Much of what we read today about higher education tends to dwell on constraints and reductions, but at least one sector of academe is actually growing. New medical schools are in various states of planning, development and accreditation, while existing schools are expanding class sizes, portending perhaps the greatest increase in this sector since World War II. Physician shortages are the primary reason cited for the growth in medical schools, with some experts predicting a shortfall of more than 50,000 physicians by 2020. Add to this the incentives and disincentives built into the Affordable Care Act (ACA): An estimated 30 million people gaining access to health insurance could translate into still more demand for physicians and other health professionals. This is especially true in rural areas where access is already limited, particularly to primary care physicians who play a central role in ACA. These doctors are already not available in sufficient numbers to meet demand. Another rationale for expanding medical schools is the greater capacity needed for biomedical research and translating new insights quickly into practical treatment methods. Advances in the life sciences and, in particular, genomics will produce new drugs, devices and treatments. That new medical colleges are being established is all the more remarkable given the costs associated with their operation. At The Ohio State University medical school, first-year cost for an Ohio resident is in excess of $51,000 and more than $70,000 for a non-resident. Medical students then confront debt payments as high as $3,300 per month over a quarter century once they graduate. One element of cost is the specialized facilities required for med schools. Typically, they need a medical education building and housing for students. In 2008 when Hofstra University in New York joined with a health system, the newly appointed dean estimated the costs for those two facilities would range from $50 million to $100 million. More recently, the Texas Higher Education Coordinating Board staff projected the cost of a medical facility at $407 per square foot. Frequently, a significant philanthropic donation becomes quite literally the cornerstone of a new medical school. The remaining costs are financed through bonds and long-term institutional debt. But costs are not deterring the expansion and establishment of medical schools, and Texas is the epicenter of this phenomenon. The Lone Star state has 27 million people and nine medical schools. By comparison, California has almost 39 million people and 12 med schools. Both states grew rapidly after World War II, so population alone can account for the number of medical schools located in each. But in the case of Texas, population pressure was accompanied by a push on the part of state leaders to improve the postsecondary education system and to make Texas a center of biomedical research. Both goals were addressed by state legislation passed in 2009 identifying seven public universities as “emerging research universities” with the potential to join Rice, UT-Austin and Texas A&M as Tier One research institutions eligible for additional state funding. Since passage of the Tier One legislation, these medicine-related expansions have taken place or were explored: Texas may be an unusual case, but the growth of med schools across the nation proves this is a sector of expansion in higher ed, notwithstanding the high costs and uncertainty of government funding or reimbursement for treatment. Former university president Richard A. Skinner is a senior consultant with Harris Search Associates. He can be reached at rick@harrisandassociates.com.
Former university president Dr. Richard A. Skinner acknowledges much of the attention in the American higher education is on “constraints and reductions,” but he highlights medical schools as a growth sector. “We have to be careful about how we talk about these numbers,” said Skinner, who retired from his position at Colorado State University last year. Despite medical schools being extremely expensive, both to run and to attend, Texas has opened three new medicine-related schools since 2009, taking its total to nine medical schools for a population of 27 million people, the highest distribution in the US.