Groups chart osteopathic med school in state

Wilson Hall on the campus of Arkansas State University is the proposed site for an osteopathic medical school.
Wilson Hall on the campus of Arkansas State University is the proposed site for an osteopathic medical school.

When the Arkansas Osteopathic Medical Association put together a five-year strategic plan in the fall of 2008, its top priority was to establish an osteopathic medical school in the state.

Arkansas residents generally are among the nation’s most under served when it comes to health care. Federally mandated insurance changes are expected to put additional strain on a system and state already lacking primary-care physicians.

Creating an osteopathic medical school, the group believed, would help meet the demand for physicians. Research and outreach began for a project that its leader admits might have once seemed far-fetched.

Separate groups in Fort Smith and at Arkansas State University in Jonesboro have been working to establish a medical school in their communities. Opening a medical school creates the possibility of a $70 million to $100 million economic impact in communities.

Only Fort Smith’s proposal, however, has the endorsement of the Arkansas Osteopathic Medical Association and its executive director, Frazier Edwards. Edwards, a 2007 University of Arkansas at Fayetteville graduate and the son of a Fort Smith osteopathic physician, became head of the organization in2008.

“It’s always been a dream of osteopathic physicians in Arkansas to have a school within the state,” Edwards said. “This started a long time ago and really got legs five years ago. It’s been a long process that has taken a lot of thought and effort by a lot of people in a lot of communities, not just Fort Smith or Jonesboro or anywhere else.”

Osteopathic doctors (DOs) differ from other physicians in a few areas. Osteopathic medicine is described as a more “holistic” approach, focused on the way the body’s parts and systems are connected. More than 60 percent of graduates from the nation’s 30 osteopathic medical schools focus on primary care.

That focus would mean additional osteopathic doctors, so important to a state that, according to the Kaiser Family Foundation, has lower life expectancy and higher rates of obesity, diabetes and smoking than the national averages. The need for primary and preventive care, particularly in medically under served areas, is considerable.

“We’re one of the last states of our size that doesn’t have a DO school,” ASU Chancellor Tim Hudson said. “There is demand. There is opportunity.”

Whether the highest demand exists in the Delta or in western Arkansas depends on who is speaking.

FORT SMITH

Supporters of the Fort Smith effort did not respond to multiple interview requests, but outlined their plans during a presentation to the Fort Chaffee Redevelopment Authority on Feb. 18. Fort Chaffee board members approved the donation of 200 acres for the Fort Smith venture, on the same day that the Fort Smith Regional Healthcare Foundation announced that it would put $58 million behind the proposal.

Building the school from scratch will take about $60 million, said Fort Smith Regional Healthcare Foundation board Chairman Kyle Parker.

Plans are to open the Fort Smith osteopathic school in 2017. Supporters plan for classes of 150 students each and hope that within four years, the school can accommodate 600 students a year. Parker told the Fort Chaffee board that the hope is to one day include a dental school and other medical training and have enrollment nearing 4,000.

A key part of the process will be hiring a chief executive officer and chief academic officer. Those hires could come as early as June, and the accreditation process cannot begin until those officers are in place.

Not being affiliated with an existing university should not hurt the Fort Smith project, Parker said last month when asked about starting without any infrastructure. Fort Smith Regional Healthcare Foundation worked with two consultants who started medical schools “from scratch” and have a model to follow, Parker said.

Choosing Fort Smithmade sense for a number of reasons, the Arkansas Osteopathic Medical Association director said. Edwards, citing data that he compiled from the Arkansas Department of Health, said western Arkansas has the greatest need for doctors. “You’ll notice that the greatest disparities in health-care professionals per 10,000 in population rest right outside the state’s largest areas for population in the River Valley and Northwest Arkansas,” Edwards said.

Proximity to potential feeder schools with pre-med programs was a substantial part of the Arkansas Osteopathic Medical Association’s endorsement of the Fort Smith venture. Edwards said having five colleges and their total enrollments of 58,430 within one hour of Fort Smith is important.

Availability of clinical rotation opportunities for the school’s graduates and community resources were also cited in Edwards’ letter. The Arkansas Osteopathic Medical Association questioned the lack of resources available in northeast Arkansas. Edwards declined to provide additional details on what resources were available to Fort Smith and told doctors in his Feb. 10 letter that that information was protected in “nondisclosure agreements.”

