March 25, 2008
The Scripps Research Institute and Scripps Health are working to set up what they hope will be the nation's first medical school entirely geared to training physicians for dual careers in research and patient care.
The coordinators, who plan to accept their inaugural group of students in 2013, would make the Scripps School of Medicine the county's first new medical school in 40 years.
They want to receive final accreditation for their school by 2018. Nationally, only one new medical school at Florida State University has been fully accredited in the past 20 years, said Dr. Dan Hunt, secretary of the Liaison Committee on Medical Education in Washington, D.C.
That committee's approval is required before medical school graduates can take the licensing exam required by state medical boards.
The Scripps institute must raise $150 million in startup money for the medical school, which would be housed in its campus on the Torrey Pines mesa. The program would enroll up to 50 students each year in a five-year curriculum that offers routine medical school courses, such as anatomy and biology, with subsequent rotations at Scripps Health's hospitals and doctors' offices.
But these students would also receive training in lab work, clinical trials and research topics such as molecular genetics. The goal is to have them bring laboratory discoveries to the patients' bedside.
There's no other curriculum and design such as this one, said Dr. Eric Topol, who holds positions with the Scripps institute and Scripps Health.
Although many of the 130 medical schools in the United States offer similar physician-scientist training, they include only a few students at a time, Topol said. Those programs can take as long as nine years, he said.
At the Scripps institute, students will have a stipulated interest in becoming physician scientists, not only for the care of patients but to conduct research to change the future of medicine, Topol said.
Chris Van Gorder, president and chief executive officer of Scripps Health, said, There's no medical school in the world that's dedicated to translational science and developing future scientists.
Scripps Health's network of five hospitals and several thousand affiliated physicians provide about one-third of the patient care in San Diego County.
The medical school endeavor is a natural extension of training programs and graduate medical education that have been offered for many years through Scripps Health, Van Gorder said.
I don't think it's going to be that big of a gamble, he said.
Van Gorder emphasized that the school will not pull money away from any patient care programs at Scripps Health. The Scripps institute is aware of that and expects our contribution to be compensated, he said.
The institute has not raised any of the money needed for the new school. With an annual operating budget of $400 million, it is the world's largest independent, nonprofit biomedical institute. It already runs an accredited graduate science program with about 200 students.
It made a lot of sense to expand our program to the medical school arena and see if we could start one, said Douglas Bingham, the institute's executive vice president and chief operating officer.
Topol, who came to Scripps in January 2007 after working with the Cleveland Clinic and Case Western Reserve University, conceived of the medical school idea in November during a conversation with Bingham.
Topol said the institute has hired Cary Thomas to help establish the program. Thomas was formerly vice dean for finance and operations for the medical school at the University of Southern California.
Several weeks ago, Scripps institute officials paid the liaison committee a $25,000 fee to file its accreditation application. The committee, which requires all medical school applicants to meet 133 standards in five lengthy phases, will visit the facility early next month for the first phase.
It's unusual for a county to have more than one medical school, if it has any. The only one in San Diego County is the 40-year-old UC San Diego School of Medicine.
Dr. David Brenner, its dean, said he supports efforts to expand programs in biomedical research and medical education.
But instead of starting a medical school, he said, the Scripps institute and Scripps Health should consider collaborating with UCSD to minimize the costly duplication of infrastructure and programs necessary . . . at a time when we are facing cuts in medical education funding at the state and federal levels.
What Scripps is attempting, Brenner said, is really hard work.
Not only do faculty members have to be hired, but new courses must be designed. Conflict-of-interest policies, diversity programs, student loan procedures and reimbursement formulas all must be established from scratch, Hunt said.
At first, it may be difficult for Scripps to recruit students because the liaison committee would not give its decision on final accreditation until students from the first class are ready to graduate.
Nationwide, many physicians groups and health policy analysts have decried a shortage of physicians. They see the problem worsening as baby boomers reach the age when they will need more medical care.
There's also a perceived shortage of physicians willing to take care of the uninsured or enter the fields of internal medicine and primary care, which are usually less lucrative than plastic surgery or dermatology.
Additionally, many physicians are retiring or practicing less because of concerns about declining reimbursement from health plans and government payers.
California is expected to be short about 17,000 physicians by 2015.
Several years ago, the Association of American Medical Colleges called on medical schools to expand enrollment by 30 percent to meet the increasing demand for doctors.
In response, some medical schools have raised the number of students they will accept, Hunt said. There were 42,315 applicants nationally for the 2007 school year, but only 17,759 were accepted, he said. That is 8 percent more than in 2002, but it's still far short of what is needed.
This year, the UCSD School of Medicine increased its incoming class size for the first time in decades from 122 students to 134.
Nine institutions across the country, including the Scripps institute, are seeking accreditation for their medical schools.
If (Scripps) stays focused on training physicians for a research niche, that might be pretty unique, Hunt said. My guess is that as they move toward becoming real, they'll broaden their mission.
