Universities across Florida are racing to start or expand medical schools. Is their goal really to solve a looming doctor shortage?
By some measures, Florida has too few doctors. The federal government considers many of Florida's rural counties, like many rural areas nationally, "medically underserved.'' Florida lags the national average of physicians per capita and falls far behind well-off states like New York.
Meanwhile, Florida's three fully accredited allopathic (non-homeopathic) medical schools -- University of Miami, University of Florida and University of South Florida -- have been steadily churning out about 450 doctors per year for the past 30 years, even as the state's population has doubled in the same period.
Factor in predictions of a coming physician shortage nationally, and some see reasons for the state to begin producing more doctors. In recent months, universities have announced plans, including two new medical schools, that could double the number of medical school slots in Florida over the next five years.
In June, Florida International University in Miami-Dade unveiled plans to open a medical school, perhaps as early as 2007. The University of Central Florida has announced similar intentions. In August, Florida Atlantic University in Boca Raton enrolled its first class of students in what will become a satellite campus of the University of Miami School of Medicine. This fall, the Lake Erie College of Osteopathic Medicine will open a campus near Bradenton, becoming only the second school of osteopathy in Florida.
Meanwhile, Florida State University College of Medicine -- the first allopathic medical school to open in the state since 1971 -- will graduate its first doctors next spring.
The biggest argument cited by the universities for creating more med school slots is the potential for a doctor shortage. "Florida has often been a national forerunner, experiencing problems before other states do. The physician shortage is no exception," says Thomas A. Breslin, the vice provost for academic affairs at Florida International.
During the 1980s and '90s, efficiencies produced by managed care were expected to limit the demand for medical services -- and doctors. Experts even warned that the supply of doctors across the U.S. could soon outstrip demand. But as the managed care revolution fizzled and demand for healthcare continued to surge, public health officials reversed course and now project a shortage of physicians.
Some argue that the shortage in Florida already extends beyond the state's rural areas. Ken Boutwell, CEO of Tallahassee-based MGT of America, a public policy research firm, says, "Patients are finding it more difficult to schedule an appointment with their doctor. It's not at all uncommon for people to wait weeks, months to see a specialist." Boutwell's firm, which is conducting a feasibility study for the University of Central Florida's proposed medical school, produced a study in 1999 challenging the warnings of a doctor oversupply.
While not disputing the possibility of a physician shortage nationally, others question whether opening more medical schools is the best way to make sure the state has enough doctors.
For one, there are few signs that doctors are reluctant to move to the state. While 90% of the doctors who move here are trained elsewhere (40% are trained abroad), the growth in the number of physicians in Florida has still outpaced the state's population growth. In the early 1990s there were about 13 million people in Florida and around 63,000 physicians (including both medical doctors and doctors of osteopathy). Since then, the overall population has increased by some 23% to 16 million, while the number of physicians has jumped by 42% to nearly 90,000.
In addition, if the goal is to have enough physicians in the state, it may be quicker to create residency programs rather than medical school slots.
Why? Studies show that doctors are more likely to settle near where they attend a residency program, not where they attend medical school. Florida ranks 43rd in the U.S. in the per capita number of residency positions. Without additional residency slots, some say that expanding or creating medical schools will just produce graduates who will finish their training and likely practice elsewhere.
"We need to put physicians in the environment where we want them to remain, setting up a practice," says Dr. Mark O'Connell, senior associate dean for medical education at the University of Miami. "It may make more sense allocating our resources toward more residency programs rather than more medical schools."
If the state is concerned about doctor shortages in rural areas, O'Connell says, it could establish residency programs outside heavily populated areas.
Officials from FIU, UCF and FAU say the state needs more residency positions, but they also believe the state needs to train more physicians here. "We also need more doctors coming from our own population of Florida residents," says Dan Holsenbeck, vice president of university relations at UCF. "To us it sounds like a no-brainer."
There are also questions, however, about whether the universities are motivated less by preventing a doctor shortage and more by other factors -- attracting research dollars, fund raising or just keeping up with other state schools, for example.
"I have trouble understanding why we need these expensive programs at this time," says Steve Uhlfelder, a Tallahassee attorney who's a member of the state's Board of Governors, which oversees the entire spectrum of education in Florida.
"Whether people want it for the prestige or to bring the research dollars in or whether they feel they need it to be a full research university, it's not like we're rolling in money in Florida for higher education," he says.
Before a university can set up a med school, it has to pass review by the state's Division of Colleges and Universities, get approval from the Board of Governors and then get funding from the Legislature.
Startup costs for a medical school can range up to nearly $60 million, with annual operating costs of more than $30 million.
The specter of a number of med school proposals fighting for approval and funding within just a few years is one that state officials don't like to imagine.
"We have a situation we need to look at thoughtfully and carefully," says Debra Austin, chancellor of the Division of Colleges and Universities.