Gov. Butch Otter’s announcement about creating the Idaho College of Osteopathic Medicine came immediately after the State Board of Education unanimously approved an agreement between Idaho State University and the private ICOM.
Q: How did this come about?
The Idaho Osteopathic Physicians Association learned last month that New-Mexico based investor Burrell Group was looking to start a private, for-profit osteopathic school in the Intermountain West. The investor group led by Daniel Burrell founded its first such college at New Mexico State University in 2013. That $85 million school will enroll its first class of 150 students late this year.
State officials had initial conversations with the Burrell Group on Jan. 20 and discussions flowed from there. The group’s model is to affiliate a private medical school with a public university. Otter met with ISU President Art Vailas several weeks ago and asked him to speak with the investor group. The governor’s office asked ISU to negotiate a draft agreement for a public-private partnership, and on Thursday, State Board authorized the agreement.
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Q: What are some details?
ICOM will be privately funded, separately licensed and independently operated. Initial capital investment is estimated at $105 million. Construction of an 80,000-100,000-square-foot, $32 million building to house the school is scheduled to begin in February 2017. ICOM will pay ISU for med school students to use shared campus space or services.
ICOM has registered as an Idaho public benefit corporation, or B Corp, a designation approved in Idaho only last year. Such corporations focus on their contributions to society and the community in addition to the financial bottom line.
Q: When will it open?
The school hopes to open in 2018 with a class of 150 students. Tuition is targeted for the mid-$40,000 range and Idaho students will have preferential consideration in admissions. It would employ about 90 instructors.
Q: What is osteopathic medicine and why is this an osteopathic school?
Osteopathic medicine emerged as a 19th century health reform that emphasized preventive care and healing without overuse of medications. Practicing physicians in the U.S. today are either allopathic physicians (MDs) or osteopathic physicians (DOs). They are the same in many ways. Both are fully licensed physicians who diagnose and treat illnesses and provide preventive care. They work in all practice specialties and go through four years of medical school, followed by up to seven years of residency. DOs are more prevalent in primary care and rural settings. They also receive training in hands-on manipulative training and osteopathic principles.
Q: What’s “public” in the public-private partnership?
Beyond the commitment the school received in the ISU agreement, ICOM received an award under the state’s Tax Reimbursement Incentive — nearly $4 million over 10 years — that it will use for scholarships and programs. The state’s program defrays a portion of anticipated payroll, income and other taxes as an incentive.
Q: Are there concerns?
Dr. Ted Epperly, who runs the Family Medicine Residency of Idaho, said the new school is based on good intentions. But he worries it might damage the health care infrastructure of the state instead of strengthening it. Stakeholders could take actions over the next several years to lessen the risk of harm, he said. Doctors must have training in a residency after medical school, and doctors often settle where they do their residency.
Epperly’s program has graduated hundreds of doctors since 1975, keeping more than half in Idaho. Many of the program’s alumni work in rural or underserved parts of the state, where Idaho’s physician shortage is most severe.
Q: What are the worries?
Epperly cites three things “to be aware of.”
1. It could deplete resources from existing programs. Idaho has three family medicine residency programs, a psychiatric and an adult primary-care residency, and nurse practitioner and physician assistant programs — all of which need “preceptors” to train students. “By bringing in all these students, it becomes a very competitive market for who gets trained in the state,” especially if the new school offers money to trainers, he said.
2. It won’t solve the problem of a physician shortage. Epperly’s residency, like others, is relatively small and takes graduates from all over the U.S. There aren’t enough residencies in Idaho to take more than a few of the new Idaho graduates each year, he said. That means more than 140 each year would leave Idaho to do out-of-state residencies — and likely not return.
3. Medical schools are producing a surplus of about 500 graduates each year, Epperly said. The new program would increase that number. “What that means, in today’s scenario, is these kids don’t get spots,” he said. “They don’t get jobs.”
Q: How can those concerns be addressed?
This isn’t a doomed proposition. Idaho should move slowly, Epperly said, investing over a 10-year period in the preparation necessary for a new medical school to do more good than harm. “Put in about five to seven more residency programs first, and then bring in a school (with) the stickiness of getting the graduates to stay in the state,” he said. “Otherwise, it’s like a sieve; they just leak out.” It takes two to four years for a residency program to be created and accredited, he noted.
At the same time, the state could create scholarships and loan repayment options, to both attract new doctors to Idaho and bring back graduates who do out-of-state residencies.
State lawmakers “should be thanked and complimented” for investments they have made in Idaho’s medical training over the years, Epperly said.