Hope on a Grand Scale
By Gary Pettus
Putting more students into UMMC’s School of Medicine would be like trying to cram a size-12 foot into a size-10 shoe.
Since the School of Medicine opened in the 1950s, little has changed, space-wise, for medical students attending lectures – except there are even more of them today.
Yet, administrators say, increasing the class size is exactly what they must do, or risk the future of health care in Mississippi.
In short, they want a bigger shoe — a new, $63 million facility large enough to kick down the current 135-student threshold and allow the student body to keep growing.
Seeking most of that money as part of a bond package that state legislators must approve, advocates are presenting their case before the court of iffy economics, where even some members of the med school family want a second opinion.
“Alumni who remember their first-year classes of 150 students are wondering why we need a new building to increase class size now,” said Dr. James Keeton, vice chancellor for Health Affairs and dean of the School of Medicine.
“The long answer is that we now have 2,700 students on campus from all the schools, and they have to share space. Every classroom is already crammed and we’re constantly moving students around.
“Also, we teach differently now. We need more space for simulation for medical students, nursing students, pharmacy students.
“But the simplest answer is: We need more doctors.”
Per capita, Mississippi has the country’s smallest supply of primary care physicians. Just to reach the national benchmark, the state would have to add to its workforce more than 1,300 of these family medicine practitioners, pediatricians, gynecologists and others, in addition to those who will be trained under the status quo.
The state goal, for now, is 1,000 by 2025, a target endorsed by Gov. Phil Bryant.
“How many doctors do we have? Not enough,” Bryant said on Oct. 26, as he announced a $10 million award in Community Development Block Grant Funds (CDBGF) to lift the medical-school cause.
“Mississippi needs more physicians,” Bryant said. “We need a new medical school.”
Awarded by the Mississippi Development Authority, the $10 million grant is dropped on top of $4.5 million appropriated by legislators in 2011 for architectural and engineering groundwork. That would leave the school’s bond-issue need at an estimated $48.5 million – the amount of the long-term loan taxpayers would repay if that total is approved.
“The new School of Medicine would be the largest building built here with state bond money,” Keeton said. “Most of what has already been built on this campus was financed by revenue bonds.
“The good news is we’ve got very good support from state leaders, including Gov. Bryant, Lt. Gov. Tate Reeves and legislators.
“When I visit with them, I’m hopeful.”
Even if Keeton’s hopes are realized, funding could be split into two parts.
“Maybe $30 million one year, and the remainder the next,” said Dr. LouAnn Woodward, associate vice chancellor for health affairs and vice dean of the School of Medicine.
If approved, the new school would be first real home for med students, who, counting all four classes, now number more than 500.
Almost from the time the state’s only academic medical center opened in Jackson in 1955, they have wandered in the wilderness of the UMMC campus.
Without a dedicated building, they must inhabit several: the Research Wing, University Rehabilitation Center, Alumni House, VA Medical Center, Jackson Medical Mall, and various other educational buildings and clinical sites.
“If I told you to go to the School of Medicine, I’m sure you wouldn’t know where to go,” said Dr. Jerry Clark, the school’s associate dean for student affairs.
Now is the time to build such a place, said Dr. Loretta Jackson-Williams, associate dean for academic affairs.
“We have this wonderful opportunity, because we have the land. Other places have to go up; we can go out.”
As envisioned, the new medical school would be a 151,000 square-foot complex similar in size to the Ole Miss law school in Oxford. Its five stories would rise just north of the Learning Resource Center, near the Student Union. Already, road work linked to the site is under way near Lakeland Drive, which it would face.
The Gross Anatomy Lab is the only on-campus facility that would stay put, Keeton said. “But plans are to spend $1.5 million to renovate it. It would be too expensive and unwieldy to move.
“All the clinics would also remain where they are.”
The new school’s cost per square foot, $368, compares this way to expansion or addition projects at other medical schools in the South: Emory University, $370 (162,000 square feet); Duke University, $630 (84,000 square feet); Virginia Commonwealth University, $793 (200,000 square feet).
