Indiana takes aim at physician shortfall with new osteopathic medical school

Premedical students in Indiana who wish to attend medical school in the state currently have just one option: the Indiana University School of Medicine in Indianapolis. All students interested in osteopathic medicine and most students interested in allopathic medicine must leave Indiana for their medical education, a brain drain exacerbating the state’s physician shortage. With only 216 physicians per 100,000, Indiana ranks 38th in physician density.

Granted pre-accreditation status by the AOA Commission on Osteopathic College Accreditation (COCA), the Marian University College of Osteopathic Medicine (MU-COM) in Indianapolis aims to curtail the migration of prospective physicians out of Indiana.

“Our mission is to provide physicians across the state of Indiana,” says Paul Evans, DO, MU-COM’s vice president and founding dean. “About two-thirds of Indiana’s counties have significant physician shortages. Primary care physicians in particular are needed in rural and other underserved areas, and close to 40% of Indiana counties have been identified as having significant shortages of mental health professionals, including psychiatrists.”

If granted provisional accreditation from COCA, MU-COM plans to open in fall 2013 with 150 students.

MU-COM has received widespread financial support, including a $48 million private gift. Two Indianapolis-based health systems each donated $5 million. In addition, both a pharmaceutical company and a medical manufacturer donated $1 million.

“We’ve had some extraordinary philanthropic support for this school,” says Dr. Evans, who previously served as the founding dean of the Georgia Campus—Philadelphia College of Osteopathic Medicine in Suwanee. He notes that establishing MU-COM has been easier because of the tremendous support and cooperation throughout Indiana’s medical community.

MU-COM also has the distinction of being the first osteopathic medical school housed at a Roman Catholic university. Sponsored by the Sisters of St. Francis Oldenburg (Ind.), Marian University has had a nursing school since 1977. Healing the sick and ministering to the underserved are integral to the Franciscan tradition, so an osteopathic medical school fits well with university’s mission, says Marian alumnus Stephen J. Noone, special assistant to the dean and former executive director of both the Indiana Osteopathic Association and the Indianapolis-based American Academy of Osteopathy.

The Indiana Osteopathic Association took the lead in drumming up support for an osteopathic medical school in Indiana and in selecting Marian from among a handful of contending Indiana universities willing to house a new med school. The association will move its headquarters to the college, according to Executive Director Erin Wernert.

One selling point for osteopathic medicine in the state is that more than 60% of Indiana’s 800-plus DOs are primary care physicians, Wernert says. In contrast, approximately 45% of the MDs graduating from the Indiana University School of Medicine pursue primary care.

“The planned osteopathic medical school at Marian has generated a lot of excitement in the Archdiocese of Indianapolis and beyond,” says Bishop Timothy L. Doherty, PhD, an ethicist with a special interest in health care who presides over the Roman Catholic Church in north-central Indiana. “Indiana has a crying need for primary care physicians. This is an area where DOs can make a tremendous difference.”

Laying the groundwork

“From the University of Notre Dame to Purdue University, Indiana has some large and very accomplished universities that produce a lot of talented students who are interested in medicine, but there aren’t enough seats at the state’s medical school to support all of them,” Dr. Evans says. “Each year, more than 200 highly qualified premedical students do not get accepted at Indiana University’s medical school simply because the school does not have enough openings. At Marian, we hope to attract a large proportion of those students.”

Because studies have shown that physicians normally practice close to their residency locations, Dr. Evans is working to establish osteopathic graduate medical education sites for MU-COM graduates, as well as rotation sites for third- and fourth-year students. A half dozen different hospitals have expressed interest in either expanding existing programs or starting new ones. “So we’re working with them to take that next step and create additional GME spots for our graduates in the future. We won’t need the positions until 2017, but it takes time to develop the programs,” Dr. Evans says.

MU-COM will have a competency-based curriculum, as recommended by the Carnegie Foundation for the Advancement of Teaching’s 2010 report Educating Physicians: A Call for Reform of Medical School and Residency. Students will be expected to master the competency domains set forth by National Board of Osteopathic Medical Examiners in 2011: osteopathic principles and practice, osteopathic patient care, application of knowledge for medical practice, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

“The curriculum is going to be focused on learning, not on teaching, which means that it is going to be student-centered and assessment-oriented,” Dr. Evans says. “All biomedical science will be presented in an integrated fashion, linked to cases the students will study, so that students will learn basic science in the context of caring for patients.”

Marian’s nursing school will be housed with the medical school. “This proximity will create the opportunity for interprofessional education,” Dr. Evans says, noting the 21st century trend of physicians working on medical teams that include nurse practitioners, PharmDs, social workers, clergy and utilization management professionals. “We need to train medical students how to effectively interact with these team members and maximize their talents in the care of patients.”

One of only a handful of U.S. medical schools located at Catholic universities, MU-COM will not discriminate against non-Catholics in its admission process and will not limit its instruction to Catholic perspectives, according to Dr. Evans. But as he said in a radio interview last September, biomedical ethics will loom large on campus as a center of discussion.

MU-COM, in fact, will have an endowed chair in medical ethics “to help us give medical students and nursing students an understanding of the complex process of providing medical care in the context of the religious convictions and cultural traditions of individual patients and their families,” Dr. Evans explains. MU-COM’s search for someone to fill the position is still in the early stages.

“When you teach medicine, you have to teach the whole science of it and many, many different points of view,” Dr. Evans says. “For example, in a medical case that students will be evaluating, there may be a Jehovah’s Witness who has an issue about receiving blood transfusions. All physicians have to be sensitive to patients’ religious beliefs in planning their care. They need to learn that illness is contextual.”

While MU-COM students will be exposed to the faith-based values of Marian University, they will not be assessed on them and are free to make their own decisions about what is morally right and wrong, Dr. Evans says.

Dr. Evans believes that he is the only current school dean who has served as the founding dean of two medical colleges. “My colleagues say, ‘Are you nuts? Why are you doing this again?’ But I enjoy starting new programs. I enjoy the challenge of making new things and leaving a legacy of something that is valuable and important to my profession and my community.”