LITTLE ROCK — From start-up costs to ongoing operating expenses to finding residency slots for graduates, Arkansas State University faces difficult challenges in its quest to establish an osteopathic medical school to help address a shortage of primary care doctors in the Arkansas Delta, 0fficials say.
ASU took the next step in a years-long process last week by hiring Tripp Umback, a nationally recognized health care and economic development consulting firm based in Pittsburgh to study the feasibility of developing an osteopathic medical school in Jonesboro.
"We’ve done our research and we realize our limitations, and that is why we’re bringing in this company, this third party, to help make an evidenced decision," Jason Penry, ASU vice chancellor for university advancement, said last week.
Penry said the study, which he projects will be completed by the end of the year, will look at both public and private medical school options and will consider a number of variables, including cost and the residency training of third-and fourth-year students as well as graduates.
The feasibility study is supported by the Delta Regional Authority, which has given ASU $25,000 to help cover about half of the nearly $50,000 cost.
Efforts to overcome the difficulties could provide dividends for rural health care, he said, by providing doctors of osteopathic medicine in areas of the state where doctors are scarce.
"A DO school could be totally transformative to the state of Arkansas because nobody disputes the need for primary health care is great," he said.
Dr. Gregg S. Silberg, who recently was part of efforts to establish an osteopathic medical school in Wisconsin, said hurdles are many and steep.
Among them would be finding residencies for the graduates because only a limited number of qualified institutions offer such opportunities, said Silberg, who is executive director of the Wisconsin Association of Osteopathic Physicians & Surgeons.
Estimated start up cost for the proposed 100 student private, nonprofit osteopathic medical school in Wisconsin would be about $80 million, he said.
There are 28 osteopathic medical schools in the United States, with the nearest being the Oklahoma State University Center for Health Services in Tulsa, William Carey University College of Osteopathic Medicine in Hattiesburg, Miss., Kansas City University of Medicine and Biosciences in Kansas City, Mo., and University of North Texas Health Science Center in Fort Worth. About 70,000 doctors of osteopathy practice nationwide.
In Arkansas, there are 463 active DO license holders, of which 275 are practicing in the state, according to the state Medical Board.
According to the American Osteopathic Association, DOs are fully trained physicians licensed by state medical boards to prescribe medication, perform surgery and practice in all recognized medical specialties. Osteopathic training includes an emphasis on "the body as an integrated whole" and the connectedness of the muscular, skeletal and nervous systems, the AOA states on its website.
While there are some differences in medical school training, once students graduate from school and begin serving their residencies the training is the same for both DOs and medical doctors, said Dan Rahn, chancellor of the University of Arkansas for Medical Sciences, the state’s only medical school.
"I will tell you at the end of the residency there is no demonstrable difference that I am aware of in the ability to mediate either primary care needs or specialty care needs," Rahn said,
He said UAMS has several DOs as residents and some as instructors.
A lack of residency positions in Arkansas and across the nation has been a problem for years and has contributed to the national shortage of doctors, according to the Association of American Medical Colleges. Funding for the national residency program, including the selected the salary, comes from Medicare. The number of positions is capped at the federal level.
Rahn said studies have shown that UAMS produces an adequate number of medical students — each class starts with 174 students — but he said Arkansas has a "maldistribution problem" because too many go to work in the larger cities while few set up practice in rural areas of the state.
Another problem is that the number of family medicine residency slots in Arkansas is capped at 160, he said.
Dr. Rick Smith, dean of the UAMS medical school, said a "majority of (doctors) settle within 60 miles of where they do their residency training, so the real issue is trying to get residency training close to where they want the physicians to be and that would be one of the really important issues if we had more slots."
Rahn declined to discuss specifics of ASU’s interest in an osteopathic medical school but he acknowledged state funding for UAMS is always an issue, noting that a plan to add more third- and fourth-year medical students to its campus in Fayetteville has been put on hold.
"We’d like to go higher," he said, noting there are 18 in each year. "We intended to keep increasing the class size but we stopped … because the state funding was anticipated to grow but did not.
"We were anticipating a $4 million annual budget for the Northwest Arkansas campus and we have a $3 million budget," he said
Rahn said another reason for not expanding the program was the cap on residencies in the state.
Gov. Mike Beebe, an ASU alumnus, said he likes that his alma mater is considering the idea of establishing an osteopathic medical school and supports the feasibility study. But he said the state would have difficulty funding a second public medical school.
"Most osteopathic schools are not public," Beebe said. "They are more private, sometimes associated with universities, but usually you don’t take resources from state-supported traditional medical schools.
"It certainly is going to require all the DOs, all the osteopaths, their organization and then those folks who do those schools to try and figure out a way to pay for it because you can’t take money away from UAMS, they already need more money."
Silberg, who once assisted with efforts to establish a school in Wisconsin before leaving because of difference with the group working to open the private school, said along the problems of start-up costs and finding accredited residency slots, federal loans for public osteopathic medical school are only available when the school is fully accredited.
"I credit Arkansas State and hopes this works," Silberg said. "I think that’s a good thing."
Frazier Edwards, director of the Arkansas Osteopathic Medical Association, did not immediately return a telephone call seeking comment last week.