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A BOLD STEP

July 1, 2013
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IDEA TAKES HOLD

Wallace’s doubts about William Carey University’s ability to launch a medical school were rooted in his understanding at the time of how medical education worked.

For decades, North Carolina has been home to some of the nation’s top medical programs and university-run hospitals. UNC-Chapel Hill’s medical program dates back to the post-Civil War era, while Duke University Medical Center traces its roots to the early 1930s. They and the Brody School of Medicine at East Carolina University and the Wake Forest School of Medicine are all affiliated with large medical centers that serve as both classroom for the students and hospital for the general public. That’s where the big costs come into play — funding and manning a hospital. That’s why Wallace found it difficult to believe William Carey, which has about half the enrollment of Campbell, could handle such a large undertaking.

“My first interview was with the dean,” Wallace recalls. “I wanted to make sure the school was behind this and that establishing a medical school was not robbing Peter to pay Paul. I wanted to make sure the English or math departments weren’t being affected and that the school could finance itself and not drain everyone else.”

As Wallace interviewed the dean, the school’s vice president and the president, he learned more about the osteopathic medical education model and how it differs from the “MD” model. Unlike the medical schools at UNC and Duke, osteopathic schools do not house a hospital. The didactic portion of an osteopathic education occurs on campus (usually the first two years), while the clinical part is distributed among partner hospitals and clinics.

“As I learned this, I thought … ‘goodness, this is the way we’re doing pharmacy,’” Wallace said. “Instantly, this whole idea just really took hold of me. I kept asking questions, and when I returned home, I read about other osteopathic medical schools.”

Wallace didn’t just learn about osteopathic education, he read as much as he could about osteopathic medicine in general. His one experience with a DO had come a few years earlier when his son, McLain, then an attorney in Rocky Mount and chief counsel for Nash General Hospital, was scheduled to have shoulder surgery. Before the procedure, Wallace met his son’s surgeon, and noticed a “DO” where he thought the “MD” should be.

“I knew nothing about DOs,” Wallace says. “This surgeon was a nice young man, but I thought he was some kind of specialist in orthopedics. McLain explained ‘osteopathic’ to me briefly, but I didn’t think much about it until, of course, just recently.”

What Wallace learned is that a DO degree is the equivalent of an MD degree, legally and professionally. The big difference? Osteopathic physicians are trained to take a holistic perspective of medicine based on a belief in treating the whole patient (mind, body and spirit) and the primacy of the musculoskeletal system and utility of manipulative medicine, while DOs emphasize prevention.

Because of their equality, in addition to substantial decrease in costs to launch one, osteopathic schools have nearly doubled in the United States since 2000. In 2011, there were about 74,000 osteopathic physicians, compared with about 29,500 in 1990.

With the additions of Campbell, Alabama College in Dothan, Ala., and Marian University in Indianapolis — all opening this fall — there are now 29 colleges of osteopathic medicine, four branch campuses and four additional teaching locations.

A quarter of all medical students in the United States are currently studying to become a DO.

‘THE ANSWER IS YES’

North Carolina ranks 30th in the nation in physician density, with approximately 202 practicing physicians per 100,000 people. For primary care physicians — the “front line” physicians who are typically the first contact for an undiagnosed patient with a health concern — the state ranks 34th.

Despite North Carolina’s reputation as a mecca for medical education, the state simply isn’t meeting the needs of the population, according to Dr. John Kauffman, the founding dean of the Campbell School of Osteopathic Medicine.

“One of the first questions in Campbell’s feasibility study was whether or not the state needed a new medical school,” Kauffman says. “The question was answered in a 2007 white paper put out by the Institute of Medicine, which concluded that by 2020, our state will be 90,000 physicians short. And that’s not just primary care physicians … we’re short on surgeons and specialists as well.”

The need is even greater in the rural parts of the state, according to Kauffman. Twenty of North Carolina’s 100 counties are without a single general surgeon, many of those counties are east of Harnett. Kauffman pointed out that counties without an obstetrician suffer from a higher infant mortality rate.

“So to answer the question, ‘Do we need a new medical school?’ … the answer is yes,” Kauffman says. “Our current doctors are getting older. People are living longer. If our graduates head out into primary care, emergency medicine and other areas, and if the majority of them are practicing in underserved regions of our state, that would justify Campbell’s decision to launch this school.”

Wallace learned of these shortages while reading the 2007 report as part of his feasibility study for the PA program. Wallace says Campbell’s PA program — a two-year program which will graduate around 40-plus students each year — will provide much-needed manpower and assistance to MDs and DOs across the state.

“Launching the PA program was a very important step for us,” Wallace said. “The idea of the medical school was born out of the research that justified bringing in physician assistants. The stars have lined up for us, and the PA program has been eminently successful.”


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