Enrollment on the rise

Medical schools are making steady gains in training more doctors and enrolling minority students. But a broader mix of stakeholders will need to support the efforts if the U.S. is to produce enough physicians to meet burgeoning patient demand, said medical education experts last week.

The assessment came during an Association of American Medical Colleges news briefing highlighting U.S. medical school enrollment figures and trends for 2010. According to the data, nationwide freshman enrollment increased by 1.5% over 2009, for a total class size of 18,665 students.

Medical schools lost a bit of ground on the number of women who applied and were accepted into the 2010 freshmen class. In 2010, 47% of applicants and new students were women, compared with 48% in 2009. Schools made progress, however, on their enrollment of students from underrepresented minority groups. Black student enrollment grew by almost 3%; Native American student enrollment increased by nearly 25%; and Hispanic student enrollment was up by 9% compared with 2009 figures.

The growing enrollment figures are getting a boost from some medical schools expanding the number of students they accept annually, as well as the recent accreditation of three new schools: Virginia Tech Carilion School of Medicine in Roanoke, which opened its doors in August; Hempstead, N.Y.-based Hofstra University School of Medicine, which is expected to open in 2011; and Rochester, Mich.-based Oakland University William Beaumont School of Medicine, also expected to open in 2011. There also are 12 other medical schools currently undergoing accreditation. Once opened, those institutions are expected to help close the gap on the physician shortage, which the AAMC has projected will reach a deficit of more than 60,000 doctors by 2015.

But while AAMC President and CEO Darrell Kirch called the growth of medical education “encouraging,” he also urged legislators, private healthcare payers and other stakeholders to finance more medical residencies. “Physician development is dependent not just on new medical schools, but also on the creation of new residency training slots,” Kirch said during the news briefing. “We’ve been very clear with Congress about the need to expand those slots by 15% in order to meet demand and create physicians who can practice in their communities.”

Kirch and other medical education experts said they are pushing lawmakers to create new funding mechanisms to pay for such an expansion. “It strikes some people as incongruous that Medicare, which pays only one-third of all healthcare costs, is the sole funder of residency positions. We believe there needs to be a model where all payers contribute to the educational pool.”

But advocates for a new medical-residency funding model acknowledged that creating new funding sources will likely be challenging under current economic climate. “If it’s an additional payer fee, I think providers would be OK with that,” said Atul Grover, chief advocacy officer for the AAMC. “But if it comes out of money slated to go to the provider, given the current fiscal setting, that might cause some resistance,” he added. “I think, though, that no matter where the money comes from, it’s going to make someone uncomfortable given this fiscal environment.”

Training a greater number of physicians isn’t the only pressing issue healthcare industry stakeholders need to address more aggressively, said medical education experts. While AAMC data showed gains in student diversity, many observers said the pace and creativeness of recruitment efforts fall far short of fulfilling the need for a more diverse physician workforce. Nationwide, for example, 80% of incoming medical school students were drawn from the top 2% of the economic quartile, according to the 2010 enrollment data. “This is something we’ve been modeling for some time, and we’re concerned that the application pool doesn’t reflect the communities they’ll serve,” said Henry Sondheimer, the AAMC’s senior director of student affairs and student programs, during the news conference.

Paul Katz, founding dean of the Camden, N.J.-based Cooper Medical School of Rowan University, which expects to open in fall 2012, said significant attention needs to be given to addressing medical debt as a means of encouraging a more financially and ethnically diverse pool of medical school applicants. “Students can come out with $200,000 in debt, and to begin your career in that kind of hole is staggering.”

Additional measures also need to be taken to facilitate diversity, said other experts reflecting on the AAMC’s enrollment data. Thomas Cavalieri, dean of the UMDNJ School of Osteopathic Medicine in Stratford, N.J., said healthcare industry stakeholders need to provide greater resources for creating medical-profession pipeline programs that reach into middle schools and high schools in underserved communities. “We target schools with large minority populations, and we have several pipeline programs,” Cavalieri said.

Walter Bland, associate dean for student affairs and admissions at Howard University College of Medicine, part of an historically black college in Washington, advocates for medical schools expanding criteria for admissions to encouraging diversity.

He said that often, potentially high-achieving physicians are overlooked if they come from underachieving school systems. “We look at factors other than test scores,” Bland said. “We look at students’ experience and their background. We look at their volunteer service and whether they lived in communities that are underserved.”