Commonwealth Medical College Tackles Looming Physician Shortage
Commonwealth Medical College Tackles Looming Physician Shortage
Creating an entirely new regional medical school from scratch brings with it a multitude of issues, everything from recruitment and accreditation to building design and funding. For The Commonwealth Medical College (TCMC) in Scranton, Pa., a five-year planning process has resulted in a community-based model intended to keep and attract physicians and provide an economic engine for the region.
“This college came up out of the community,” says Dr. Robert D’Alessandri, who signed on as the founding president and dean of TCMC in the spring of 2007, becoming the first full-time staff member. “So it’s not just the training or the education of the student but the entire mission of the college itself that is community based.”
TCMC will put its model to the test in less than a year when the inaugural class of students arrives for the fall semester of 2009. The school received degree-granting authority from the Pennsylvania Department of Education in July 2008 and its preliminary accreditation from the Liaison Committee on Medical Education (LCME) in October. D’Alessandri expects to receive approximately 2,000 applications. From this pool of applicants, they’ll accept 60 students for the inaugural class.
TCMC will hold classes for the first two years at a temporary facility in Scranton, while its permanent home is under construction. Site preparation work for the school’s first permanent structure began in December 2008, with major construction scheduled to begin in March. Designed by HOK (in conjunction with local architects Highland Associates), the 188,000-sf, $84-million Medical Sciences building is scheduled for occupancy in August 2011.
Once the new building is complete, TCMC plans to increase class size, first to 100 students in 2011, then to 120 students in 2013. In the meantime, D’Alessandri has a little timer on his desk counting down to the day next August when the first students arrive.
“All of our Board members have these on their desks,” he says. “It helps to keep us focused.”
The idea for a new medical school was first proposed in 2004 by a group of local business, civic, community, and educational leaders seeking to address a looming physician shortage in Northeastern Pennsylvania.
“About 35 percent of the physicians in this community are expected to retire in the next 10 years,” says D’Alessandri, “and every hospital in the area is recruiting.”
That community group officially established the Northeastern Pennsylvania Medical Education Development Consortium (MEDC) in 2005 and commissioned a Tripp Umbach study, completed later that year, which confirmed the viability of creating a new regional medical school.
D’Alessandri says the research indicates that medical schools increase the number doctors in an area in three ways:
- Training new doctors, many of whom eventually go on to practice in the area.
- Increasing job satisfaction of existing physicians, thus making them less likely to leave.
- Attracting new physicians to the region with research or educational opportunities.
The debt burden associated with medical school (currently averaging around $200,000 per student) is another factor discouraging medical students from settling in areas like Northeastern Pennsylvania where median incomes are lower. TCMC plans to counter this trend by offering each student a partial four-year scholarship.
“We now have funding for 52 of these amounting to $20,000 a year for four years or $80,000 for each student,” says D’Alessandri.
TCMC’s emphasis on the community manifests itself in the school’s approach to everything from recruitment and building design to teaching methodologies and funding. D’Alessandri says it also addresses ongoing changes in the delivery of care.
“Healthcare today is really delivered by a team,” says D’Alessandri. “Twenty years ago, a woman who found a lump in her breast went to a doctor and that doctor would send her to a radiologist to get an x-ray and then to a surgeon. That was it. Today, that patient not only gets surgery but also radiation treatments, chemotherapy, counseling, and physical therapy. That’s why care is so much more expensive today, but the results are so much better.”
TCMC will employ a distributive model of education: Students will spend the first two years on campus primarily, receiving their basic science education. The clinical portion of their education will take place largely in the last two years when they’ll be assigned to work with practicing physicians on one of three campuses in the region: Scranton, Wilkes-Barre, and Williamsport. (The number of participating campuses will increase from three to six once the total number of students reaches 120.)
“The goal is for the students to actually live and learn in those communities and for those communities to become involved in helping to educate the students,” says D’Alessandri.
The participating physicians are termed “voluntary faculty members” under TCMC’s educational model. The school has signed up more than 400 such faculty since February 2008.
“They’ll have a student assigned to them for one month for maybe one or two months a year,” says D’Alessandri. “A student may be assigned to a cardiologist once a week for three months to work in their outpatient clinic.”
D’Alessandri says about 60 medical schools in the U.S. have similar “clinical campus” models. Students in these programs tend to do just as well as those enrolled in a more traditional school, but that satisfaction ratings tend to be higher.
The admissions policy at TCMC also focuses on the community.
“Seventy percent of our students will come from the region or the state, which would be the highest percentage of in-state students of any school in the state,” D’Alessandri says.
Despite Northeastern Pennsylvania being home to a number of colleges and universities, TCMC will operate as a stand-alone entity.
“We decided it would be better to work with all of them, rather than select one and be limited to that one university,” says D’Alessandri.
