While the medical school that’s planned for downtown Phoenix awaits a start-up appropriation, two legislators are expressing concerns about the school’s focus and finances.

Sen. Bob Cannell, D-24, and Rep. Doug Quelland, R-10, say they worry that the school, which plans to admit its first 24 students in July 2006, will focus on graduating research physicians, rather than practicing MDs, especially doctors who will stay in Arizona. “We’re losing doctors in this state to a rapid degree, and we need to replace the doctors that we’re losing,” Mr. Quelland said. “So, if we’re losing gynecologists, let’s replace them with gynecologists. If we’re losing orthopedic surgeons, let’s replace them with orthopedic surgeons, not with DNA-molecule-scientists.”

Mr. Quelland, chairman of the House Health Committee, said the state needs 200 more physicians per year, but the shortage is not caused by physicians leaving because of high malpractice premiums or other often stated reasons.

“We’re not replacing doctors that are retiring, leaving town or dying,” he said. “We’re just replacing the doctors who have lost their licenses because of drug and alcohol abuse.”

Mr. Cannell, the only MD in the Legislature, says there’s nothing wrong with research, but the school should focus on graduating doctors who want to practice medicine, especially in rural and other underserved areas.

“I think the main push, at least from the president of ASU, is to help enhance research efforts,” he said. “There’s no problem with that, but the main thing we want out of them is practicing physicians.”

In its support for a third medical school in Arizona and for malpractice reform as well, the medical community often cites a 2001 Goldwater Institute study that reported the state had about 172 physicians per 100,000 population, while the federal Bureau of Health Professionals recommends a ratio of 231 physicians per 100,000 people.

School Will Be Branch of UofA

The Phoenix medical school will be a branch of the University of Arizona College of Medicine at the downtown Phoenix Biomedical Campus in partnership with Arizona State University. Governor Napolitano is seeking $6 million in state funds to renovate three buildings for the school, purchase equipment and hire faculty and staff and $1 million for an ASU biotech program. The Legislature’s budget, which the governor vetoed last month, did not appropriate funding for the medical school, but Ms. Napolitano continues to fight for the money in current budget negotiations.

“We have a shortage of physicians now, and it [the Phoenix medical school] will increase the number of physicians,” Ms. Napolitano said. In response to Mr. Cannell’s and Mr. Quelland’s comments about research, she said, “The curriculum at the school has not been designed.”

Mr. Cannell said there’s a chance the opening of the Phoenix medical school could be delayed, but “since the governor wants it, I suspect we’ll get it.”

By executive order, Ms. Napolitano created the Commission on Medical Education and Research to develop an overall plan that includes curriculum for the medical school. She gave the commission an extension to June to come up with a plan.

University and commission officials say the two lawmakers’ concerns are unwarranted.

“The vast majority of graduates will be practicing MDs, said Virgil Renzulli, ASU vice president for public affairs. He added, however, “We would like the MDs to be as research capable as possible because medicine is changing so quickly. The days of the old country doctor are over.”

Commission member John Murphy of the Flinn Foundation said, “While medical students may pursue a “PhD/MD” research curriculum, only three from a recent class of 110 students at UofA did so.

The Flinn Foundation is a philanthropy that studies medical education and physician supply. Mr. Murphy said the foundation will report on the state’s physician needs to the commission.

“The biggest deficiencies are in non-urban areas and in certain specialties,” he said.

Sen. Carolyn Allen, R-8, chairman of the Senate Health Committee, was recently appointed to the commission.

“I think there are a lot of people putting out concerns that are red herrings,” she said, but added, “This debate is going on amongst the medical community now. I’m not concerned.”

Ms. Allen said the medical school could produce both cancer researchers and general practitioners.

Dr. Keith Joiner, dean of the UofA College of Medicine, said concerns about an over-emphasis on research at the Phoenix school were generated by some of the governor’s commission members in charge of designing a curriculum.

“That notion has been taken off the table,” he said. “We know we need to train physicians that will practice in Arizona.”

Mr. Joiner said roughly half of the medical school graduates stay in the state to practice. “We would like a higher percentage,” he said.

The UofA medical school in Tucson is at near capacity, Mr. Joiner said. Currently, it only accepts students from Arizona, as will be the case at the Phoenix branch, he said, but that policy could change if there are not enough Arizonans in the future to fill available slots.

John Rivers, CEO of the Arizona Hospital and Healthcare Association, says researchers and practicing physicians are needed.

“I think it’s far too early to predict whether the new medical school will achieve the right balance between research and education,” he said. “Because the medical school will be on the TGEN (Transitional Genomics Research Institute) campus, both research and producing new doctors will be a critically important part of its mission.”

Sen. Richard Miranda, D-13, has introduced a bill, S1468, requiring medical schools in Arizona to provide a course in “cultural competency that addresses the problem of race- and-gender-based disparities in medical treatment decisions.”

