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Proponents say the Abingdon facility could provide a major economic boost and help underserved areas.
Dr. William Kanto
Dr. Phillip Bagnell, dean of the Quillen College of Medicine
Sunday, May 19, 2013
ABINGDON — Soon, another new medical school may open its doors in Southwest Virginia.
Discussions between the proposed school’s independent board and East Tennessee State University have created a buzz on both sides of the state line over a project that has evolved with broad regional cooperation.
Tariq Zaidi, the proposed school’s interim president and chief operating officer, said the school could provide a major economic boost while improving health outcomes in medically underserved areas throughout Southwest and Southside Virginia.
“You can go to towns and take a look at where they were before a medical school came into the community and after,” said Zaidi, who hopes to have the first class of medical students enrolled by 2015.
“There is a significant difference in terms of job creation, in terms of salary across the region, spending through construction, through visiting the retail businesses, and then other businesses — not just businesses that are directly related to providing health care, but businesses that are looking to locate in a region where there is a high quality of living.”
The board hopes to develop the still unnamed medical school in Abingdon, which has committed nearly 35 acres in its Stone Mill Business and Technology Park beside Interstate 81’s Exit 14.
The $3.5 million site is part of a $15 million grant package promised by Abingdon and Washington County. The state has approved a $250,000 planning grant, and the Virginia Tobacco Indemnification and Community Revitalization Commission has pledged $25 million.
“It’s our biggest grant to date, but there’s a big need for more primary care doctors in Southwest Virginia and throughout the central Appalachian region,” said Del. Terry Kilgore, R- Scott County, chairman of the tobacco commission. “It’s been going slower than we’d like, but in the last few months it’s really picked up some steam.”
Kilgore said he envisions medical residency programs and teaching hospitals in Virginia’s coalfield counties, attracting jobs and investment in new medical facilities linked to the school.
First imagined with a 300,000-square-foot building, the school is now being planned with a high-tech footprint one-third that size. Estimates for its eventual economic impact top $1 billion annually.
“The way we’re teaching medical education in this country is drastically changing,” said Abingdon Town Councilman Jason Berry, vice chairman of the proposed school’s board of directors.
“The model for UVa and for a lot of these other big schools is … the students are learning by case models instead of traditional lecture models,” Berry said. “We can use that in Abingdon from the very beginning, which means you don’t have to build a huge building that costs a lot of money to operate. It can be a smaller footprint and put the money back into education and future development.”
While Zaidi isn’t ready to share specific dollar figures, he said the school would realize a significant savings on start-up costs through partnerships and working with ETSU’s James H. Quillen College of Medicine, which would allow a streamlined and far less costly accreditation process.
He said he hopes to involve all of the region’s major health care providers and adjacent educational institutions, which could make it possible for some students to study from community college through medical school on a single campus.
Most other medical institutions in the region, including the Virginia Tech Carilion School of Medicine in Roanoke and the Edward Via College of Osteopathic Medicine in Blacksburg, have yet to comment on the project. Zaidi said the project has received a letter of support from Lifepoint Hospitals, which operates hospitals in places including Galax and Richlands, but no formal commitment has been made yet from the region’s two major health systems, Wellmont Health System and Mountain States Health Alliance.
Mountain States, while expressing general support for medical education in Southwest Virginia, said in a statement that it has no involvement with the proposed school. Wellmont said dialogue is ongoing.
Working out details
Dr. Phillip Bagnell, dean of the Quillen College of Medicine, said there’s good reason to believe the details can be worked out with the board of the proposed Abingdon medical school.
“There are multiple things that we have to negotiate, but they weren’t absolutes that we’re not willing to give on,” he said.
“From my perspective, the only major absolute that I was not prepared to negotiate on is that it has to be a full program and I have to have [medical] residents involved. I think that’s the only way to do it well and long-term, have it be successful and give us the kind of graduate physicians that we want for our communities.”
Dr. William Kanto, chief medical officer of Georgia Regents Medical Center and chief medical adviser for the proposed medical school, said he envisions a model similar to the partnership between Georgia Regents and the University of Georgia, where students begin their studies on a main campus and do clinical rotations at other sites.
Kanto said this model can expand the capacity of existing health care infrastructure to serve more patients, particularly as the Affordable Care Act increases access to government-funded health care programs. It can also give students exposure that could encourage them to practice in the region as physicians.
“We really envision it as coming out of Southwest Virginia and stretching across the southern part of the state,” he said.
Kanto, who grew up in Norton, said that if no action is taken, the coming shortage of doctors will hit particularly hard in these regions. Rural areas aren’t the most lucrative places for physicians to practice, he said, and so-called “safety-net hospitals,” heavily funded through Medicare and Medicaid, are facing a budget squeeze that could eliminate existing medical training slots.
The proposed school is also part of a larger response to the American Association of Medical Colleges’ call for a 30 percent expansion of U.S. medical school enrollment.
It would be Virginia’s sixth medical school and the third in Southwest Virginia, which also is home to the Appalachian College of Pharmacy and Appalachian College of Optometry, both in Buchanan County. Additionally, a dental school is being developed by Bluefield College.
Like Quillen and Georgia Regents, Abingdon’s proposed medical school could start with between 25 and 40 students.
