During his six years on the Medicare Payment Advisory Commission (MedPAC) at the start of the 21st century, 2012-13 AOA President Ray E. Stowers, DO, who took office Saturday, pushed for better reimbursement for rural physicians and primary care services and raised the profile of the osteopathic medical profession. From the beginning, the very smart, tenacious yet easygoing Oklahoman made an indelible impression on fellow commissioner Pete DeBusk, the owner and chairman of DeRoyal Industries, a Tennessee-based global medical products manufacturer.
From Dr. Stowers, the first DO to serve on MedPAC, DeBusk learned about osteopathic medicine’s strength in primary care and the profession’s growth in medically underserved regions of the country. He also learned about the philosophy of Andrew Taylor Still, MD, DO, and discovered that osteopathic medicine’s founder had lived in a cabin roughly five miles from the southwest Virginia coal-mining community where DeBusk himself was born and raised.
After attending Lincoln Memorial University (LMU) in Harrogate, Tenn., on a basketball scholarship, DeBusk had traveled extensively in Appalachia as he built his business, noting severe physician shortages. “In visiting Appalachian hospitals, I saw the inadequacies of health care. It was very apparent that something needed to be done,” he says. “I asked myself, ‘Could I ever do something about it? Could I ever make a difference?’ ” With Dr. Stowers, the chairman of the LMU Board of Trustees saw his opportunity.
“One day, in late 2004, I was getting ready to testify, and Pete gave me the elbow and said, ‘I want to start a new osteopathic medical school in Harrogate,’ ” Dr. Stowers remembers. “This was completely out of the blue; we had never talked about it. And I replied, ‘Are you kidding?’ ”
Because of the huge capital outlay required and DO schools already established in Kentucky and Virginia, Dr. Stowers attempted to talk DeBusk out of the venture—to no avail. Adamant that a medical school was direly needed in the central Appalachian Mountains, DeBusk persuaded Dr. Stowers to conduct a feasibility study on the idea.
Not a year later, convinced of the school’s viability, Dr. Stowers left Oklahoma for Tennessee to become the founding dean of the LMU-DeBusk College of Osteopathic Medicine (DCOM). The school admitted its first class of 160 students in 2007.
DeBusk knew his friend was the right person for the position because of Dr. Stowers’ track record in Oklahoma, where he led transformations in rural health care and rural osteopathic medical education. Among his accomplishments, Dr. Stowers helped found the Oklahoma Rural Health Association and twice chaired the Oklahoma Physician Manpower Training Commission. A family physician who practiced in Medford, Okla., for 25 years, Dr. Stowers had also established and managed five rural health clinics serving a large swath of northern Oklahoma and southern Kansas. And as the associate dean for rural health at the Oklahoma State University College of Osteopathic Medicine (OSU-COM) in Tulsa, he set up clinical training sites for students and graduates throughout Oklahoma.
“Ray Stowers knows as much about how to run a medical school as anybody in this country,” DeBusk says. “He is very personable and laid-back. But he can get more stuff done than anybody I’ve ever seen.”
“Ray is an interesting study because he is truly down-to-earth and yet he is an intellect,” adds James B. Dawson, EdD, LMU’s president, who joined the university three years ago. “The man is brilliant. He knows so much, not just about his own discipline but about the entire medical field and health care in the United States.”
Upon learning that Dr. Stowers had been named dean of a new osteopathic medical school, Burton N. Routman, DO, gave his friend of 30 years a call. “I congratulated him and told him I wanted to throw my hat in the ring for a job,” recalls Dr. Routman, a professor and chairman emeritus of family medicine at LMU-DCOM. “After confirming that I was serious, he said, ‘OK, you’re hired.’ I was the first faculty member to commit to coming here. I knew that with Ray as the dean, the school would be a place where I would feel comfortable.”
With 37 years of experience in academic medicine, Dr. Routman has worked for several institutions in which barriers exist between basic scientists and clinicians and between faculty members and administrators. “I knew that if Ray was going to design a school, there would be no barriers, and there aren’t,” he says. “We have open doors. We teach together. We celebrate together. And we’re a family.”
LMU-DCOM’s mostly systems-based curriculum, which integrates the basic and clinical sciences, reflects this collaborative approach, says biochemistry professor Dennis Kiick, PhD, the vice president for health science research. Both a basic scientist and a clinician coordinate the instruction for each organ system. “This was very much by design because we want the basic scientists and the clinicians to develop close working relationships,” Dr. Kiick says.
