MCG seeks 'innovative' change

It is "the biggest thing we've done since 1828," when the Medical College of Georgia was founded, Dean David Hess said. An expansion and radical change to the education of medical students also could provide dozens of new doctors to rural areas of Georgia in need of them.

Hess and Augusta University President Brooks Keel have approached state leaders about expanding the medical school by 50 students and shortening medical school from four years to three, while also pitching the idea of the state paying the tuition of those students who agree to spend at least six years in underserved areas of the state, which is almost every county outside of the metro areas. Those students who complete the three-year program would then go into a three-year primary care residency in the state, Hess said.

When MCG was looking at expansion in 2008 and opening a branch campus with the University of Georgia in Athens, the original vision was to get to 300 students per class, with 240 in Augusta and 60 in Athens, Hess said. That plan was abandoned when the financial crisis hit, but it has recently been revived. Athens still plans to increase to 50, then 60 students after new construction is completed, he said. MCG's main classroom building, the Harrison Education Commons, was built to accommodate up to 300 students per class, Hess said.

The looming physician shortage breathed new life in adding those additional 50 students and ensuring they were looking at primary care, he said. Georgia ranks near the bottom in physicians per capita.

"So we said if we’re going to do this, why don’t we do something novel and innovative," Hess said. "If we’re going to increase by 50, let’s reduce the medical school (debt) because the other thing we have been working on is our student debt."

Going to three years means one less year of medical school tuition, he said.

A three-year medical education is not a new concept. Many medical schools went to three years during World War II to produce much-needed doctors more quickly, and many schools experimented with it in the 1970s, said Dr. Alison J. Whelan, the chief medical education officer for the Association of American Medical Colleges. Most of them went away from the idea because the faculty thought it too constraining, she said.

As the burden of medical school debt has grown – a 2017 survey found a third of students owed $200,000 or more by the time they graduated – the idea has come to the fore again. New York University's School of Medicine, which began a three-year program in 2013, and seven others with accelerated three-year programs formed the Consortium of Accelerated Medical Pathway Programs in 2015. It now includes 12 U.S. medical schools, including Mercer University's School of Medicine in Georgia, as well as a Canadian medical school.

"I think many schools are undertaking serious, interesting curricular innovation approaches and, with that, being open to the possibility of a three-year program as one of the multiple innovations that different schools are trying," Whelan said.

Part of the thinking is that for many medical students, the fourth year is largely tied up with interviewing with different programs to nail down a residency and is of not much use, Hess said. But different schools handle the fourth year differently, and some use it to offer students experiences beyond the clinic, from research to service in the community or even internationally, Whelan said.

"That can be really enriching and actually help with your professional and career development," she said.

Some students need time at the end of the third year or beginning of the fourth to help decide what specialty they want to enter and might feel rushed if it is not available, Whelan said.

"Some students use the fourth year to really expand their core skills because it takes some people longer to learn things," she said.

But for those students who have decided and feel ready to go at the end of the third year, "that could very well be a really logical approach," Whelan said.

The accelerated program could take advantage of the 500 to 600 new residency positions recently created and funded by the state that are scattered throughout Georgia, many of them associated with MCG and its regional affiliates such as Phoebe Putney Health System in Albany, Hess said.

That could have a further advantage for the state – according to the Georgia Board for Physician Workforce, of the students who go to medical school and do a residency in Georgia, 72 percent stay and practice in the state, compared with about half who do a residency elsewhere.

They are also proposing the state pay the tuition of the 50 expanded positions in exchange for those students practicing for at least six years in an underserved area of the state.

"We want to have an opportunity for students to go to medical school for free so when they graduate they don’t have any debt at all if they will go practice in rural Georgia for six years," Keel said. That in turn would attract some students to MCG who want to practice primary care but are concerned about the debt they would carry after graduation, he said.

"We think we can use that as an aggressive recruiting tool, especially for students who are already from the rural part of the state," Keel said. "They know what it’s like, have family there, understand the benefits of being in a rural part of the state and won’t have any qualms about going back there."

The cost would be $5 million a year, but the return for the state would far outweigh that, he said.

"Any kind of money you get on a recurring basis is a big deal. We certainly appreciate that," Keel said. "But $5 million a year is not a whole lot of money when you are talking about the impact we could potentially have for the state."

An analysis by consultant Tripp Umbach found that by 2028, putting 48 MCG-trained doctors into underserved communities would yield an economic benefit of $347.3 million to the state for an investment of $20 million, or a return of roughly 17-to-1. That comes in a couple of different ways, Hess said.

There is a direct economic benefit in that a primary care practice typically results in nine jobs, he said. Also, studies have found that putting a primary care physician into a rural community is worth about $3 million, not only in the care received but also in the savings from patients not having to use the emergency room for basic care and from keeping people from getting sicker and costing more down the road, Hess said.

Local legislators have been briefed on the proposal, as well as Gov. Brian Kemp's office and House and Senate leadership, and those are ongoing conversations, Keel said. The hope is it could pass this legislative session or the following year, he said. The idea should be able to get widespread support because those new physicians would be heading into nearly every corner of the state, Keel said.

"This is not just an Augusta political issue, it’s an entire state," he said. "When you consider where our branch campuses are, it touches virtually every legislator in the state."

The reception has been "incredibly supportive" so far, Keel said, and they are "guardedly optimistic" about its chances. The school's accrediting body, the Liaison Committee on Medical Education, would have to sign off on it, and the school has begun that process with the hope of presenting it to them this summer, Hess said.

For taking on those tough issues, they are to be applauded, Whelan said.

"The focus on primary care and the focus on a creative way to help students work in an underserved area is really important," she said. "Medical schools that are taking creative ways to support students and to get them to work in underserved areas should be commended. I think the more schools that look for solutions that work, the better the country will be in terms of serving our population. I think the fact that they are looking at both of those is really terrific."

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Putting 48 physicians trained at the Medical College of Georgia at Augusta University into 48 underserved communities would yield the state an economic benefit of $347 million or a 17-to-1 return on its investment, an analysis by consultant Tripp Umbach found. That comes in a couple of different ways, MCG Dean David Hess said.

There is a direct economic benefit in that a primary care practice typically results in nine jobs, he said. And studies have found that putting a primary care physician into a rural community is worth about $3 million, not only in the care received but the wasted care avoided from patients not having to use the Emergency Room for basic care and from keeping people from getting sicker and costing more down the road, Hess said.

Doctors make cents