TCMC will hold classes for the first two years in temporary facilities on the campus of Lackawanna College in Scranton. Renovations totaling about $5 million (construction and equipment) were completed in the summer of 2008.
“The Lackawana College facility is all program- and student-focused space with faculty touchdown space,” says Jim Berge, director of HOK’s Science + Technology Group.
TCMC students will have a separate entry to the temporary facility. The only space where they’ll mix with Lackawana College students is a fourth floor cafeteria (which coincidentally affords a view of the construction site for TCMC permanent facility). An additional 23,000 sf for administration, operations, and overflow faculty is located off site, bringing the total temporary facility area to 45,500 sf. Berge notes that TCMC will be able to move about 60 percent of the equipment installed in the temporary facility (including tables, prosection components, fume hoods, exhaust fans, etc.) to the new facility.
Although some may view the temporary facility as throwaway money, Berge says it’s turned out to be a good investment because the process got the school up and running, while crystallizing the programming for the permanent facility.
“Because TCMC started with a very small staff, we relied on something we termed ‘surrogate staff,’” says Berge. “These were professionals borrowed from other institutions on a consultant basis to help with programming definitions for both the temporary and permanent facilities. This provided TCMC with expertise in a variety of medical education disciplines, including anatomy, library services, facilities, research services, and vivarium operation.”
The team used the information provided by the surrogate staff to develop a “strawman” program they could benchmark against to determine everything from the initial class size to the size and number of problem-based teaching rooms, lecture halls, student learning areas, and so on. Berge says this approach allowed the team to maintain a relatively brisk pace throughout the accreditation process.
“We were able to go from start-of-application to accreditation in 16 months,” he says, adding that since permanent staff members have started to come on board, there has been little variance from what they established early on in the programming sessions due to the quality of information established with surrogate staff.
The Medical Science building is composed of a pair of four-story structures connected by a two-story bridging structure (featuring a 120-seat café and other interaction spaces).
The ground floor of the north structure contains a simulation facility with 12 mock exam rooms for standardized patients (actors portraying patients) and several suites for simulated surgical procedures using high-fidelity robotics, as well as breakout rooms and small group work areas. The gross anatomy lab is also included in this area. All these areas will be fully wired for video.
The south side of the ground floor features a 250-seat lecture hall with breakout space that opens into a large lobby, as well as administrative spaces. The upper floors of the south structure will feature two more large auditoriums, the school’s library, teaching labs, and faculty offices.
Research space occupies the second and third floors the north structure, with open laboratories from end to end on either side, a support core in the center, and offices grouped at the end. Shell space for more labs is on the fourth floor. In addition, the building is designed so the entire lab block can be expanded to the north without adding additional stairways or elevators.
D’Alessandri says the laboratories in the research block of the new building have been a significant part of attracting a high caliber of faculty to TCMC. So far, 26 full-time basic science faculty have signed on, including two from MIT, two from Yale and one each from the University of Michigan, Texas A&M, and the University of Florida. Because several of the full-time faculty are funded by NIH grants, part of the recruitment process was making sure there would be high-quality laboratories available.
Full-time faculty are also a potential income source for the college, as some of the researchers have discoveries that could be patented. D’Alessandri says one patent is already in the works.
“We think it may yield a diagnostics company within the next 12 to 16 months,” says D’Alessandri.
Berge says a sustainable design approach to the building’s design also supports TCMC’s focus on community stewardship by relating it to environmental stewardship. These initiatives include heat recovery for energy efficiency and storm water harvesting and collection. The auditoriums will feature a displacement ventilation design that conditions only the spaces that surround people rather than the entire volume of the space. Stone cladding for the building’s exterior is from local quarries and represent just a few of the efforts to achieve a LEED Silver building.
“We’ve had some good feedback from recruiters regarding student’s interest in sustainable design as a requirement for their University selection,” says Berge.
More Challenges Lie Ahead
Not surprisingly, the school’s funding picture remains an area of special concern going forward. In the fall of 2006, the State of Pennsylvania committed $35 million toward a new building. Shortly thereafter Blue Cross of Northeastern Pennsylvania announced a $25 million gift for operations.
“We received another $20-million gift recently and we’re just getting our capital campaign underway,” D’Alessandri says. “We hope that will get us through a significant portion of this current economic downswing and to the other side.”
He notes that, thus far, TCMC has been meeting its funding targets.
“Soon our targets are going to increase dramatically, and that will be the real test.”
Residency programs are another challenge. The current number of programs in the region are not adequate to meet the needs of the projected volume of TCMC students.
“We’re focusing on graduate medical education as well and expanding residency programs at a time when federal funding is flat for that, so we have some challenges there as well,” says D’Alessandri.
By Lee Ingalls