A survey of nine Southern medical schools revealed that at least five are either planning renovations/expansions or had completed improvements within the last couple of years: University of Tennessee College of Medicine-Memphis, University of Alabama-Birmingham (UAB), Louisiana State University-New Orleans, University of South Alabama (USA) in Mobile and University of Arkansas-Little Rock.
UAB, USA and, particularly, Tennessee’s college in Memphis lap up Mississippians from the state’s candidate pool, Jackson-Williams said.
Between 2000 and 2011, 292 Mississippians chose to get their medical education out of state. That’s according to figures provided by Dr. Steve Case, associate dean of Medical School Admissions, who based his calculations on findings from the Association of American Medical Colleges.
Since UMMC’s med school accepts Mississippi residents only, it cannot make up the deficit with out-of-staters. A new, modern building might lure more candidates to stay closer to home, Woodward said.
“Updated, modern space and technology would not only help us recruit students,” she said, “it would also help us in faculty retention and satisfaction. In some courses, faculty members are teaching in spaces that are markedly outdated.”
Of course, not all doctors trained here stay here. But more than half do, Woodward said.
Still, the national accrediting body, the Liaison Committee on Medical Education (LCME), must give permission for a school to pump up its student body. It won’t unless the institution shows that it has enough resources and breathing room.
“The most important thing we provide for our students is a quality education,” Woodward said.
“When George Washington University School of Medicine was put on probation in 2008, a big issue was study space for students,” Jackson-Williams said.
UMMC’s school has beefed up its resources twice in order to earn approval to boost enrollment, Woodward said; but, now it has arrived at a crossroads.
In 1987, when Woodward entered UMMC med school, class size had fallen from a high of about 150 to 100 – a figure that wouldn’t change for nearly two more decades.
“At that time, there was a consensus of opinion that medical schools were producing too many doctors, that the country would experience a glut,” Woodward said. Schools, including this one, began cutting classes.
By 2003, the wheels of conventional wisdom had made a U-turn: The Association of American Medical Colleges warned that a doctor shortage loomed – because of a large, aging and ailing Baby Boomer population; a rise in the ranks of retired physicians; and a surge in the number of female doctors, many of whom are committed to maintaining a balance between their professional and personal lives.
“Not only are we not replacing retiring doctors at a 1 to 1 rate,” Woodward said, “the new doctors will not have the same work schedule.”
Starting around 2005, the school cracked the admissions door a little wider, bumping up first-year classes incrementally until the total topped out at 135.
“About two years ago, we decided to hold at that number until our accreditation visit, which was completed this year,” Woodward said.
But if the class size holds at 135, it won’t be enough, she said.
“Mississippi would still be last in physicians per capita.”
The new target is 165-170. To persuade the accreditation committee they can handle it, they’re going to need that new school, administrators say.
“If we do things the way we’ve done the last 25 years,” Woodward said, “we won’t be able to add students.”
As Keeton pointed out, this is not your father’s med school; it’s probably not even your older sibling’s.
Changing accreditation requirements call for new teaching methods that stress small-group discussions and hands-on learning and simulations; they rely less and less on lectures.
“The new building is designed to allow you to work in small groups, to turn around to the person behind you for discussions,” Clark said. “It also has a group of smaller meeting rooms, to replace our current so-called meeting ‘rooms,’ which include lobbies.”
Other features: a large amphitheater, a clinical skills assessment center, a mock clinic, a multi-purpose lab and a computer lab.
“Students today must bring their own laptops to class,” Clark said. “We have no computer lab for them to go to. Yet, in a few years, they’ll be taking only computerized tests.”
But for students, alumni and others emotionally linked to their medical school, new computers and clinics may not matter any more than this: “A new dedicated building would give the school something it has lost over the years: an identity,” Clark said.
So, when someone asks them, “Where is the medical school?” they’ll know.