Michigan State University

College of Osteopathic Medicine

Expansion to Southeast Michigan

May 16, 2007

As Michigan faces a critical physician shortage in the years ahead, the MSU Board of Trustees will consider a proposal at its May 18 meeting to expand education of first- and second-year College of Osteopathic Medicine students to sites in southeast Michigan.

The Michigan State University College of Osteopathic Medicine (MSUCOM) has been studying the need for expansion, the conditions necessary for a successful expansion, and the ideal location(s) for such expansion for several years. The following provides background and context for understanding the proposal the board will be considering. 

Michigan State University College of Osteopathic Medicine: Background and Highlights

The Michigan State University College of Osteopathic Medicine was founded in 1969 under a legislative mandate to produce primary care physicians for the state of Michigan. It was the first college of osteopathic medicine at a major university and the first to receive regular public funding. MSU offered the first D.O/Ph.D. dual-degree program in the nation.

MSUCOM currently enrolls nearly 700 students in four classes—two on the East Lansing campus and two in affiliated base hospitals located elsewhere in the state. The college maintains one of the nation’s largest consortia for graduate medical education with nearly 2,000 volunteer physician faculty and 26 hospitals in its Statewide Campus System. Hospitals in the system include those in Bay City, Clinton Township, Coldwater, Commerce Township, Detroit, Farmington Hills, Garden City, Grand Blanc, Grand Rapids, Hillsdale, Howell, Kalamazoo, Lansing, Madison Heights, Mount Clemens, Muskegon, Pontiac, Southfield, Traverse City, Trenton, Warren, and Wyandotte.

MSUCOM Highlights

* MSUCOM has been ranked the best osteopathic college in the nation for primary care education by U.S. News & World Report for seven years running and is ranked fifth (top 3 percent) among all 146 medical schools in the nation (M.D. and D.O.) for primary care education

* Michigan residents make up 85 percent of MSUCOM’s student population

* All MSUCOM students must pass part two of the National Board Exam and be eligible to practice medicine in order to graduate

* Approximately 90 percent of MSUCOM graduates take internships and residencies in Michigan

* More than two-thirds of MSUCOM graduates stay in Michigan to practice, serving in nearly all of Michigan’s counties

* MSUCOM is the top osteopathic college in the nation for research funding from the National Institutes of Health

Expansion to Southeast Michigan: Framework for Decision Making

Meeting the State’s Needs

MSUCOM is interested in expanding its program because there are well-documented projected physician shortages across the nation and particularly in Michigan. The Blue Ribbon Committee on Physician Workforce projects Michigan will be 900 physicians short by 2010, 2,400 short by 2015, and 4,500 short by 2020.

MSUCOM was established by the Legislature with a mandate to produce the number and kind of physicians Michigan needs most. The college excels at delivering on its mission by producing the highest percentage of primary care doctors of any medical school in the state, and it has the highest percentage of graduates staying and practicing in Michigan compared to the state’s other medical schools.

Selecting Southeast Michigan

MSUCOM focused on southeast Michigan as the preferred area for expansion because:

* It meets the needs of our hospital partners: Expanding to southeast Michigan would place students in a region of the state with the greatest concentration of population and clinical education resources and the greatest human need. Of the 26 hospitals that are part of the MSUCOM’s Statewide Campus System, 14 are in southeast Michigan. The interns and residents active in this area provide vital services in these hospitals and, because of the reimbursement structure for graduate medical education, their presence creates an important source of federal revenue for those hospitals.

* A long history and a supportive D.O. physician community: MSUCOM has been teaching students, interns, and residents in southeast Michigan for nearly 40 years, and the college has a large volunteer clinical faculty in southeast Michigan that is eager to work more closely with the college, providing the opportunity to expand residencies in the area.

* Social justice and better physician training: In southeast Michigan, the college can develop increased clinical and educational opportunities for its students to work and learn in medically underserved areas and with economically disadvantaged and ethnically diverse populations. Students trained in this environment will be better prepared to work with these populations in doctor/patient communication, patient education, specific disease states, and in enhancing compliance with physician recommendations.

* Consistency with MSU values: In alignment with MSU’s land-grant tradition of service to the state and world-grant vision of furthering the core values of quality, inclusiveness, and connectivity, the southeast Michigan site will provide a focal point for community and clinical service to the medically underserved and diverse populations of the area. It also will manifest the university’s Boldness by Design principles of enhancing the student experience; enriching community, economic and family life; increasing research opportunities; and strengthening stewardship.

