By JULIE ROVNER
For Kaiser Health News
The announcement by Kaiser Permanente that it plans to open its own medical school in Southern California has attracted a lot of attention in the healthcare community.
But Kaiser is actually at the trailing edge of a medical-school expansion that has been unmatched since the 1960s and 1970s, say medical education experts. (Kaiser Health News is not affiliated with Kaiser Permanente.) In the past decade alone, according to the Association of American Medical Colleges, 20 new medical schools have opened or been approved.
That’s no coincidence. In 2006, the AAMC called for a 30 percent increase in medical-school graduates by 2015 to meet a growing demand, both through expanded class sizes and newly created medical schools.
“We’re on track to meet that 30 percent increase in the next three or four years,” said Atul Grover, AAMC’s chief public-policy officer. “Enrollment is already up 25 percent since 2002.”
Many of the new schools focus on producing more primary-care physicians — those specializing in pediatrics, family medicine or general internal medicine. In fact, Kaiser Permanente already has a partnership with the University of California at Davis in the northern part of the state on a fast-track training program for primary care.
But Kaiser leaders say their new school (projected to enroll its first class in 2019) is about more than just primary care.
“We need to prepare physicians for the way healthcare is delivered in the future,” said Edward Ellison, M.D., executive medical director for the Southern California Permanente Medical Group. He said students need to learn not just medicine, but about integrated systems of care and how to work in a much different medical environment. “Our advantage is we can start from scratch,” he said.
Another advantage is the HMO’s deep pockets.
“They’ve got huge resources,” said George Thibault, president of the Josiah Macy Jr. Foundation, which focuses on medical education. “This is a grand experiment, but if anybody can do it, Kaiser can.”
Kaiser Permanente is far from the first healthcare provider to launch its own medical school — the Mayo Clinic has had one since 1972 and is about to expand that school from its home base in Minnesota to its satellite campuses in Arizona and Florida.
Thibault said health-provider systems are already heavily involved in the new medical schools, often as partners with degree-granting universities, “which itself is a new trend.” For example, on Long Island, the North Shore-LIJ Health System co-launched a medical school with Hofstra University in 2011.
One big question is whether all these new schools will eventually produce more students than there are residency positions, which are necessary to complete the training. The federal government, which funds the majority of those residencies through the Medicare program, capped the number of residencies it would fund in the 1997 Balanced Budget Act.
Currently there are about 27,000 residency slots available each year, which are filled by students who have earned M.D. or D.O. degrees (doctors of osteopathy) in the U.S., as well as foreign medical-school graduates and U.S. citizens who have graduated from medical schools overseas.
Between the new M.D.-granting schools and a rapid expansion of osteopathic medical schools, AAMC’s Grover said, demand will soon outstrip supply. Residency slots “are growing at about 1 percent per year,” he said (mostly funded by health systems themselves since Medicare will not), “while undergraduate medical education is growing about 3 percent per year.”
But Edward Salsberg of George Washington University, who has spent a career documenting health workforce trends, said any potential conflict is still a long way off.
“When you start with an excess of 7,000 slots” of residencies over graduating U.S. medical students, “it takes a very long time” to consume that excess, he said. By the year 2024, he and others concluded in a recent article in the New England Journal of Medicine, there will still be 4,500 more slots than graduates.
“So yes, U.S. medical students will have a slightly more limited range of specialties to choose from,” said Salsberg, “but still plenty of room.”
There are also questions about whether there even is a physcian shortage that all these new schools are aiming to alleviate.
Grover, whose organization has led the call for more physicians, said the anticipated shortage of primary-care physicians might not be as acute as originally thought. That’s because the U.S. is producing dramatically more nurse practitioners and physician assistants, who also provide primary care.
That’s probably a good thing, at least in supply terms, said Thibault of the Macy Foundation. Because it turns out that many students graduating from new primary-care-focused school’s programs are in fact opting to become specialists instead.
“The career choices in the new schools look remarkably similar to career choices of more traditional schools,” he said. The graduating medical students “are responding to the same set of signals and stimuli” about prestige, income and lifestyle.
