Growing here: Physician education

By Lyn Riddle  

APRIL 9, 2010 6:11 p.m. (0)

Steve Sloate’s job is to live 15 years in the future, then figure out how to get there.

What he envisions for Greenville is an expansion of medical training in an empty shell of a $20-million building on the campus of the Greenville Hospital System University Medical Center.

The idea, Sloate said, is the natural evolution of a medical facility that has been training third- and fourth-year medical students from the University of South Carolina for almost 20 years.

A team of 50 people at Greenville Hospital System, along with consultants such as Sloate, has been working on the plan to add training for first- and second-year medical students for about a year.

It would be known as the University of South Carolina School of Medicine – Greenville.

When fully ramped up in 2016, 400 medical school students would be living and learning in Greenville and as many as 18 professors of basic science and another 12 ancillary staffers would be hired at an average salary of $80,000.

The hospital system already has the clinicians needed to instruct and mentor students in the hospital setting.

And it has the building, which faces Grove Road just north of the main hospital. Both of which are significant, said Dr. Spence Taylor, chairman of the department of general surgery at GHS and operations director of the USC School of Medicine/Greenville Development Team.

“We are leveraging what we’ve got,” he said.

The total cost is $40 million to upfit the building, which would come from hospital revenue, donations and a one-time request for state funds.

Start-up subsidy for seven years, Sloate predicts, would be $18 million to $29 million, Spin-off economic benefit to the community: $33 million a year.

“People might think we don’t need a third medical school and I would agree with that,” said USC President Harris Pastides. “What we need is an expansion of physician training.”

Sloate, president of Cirra Inc. and an adjunct associate professor at University of North Carolina at Chapel Hill, was hired by the hospital system to vet the idea.

He has worked at Shands Hospital in Florida and at Duke University Medical Center in North Carolina.

 

Candid analysis

“This was a complete, candid introspection of the strengths and weaknesses,” he said.

Bottom line: it will work.

It is a business that will enhance the Greenville Hospital System portfolio, and the numbers add up. Tuition and other funding will guarantee a break-even performance on the balance sheet by the time the school is fully functional.

Doctors trained here are likely to stay, and, Taylor adds, doctors properly trained will buy into what the hospital system is trying to accomplish.

Generally, medical schools specialize in one of four areas: research, education, health care delivery or community service, Taylor said.

The strength of the Medical University of South Carolina, located in Charleston, is basic science research. The University of South Carolina in Columbia specializes in education, most especially its ultrasound curriculum, which is nationally known.

GHS wants to bring health care delivery to the mix of medical school choices.

“We’re a hospital first,” he said.

Taylor said doctors being trained are not focused on health care delivery. He said in the 1950s the great medical frontier was heart disease.

Now the biggest nemesis is getting health care to those who need it.

“Even if you cured cancer you couldn’t get it to the people because the medical system is broken,” he said.

 

The mission

The approach must be all hands on deck, not how can a doctor get rich and pay back his huge student loans, which average $185,000 per student.

Doctors must focus on taking care of everyone who is sick and the monetary rewards must go to those working the trauma room as well as those performing facelifts, Taylor said.

He wants doctors to work with the hospital, not against it. Competition is genetically wired in doctors, from getting into medical school in the first place to snagging the best residency.

“This has to be bred into the kids. Right now we’ve got golfers and when they get out we expect them to play basketball,” he said.

Medicine is a collective mission, not a competition.

For the people of the Upstate, medical training expansion brings research in best practices. It enhances preventative medicine. It lures better talent.

“We want to continually raise the bar to increase the sophistication of health care in our community,” said Dr. Jerry Youkey, the GHS vice president for Medical Services and dean of Academic Services.

Youkey said the present initiative can be traced back to the first agreement to train doctors in 1991 and more recently in his collaboration with Pastides. In a series of meetings in 2008 and 2009, they talked about the need to train more doctors. Initially they thought they would simply increase the number of upper-level students, but that was not practical.

Enticing students to uproot spouses or children to move from Columbia to Greenville was not easy. And it put USC at a competitive disadvantage in attracting students.

 

Expansion reasons

Pastides said the Greenville expansion makes sense on several levels and not the least of which is that the facilities and the associated health care systems in Columbia and Charleston are maxed out.

“Classrooms, labs, auditoriums and we don’t have all the clinical training we need,” he said. “Greenville is in the vanguard of where health care is going.”

Pastides said people who don’t understand the critical shortage South Carolina and the rest of the nation is facing might oppose the idea. Money is tight, to be sure, but already the nation is experiencing a shortage of doctors and it will only get worse in the next five years as a significant percentage of those now working retire. By 2020, the nation will be short 125,000 doctors.

“We will have a horrible health care shortage for five to 15 years,” Sloate said. “Ramp-up times are significant.”

And as this unfolds, health care needs are expanding with an aging population. Sloate said the problem is compounded by the fact Americans simply don’t take care of themselves. Fifty percent of all medical problems are caused by the lifestyles of the patient, obesity and smoking being only two of the troubling behaviors.

Research shows the nation needs to increase the number of medical students by 30 percent. South Carolina educates about 170 students at MUSC and 85 at USC each year.

No new medical schools opened from 1980 to 2005.

One of the innovations of the GHS plan, Sloate said, is the tuition forgiveness program offered to doctors in much-needed areas such as family medicine or obstetrics who chose to come back to Greenville to work after residencies.

 

Decisions

GHS sent an application in January to the Liaison Committee on Medical Education, which accredits medical schools. The curriculum has been developed. A business plan is nearing completion. A formal affiliation agreement is being worked on between GHS and USC. And sometime this summer the two boards will make a final decision about whether this place will come about.

Already, business leaders in Greenville are looking at where to build housing, what new businesses might be attractive.

Sloate said it often comes to pass that businesses spin off the research done in medical schools affiliated with hospitals. Device manufacturers, software developers, entrepreneurs would be attracted to the area.

And the value of a medical school and strong hospital in industrial recruiting can’t be underestimated.

“It’s a game changer,” he said.

Sloate said it has been his experience that 85 percent of failure can be explained in two ways: a beautiful strategy implemented by idiots or a flawed strategy implemented beautifully.

Greenville’s hospital is in the top 10 percent of hospitals in the nation, Sloate said. Its bond rating is high, its debt low, its leadership sound.

“This is not only do-able, but timely,” he said. “They can execute on this strategy.”