AUGUST 2001

FSU MEDICAL SCHOOL STARTS STRONG

The first class of Florida State's brand new medical school arrived in May.
Two months later, when the new dean took over, he found major steps already taken.

The 30 students in the first class had been through the formal ceremony of donning the doctor's white coat for the first time, and they were well into the tough first-year load of science courses.
They had organized a major extra-curricular project: working with volunteer physicians in Tallahassee to provide basic medical services to poor people.

And a few had already made a revolutionary promise: when they're doctors, they'll make house calls.
It was a running start for the only new allopathic (as opposed to osteopathic or chiropractic) medical school in the United States in the last 20 years.

And it was a start that already shows signs of keeping the promise made to the Florida Legislature that created it last year: The FSU Medical College would produce a much-needed new kind of doctor. Most of the FSU medical school graduates would be primary-care physicians well educated in modern medicine. But their mission was to forego the sterile academic centers dominated by medical specialists and high-tech machines - and return to whence they came, to heal, with human hands and compassion, the ailing bodies of rural Florida.

"The healing is how you feel about your physician, the mind and body part of it," explained Myra Hurt, midwife to the birth of the new medical college. "I want the kind of physician that I want holding my hand when I'm 88."

Hurt's been at the job of producing that rare type of doctor since 1991, when Florida State opened the Program in Medical Science (PIMS), a first year of medical school that until now has turned the second-year students over to the University of Florida.

According to Hurt, a molecular biologist and cancer researcher, the program, which transferred its last class to the University of Florida this spring, has been a success. Sixty-five percent of FSU's PIMS graduates practice primary care in Florida.

Starting now, the students will no longer transfer to UF to finish their medical training. Beginning with the class of 2005, they will stay at Florida State and pursue a medical education designed to produce the generalist physicians needed by the medically under served: rural and small-town, elderly, minority and low-income Floridians.

The launch of the new medical school was set in motion last year, when the Legislature signed off on the $50.8-million project. Chief among the school's backers was FSU alumnus and then House Speaker John Thrasher.

Gov. Jeb Bush signed the bill creating the new medical school in June 2000.
For now, the college's operations center is a construction trailer tucked behind the walls of the university's nursing school. Students are taught at classrooms throughout the campus, but that will change over the next few years as students from Florida High move to a new building and the vacated classroom space becomes a transition area for the medical students.

A new building to house the medical school is expected to be completed by 2005.

Enveloped by parking lots, idling backhoe machinery and the whir of normal campus activity, Hurt ignores the noise and ducks into her tiny office to explain why the school chose a non-traditional approach to educating its new students.

Although established medical schools produce some of the best medical specialists available, patients are not getting the medical care they need, she said.

Traditional medical schools equip specialists to treat exotic diseases but fail to train them in common afflictions like plantar's warts or herbicide exposure.

A family doctor "faces everything that can go wrong with a human being," said Hurt, adding medical schools "turned out medical scientists, but what we lost is the physicians we had 40 years ago, who came to your house, who cared about their patients."

"Our state needs a complex like Shands, but it doesn't need another one," said Hurt. "It needs primary-care physicians."

In Florida, the need for primary care physicians is acute.

According to FSU figures, 40 percent of Florida's counties have fewer than half the national average of 224 doctors per 100,000 persons.

Thirteen counties - including Taylor, Wakulla, Gadsden and Suwannee - are federally designated as under-served, with fewer than 22 doctors per 100,000. And in the few areas that have a high number of doctors, the ratio of specialists to primary care doctors is typically not proportional to the community's needs.

Part of the reason for the deficit stems from an overall reluctance by physicians from urban areas to establish practices in rural communities, because they fear isolation from academic centers and colleagues.

That's changing with the internet, and Hurt said a new communications network connecting the primary-care physicians should help alleviate the isolation factor.

Another reason is the nature of the medical hierarchy.
In the past, medical students were discouraged from pursuing careers as primary-care physicians because they were "too smart," Hurt said, or because of economics.

