May 14, 2007

IN THIS ISSUE

WSU Med Students Rally Against MSU Detroit Expansion
Editor's Column: The WSU Medical Students' Letter
WSU Student Letter
Schwarz To Chair Business Panel On Health Crisis
WSU, MSU, UM Student Letter
WSU, MSU, UM Student Position Statement
Links to Recent Editorials On The WSU/MSU Issue

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WSU Med Students Rally Against MSU Detroit Expansion

By PAUL NATINSKY
First it was an expression of concern; then a protest that grew into a movement. Now it seems to be approaching revolt status. I’m talking about the medical student uprising that has involved students from three of Michigan’s medical schools, but mostly features Wayne State University School of Medicine Students.

WSU med students – 390 of them – peppered the Michigan State University Board of Trustees with a letter of concern regarding the effect of moving a satellite campus of the MSU College of Osteopathic Medicine to Downtown Detroit. I received a copy of that letter May 7. I received another letter that day crafted by student leaders from WSU, MSU and the head of the MSMS Student Section, who is a fourth-year med student at the University of Michigan. That letter expressed similar concerns about crowded clerkships and a potential shortage of physicians to teach medical students. It came with a position statement attached.

Last weekend my e-mail box was bombarded by at least 24 student e-mails. The onslaught was spurred by a form letter protesting the satellite campus and citing an as-yet-unavailable study commissioned by WSU two years ago that indicates the system can only handle an increase of 30 students (those spots have already been assigned to WSU students). While the letter was a group concoction, several students added their own expanded views to the text and many came up with their own e-mail subject lines and salutations, addressing recipients variously as “friend” or “esteemed Michigander,” which sounds a little like a title bestowed upon the head of the some benevolent organization or another.

For its part, the DMC views the move as a boon for primary care in Southeast Michigan and a hedge against the impending physician shortage that is expected to leave Michigan short 4,000 to 6,000 doctors a decade from now. DMC CEO Mike Duggan told an audience of WCMSSM physicians March 23 that he intends to make “sole-sponsored” residency slots at Sinai-Grace and Huron Valley hospitals available to osteopathic students, in part by moving to have those residencies jointly accredited by the American Osteopathic Association as well the allopathic accrediting agency, the Accreditation Council for Graduate Medical Education.

That’s the big picture. As regards students, Duggan said the additional students that will come Downtown from Michigan State would be first- and second-year students and will be in classrooms, not hospitals. During their third- and fourth-year students would have the benefit of rotating through a Level II trauma center at Sinai-Grace, something they he said is not in great abundance at the 28-hospital “statewide campus” which the osteopathic school at MSU uses for medical student clerkships. Duggan’s idea is that once the students get a taste of Detroit through their classroom education, they might warm up to coming here for their residencies. That would be residencies in primary care that would not interfere with programs DMC operates jointly with WSU, according to Duggan.

Like an onion, this story has one layer after another. Both the Detroit Free Press and the Detroit News editorialized on the issue over the weekend, recommending that the MSU Board of Trustees vote May 18 against allowing the satellite campus and permitting a group urged by business leaders and assembled by physician and former state and federal legislator John Schwarz to evaluate Detroit's overall health care scene. That group is expected to complete its work by Aug. 1. The News went the extra step of stridently criticizing the Duggan administration for its ties to the governor and “the old McNamara political machine,” and expressly for serving as a "fattening pen" for cronies of that machine. The News' Nolan Finley even stated that Gov. Granholm "bought" Mike Duggan his job when the state bailed out DMC with $50 million in 2004.

In this edition of DMN Online, we feature a column from Editor Joseph Weiss, MD, and as well as the text and talking points from the WSU students and the student leaders from WSU, MSU and UM. We also included links to last weekend's editorials. There will be no finger pointing in this space; there's enough of that going on. We'll let you draw your own conclusions on the issue.

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Editor's Column: The WSU Med Students' Letter

By JOSEPH WEISS, MD
The WSU medical students' letter (see below) to the Michigan State University Board of Trustees deserves our attention. The students presented their perspective on the impact of additional MSU students into the DMC teaching wards in an admirable fashion.

In particular, the letter’s second paragraph with its lines: “At this point we begin to learn by doing…” provided an excellent beginning to the explanation of why limits to size must take precedence over growth. 

It may be our job to teach students the fine points of auscultation and joint examination, but we can also learn from the Wayne State M3s and M4s. The medical students’ letter illustrates advocacy at its best. It was at once forceful and courteous, and reflected their ward clerkship experience. The 390 signatures that accompanied the letter, indicated the depth of support for the student position. Furthermore, they focused attention on the individuals who count: the Board of Trustees making the decision on May 18.

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WSU Student Letter

The following is a letter sent in early May to all members of the MSU Board of Trustees and signed by 390 WSU medical students.

Dear Joel Ferguson:

I am a Wayne State University School of Medicine writing in regard to the proposal that would establish a Michigan State University College of Osteopathic Medicine satellite school on the main campus of the Detroit Medical Center. I am pleased and encouraged to see Michigan State join Wayne State in alleviating the projected shortage of physicians in the State of Michigan by increasing medical school class sizes. However, I would like to express my concerns about the negative impact such a move may have for all parties involved.

