With North Carolina facing a looming shortage of primary care physicians, a new school of osteopathic medicine at Campbell University is a welcome addition.
By Brenda Porter-Rockwell
For a lucky few, back-to-school means being the first class of students to open Campbell University’s School of Osteopathic Medicine. First-year medical student Richard Baggaley, one of 3,800 applicants and 477 students interviewed, landed one of Campbell’s coveted 162 available slots.
Two years in the making, the medical school welcomed its first class at the end of July.
“When I interviewed here in the spring, I just felt a connection,” Baggaley said. “It held my Christian values and the university has a great educational reputation.
Even with four other medical schools in the state, the North Carolina Institute of Medicine (NCIOM) estimates a decreasing number of physicians in the state by 2020, and a report by the American Association of Medical Colleges estimates a shortage of as many as 91,500 physicians nationwide by the same date.
In 2006, NCIOM’s Task Force on Primary Care and Specialty Supply convened to examine trends in physician supply across the state, including in rural areas. A final report identified a need for a new medical school.
“We don’t need them in the big cities like Raleigh,” said N.C. Osteopathic Medical Association President Donald C. Maharty, who is also a practicing family physician in Lumberton and Fairmont. “We need them to fill the voids in some of these outlying rural communities.”
According to the NCIOM’s Task Force on Rural Health, nearly three million people live in a rural county (those with populations under 50,000) and are less likely to have access to health services and more likely to engage in risky health behaviors and have a higher mortality rate than North Carolinians living in non-rural areas. The health disparities between urban and rural residents are due to a number of factors including differences in demographic and socioeconomic factors, health behaviors and access to and the quality of health care.
“There’s a tremendous mal-distribution of physicians in the state,” said the school’s founding dean, John M. Kauffman Jr. “We have one county that doesn’t have any physicians. Why is that?”
And that’s where Campbell’s new med school aims to make a difference – by training doctors to practice in North Carolina’s rural areas.
Breaking new ground
North Carolina, a large state with a growing and aging population, ranks 34th in the nation in the number of physicians it graduates. Kauffman pointed to the existing medical school model in North Carolina as the culprit for its glut of allopathic physicians (MDs) that cluster tightly around the university medical centers and other urban areas.
“That model is a brilliant model for training researchers and subspecialists. But it’s a very poor model for training primary care doctors and general specialists,” said Kauffman, noting that less than 10 percent of the graduates of the state’s other medical schools practice family medicine.
He said Campbell’s osteopathic model emphasizes holistic health alongside traditional approaches. The school expects about 50 percent of its graduates to become primary care providers and about 25 percent to go into family practice. The rest will go into fields ranging from internal health, general surgery, pediatrics and obstetrics and gynecology to emergency medicine and psychiatry.
“If 25 percent of our graduates go into family practice, that should be as many as all of the other med schools combined,” Kauffman said.
Campbell intends to graduate about 162 medical students annually; by 2016, the school will have enrolled about 600 students.
“I have been given this amazing opportunity to come and study here,” said Baggaley. Originally from Salt Lake City, he said he could see himself calling one of North Carolina’s rural towns home, permanently.
“I want to pay it back – practice here someday – give back to the community,” he said. “Being here in Buies Creek gives me an idea of what life would be like in rural North Carolina.”
The $35-million facility includes classrooms and labs that simulate screening rooms, intensive care units and a hospital waiting room. It’s the state’s first medical school since East Carolina University’s Brody School opened in the 1970s and is the only osteopathic school.
Instead of constructing another large research or university hospital, Campbell erected two buildings a half-mile west of the university’s main campus in Buies Creek, a rural town located just outside of Fayetteville.
Live here, work here
Kaufman said the school’s rural location will hopefully play a role in encouraging students to stay and practice locally.
But the best predictor of becoming a rural family practitioner is rural birth, he said.
“If we can take someone in from an underserved community and [they] go back home for their residency training and their practice, they’re going to be more likely to stay there. That’s where their family is,” said Kauffman, adding that the school is making a concerted effort to reach out to schools in rural towns here.
While rural medicine is a primary focus for Campbell, the students will spend four years preparing for real-world practice with training in both rural and non-rural community hospitals across the state, including at WakeMed Hospital in Raleigh, Fayetteville’s Cape Fear Valley Medical Center, Johnston Health in Smithfield and Southeastern Regional Medical Center in Lumberton.
“If your medical school curriculum is all about subspecialists and it’s taught by all subspecialists, then students are more likely to become subspecialists,” Kauffman said. “Every one of our third-year students will do a month of family practice, but they’ll also do a month of rural underserved care.
“They can get out into an area, spend a month with a doctor who has made their life there and hopefully forge a bond and see themselves practicing there in the future.”
Donald Jablonsky, former president of the North Carolina Medical Board and an osteopathic family medicine doctor in Etowah, a rural community 25 miles from Asheville, said the timing of the opening of Campbell’s med school is right.
“The focus on osteopathic physicians has come and gone,” he said. “Somewhere along the lines, this kind of practice got lost in the milieu. But it’s en vogue right now. Even still, it’s hard to recruit from the big city and drop them into Podunk, North Carolina.”
In addition to the other hospital relationships, Campbell is in talks with the Brody School of Medicine to co-develop a curriculum to establish rural teaching sites for students and residents.
“We’ve been around for 39 years. I hope that we’ve gotten it right in all of these years so that we may be able to share some of our successes and some of our approaches to improving rural health,” said Brody School Dean Paul R. G. Cunningham, noting the two schools share a common goal of enhancing rural medical practice.
“The question is how are we going to face this issue together. How do we encourage medical school graduates to want to live and practice in that rural county? There’s an art form to master. And if there’s a school out there who can help with that, we should be there to support them,” said Cunningham.
Campbell will also rely on its Christian values to attract new doctors to rural areas. In addition to local hospitals, students can practice in developing nations like Tanzania under the supervision of school faculty.
Others, Kauffman said, will become “missionaries” to places like rural Eastern North Carolina.