S.C. needs med school expansion

The diagnosis is clear. The growth in the number of students in our state's two medical schools (MUSC and USC) has not been keeping pace with the growth in our population. We have fewer medical students per 100,000 South Carolinians than we did eight years ago. During the same period, the number of full-time primary care doctors per 100,000 population has dropped by a whopping 25 percent, so that we now rank 43rd in the U.S.

The prognosis improved on Aug. 6 when the respective University of South Carolina and Greenville Hospital System boards of trustees unanimously approved expansion of the current two-year medical program at GHS to a four-year program, with the preparation of primary care doctors as its principal goal.

South Carolina is by no means facing the doctor shortage alone. The Association of American Medical Colleges (AAMC) has predicted a shortage of 150,000 physicians in the U.S. by 2025 and has recommended that over the next decade medical school enrollment be increased by 30 percent from the 2002 level. Thus, they have encouraged the creation of about a dozen new medical schools, the first expansion in the number of institutions since the 1970s, when five new medical schools, including ours in Columbia, were launched.

Expansion of the USC program in Greenville comes as demand is sure to increase. The projected shortage of physicians, especially in primary care, has been made even more urgent by the passage of the Health Care Reform Act, which will add an estimated half-million South Carolinians to the rolls of the medically insured. Because these are people who previously experienced financial barriers to receiving medical care, without such disincentives they will presumably seek greater access to treatment, placing ever greater demands on our health care system.

Moreover, currently practicing physicians, on average, are working about 6 percent fewer hours than they did a decade ago. So we have proportionately fewer primary care doctors, each of whom, on average, is seeing fewer patients. To make matters even worse, nearly a quarter of our state's doctors are 60 years or older and will be retiring soon. All of this adds significantly to the problem.

Two-thirds of all USC medical school graduates go into primary care specialties (internal medicine, pediatrics, and family medicine) and those specialties that are considered underserved in South Carolina (emergency medicine, psychiatry, and obstetrics/gynecology). Still, we aren't keeping up with the growth in our population and thus are failing to meet adequately our state's health care needs. Given the very high rates of cardiovascular disease, stroke, diabetes and other preventable diseases in our state, the need for primary care is all the more acute.

Put simply, here's our situation. We aren't graduating enough South Carolinians from our state's medical schools to meet the needs of our hospitals, clinics and medical practices, so we import doctors from other states and other countries to fill our residency programs in order to meet the health care needs of our citizens. But our actions now will begin to close the gap.

Since 1983, medical students at USC have been receiving training at the Greenville Hospital System. In 1991, this site was accredited as a Regional Campus of USC School of Medicine, and currently about a quarter of our medical students complete half of their four-year M.D. program there. The action by both boards earlier this month recognizes the physician shortage as well as the decreasing supply of primary doctors in relation to the substantial growth in need and demand for health care. It keeps our focus on the preparation of primary care doctors as our principal goal - as it has been since the inception of the Regional Campus nearly 20 years ago. Pending approval by accrediting agencies, the first four-year students in Greenville will be admitted in the fall of 2012.

We see more opportunities ahead to expand education in the health care field and welcome broader participation. Through collaboration with MUSC, Clemson and other institutions of higher education, we can and must address the critical health care needs in the Palmetto State.

Dr. Andrew Sorensen is Distinguished University Professor and Distinguished President Emeritus of the University of South Carolina. He has a tenured faculty appointment in Internal Medicine. These remarks were adapted from an article by Dr. Sorensen that appeared in the August 2010 Journal of the South Carolina Medical Association.