The bill, which did not get a hearing this session, would require students to pass the course as a condition of receiving their diploma. The New Jersey Legislature recently passed a similar law.

“I don’t think that’s a bad idea, but I think the university already is pretty culturally sensitive,” Mr. Cannell said. “Not only are they culturally sensitive, they’re trying to get minorities to enter the practice of medicine.”

The governor’s Commission on Medical Education is to devise “a curriculum that is socially and culturally sensitive to the Phoenix metropolitan area’s health care needs,” the Flinn Foundation states.

Lawmaker Says Med Schools Should Be Private

Of the 33 medical schools in the 10 largest U.S. cities, 20 are private, and Mr. Quelland says the Phoenix school should be private.

“I think that’s very short-sighted,” Ms. Napolitano said. “Medical schools are for the public good and should be part of our public education system.”

Mr. Quelland said legislators are reluctant to appropriate money for the school because they haven’t seen a plan.

“As a businessman, funding without a plan doesn’t cut it,” he said. “ If I went to a bank to try to borrow $7 million with the plan that they came to us with, the bank wouldn’t even consider it. There’s no plan there whatsoever.

“I don’t know why we think we have to have a publicly funded one, when I know we have people chomping at the bit to put in lots of money for downtown,” Mr. Quelland said.

He said the city of Phoenix
should leverage $25 million in tax credits to raise private funding for the school. Otherwise, he said, the school eventually could cost the state $50 million.

“Phoenix been successful in the past with light rail, the Civic Plaza and TGEN in coming to the state at the last minute to get funding for city projects,” Mr. Quelland said. “If they smell that this [medical school] can go, they will inundate this place with lobbyists. They’ll buy every lobbyist in town for a day . . . whatever it takes, and they’ll get the funding for it.”

Senator Concerned About Rural Areas

Mr. Cannell said he is also concerned about a lack of cooperation between the UofA medical school and the osteopathic physician, or DO, community.

“The medical school has been resistant to endorsing clinical rotations [third and fourth-year student training in hospitals] for osteopaths,” he said. “That to me is a sign that they’re not interested in serving the underserved populations of Arizona. Most osteopaths go into primary care. In talking to the [DO] students, they would prefer to stay in Arizona.

“Before I get on this medical school thing wholeheartedly, I want assurance that they’re going to actively support the osteopathic clinical rotations.”

DOs receive the same medical education as MDs, with additional emphasis on the musculo-skeletal system.

Mr. Rivers of the hospital association says Mr. Cannell’s comments “are quite valid.”

“But the roadblock to a more collaborative relationship between our teaching hospitals and the osteopathic college of medicine is not within the hospital community,” Mr. Rivers said. “Historically, the roadblock has been at the University of Arizona College of Medicine which, so far, has actively stood in the way of a more collegial relationship with Midwestern University” [Arizona College of Osteopathic Medicine], a private school established in Glendale in 1995.

“This definitely needs to change, but it could change in about five minutes if the [UofA] College of Medicine would give the green light,” Mr. Rivers said.

The UofA’s Mr. Joiner said the DO situation is the result of a policy by his predecessor.

“I don’t believe that is one we should use going forward,” he said. “The most important thing is to work collectively to come up with a new policy that takes all factors into account.” Mr. Joiner said, however, there are complex organizational, financial and curriculum factors to consider in a new policy.

Third-and-fourth-year UofA medical students serve clinical rotations at nine Valley teaching hospitals.

Kathleen Goeppinger, president and CEO of Midwestern, said there have been some hospitals in Phoenix that — “out of allegiance” to the UofA — have not accepted DOs for their available rotations, but added, “We don’t find any discrimination.” She said Midwestern is setting up residency rotations in Sierra Vista and Kingman, and MDs often take DOs into their practice.

Over the past four years, an average of 21 per cent of Midwestern graduates who served internships and residencies in Arizona have stayed in the state to practice, the school said.

Midwestern spent $80 million in capital expenses to launch the school and operates on a $40 million annual budget.

The university also graduates pharmacists, podiatric physicians, physician assistants, nurse anesthetists, perfusionists and occupational therapists.

Amanda Weaver, executive director of the Arizona Osteopathic Medical Association that licenses and regulates 1,400 DOs, said there has been a problem getting surgical rotations at some area hospitals.

“I’m not sure what it’s all about, but there is a problem,” she said.

The Phoenix medical school expansion would be part of the Phoenix Biomedical Campus a few blocks north of Bank One Ballpark. The area is land the city of Phoenix donated as part of a $92 million public and private effort to lure what is now TGEN.

The proposed expansion also will include the UofA College of Pharmacy, as well as the ASU College of Nursing.

The project will generate $2.5 billion in annual economic activity, Tripp Umbach Healthcare Consulting reported. —

Reporter Jim Small contributed to this article.