While other medical schools have opened with partnerships similar to the one proposed here, Bagnell said the proposed school’s location less than an hour from Quillen’s front door makes the project unique. He talks about it in terms of expanding ETSU ’s Tennessee rural health care mission to a broader Appalachian mission that includes Southwest Virginia.
“ETSU views itself as a regional medical school,” he said. “We view Abingdon as being part of our cultural region … so to be involved in this is a natural fit for us.”
There is a potential hurdle in that the proposed partnership involves two states, but it’s also on the radar of public health officials in Nashville, including Tennessee Commissioner of Health John Dreyzehner, a doctor who spent years working on health issues in Southwest Virginia and has expressed support.
A healthier region
Berry said collaboration across the state line is a necessity because of decreasing state and federal dollars, but it is embraced in a mountain region that has historically relied on cooperation to ensure that its needs are known in the faraway state capitals of Richmond and Nashville.
“No matter what state or county or local government you’re in, a lot of resources are smaller today than they were five years ago,” Berry said. “In this world where there’s less resources, I think it makes sense to partner because you can share knowledge, share expertise, potentially share staff, and not re-create the wheel.”
In terms of health care, no one disagrees that Southwest Virginia needs doctors. According to the Virginia Department of Health, 11 counties from Wythe westward are medically underserved, meaning they lack sufficient health resources to meet medical needs. The same is true of Southside counties from Patrick east — and the reports pointing to a crisis are many.
In 2006, the American College of Physicians released a report on “the impending collapse of primary care medicine,” which pointed to an aging population and increase in chronic disease — and a decline in the number of medical students entering primary care.
Estimates of the physician shortage by 2020 range from 55,000 (according to the U.S. Department of Health and Human Services) to 80,000 (U.S. Council on Graduate Medical Education). The American Association of Medical Colleges predicts a shortage of 124,000 physicians by 2025.
According to numbers released early on in the Abingdon project, the southern highlands region of central Appalachia will be short 6,500 doctors by 2020.
“There’s a lot of local students with very, very bright minds here in this region,” said Zaidi. “If they go to medical school 300 miles from here, the odds are against them coming back. But if we can provide a high quality of medical education here, we want to attract them to come to our medical school and stay in the region — stay at home.”
Dr. Andrew Rhinehart, medical director and diabetologist at the Johnston Memorial Diabetes Care Center in Abingdon, said the project has the potential to not only increase the number of doctors but to raise the bar for all physicians practicing in the region.
“Change scares people, and some people are a little apprehensive as to how this may work,” Rhinehart said. “But I think the overall discussion is this is good for our community.”
As the only diabetes specialist in the nine-county region of Virginia that he covers, Rhinehart isn’t worried about competition. His nearest colleagues are two hours away in Roanoke, he said, and he has patients who drive from West Virginia and Kentucky to see him.
“If we can get some help taking care of these people, it’s never a bad thing, because there’s plenty of patients that need to be taken care of,” he said. “It’s kind of the more the merrier in some respects.”
A healthier economy
When Abingdon and Washington County formalized their commitment to invest in the medical school project in 2011, Abingdon Mayor Ed Morgan said the start of the project had begun “a new era in the history of southwestern Virginia.”
Washington County Board of Supervisors Chairwoman Dulcie Mumpower said the school would not only help to alleviate the region’s physician shortage, but also would bring millions of dollars in revenue and hundreds of jobs.
Morgan expressed hope that the medical school could help address the region’s health challenges — issues such as prescription drug abuse, lung disease, diabetes and obesity — and make strides toward developing a rural health care model that could be used nationwide.
“If we can help to develop some programs to address those problems here, they may very well have some possibilities of helping the country as a whole,” Morgan said. “It’s not particularly easy to find a model that will work in a rural area, where there are problems of isolation and transportation and poverty, and these are things that I think the school could go a long way towards helping to address.”
In what has been called a roller coaster ride, the project first pitched in 2009 by King College in Bristol received a big local funding commitment in 2011 but stalled until its independent, Virginia-based board was formed in 2012 and began to pursue a partnership with ETSU.
“I think the project has garnered so much interest because it touches on so many things that are important to this region: health care and economic development, the creation of jobs, the recruitment of jobs and businesses,” said Zaidi. “It just really does touch on so many facets of life that it’s hard not to get excited about a project like this.”
Berry points to ETSU’s Quillen School of Medicine, which employs 600 people and has an annual economic impact of $435 million, as an example of what Abingdon’s proposed medical school could become.
“We’re not going to be that right away; it’s going to be many years,” Berry said. “But if we were a small fraction of that, even 10 percent of that, in a small town like Abingdon … that’s a major impact on our community.”
The kind of change a new medical school could bring is not measured only in dollars, said Berry, an Abingdon native who attended ETSU and worked in Washington, D.C., before returning home to settle down. He said the quality-of-life change it would bring could make the whole region more attractive to business and industry, entrepreneurs and capital, as Quillen has in Johnson City.
Kanto said there’s still much work to be done to make the project a reality.
“It’s not something that can be done by an individual,” he said. “It requires the community and the institutions to have the will to make this happen.”
Zaidi said it still requires more fundraising, the finalization of an agreement with ETSU, and the support of health care systems in the region.
“Is it going to happen?” Zaidi said. “I believe that the foundation is now in place to make this project a reality.”
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