An acute physician shortage in Indiana is driving a request for an additional $5 million in annual funding to expand enrollment at the state's only medical school.
The Indiana University School of Medicine's Physician Workforce Task Force conducted a study in 2006 that found the state already had 3,500 fewer physicians than it should. Indiana had 12,534 doctors in 2005-a number that remains relatively flat because the medical school churns out the same number of graduates each year.
Over the next 20 years, demand for physicians is expected to rise as more reach retirement and as baby boomers age. Based on current trends, Indiana will narrow but not eliminate the gap unless it starts training more doctors now.
Medical leaders say that can't be accomplished unless the medical school receives more state funding to pay for the expansion. They have been meeting with state officials and lawmakers to drum up support for the extra $5 million a year before the Legislature convenes in January to craft a two-year budget.
Dr. Stephen Leapman, executive associate dean for educational affairs at the medical school, thinks the request is reasonable. By comparison, the University of North Carolina is building medical schools in Charlotte and Asheville, at a total cost of $140 million.
"When I talk about increasing enrollment by 84 students and asking for 5 million bucks, that's peanuts," he said. "That's the point we're trying to make to our friends in the Legislature."
In 2025, Indiana still will have 1,300 fewer doctors than it needs, according to task-force projections. However, if IU expands its annual enrollment 30 percent-or 84 extra students each year-the state would lack just a few hundred doctors by 2025.
Although funding has yet to be approved, the medical school already is embarking upon its mission to increase enrollment. It admitted 12 additional students last year and doubled that number this fall. It will continue adding 12 more students than the previous year for the next six years, until the total class size hits 364, or 84 more students than the 280 that were traditionally admitted.
During a 10-year period-after the sixyear ramp-up-840 more doctors will be practicing in the state by the year 2025.
About half the 280 students the medical school enrolls each year spend their first two years at one of IU's eight regional campuses: They're in Bloomington, Evansville, Fort Wayne, Gary, Lafayette, Muncie, South Bend and Terre Haute.
The students then return to Indianapolis to receive clinical training in internal medicine, surgeries, pediatrics and other areas. But local hospitals will be unable to accommodate the additional students enrolled under the expansion, Leapman said. They will complete their training at hospitals within the same cities as the regional campuses.
Although the medical school will need to develop new clinical rotations for the students, the move could have a positive impact on the state. Students who train outside of Indianapolis might be more likely to remain there and, thus, increase the quality of medical care in rural areas.
That's particularly important to Dr. David Welsh, a surgeon in Batesville who is president of the Indiana State Medical Association. The ISMA is one of several organizations in the state that participated in the medical school's study.
A rural problem
Originally from Indianapolis, Welsh has spent 20 years at Batesville and is well aware of the challenges recruiting young physicians to the region. Primary care physicians are in the highest demand.
"It's convincing them to try it," he said. "Quite frankly, once they do, a lot of them like it."
An IU and Indiana State Department of Health study published last year cites sources that show from 1975 to 1995, the number of physicians practicing in metropolitan areas increased 59 percent, while non-metro-area growth was just 31 percent.
The limited number of physicians in rural areas is not a new problem, the study said. But the growing prevalence of chronic diseases in an aging rural population underscores the need to increase the number of physicians in those settings.
Having students complete their training outside of Indianapolis might help IU replicate the Rural Health Program the school started in Terre Haute 10 years ago. The program recruits talented students from rural high schools, promising scholarship and admission to medical school (if they keep their grades up)-with the hope they work as doctors in rural areas.
The Terre Haute regional campus is hosted by Indiana State University and receives support from the local hospital and doctors.
IU is embarking upon its plans to expand enrollment now, because of the length of time it takes to become a doctor. Four years of college is followed by four years of medical school and a three- to five-year residency. The number of new physicians coming out of medical school would help close the shortage gap by 2025.
The IU study follows a similar one from the Association of American Medical Colleges that calls for a 30-percent enrollment increase from U.S. medical schools by 2015.
Yet, any plans to grow the number of physicians and increase the quality of rural health care depends upon the medical school's ability to wrestle additional funds from the state.
"If we don't get an increase in state appropriations to run this program," Leapman at IU said bluntly, "we cannot afford to continue it."