Why a New Public Medical School in South Florida?

Florida International University is developing the first public medical school in South Florida. Rapid population growth and competition from other regions for physicians has overwhelmed the ability of the region’s two private medical schools and the three upstate public medical schools to provide enough physicians for the 5.3 million people living in the four counties of South Florida.

Nationally, competition for doctors, especially in some critical specialty areas, is becoming stiffer. Nationwide physician shortages are expected to grow to more than 200,000 by 2020.

Aggravating the problem is the age of Florida’s physician workforce, the oldest in the nation. Sixty-nine percent of Florida’s physicians are over 45 years of age, compared to a national figure of 58%. Thirty-nine percent of South Florida’s physicians are 55 years of age or older; eleven percent are 70 or older. Many will probably soon be retiring.

Apart from University of Miami Miller School of Medicine which provides about 10% of the region’s physicians, each of the other medical schools in the state provides 3% or less of the region’s physicians. This leaves the region exceptionally dependent on international medical schools for its physicians. Nationally, 24% of physicians are foreign-trained; in Florida, 35.5%; in South Florida, 47%.

Some experts predict that the future shortage of doctors will be as acute as today’s shortage of nurses. The experts have been studying the causes and debating solutions for the physician shortage.

A meeting of more than 200 experts called by the Association of American Medical Colleges in Washington in May 2005 provided some answers. Enrollments in allopathic medical schools have not kept pace with population growth. From 1980 to 2000, the U.S. population grew 22% but medical school enrollments hardly grew. As a result, the number of medical students per 100,000 in population declined 13%. During the same period, as the number of allopathic medical graduates grew by just 4%, US per capita income grew by 55% and health spending by 434%.

Physician shortages would have appeared sooner and been more severe but for massive increases in the number of osteopathic physicians and foreign trained physicians. Osteopathic graduates increased by 118% and graduates of foreign medical schools by 119%.

For the last 25 years, only one new allopathic medical school was developed in the US, at Florida State University. Lack of access to US medical schools also forced many US college graduates to study abroad. There are now 26 medical schools in the Caribbean basin whose programs are similar to accredited programs in the US. Thousands of their graduates are now practicing in the US, many of them in South Florida.

One of the nation’s foremost experts on the physician workforce, Richard A. Cooper of the Medical College of Wisconsin, summarized the overall picture in a July 2003 article in Health Affairs: “The 125 allopathic Medical Schools have been practicing academic birth control from 1980. In contrast, osteopathic medicine reassumed growth in 1992, establishing five new medical schools over the next decade, which has brought their total to 20.”

There are only three solutions to the shortage of medical professionals: delegation of more responsibilities to non-physician clinicians; reliance on greater numbers of international medical graduates; expansion of the capacity and the number of US medical schools.

The AAMC meeting in Washington recommended only two solutions: Expansion of existing medical schools and residency programs and development of new medical schools.

The State of Florida’s education think tank, the Council for Education Policy, Research and Improvement (CEPRI) studied Florida’s need for medical education and issued a report in November 2004. Just to reach the national average ratio of medical students to population would require 2,700 more medical students in Florida but under the most optimistic forecasts Florida’s existing medical schools could only contribute a total of 1504 allopathic and 720 osteopathic medical students.

CEPRI called for expansion of graduate medical education, medical residency positions. Expansion is most likely to occur in hospitals without existing residency programs and hence eligible for federal assistance. A key ingredient in meeting strict graduate medical education accreditation requirements is highly qualified teaching faculty, an expensive ingredient most efficiently provided by nearby medical schools.

Florida’s need for more medical students and more medical residency positions points to a need for at least one more public medical school.

FIU’s proposed medical school has a mission of educating high quality, culturally competent physicians to practice in South Florida.

More than any other university in the nation, FIU is in a position to fill the need for this type of health professional. One of the fastest growing public universities in the US, 59% of FIU students are Hispanic, 19% are Black, and 80% remain in South Florida after graduation. To ensure that the doctors it trains will understand the community’s needs and behaviors, FIU is building a complete pipeline into medicine, starting at the pre-college level, passing into a newly restructured pre-med collegiate program, the medical school itself, and a graduate medical education program with more than 500 residency positions. FIU also expects to participate very actively in the professional education of the area’s physicians.

FIU is not building new medical facilities to provide clinical training. Instead, it will benefit from the many resources, human and physical, of important health care organizations organization in South Florida. FIU’s main partners in the endeavor are Mount Sinai Medical Center (the primary teaching hospital), Miami Children’s Hospital, Mercy Hospital, Baptist Health South, and a number of ambulatory health care clinics in Miami-Dade and Broward County.

For more information about FIU, visit www.fiu.edu.