* Enhance clinical research: A strong presence in southeast Michigan with a high concentration of clinical resources in our Statewide Campus System provides MSUCOM with tremendous potential for organizing resources for clinical efficacy and outcomes research.

A Cost-Effective, Community-Integrated Model

Osteopathic Educational Model vs. Allopathic Educational Model

The osteopathic (D.O.) model of medical education is structured differently from the allopathic (M.D.) educational model. Most M.D. medical schools operate in an academic medical center model: one college and one hospital dependent on each other with physicians paid to train medical students and residents. Osteopathic education operates with consortia of colleges and hospitals where residents are trained by volunteer physician faculty who are not compensated for their teaching. This model is supported by the tenets of osteopathic culture, which mandate that its members cooperate, share resources, keep costs down, and give back to the profession to ensure D.O. care for subsequent generations. Expanding the number of students taught within the D.O. educational model is, therefore, much more cost-effective than expanding traditional allopathic medical education.

MSUCOM’s Statewide Campus System is the national model for the osteopathic educational model. In partnership with hospitals from Traverse City to Detroit, the Statewide Campus System offers nearly 1,200 resident positions, all filled by students from U.S. colleges. Of the 26 hospitals in the system, 19 are “base hospitals,” which means each teaches an average of 18 third- and fourth-year medical students per year. Supporting these efforts are nearly 2,000 volunteer physician faculty.

Specifics of Expansion in Southeast Michigan

MSUCOM’s proposed expansion into southeastern Michigan is specifically for education of first- and second-year students. When these students enter their third and fourth years, they will join all other MSUCOM students in a coordinated clinical education program in one of the college’s affiliated base hospitals, of which there currently are 19.

First- and second-year students receive education in a classroom setting in basic science (such as anatomy, biochemistry, physiology, and microbiology), basic clinical skills (such as doctor/patient relationship), and integrated studies of organ systems (such as cardiovascular, respiratory, and integumentary). Delivery of the first two years of the medical education curriculum in southeast Michigan would rely on a technologically and administratively linked extension of the East Lansing program that would be highly cost-effective.

It also would provide an opportunity for curricular innovation. The passive learning environment that characterizes much of medical education, although cost-effective, is increasingly viewed as a problem. New technologies can be used for the organization, presentation, and evaluation of curricular content in ways that create a more interactive and dynamic learning experience. These innovations already are being developed and implemented on the East Lansing campus and can be distributed to another location.

Consideration Criteria for Potential Sites in Southeast Michigan

Michigan State University reviewed proposals from more than a dozen locations in southeast Michigan for location of the College of Osteopathic Medicine. In evaluating potential sites, the university and MSUCOM sought the following characteristics:

* Institutional and community enthusiasm for having MSUCOM on site

* An environment highly conducive to learning that would facilitate recruitment of faculty and students, including proximity to amenities such as restaurants and bookstores

* Reasonable costs for purchase/rent, physical plant modification/construction, information technology automation, furnishings, and facilities maintenance, as well as a reasonable timetable for implementation of necessary modifications

* Osteopathic leadership appropriate to meet American Osteopathic Association accreditation standards, building on the existing strength of the profession in southeast Michigan to deliver the college’s curriculum

* The opportunity for identification and signage to clearly indicate the presence of both the university and the college

* At least 20,000 square feet of dedicated space configured to accommodate lecture halls, study space, small group rooms, clinical skills training, offices for six to eight full-time faculty/staff, an educational resources center with capabilities for electronic linkage to MSU library resources, and administrative offices

* Opportunities for research collaboration

Finalist Sites: Macomb Community College and Detroit Medical Center

Using the list of consideration criteria developed to explore and review potential sites, MSUCOM determined that both Macomb Community College and Detroit Medical Center’s old Hutzel Hospital were highly attractive options.

Upon the recommendation of the president, provost, and dean of MSUCOM, the MSU Board of Trustees made visits to both sites May 1. The board will consider a resolution on May 18 for the final location of the MSUCOM expansion. Because of the excellence and complementary nature of both locations, expansion to both sites is under serious consideration.

Expansion of education of MSUCOM’s first- and second-year students to two sites rather than one in southeast Michigan would allow twice as many students to be enrolled, increasing the pipeline of potential physicians to serve Michigan as the state approaches a critical physician shortage.