Fort Smith school supporters have yet to authorize a third-party feasibility study that is required as part of the accreditation process.

“You could say a feasibility study has been going on the last five years,” Edwards said. ASU/NY INSTITUTE OF TECHNOLOGY

Wilson Hall has been a landmark on the ASU campus since the early 1930s. University officials hope the three-story, beige-brick building will become the cornerstone of its branch of the New York Institute of Technology’s osteopathic medical school.

Renovating Wilson Hall will be the biggest out-of pocket expense that university leaders said they will have to pay if the medical school opens with its first class of 115 in 2016. Hudson said establishing a medical school will require no additional public funding and will have “no impact on existing student fees, programs and tuition.” Spending to update Wilson Hall has to happen regardless of what locates there in the future, the chancellor said.

A lease agreement with the New York Institute of Technology would allow for the Wilson Hall refurbishment to be paid back over time, Hudson said.

With the building, existing student services and the Institute of Technology agreeing in principle to shoulder much of the $10 million expense for establishing the school, ASU would appear to have a shorter path to accreditation than a school that is starting from scratch.

“We have things you can’t invent overnight,” Hudson said. “This is not an upstart company here. This is not a new idea of us investigating a social need and trying to address it. We do this all the time. We have that strength.We have the demand. [The Institute of Technology will] bring the expertise.”

The New York Institute of Technology’s School of Osteopathic Medicine opened in 1977 in New York. Barbara Ross-Lee is vice president for health sciences and medical affairs, or dean, of the institute’s medical school. Ross-Lee would oversee the school in Jonesboro, eliminating the need to hire a separate dean.

Partnership with the institute was listed among the strengths outlined in a feasibility study conducted by Tripp Umbach, a medical education research firm in Pittsburgh. ASU’s proximity to the Delta and its distance from the nearest osteopathic medical schools - approximately 370 miles from Tulsa and Hattiesburg, Miss. - help its cause, according to the study.

Tripp Umbach president Paul Umbach, who estimates that a third of the studies his firm conducts find that medical school proposals are unfeasible, cited the Delta as “one of the poorest and most under served areas in the United States. Our data screams that. There is no other place that has the same need. It’s not even close.”

SOME FRICTION

ASU was first approached by the Arkansas Osteopathic Medical Association five years ago at a time when the university was under interim leadership and seemed lukewarm to the prospects of a medical school.

Hudson made the osteopathic school a priority when he was hired in 2012 as chancellor. Since then, Hudson and others affiliated with ASU have engaged in talks with the Arkansas Osteopathic Medical Association.

That relationship began to show signs of strain in the summer of 2013. Documents obtained through a Freedom of Information Act request illustrate the tension.

After a June meeting, ASU System President Chuck Welch sought clarification regarding the Arkansas Osteopathic Medical Association’s evaluation process. In a letter sent to Edwards and copied to Gov. Mike Beebe and Dr. Jim Zini, a practicing physician in Mountain View and past president of the Arkansas Osteopathic Medical Association and the American Osteopathic Association, Welch wrote, “Your input could be instrumental in clearing up any doubts, perceptions of bias or misunderstandings over the process of determining what is in the best interest of Arkansas and its citizens.”

ASU reached out to the Arkansas Osteopathic Medical Association in August, seeking approval to refer to the association in a news release regarding the launch of ASU’s school feasibility study. Jason Penry, vice chancellor for advancement, emailed Edwards on Aug. 30 and later that day received a denial of that request from Edwards and Zini.

“We respectfully request that you not mention anything about the AOMA, AOMA leadership nor any AOMA member,” read an Aug. 30 email signed by Zini and sent from Edwards’ account. “We are not giving you permission to use our name, likeness or support. Please acknowledge your willingness to cooperate.”

Zini, who could not be reached for comment for this article, later added: “That also goes for any osteopathic physician as well as our Executive Director.”

Edwards created further distance in a September email exchange with Mendy Hendrix, Penry’s assistant. Asked to participate in ASU’s feasibility study, Edwards replied that the Arkansas Osteopathic Medical Association “does not support/endorse Arkansas State University and the city of Jonesboro’s endeavour for developing an osteopathic medical school.”

