In a shivery-cold room inside a three-story building on the prairie, brand-new medical students dressed in white lab coats cut into cadavers.
These Rocky Vista University students are Colorado’s future doctors, an upcoming class of medical trainees needed to stave off a national physician shortage, which the Council on Graduate Medical Education predicts will reach 85,000 in the next decade.
Colorado’s two medical schools began training a combined 322 aspiring physicians this fall, far less than what’s needed to meet the looming shortage.
The Association of American Medical Colleges called for a 30 percent boost in the number of medical school students from 2002 to 2015. Even so, the class size at the University of Colorado Denver School of Medicine has increased by just four students in the past four years — partly because the school fluctuates between dead-last and second-to-last in state funding among public medical schools.
Meanwhile, a new school for osteopathic doctors — physicians with a D.O. instead of an M.D. after their names — has opened in Parker. In its second year, the private Rocky Vista University College of Osteopathic Medicine will send its first graduates off to residencies in 2012.
But even with two medical schools in the state, hundreds of qualified applicants are wait-listed or rejected. CU admissions staff say more Colorado students than are accepted at CU leave the state to study medicine, a problem because new doctors often work within 100 miles of where they train.
Need outnumbers slots
The looming doctor shortage — mostly in primary care but also in cancer specialties and general surgery — brings up a key concern in the national health reform debate. Just because the country adds millions of uninsured Americans to the ranks of the insured doesn’t mean they can get doctor’s appointments.
“There is a major need for additional physicians, all physicians, in the future,” said Dr. John Prescott, chief academic officer of the Association of American Medical Colleges in Washington, D.C. “There are many applicants who are qualified for medical school, and we don’t have slots for all of the individuals who are qualified.”
Among thousands of unsuccessful applicants this year was Sheila Maier, who has a master’s degree in integrative physiology from the University of Colorado at Boulder, a grade-point average of 3.71, and a competitive score of 32 on the Medical College Admission Test, the MCAT.
Maier, who has dreamed of becoming a doctor since grade school and later volunteered at a Denver hospital, applied to 13 medical schools, including CU. She was wait-listed at Tulane and Wake Forest universities.
“When I was interviewing, I felt that almost all the other candidates I met would make good doctors, and yet only 10 to 20 percent of us could be accepted,” she said. “It’s sort of like golf; you’re not playing each other, you’re playing the course, but only a few of you can finish the game.”
Maier, 23, is working at a nursing home now — and preparing for another round of medical school applications. This time, she’ll also apply to Rocky Vista.
Keen competition
CU has 160 first-year medical students this year, including 120 from Colorado. They were selected from 3,660 applicants and 573 candidates qualified enough to secure interviews.
“The competition to get into this medical school is extremely keen,” said Dr. Norma Wagoner, CU medical school’s associate dean for admissions.
CU moved its medical school to the Anschutz Medical Campus, where two impressive research towers loom above Aurora, in 2008. There is room now for 200 students per class — 40 more than CU has this year. But with more students comes the need for more faculty, and if class sizes increased, the highly ranked school would face more frequent accrediting inspections.
CU officials are considering adding more students in Aurora or perhaps opening a Grand Junction campus for third- and fourth-year students in “rotation,” a series of month-long stints shadowing pediatricians, surgeons, family doctors and other specialists.
“Always the caveat for our school is the fact that the funding from the state places us either 49th or 50th of all the medical schools in the United States,” Wagoner said. “The higher-education funding has been very troubling.”
The Association of American Medical Colleges — which represents only schools that offer M.D.s — surveyed schools in 2002 and found that 113 out of 125 planned to increase class size within five years. There were 16,488 first-year medical students that year and by 2013, the association is expecting 19,946 first-year students.
Rise in D.O. schools
In the past 10 years, while the number of M.D. schools has increased modestly, the country has seen a surge in osteopathic medical education.
Since 2003, five new osteopathic medical schools and three branch campuses have opened. There are now 25 osteopathic schools, most of them private.
The number of osteopathic students has climbed from 12,600 in 2005 to 16,893 in 2009, according to the American Association of Colleges of Osteopathic Medicine. There are more than 67,000 osteopathic physicians in the United States this year — making up about 7 percent of all U.S. doctors, up from about 4 percent in 1980.
Osteopathic medicine — based on a personal, holistic touch that includes hands-on muscular-skeletal manipulation — is booming in part because more people are seeking osteopathic doctors, said Dr. Thomas Mohr, interim dean at Rocky Vista. Also, it’s easier in some ways to start an osteopathic college because unlike M.D. schools, they aren’t required by their accrediting body to link with a medical center and include a large research component.
“We are about training physicians, rather than training in the ivory tower,” said Mohr, noting osteopathy’s major emphasis on family and rural medicine. “We don’t see ourselves as a second choice. We see ourselves as a first choice for primary care.”
Rocky Vista clearly doesn’t have the prestige of CU — the new school can’t become fully accredited until its first class nears graduation — but more than 4,000 students already have applied for next fall.
“We’re going to be putting out as many D.O.s as CU is M.D.s,” Mohr said. “The region was exporting quality students to go to medical school.”
Rocky enrolled 162 new students this fall, chosen from 3,139 applications. The school, started by the owner of an American medical school in the Caribbean, had to put $30 million in an untouchable fund just in case it doesn’t achieve full accreditation and has to send all of its students to other medical schools.
Cecily DuPree, a 33-year-old Rocky student from Denver, has confidence in the school because so many faculty have come from osteopathic colleges with high pass rates on board exams. And she appreciates the camaraderie and “team effort” that comes with the school’s “very first class.”
She’s heard stories about schools “where people intentionally try to sabotage other students — it’s all about the ranking.”
“Here, all of the students kind of work together for the common good,” DuPree said. “If somebody does a study outline, they will share it with the class.”
Interviews, used to judge a medical school candidate’s interpersonal skills and desire to practice family medicine, play a huge part in admittance at Rocky. The school also requires students to spend two months in small-town Colorado, Wyoming or Montana with the intent of getting them hooked on rural medicine.
More than half of the counties in Colorado meet federal criteria for a family doctor shortage area. Four rural counties in the state have no doctor, relying instead on physicians’ assistants and visiting doctors. The state has 20 percent fewer geriatricians per 100,000 seniors than the national average, according to the Colorado Health Foundation.
Expanding medical education
Population growth, including aging baby boomers with chronic diseases, has outpaced expansion of medical education.
Dr. Thomas Told, a family doctor in Craig for 35 years and now an assistant dean at Rocky Vista, blames the shortage on “short-sighted planning” in the 1980s and 1990s. His job now is finding clinical rotation spots for students from Craig to Alamosa to Lamar.
While about 20 percent of people live in rural areas, just 9 percent of the nation’s doctors do, Told said.
Another major issue affecting the doctor shortage is the inadequate number of residencies available at hospitals across the country, said Antonio Prado-Gutierrez, executive director of the Colorado Association of Family Medicine Residencies.
“You can develop all the new medical schools and increase the class sizes as much as you want, but you’re not going to increase the number of doctors because the residencies are capped,” he said.
The federal government, which funds most residencies, halted the number of Medicare-funded residencies at 1996 levels. Prado-Gutierrez and others are lobbying federal lawmakers to lift that cap.
With the opening of Rocky Vista, Prado-Gutierrez expects a “new pool of students interested in family medicine.”
Rocky Vista president Robert Black said the new school in Parker will help “contribute to the unmet need” in the Mountain West. Still, it will take years to churn out a new batch of doctors.
“You can’t just turn the switch and close this gap,” he said.
Jennifer Brown: 303-954-1593 or jenbrown@denverpost.com
