1) The Dallas-Fort Worth Metroplex is where the greatest number of Texas’ first-year students come from, according to the Texas Health Care Policy Council. (p. 19)
I. UT Southwestern and TCOM are increasing their classes to 230 students per year. The total of first-year and thus future medical graduates will be 460 per year. There are only two institutions in Fort Worth, Medical Plaza Center and John Peter Smith Hospital, which offer residency programs (only about 70 first-year slots), while UT-Southwestern Medical Center Dallas at Dallas Methodist supports about 350 entry-level residency positions. There is still a deficit of 40 entry-level residency slots.
II. It seems obvious that, to address Tarrant County’s future needs for physicians, priority should be given to developing new residency opportunities, not to increasing medical school graduates. UNT’s push for another 100 medical students per class on its Fort Worth campus is not only poor planning and misplaced effort, but it will divert taxpayer monies from areas of real need in the state.
III. UNT’s second medical school, with its 100 additional medical students, would create the largest medical school conglomerate in Texas in a region of Texas that has the least need. Fort Worth would be graduating a combined 330 students annually in a city with grossly inadequate residencies and therefore nominal opportunity for those graduates.
2) The UNTMD business plan estimates the start-up cost is only $21.5 million and it has garnered $25 million in pledges from the community to sustain the school free of charge to the state for the first five years (2011-2015).
I. History has shown that studies’ cost projections are always wrong or overly optimistic. Therefore, it is wise to err on the side of the real facts and costs of recently established medical schools in Texas and across the nation.
- The Foster School of Medicine in El Paso cost $100 million to the state in addition to a donation of $50 million.
- Seton Health System and UT Southwestern plan to invest $1.5 billion to establish a medical school and center in Austin.
- UT South Texas Medical School, approved by the legislature in 2009, won’t receive funding from the legislature until 2015. The Texas Higher Education Coordinating Board (THECB) estimates the cost to be $98 million.
- THECB estimated in 2008 that the start-up cost (e.g., administrative and faculty costs) for a new medical school of 60 students per class is $92.6 million, without including the cost of a 160,000 square-foot building.
- Across the nation, the average cost of a new medical school is $100-150 million.
II. UNTMD plans to admit the first class in 2013 and plans, during its first five years, to waive the formula funding that is typically provided by the state. This means that the UNTMD plan calls for waiving $30 million from the state, while the pledges only amount to $25 million.
3) The majority of DO (Doctor of Osteopathic Medicine) physicians in Texas and across the nation are opposed to the current proposed MD school on the UNTHSC campus because it is financially unfeasible and will destroy the one of the best osteopathic institutions in the nation.
- The Texas College of Osteopathic Medicine (TCOM) obtained its founding charter in 1966 and started as a private institution. From its humble beginning in 1970, it graduated its first class in 1974 and became a state-sponsored medical school in 1975. TCOM has grown into the present-day UNTHSC by legislative act in 2001. TCOM’s status is reflected in the Texas Education Code, Sec. 105.402., which recognizes and protects the osteopathic heritage and identity of the institution by specifically prohibiting the UNT Board of Regents from awarding an MD degree. In addition, the president of the UNTHSC has to be a DO.
- TCOM has been the cornerstone of UNTHSC by providing its resources to starting up the new colleges: the Graduate School of Biomedical Sciences, the School of Public Health, and the School of Health Professions.
4) DO physicians are opposed to the establishment of an MD program at UNTHSC in part because the integrity, the process and the real motives of the MD initiative study group, which was set up at the end of 2008, are questionable.
- In 2006, Dr. Scott Ransom was hired to take over the reins of UNTHSC upon the retirement of the president, Ronald Blanck, a former 3-star general and Surgeon General of the Army. Dr. Ransom has been offered the most generous salary ($904,562 per year) that a medical educator/president receives relative to the size of each institution’s operating budget. In a recent letter, Dr. Ransom recognized that the MD School initiative started around 2006 and not in 2008.
- The most accomplished Dean Hahn was forced to resign, administrative leadership positions were replaced and inflated from 29 to 42 positions, and the institution experienced an unprecedented exodus of its most experienced and senior faculty members.
- The composition of the MD study group was biased and the outcome of the study was predetermined.
5) Dr. Ransom, a DO himself, keeps arguing that TCOM has been effective in producing primary-care physicians and that an MD school is needed to produce more specialists and researchers. This condition of bias and prejudice against DOs is unfounded and groundless as TCOM graduates have been going into any specialty and subspecialty that existed in medicine. Certainly that DO brand name is less well-known as DOs represent only 7 percent of the physician workforce. However, the osteopathic profession has experienced exponential growth over the past three decades, and today 20% of US medical students are DO students.
- What is a DO? In simplistic words, DO= MD + DC (Doctor of Chiropractic). Osteopathic medicine includes the rigorous medical curriculum and the manual medicine component that inspired the chiropractic profession.
6) The claim that an MD school at UNTHSC campus provides unique opportunity for DO and MD students to be trained side by side.
- DO and MD students/graduates have already been training side by side for years. Two-thirds of DO graduates are doing “MD” residencies/ ACGME accredited residencies.
- TCOM students are being taught by some MDs and doing core clerkships along with UT Southwestern medical students at John Peter Smith Hospital, Texas A&M medical students at Cook Children’s Medical Center in Fort Worth, Driscoll Hospital and Spohn Memorial in Corpus Christi, and UT Health Science Center in Tyler.
Texas is facing a $27 billion budget shortfall—the worst in its history. Investing taxpayers’ money to produce more medical students and then exporting them to other states is not sound public policy. Currently, the medical student enrollment increases are on track with the recommendations offered by AAMC; this is expected to continue until 2017. Medical student enrollment has already outpaced the residency slots (graduate medical education/GME).
The THECB will make a thorough review of the projected physician need in 2015 and determine whether additional enrollment increases are necessary.
Therefore, it is unconscionable for Texas to approve another medical school in Fort Worth when there is such dire need in South Texas. The priority of addressing the physician shortage is to increase GME opportunity. In 2010, Texas GME is already deficient by 154 entry-level residency slots compared to the recommendation offered by the THECB, which advises keeping GME levels 10% above the medical student graduation levels. It is projected that Texas medical school first-year enrollments will reach about 1,700 by 2012 and 1,800 by 2015. (p. 26); an addition of 590 entry-level residency slots is needed to close the GME gap by 2015.
Perhaps the best use of the $25 million in pledges created by this fervor to establish another medical school in Fort Worth would be to develop 125 additional residency slots in Fort Worth- area hospitals. That seems a more sensible and cost-effective strategy for responding to the rumored physician shortages in Tarrant County. If the local community wants an MD school, let’s encourage them to start a private medical school and invest the real money, like $1.5 billion in Austin. On a side note, Tarrant County, the county in which Fort Worth is located, has 1.7 million residents, 3 times the population size of El Paso, and has only pledged $25 million for a new school in contrast to a single philanthropic donation of $50 million in El Paso.