Dr. Stowers encouraged creativity among the members of LMU-DCOM’s founding team and gave them the resources to implement their ideas. “When we got here, he said, ‘Think of how you always wanted to do it better but for whatever reason, political or otherwise, you weren’t able to make it happen at your previous schools. Let’s make it happen here,’ ” says J. Michael Wieting, DO, the college’s acting dean while Dr. Stowers serves as AOA president.
Named LMU’s vice president for health sciences in 2010, Dr. Stowers is a team player at all levels of the university, according Dr. Dawson. “Ray Stowers works very closely with all of the other vice presidents and understands that while the medical school holds a prominent position at LMU, the university has to balance many priorities,” he says.
Dr. Stowers also nurtures close relationships with students on and off campus. “Dean Stowers has been an amazing mentor to all of us,” says Alan J. Aiken, OMS III. Dr. Stowers and his wife, Peggy, have had students over for dinner. Encouraged to follow suit, faculty members also invite students to their houses for movie nights and similar activities.
“This lessens the stress of being in medical school,” says Aiken, who is from Tennessee. “It’s really nice to be at a place where administrators and faculty want to know who you are beyond just being a student.”
“LMU-DCOM was my first interview. I felt comfortable as soon as I walked in the door,” adds Kevin Cope, OMS III, an Alabama native. “Dean Stowers wants to develop a personal, deeper relationship with students that I don’t think is found in many places. The family atmosphere here is genuine.”
Getting things done
When Dr. Stowers first came to LMU, the future site of the medical school consisted of “a cow pasture with a radio tower on it,” as he describes it. By summer 2007, a four-story, 105,000-square-foot building had been constructed that includes two auditoriums, a simulation laboratory, an anatomy laboratory, 10 mock clinical examination rooms, an osteopathic principles and practice laboratory, a learning resource center, a distance learning center, 15 student conference rooms and a student lounge.
Etched in marble on the lobby floor of the atrium-style facility is the college’s logo, which Dr. Stowers conceptualized: Abraham Lincoln and A.T. Still are depicted in profile facing one another, with the staff of Aesculapius rising between them. Atop the DO symbol is the heading “Continuing the Legacy.”
Established in 1897, LMU memorializes President Lincoln, who years earlier asked Union Army Gen. O.O. Howard to establish a university in the Cumberland Gap Mountains after the Civil War to enhance the educational options of Appalachians. “Coincidentally, the AOA was also founded in 1897,” Dr. Stowers points out. “And our campus is just 30 miles from the birthplace of A.T. Still, who served as a Civil War surgeon. Although A.T. Still and President Lincoln didn’t know each other personally, their paths likely crossed. At DCOM, we honor their twin heritages.”
The mission of LMU-DCOM is primarily to educate students from Appalachia and across the state of Tennessee, with the intention that many of them will train and practice in the region. But the school accepts many qualified applicants from beyond this geographic area. While more than half of the students come from Tennessee, Virginia, Kentucky and other Appalachian states, several students a year hail from Oklahoma and more than a dozen other states, according to Dr. Stowers. “We are mainly a regional college, but we are developing a national reputation for our strength in rural medicine,” he says.
Beyond solid scores on the Medical College Admission Test and a high grade point average, “when we assess a potential student, we put a lot of weight on the interview and a lot of weight on whether the student comes from a rural background,” Dr. Stowers notes.
While the basic sciences are emphasized in the first year, students hone their clinical skills from the beginning. “Students can do a complete history and physical exam at the end of their first semester,” Dr. Stowers says, noting that they practice in the sim lab and with standardized patients. “And students start learning osteopathic manipulative medicine on Day 1.” First- and second-year students help care for patients in the community through a variety of volunteer projects, most notably LMU’s annual Remote Area Medical Clinic.
LMU-DCOM has set up rotation sites for students at more than 30 hospitals. “Almost all of them were virgin hospitals that we started new programs with,” Dr. Stowers points out.
Third-year students are assigned to a core hospital site and serve all of their rotations within 60 miles of that location. Fourth-year students may travel farther for their electives and audition rotations, as they decide on their specialties and preferred residency programs. “Our students have made us very proud out there in the field,” Dr. Stowers says. “We have stacks and stacks of letters that say our students are excellent.”
