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FSU Readies Its New Medical School Teaching to Focus on Primary Care

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By Joe Humphrey
Dec. 31, 2000
Times-Union staff writer

TALLAHASSEE -- A group of 10 Florida State University seniors applied to medical school last year, seeking a chance to study at one of the state's four medical schools. They had practically equal grades and near-identical entrance exam scores.

"I knew they'd all be good doctors," Mark Helquist, one of the students, recalled. "They all had good patience, good temperaments."

But as students in Florida, where medical school slots are among the scarcest in the country, they also had long odds of getting accepted.

Only two people in the group, Helquist included, made the cut. The other eight have scattered to pursue careers as nurses, marine biologists and homemakers, among other vocations.

More than test scores and grades go into determining admission, but Helquist thinks more than just two would have been accepted if more space had been available for potential doctors. Beginning in May, a new medical school at Florida State will provide additional opportunities, as a charter class of 30 students begins its studies.

The state's first new medical school in more than a decade promises to offer something its counterparts don't: a strong focus on training primary care physicians who will work in traditionally underserved rural areas. Students will spendt their third and fourth years studying in clinics, doctors' offices and hospitals in Pensacola and Orlando. Florida also has one of the nation's fastest-aging populations, making geriatric care a priority.

The school has been deemed by many a political coup engineered by powerful FSU alumni, including former House Speaker John Thrasher, R-Orange Park. Critics say Thrasher, in his final year as a state lawmaker, led the charge to deliver his alma mater an impressive feather in its cap.

But Myra Hurt, interim dean of FSU's College of Medicine, offers this statistic to underscore the need for a new school: Florida licenses about 2,500 doctors annually but graduates only about 500 from its medical schools.

"We have always relied on the kindness of strangers," she said.

Optimistic beginning

Its medical school is new, but Florida State has three decades of experience offering medical education. Since 1971, FSU has offered a first year of medical school in conjunction with the University of Florida. Students spend a year in Tallahassee studying basic science, then transfer to Gainesville to complete their degree. So when 30 students show up in May, ready for their first year of school, Florida State will be prepared.

"It's an easier project than I thought it would be," FSU President Talbot "Sandy" D'Alemberte said. "To say we're going to deliver the first year of medical school next year, that doesn't cause us much concern at all. The real tricky questions are going to come a little bit further down the line."

Helquist, who earned his undergraduate degree in biology, is halfway through his first year of medical school in Tallahassee. He and 29 others will move on to Gainesville next year and will be replaced by Florida State medical students.

Enrollment is projected to grow from 30 students this year to 480 in eight years. By then, each class will have 120 students. To fulfill its mission, Florida State wants to find students with a clear interest in pursuing primary care.

"We will not have any problem in recruiting 30, 40, 50 students as we expand the medical school," D'Alemberte said. "The issue, in my mind, is whether we will get the applicants we want to fulfill our mission. Based on what has happened so far, I'm optimistic that we'll see those people come."

Helquist, for example, said half of his class has already decided to pursue primary care. He is still undecided.

As the classes grow, so too will the budget. And medical education is not cheap. A new building is needed in the next few years to house the college. The school must also purchase equipment, pay faculty and staff and manage its students throughout the state. FSU estimates it will need $15.2 million from the state this coming year and $34.1 million by 2008-09.

Selling primary care

Primary care doctors don't try to cure cancer or perform emergency surgery. They don't garner front-page headlines or collect big-time paychecks. But they are the type of doctors Florida needs most.

"One of the things we constantly face in our rural areas is a shortage of physicians, especially primary care," said Art Clawson, who directs emergency medical services and community health resources for the Florida Department of Health. "Any program designed to enhance that is very important to us."

The key is finding students who are willing to abandon the big cities and comfortable suburbs.

"We want people who understand that they may not be making the top dollars specialists make, but there's a lot of psychic income," D'Alemberte said. "Community involvement, a lower cost of living."

Hurt, who is leading the college as it searches for a full-time dean, said FSU must search for qualified students who come from the underserved areas, primarily those in the Panhandle.

"Our challenge over the next several years is going to be to get out into the communities of Northwest Florida and develop the applicant pool," she said. "They don't have people in their backgrounds who know what the ropes are."

D'Alemberte said he expects 65 to 75 percent of graduates to pursue primary care.

Thrasher said he expects the Legislature to ensure Florida State sticks to its mission. The oversight, he said, will occur in the funding process, where FSU will depend on millions of dollars annually to keep the school running.

"I think they'll stay to their mission," he said.

Students will spent their first two years in Tallahassee, studying basic science. The final two years will be spent at clinical campuses throughout the state. There, students will study with doctors in offices, clinics and hospitals.

Florida State plans to launch programs in Pensacola and Orlando, with its eyes on Jacksonville for expansion down the road.

The goal, D'Alemberte said, is to give students exposure to a wide range of problems, providing a chance to treat all cases, not just severe ones that only a specialist would see.

"We anticipate that probably less than 50 percent of our training will be in a hospital," he said. "We will attempt, through various devices, to get people out in the areas where they will see patients other than those examples with the most exotic types of diseases."

The plan also allows FSU to operate a medical school without a teaching hospital such as UF's Shands, which adds millions of dollars to an operating budget.

Said Thrasher: "Other states are looking at Florida and seeing this as a non-traditional way to create a medical school because of the savings for tax dollars."

UF pledges help

Did Florida need to spend millions of dollars to build a new school?

Months after the Legislature approved it, over the objections of the state's other medical school deans -- who said they could have increased their enrollments -- that argument has been muted.

"I think that nobody is worrying about the fight anymore," said Kenneth Berns, dean of UF's medical school. "The real issue is to try and help them get off to a successful start. Fundamentally, whenever they ask us for help, we give it to them."

The Board of Regents, which governs state universities, initially opposed the school's creation, then backed off, deciding the Legislature should have the final word. Spokesman Keith Goldschmidt said the regents now are fully supportive of the school.

Hurt said FSU's new medical school will prove its worth by creating more opportunities for potential doctors and by better serving areas that need physicians.

"In this state," she said, "it's harder to get into medical school than just about anywhere else in the country. There are a lot of people applying to medical school who are not getting in who are qualified and motivated."