I can appreciate that adding several students, or even several dozen students, to a current population of 270-plus per year may not seem like a significant increase. Certainly, within the context of classroom education it is relatively easy to accommodate more students. However, during the third and fourth years of medical school, the method of teaching changes drastically and resembles the education of a resident. At this point we begin to learn by doing, not merely by seeing or reading, and thus factors such as resident-to-student ratios are of paramount importance to medical education.

When Wayne State recently increased its class size to help allay the predicted physician shortage, the school first carefully evaluated how many students could be added, bringing outside consultants to aid in this decision. Based on careful evaluation, it was decided that the patient cases that are suitable for teaching purposes and the local medical community at the DMC could support an increase of no more than 30 students per year. Wayne State requested and received permission from its national accrediting organization to increase its class size by that number and added those students to the Class of 2010, which entered in 2006. Accordingly, the DMC has reached capacity, as defined by patient cases that are suitable for teaching purposes, and the establishment of a Michigan State satellite campus at the DMC will result in overcrowding and detrimental effects on the education provided by both schools.

Again, I welcome the joint efforts of Michigan State and Wayne State in addressing the medical needs of Detroit and of Michigan. Establishing a satellite campus in Macomb County would provide close proximity to three teaching hospitals, staffed with a significant number of osteopathic doctors who will provide a rich patient base required for hands-on clinical training for your students. A satellite in Macomb County accommodate the potential for increasing students, should your school desire to expand.

I sincerely hope that your decision will best serve both student bodies and thus provide the best trained clinicians for Detroit and Michigan. Thank you for your time and attention to this important matter.

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Schwarz To Chair Business Council On Health Crisis

The Detroit Regional Chamber and Detroit Renaissance has formed a panel of distinguished business executives to develop recommendations for growing the region's medical education and research capabilities and achieving greater collaboration among the region's medical institutions, according to a press release. The business community believes medical education and research can play a major role in driving economic growth in the region and that a long-term strategy is needed to achieve this goal. In addition, the business community is concerned that there continues to be inadequate collaboration among the regional's medical institutions which could threaten access to quality care and the ability to maximize the growth potential of this industry.

The panel will be chaired by former US Congressman and Michigan state Senator John Schwarz, MD Dr. Schwarz recently served on a congressional panel investigating care at Walter Reed Hospital and is recognized as one of the state's most experienced leaders in health care policy.

Panel members will include Dennis Archer, Chairman of Dickinson Wright; John Barfield, Chairman and CEO of the Barfield Group; Daniel J. Loop, President and CEO of Blue Cross/Blue Shield of Michigan; Cynthia J.

Pasky, President, CEO & Founder of Strategic Staffing Solutions; Daniel F. Ponder, CEO of Franco Public Relations Group; Florine Mark, President & CEO of the WW Group; Alfred Glancy, Chairman, Unico Investment Company; Randolph Agley, Chairman and CEO of The Talon Group; Richard M. Gabrys, Former Managing Partner of Deloitte and Touche; and Richard Russell, CEO of Amerisure Insurance Company.

The panel's objectives are to:

*Identify steps to increase graduate medical education to meet the region's needs for more doctors across specialty areas

*Identify short and long-term recommendations for substantially growing the region's medical education and research cluster

*Develop models for increasing collaboration throughout the region among health care providers, systems and education and research facilities to ensure access to quality care to all citizens of the region and the growth o f the region's medical community

 The panel is expected to complete their work by August 1.

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WSU, MSU, UM Student Letter

The following is a letter from medical students from WSU, MSU and the UM to the Detroit City Council.

Dear Detroit City Council Member:

On May 3rd medical student leaders from across the state met on common ground to reaffirm our commitment to the patients of Michigan and to our colleagues.  We acknowledge the forecasted physician shortage, and we appreciate the response of medical schools to increase the supply of trainees.  However, the rapid expansion of medical schools will further deteriorate already strained clinical training opportunities, especially in the Detroit area.  As medical students, we stand united in our efforts to provide quality care to our patients and to strengthen medical education for future physicians, despite the political struggles apparent in the relationship between the DMC, WSU-SOM, and now potentially MSU-COM.

Physician supply.  Two independent reports have forecasted a statewide physician shortage[1]^,[2].  This shortage may be most acutely felt in already underserved populations such as Detroit, but we cannot ignore the need for physicians throughout the state.  How best can we increase the number of physicians who practice in MI?  Only about 1/3 of active practicing physicians attended MI medical schools, while 1/2 of these physicians completed their residency training in MI².  It would seem that our state needs to focus on recruiting and retaining both students and residents to the state of MI, rather than just spending more to train physicians who will leave to go elsewhere.  Needless to say, the instability of the residency training programs in the Detroit area, including the recent loss of 5 residency programs between DMC-WSU does not encourage medical students to commit to several additional years of training under a unilateral contract at remaining DMC programs.  We further recognize that retention of our well-trained physicians will not adequately address the community’s dire needs without an overall increase in the number and quality of residency training positions. 

