Push for another medical school based on a faulty premise

A May 22 Post and Courier editorial rightly questioned the wisdom of permitting the University of South Carolina to create an entirely new medical school without any state review.

Medical schools are the most expensive components of universities and especially the basic medical science departments. Physicians now, and in the future, require a working knowledge of immunology, genetics, biochemistry and other sciences to diagnose and treat patients with highly complex technology and medications. Recruiting a critical number of scientists is crucial to success of a medical education, yet it is expensive and not easily done.

The rationale for a new school is a presumed shortage of physicians and especially generalists in rural areas. South Carolina is about average for Southern states in numbers of physicians per capita, though clearly an increase will be required if more of our population receives adequate care. A new school is most unlikely to foster significantly more generalist or rural physicians because the major factors in reducing their number is national in scope and include poor relative compensation.

Medical students enter practice with educational debts, often of $150,000 or more, leading them to enter better- paid specialty areas. Only a change in federal and insurance industry reimbursement policies will address this.

Another concern is the number of qualified S.C. college graduates who seek medical careers. South Carolina already has the nation's highest number of in-state students attending its two medical schools and very few attend out of state. If there are insufficient numbers, students must be recruited from states with excess qualified students, mostly in the Northeast.

There would be an insufficient number of residency training positions in South Carolina to accommodate a substantial increase in medical graduates unless Medicare or the Veterans Administration were to increase positions. That is problematic in a time of intense retrenchment in the federal budget.

It is reasonable to search neighboring states to see how they have addressed these issues. I have been on the faculty of state medical schools in North Carolina, Virginia and Alabama. Each state has expanded medical education and each provides a different model. North Carolina, in an era of prosperity in the 1960s, established a new school at East Carolina University.

The faculty at Chapel Hill, where I worked, assisted in developing basic and clinical departments but most importantly there were existing general science departments and an experienced university administration to support the program. After some 15 to 20 years it was a success. Virginia took another route and a free-standing medical school was established in Norfolk, based on a sales tax in five counties. It was not to seek state funds but did. It was an institution with rapid turnover of leadership, name and faculty. It is not a highly regarded institution, in large part, related to the absence of a university setting.

I was dean at the University of Alabama School of Medicine in the 1990s and very impressed with the three campus program established in that state. George Wallace had wanted independent schools in Tuscaloosa, Huntsville and Birmingham, but a more conservative legislature approved just one school with basic science courses in Birmingham and two additional clinical programs at hospitals near the campuses in Huntsville and Tuscaloosa. It is cost-efficient, highly successful and provides graduates who know the diversity of the state. Finally, Georgia has recently added a new school, on the campus of the University in Athens. The basic science programs rely heavily on existing university departments. The common denominator is to reduce cost by placing new schools with existing university science departments and providing strong administrative structure.

South Carolina might better expand the physician base by enlarging current clinical programs in the Greenville area, leaving basic science education to existing schools. Also, there must be an expansion of residency training positions in the state -- perhaps funded by hospital systems themselves.

The data suggest that physicians tend to practice in the area of residency training. It is worth remembering that all medical education eventually depends either on the general taxpayer or the health-care dollars generated from patients and insurance. Tuition, if kept in a feasible range, contributes, but cannot alone provide for a modern medical education.

Dr. Harold J. Fallon served as home secretary of the Institute of Medicine, dean of the University of Alabama School of Medicine and vice chair of medicine at the University of North Carolina.