It also would have positive effects for medical education and for recruitment of faculty and staff. The strengths of Macomb Community College (MCC) and the Detroit Medical Center (DMC) are complementary. MCC offers a vibrant educational milieu, and DMC provides an active medical milieu. The suburban/urban differences of the sites will appeal to a broad array of osteopathic students as well as provide a full spectrum of educational, cultural, and voluntarism opportunities.

Other Advantages of Locating at MCC and DMC

Enthusiasm: The people of Macomb County—including municipal and county leadership, state legislators, members of the osteopathic profession, and hospital partners—have been exceptionally proactive in expressing their enthusiasm for MSUCOM to join their communities. The osteopathic leadership and osteopathic institutions in the county are highly supportive of our presence there. In the case of DMC, the mayor of Detroit, the city council, local legislators, the leadership and physicians of DMC, and the larger osteopathic community are enthusiastic about hosting MSUCOM at this site. DMC comprises allopathic hospitals but it recently applied to become a member of MSUCOM’s Statewide Campus System for graduate osteopathic medical education.

Cost: At MCC, there would be minimal capital outlay from MSU to occupy existing space and there is the possibility that a new facility to support MSUCOM programs might be constructed at no cost to MSU. In the case of DMC, the cost structure of occupying this site is favorable and includes cost sharing with DMC and competitive lease rates. DMC has committed to match the lowest lease bid.

Concerns Raised by Wayne State University

Wayne State University has publicly stated that there will be negative effects on its medical education programs if MSUCOM students are educated at the DMC. Specifically, Wayne State is concerned that adding MSU D.O. students at DMC will displace Wayne State students, displace Wayne State allocated residency slots, and lower the quality of education by affecting the availability and quality of clinical experiences during the third and fourth years.

Michigan State University sees the situation differently. The structure of the proposed expansion and, indeed, the structure of the D.O. model of medical education—quite different from the typical M.D. (allopathic) model—do not support these fears.

* The proposed site for educating first- and second-year MSUCOM students—the former Hutzel Hospital—is a building that is not extensively used. These students spend the vast majority of their time studying basic science and body organ systems in classrooms with very little clinical time. MSUCOM students will not be taught in classrooms used by WSU students.

* MSUCOM students will be taught by faculty affiliated with departments within the College of Osteopathic Medicine, with no presumption that Wayne State faculty would be directly involved. This means that if MSUCOM were to locate at the DMC, these first- and second-year students would have limited presence in active DMC hospitals, with the following exception: Currently only nine MSUCOM students use DMC’s Huron Valley-Sinai Hospital in Commerce Township for their third- and fourth-year base hospital rotations, and a few students displaced by St. John Riverview’s closing may also be placed at Sinai-Grace Hospital in northwest Detroit. However, this is coincident, not caused by, the proposed expansion to DMC.

* When the students who might receive their first- and second-year education at the old Hutzel building enter their clinical training in their third year, they will become part of the pool of all MSUCOM students in their classes who are educated in 19 base hospitals across the state.

* Independent of locating MSUCOM predoctoral students there, the DMC has applied for membership in MSUCOM’s Statewide Campus System for graduate medical education. Whether first- and second-year students go to DMC or not, this application could affect residency programs offered at DMC hospitals. However, in the past, many of these residency slots have been left vacant or have been filled by graduates of medical schools from outside the country. Filling these residency positions with graduates of MSUCOM would not offer competition to WSU graduates.

Student Quality

As plans develop and student enrollment numbers grow, there are some concerns that the overall quality of the admitted student population will suffer. However, MSUCOM data indicate this will not be the case.

* For MSUCOM’s incoming class, the overall science grade point average (GPA) is 3.6, up from 3.5 a year ago.

* The average Medical College Admission Test (MCAT) score is above 26, up from last year’s 25. Approximately 25 percent of the class has an MCAT score of 29 or higher.

* Approximately 209 students will be admitted for summer of 2007. Average MCAT scores have risen since the college increased its entering class size by approximately 50 students in fall 2005.

* Since the decision was made to increase enrollment, annual applications to MSUCOM are up by approximately 1,000. Applicants placed on the alternate list (160 applicants) have GPAs and MCAT scores equivalent to the admitted class. Even with current numbers, MSUCOM is admitting only about 8 percent of individuals who apply.

Questions about the expansion? Please submit your question here.