Expansion of Medical Schools and Clinical Training.  In response to the forecasted shortage, medical schools across the nation have increased class sizes for the first time since 1980.  However, only 30% of these medical schools have definite plans to also form new clinical affiliations to provide for clinical training[3].  With the closure of multiple hospitals in the Detroit area, the academic leadership of our MI institutions struggles to recruit and maintain clinical affiliations that offer suitable training opportunities for students.  Our school administrators work hard to distribute medical students in clinical clerkships that achieve our educational objectives and avoid overcrowding, even though hospital administrators state that they have greater capacity for training students.

Students report that under the current clerkship conditions, MSU-COM is committed to placing their students in one of 28 hospitals across the state.  While some third year students may find themselves on a team of 4 students, many other students work independently with the healthcare team in an optimum learning environment.  Under the current agreement with DMC, WSU-SOM students report that on some rotations they may have as many as 5-7 other medical students, as well as 1-2 physician assistants in training, which shows the strain that has been placed on the physician training system in the Detroit area over the last few years.  As a specific example, a student from the WSU-SOM class of 2004 reports being involved in 40 deliveries during his ObGyn clerkship, while a member of the class of 2008 reports being involved in only 8 deliveries total.  Clinical training is not as simple as seeing a procedure once to be able to perform it.  Since every patient and every instance is different, only the exposure to multiple scenarios and hands on experience results in quality physicians. 

Unfortunately these training conditions stand to worsen over the next few years.  While the collaboration between Oakland University and Beaumont Hospitals to form a new medical school is encouraging, it will place further strain on the system that currently trains WSU and UM medical students.  The considerable increase in pre-clinical class sizes at WSU-SOM and MSU-COM will become evident over the next 2 years as these students begin their clinical training.  We welcome the addition of MSU-COM students to those who provide healthcare to the underserved population of Detroit, but the addition of these medical students without adequate provisions for their clinical training will only serve to decrease the quality of all physicians that we produce.  We ask community leaders to respect our medical school administrations in accurately determining the capacity and conditions for clinical training.  We also ask the community for their help in ensuring that medical students continue to receive the quality of training that ensures that we will be safe, effective, and productive physicians.

Political struggle.  We would like to emphasize that both MSU and WSU are instrumental in addressing the physician workforce shortage in the Detroit area.  However, moves which threaten the relationships between these academic institutions and their clinical partners could ultimately jeopardize this goal.  There is already concern about the DMC and WSU relationship, which may be strengthened by finalization of a completed, definitive contract between DMC and WSU.  As medical students, we commend the long standing commitment that WSU-SOM has had to serving the underserved population of Detroit and to training quality physicians whom we cannot afford to lose.  We would like to see MSU-COM join this mission, but we question the wisdom of building the ‘campus of breakthroughs’ directly in the midst of the WSU campus, which only serves to antagonize the two campuses.  Instead, we would like to see both universities united in service to the population of Detroit.  We believe the solution is to increase clinical training capacity and healthcare delivery in the Detroit area, so that we can meet this mission without sacrificing the identity of either university. 

On behalf of AMA and MSMS medical student members in the state of MI,

Laura Chromy, Ph.D., Chair, Medical Student Section, Michigan State Medical Society

University of Michigan School of Medicine, Class of 2008

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WSU, MSU, UM Students' Position Statement

The following is a position statement formulated after a meeting of medical students from WSU, MSU and the UM

Michigan Medical Student Position Statement
May 7, 2007

On May 3rd medical student leaders from across the state met on common ground to reaffirm our commitment to the patients of Michigan and to our colleagues, as stated below:

·  We acknowledge the forecasted physician shortage.

·  We believe that our state needs to focus on recruiting and retaining both students and resident physicians to the state of MI, rather than just spending more money to train physicians who will leave to practice elsewhere.

·  We appreciate the response of medical schools to increase the supply of trainees.  However, the rapid expansion of medical schools will further deteriorate already strained clinical training opportunities, especially in the Detroit area. 

·  We would like to emphasize that both MSU and WSU are instrumental in addressing the physician shortage only if they are united in service to the population of Detroit instead of competing for clinical opportunities.  We believe the solution is to increase clinical training capacity and healthcare delivery in the Detroit area, so that we can meet this mission without sacrificing the identity of either university. 

As medical students, we stand united in our efforts to provide quality care to our patients and to strengthen medical education for future physicians.

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Links To Editorials On The WSU/MSU Issue

The following are links to the newspaper editorials referenced above:

http://www.detnews.com/apps/pbcs.dll/article?AID=/20070513/OPINION01/705130304/1008

http://www.detnews.com/apps/pbcs.dll/article?AID=2007705130302

http://www.freep.com/apps/pbcs.dll/article?AID=2007705130533

Detroit Free Press Editorial (Monday, May 14) http://freep.com/apps/pbcs.dll/article?AID=/20070514/OPINION01/705140307/1068/OPINION

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