New Directions In Medical Education in Indiana

Paul Evans DO, FAAFP, FACOFP

Vice President and Dean

College of Osteopathic Medicine

• Introduction– Presently there is one medical school in IN

(Indiana University School of Medicine)– In January 2010, Marian University

announced the creation of a new osteopathic medical school

– First new medical school in state for over 100 years

• Why do we need a new medical school in Indiana?

• What is osteopathic medicine, and what are differences between DO and MD physicians?

• What are the plans for MU-COM?• How will the new school affect the city

and state?

• Needs - National– Needs will exceed capacity to produce new doctors

at today’s output– Mismatches in primary care vs. specialist distribution– Physician population is changing

• Specialty selection• Work hours• Retirement

– Access challenges (geographic and financial)– Population increases and changes influence health

care needs• New schools, expanding class size – but…• Capped residency programs CMS (BBA 1997)

MD and DO First Year Enrollment 2002-2014

• Needs – Indiana– Indiana population projections– Over age 65 doubles from 2000 to 2030 (2x visits)– More need with chronic diseases, obesity– Physicians are aging, retiring too

• earlier retirement now than in past• working fewer hours

– 55.9 hr/wk (1976) vs. 50.2 hr/wk (2006) [JD 44.9, RN 37.3]

– more females– life style more important

– Indiana short 5,000 physicians for population, state-wide

• Needs – Indiana– By 2020 the state needs 2,000 more primary

care physicians • needs met in only 19% urban, 2% rural

counties– 54% Indiana counties = medically

underserved (57 of 92)

– 38% mental health provider shortage– 30% primary health care shortage

Fam Med

IM Gen

Peds

(McKeag et al – IU)

• So why are primary care physician numbers going down?

Figure 3. Inflation-Adjusted Physician Fees Between 1989 and 2006

JAMA. 2010;303(8):747-753

• Osteopathic Medicine– DO (Doctor of Osteopathic Medicine) fully trained,

conventional physicians– Licensed for all facets medical practice– Differences

• Emphasis on– Whole patient philosophy (illness treatment in

context of person, family and community)– Wellness and Prevention– Mind-body-spirit approach

• Additional training in osteopathic manipulation– Structure intimately related to function– Musculoskeletal system more than just motion and

support (soft tissues, neural, lymphatics, circulation)

• Osteopathic Medicine– Very fast growing

• In 2010, DO students are 1 in 5 of all medical students

• Projected 1 in 4 by 2015

– About 30 schools nationwide– Easier to start DO school with less emphasis

on academic medical center model– No ownership of hospitals– Use community clinical training resources

New and Planned Colleges of Osteopathic Medicine

• Osteopathic Medicine– Higher percentage of primary care

• 41% Family Medicine• 10% General Internal Medicine• 5% General Pediatrics• 4% OB/GYN

– Higher percent of practicing physicians– Higher percentage of practice in rural and

underserved communities

• MU-COM Plans– Plans to start August 2012– Class size 150– Geographic preference IN residents– Mission is to produce osteopathic physicians

for IN and surrounding states– New health sciences building for both COM

and School of Nursing– Clerkships in communities around the state– Encourage new residencies in Indiana

• MU-COM Affects on Indiana– Economic development building project in

Indianapolis• $53.5 million construction

– To compare, Final 4 in 2006 = $40 million– 318 direct jobs– 185 indirect jobs

• Hiring faculty, staff (about 60 full and part time)• 600 students when all 4 years are full in 2015• Expansion of Marian University

– If 50% of DO graduates stay in IN, then 75 new physicians per year starting in 2017

• Summary– Marian University College of Osteopathic

Medicine plans to start in 2012 with 150 students

– First Doctor of Osteopathic Medicine (DO) graduates in 2016

– MU-COM goal = to complement existing Indiana medical education by providing osteopathic physicians to address the predicted shortage

– Outcome = to improve the health of the citizens of Indiana