More Michigan med school grads, too few residency spots

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Capital News Service
LANSING — Despite three new medical colleges opening within a three-year span, Michigan likely won’t see an increase in doctors, but rather an increase in the exodus of graduates to other states, experts say.
Oakland University, which opened its medical program in 2011, admitted 50 students in its inaugural class and 75 more in 2012. Central Michigan University’s medical school, set to open this summer, plans to admit about 60 students into its class and Western Michigan University plans to take 50 for its pioneer class in August 2014.
All intend to increase admissions annually during their first few years.
However, that increase will have little effect on the number of physicians practicing in the state, particularly in the already-underserved areas of Northern Michigan, because the state doesn’t have enough graduate medical education (GME) programs to accommodate them, said Sheri Clarke, president of the Michigan Association for Medical Education.

“The short answer is no, there aren’t enough,” Clarke said.
Therefore more students must go out of state for residencies required for licensing.
Michigan has 47 teaching hospitals, but most are located around the state’s major metropolitan areas. The only two facilities in the northern region are Munson Medical Center in Traverse City and Marquette General Health System.
To become a licensed physician, a graduate needs three to five years of post-graduate training at a GME facility. During that time, Michigan State Medical Society President John Bizon explained, many begin their families or become in some other way rooted to an area.
Having a residency program in an area greatly increases its retention rate, Bizon said.
“We find that doctors will oftentimes return to the place where they come from, but more often they stay in the area that they trained,” he said. “If you can get a doctor to be trained in an area, the chances of keeping them there are much better.”
The addition of the new medical schools — particularly Central Michigan in Mt. Pleasant and Western Michigan in Kalamazoo — was intended to provide more health services to rural areas in southwestern and northern parts of the state and to, ideally, drum up new GME facilities, Bizon said.
Most funding for GME programs comes from the federal government, but financial constraints have resulted in a freezing of such support, Bizon said, making the outlook for new programs bleak.
“To a large degree, funding depends on where the training programs were in the past and where they continue to be,” he said. “They froze GME, but they froze GME in a way that continues funding to existing programs.
“So if you say where we have had GME funding in the past, I’d be willing to say that’s where they’re going to get GME funding in the future. And if you haven’t had GME funding in the past, then getting it into those locations that may need it desperately is going to be something that will be more of a challenge,” he said.
Graduates don’t select the residency program they enter, but rather are matched to a program that fits their needs, wants and qualifications.
In 2012, University of Michigan Medical School, Wayne State University School of Medicine and Michigan State University’s colleges of human and osteopathic medicine matched a combined 773 graduates. About 415 of them entered in-state residency programs.
Those numbers are on par with years past, but the MSU College of Osteopathic Medicine is set to see its graduation class increase this fall as a result of upping admissions by 100 students four years ago, said Pat Grauer, director of public relations for the college.
In 2011, Michigan had 4,737 medical fellows and residents on duty, the seventh-highest per capita rating in the country, according to the Association of American Medical Colleges. The state also ranked favorably in retention of graduates, coming in at 17th with 44 percent. GME retention was comparable with 45.6 percent, the 26th-best in the U.S.
“But the numbers lie,” Clarke said.
Because Michigan has so many graduates in GME programs, it’s not viewed as an in-need state by the federal government, Clarke said. And because the medical facilities are so densely concentrated in specific areas, it skews the statewide statistics.
Twenty-one counties have no obstetrics and gynecologist (OB/GYN) physicians and 13 more have a population-to-OB/GYN ratio of at least 20,000 to one, according to the Department of Community Health. Six of the Upper Peninsula’s 15 counties have hospitals that provide OB/GYN services.
“Michigan itself has more residents per capita than many other states. That’s why the federal government does not see that there’s a shortage,” she said. “Many of our residents are in the corridor from Detroit to Grand Rapids, with some in Lansing and up through to Bay City.”
Some GME programs have outreach activities that use residents to serve underserved areas. For example, the Marquette General Health System requires its residents to serve an eight-week stint in one of eight Upper Peninsula regions after completing their third week of training.
Though these programs serve these more remote areas, Colin Ford, director of state and government affairs at the medical society, said having limited medical care readily available is a fact of life some residents have come to accept.
“If you live in the far reaches of the Upper Peninsula, you’re not expecting to go and have a fully staffed, level-one trauma center in a town that only has two or three thousand people,” Ford said. “Doctors are able to meet the community standard.”

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