With the inaugural class of 2011 and the class of 2012 currently serving their residencies, Dr. Stowers points with pride to his school’s statistics. Approximately 75% of the first class and 80% of the second class are entering primary care specialties, which LMU-DCOM defines as family medicine, internal medicine, pediatrics, obstetrics-gynecology and emergency medicine. The average for osteopathic medical schools ranges from 50% to 60%, he says.
By speaking about his adventures and financial success as a country doctor and asking other osteopathic family physicians to share their experiences with students, Dr. Stowers promotes family medicine as a career. “We instill in students that it’s OK to be the best and the brightest and go into family medicine,” he says.
Every LMU-DCOM graduate has matched into a residency, according to Dr. Stowers. And more than 60% of the graduates in both classes participated in the AOA Match, which is 10% higher than the national average for DO schools. The 2012 graduates are serving residencies in 27 states, with 40% training in the Appalachian region.
“It’s just amazing what this medical school has meant to this area of the country,” DeBusk says. “And when I look at our students, I’ve never seen anybody anywhere so proud and happy to be in school.”
LMU-DCOM is working to establish more osteopathic graduate medical education programs in its core region, recently securing residencies in Virginia and North Carolina. While currently participating in A-OPTIC, which was created by the University of Pikeville-Kentucky College of Osteopathic Medicine, LMU-DCOM intends to start its own osteopathic postdoctoral training institution in the near future, Dr. Stowers says.
DeBusk notes that the success of LMU-DCOM has allowed the university to add new programs and strengthen others. The university has built a new 145,000-square-foot math and science center that will house some of the medical school’s facilities, including a much larger anatomy lab, an auditorium seating 400 people and a new research division headed by Dr. Kiick.
“I see us doing basic science research with a strong clinical flavor,” Dr. Kiick says. For example, he hired Paul Wood, PhD, a professor of pharmacology, who has done extensive research on metabolomics, the study of chemical processes involving metabolites. Working with clinical professors, Dr. Wood will examine the effects of stress on salivary metabolites and see whether OMM influences the results.
Spearheaded by Dr. Wieting when he was the dean of clinical medicine, the university has also initiated a dual DO-MBA program designed to be completed in four years. Roughly 20 students will earn dual degrees next year. In addition, LMU is considering starting a master’s degree program in the biomedical sciences, as well as programs in other health science disciplines.
“You can get more done here in less time than at any place I’ve ever worked in academics,” notes Dr. Wieting, a professor of physical medicine and rehabilitation who came to LMU-DCOM from the Michigan State University College of Osteopathic Medicine in East Lansing.
Leading by example
While a student at OSU-COM in the late 1980s, Dr. Wieting served a family medicine rotation with Dr. Stowers. “My initial impression, which still holds true, was that Ray Stowers is an excellent clinician, but he is especially gifted at combining that clinical skill with being able to read people and think beyond the immediate situation,” Dr. Wieting notes. “He showed me that when you do that rather than focusing just on the encounter, you ultimately take better care of people.
“In academia, as in private practice, Dr. Stowers leads by example. One of the things I respect so much about him is that all of his decisions are motivated by what is best for students, for the school and for the profession.”
Students have appreciated Dr. Stowers’ holistic and collegial approach to leadership. “The thing about Dean Stowers is that he listens to you,” Cope says. “He takes student input very seriously and will change things based on what students say.”
“Although he will be greatly missed on campus, it’s very exciting for students that Dean Stowers is leading the AOA,” Aiken adds. “Even though he is going to be very busy, I have no doubt that any of us can call him on his cell phone at any time. If he can’t take a call at that moment, he will get back to us as soon as he can about whatever we need.”
While Dr. Stowers is at the helm of the AOA, the profession will face many challenges: the impending rollout of major Affordable Care Act provisions, ongoing Medicare and private-payer reimbursement issues, new mandates and incentives related to quality assurance, increasingly stringent maintenance of licensure requirements, the Accreditation Council for Graduate Medical Education’s proposal not to accept OGME.
“Because of his understanding of health policy, Ray Stowers is the right person to lead the profession during this period of rapid change in the U.S. health care system,” Dr. Wieting says. “With his knowledge and skills, he is optimally equipped to guide the AOA through this pivotal time.”