Umbach said he has been involved in 2,000 projects over the past 26 years. Participation from the state association is generally a foregone conclusion, but the Arkansas Osteopathic Medical Association, in Umbach’s words, “ actively refused to participate.”

“We tried multiple options,” Umbach said. “We called. We sent letters. Emails. Participation is usually a very easy thing to achieve. Never have we not received support and never have we been refused any interface.

“It’s completely unprofessional in my opinion that the leadership who would be able to speak on the need in the state wouldn’t. Instead they proposed their own medical school.”

Edwards said the Arkansas Osteopathic Medical Association declined to participate because it had already put its support behind Fort Smith. Publicly, the organization didn’t endorse Fort Smith to the state’s 265 practicing osteopathic physicians until sending a 19-page letter on Feb. 10. Tripp Umbach’s study was conducted in the fall, and the results were released Feb. 4.

“We don’t want to hinder their process,” Edwards said. “It’s their process. We’re just not involved with it. We’re going to continue to focus on Fort Smith.”

FINAL DECISION

Ultimately, the Commission on Osteopathic College Accreditation will have final say in the osteopathic school efforts in Arkansas. The proposals for both schools will be judged independently based on an application process that takes between 18 months and two years.

It’s possible neither venture could gain approval. The Commission on Osteopathic College Accreditation also could approve one or both after evaluating whether they followed the steps outlined in an 88-page handbook.

Establishing a need is an important component, but the most critical piece of the accreditation puzzle will be finding doctors, hospitals, clinics and other qualified providers with the willingness and resources to provide clinical rotations and residencies for graduates.

Even the University of Arkansas for Medical Sciences, established in 1879, faces challenges when it comes to finding residencies for its graduates. A UAMS goal to increase its class sizes to 200 students - in an effort to address the physician shortage - has been put on hold because of a cap on federal funding and other limiting factors.

Adding 100-250 students looking for residency opportunities would further strain state resources, UAMS Chancellor Dan Rahn said. Arkansas requires only one year of residency for a student to be eligible for a medical license, but 45 of the 50 states require residencies of at least three years.

“We don’t see the wisdom of adding another 250 medical school students per year on two campuses,” Rahn said. “There is already a bottleneck in the pipeline.”

Rahn estimated that 1,000 medical students nationally failed to find residency programs last year. Without a residency, a medical school graduate is not allowed to practice medicine or write prescriptions.

If a solution can be found for residencies, Rahn said, he would feel better about an additional medical school opening in the state. ASU leaders have visited with UAMS officials to discuss ASU’s plans, but Rahn said he has yet to meet with anyone regarding the proposed Fort Smith campus.

Fort Smith leaders said Feb. 18 that they have commitments for residencies in principle from Mercy Health System, Sparks, Cooper Clinic and the Choctaw National Health Services Authority. ASU is working with the New York Institute of Technology to secure local, regional and national residencies for ASU students. Both ASU and Fort Smith have the backing of the nonprofit Community Health Centers of Arkansas.

Edwards maintains that Fort Smith will emerge as the best option and secure the accreditation needed to open by 2017.

“Other entities fully have the right to continue their own process, but our association’s endorsement came down to the location we believe had the best chance for success,” Edwards said. “Our board made the decision that it thought was in the best interest for Arkansas.”

Hudson, Penry and others affiliated with ASU’s efforts feel confident that they’ll establish a school in Jonesboro, with or without the support of Edwards and Arkansas Osteopathic Medical Association.

“We feel very good about it,” Penry said. “We know there is a challenge to creating these residencies. We feel like we’re going down the right path. We have the best professionals at the table to help make this a reality. I’m very hopeful, as is everybody else involved in this, that in 2016 we’ll have medical students walking across campus.”

Ross-Lee, the dean at the New York Institute of Technology, said establishing an osteopathic medical school should be the primary focus.

“They’ve made our job a little bit harder,” Ross-Lee said of Arkansas Osteopathic Medical Association. “I have spent most of my career bringing the profession together, not competing. That’s not going to work. The people involved are very bright. They will understand this is not a game or competition.

“We are educating future physicians.”

Front Section, Pages 1 on 03/02/2014

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