commonwealth this spring received more than 3,000 applications for 65 spots - up from 1,300 the year before.

Some students relish being part of an inaugural class.

"We're going to be able to work together and make a real difference in a college," said Stephen Chorney, 23, who is from Cherry Hill.

Getting $20,000 a year - more than half the $35,000 instate tuition - from local sponsors helps, too.

It means a lot, considering the average debt for a medical-school graduate ranges from $140,000 to $170,000.

"I don't have to worry as much as friends of mine," said Chorney, "about how much money I have to owe."