"Specialists have most of the power and prestige and money, if you will," she said. "What we hope to do is break that mold."
Breaking that mold started with PIMS, the joint FSU/UF program that trained doctors to serve the rural populations of northwest Florida as primary-care physicians.

Although some skeptics fear that students in the new medical school might abandon primary-care practice once they graduate, Hurt points to the success of PIMS as evidence of FSU's ability to pick the right kind of students.

Many come from small towns that dot the north Florida landscape - towns like Perry, Havana, Quincy - where Hurt said locals typically seek medical care only in emergencies and rarely visit academic medical centers where most of the specialists are located.

To redirect doctors to where the need is greatest, the school drew its new students from medically under-served communities with the expectation that they will return to those neighborhoods as primary-care physicians.

FSU alumnus (magna cum laude, '01) Joda Lyne, 22, of Perry, and Garrett Chumney, 28, of Apalachicola, are two such students.
Chumney, a graduate of Auburn University, says he will return to his small coastal hometown once he finishes his training.

"A lot of people in the community, if they do go to a doctor, they have to be deathly ill," he said. "The hospital's not up to par; it's not very big. There's not much access to health care."

Lyne, who said he chose Florida State because of its "emphasis on training physicians who return to rural communities," agreed.
"There is a need for more physicians in our community ... who want to stay there," Lyne said. "What I won't gain monetarily, I'll gain in people satisfaction."

To help Lyne reach that goal, his hometown hospital tapped its own budget to pay the $50,000 to $60,000 in expected costs for Lyne's medical education and expenses over the next four years.
Jim McKnight, chief executive officer of Doctors' Memorial Hospital, said the scholarship was a "first of its kind."

Recruiting doctors to come to rural areas is very expensive, with no guarantees that they'll remain, McKnight said. Assisting Lyne, a Perry native who already has family and community ties, was a "proactive way ... to grow your own [physicians]."

"The impact of this young man coming back here would be 100-fold what we paid for it," McKnight said.
The first-year curriculum of the new medical-school class is expected to mirror the PIMS program. Classes are taught on FSU's campus by existing faculty from the former program, many of whom are expected to sign on at the new college.

The medical school is also busily recruiting faculty to teach the second year, when students will continue to master such basic course work as physiology, anatomy, biochemistry and molecular biology.

Then, in a departure from traditional medical training, in which students typically complete their last two years by performing clinical rotations at one hospital, the physicians-in-training will farm out to clinical rotations in hospitals and other medical-care centers in towns and cities across the state.

That kind of community-based training is what makes the medical school unique, according to Hurt.
"Seventy percent of the training" will be in "non-hospital settings," she said, making it a "first of its kind."

Although the first class consists of only 30 students, that number is expected to grow to a maximum of 120 by the year 2005.
The admission criteria includes non-academic as well as academic qualifications.

Although the grade point averages and medical admissions test scores of the selected students are slightly lower than those accepted into some medical schools, Director of Student Affairs Helen Livingston said "we saw in those students non-academic qualities that we wanted."

The average GPA for FSU's entry medical class was 3.56, Livingston said, while the average MCAT score was 26, slightly above the national average of 24.

Most of them are older, so called "non-traditional" students, who graduated college in one field, launched careers, but changed course to become physicians, many for "altruistic reasons," Hurt said.

The average age of the new students is 24; the oldest is 30.
All are Florida residents, and their backgrounds include stints in the air force, fire fighting, pharmaceutical sales and chemical engineering. Twenty-five are graduates of Florida schools, including seven from FSU. Five earned their undergraduate degrees from out-of-state universities.

Despite acceptance by some at other medical schools, Livingston said, "many of [the students] chose to come here," largely because of the emphasis on training primary care physicians.

A national search headed by Hurt, who was acting dean, led to the selection of Dr. Joseph Scherger, as the medical school's new head. Scherger, the former associate dean for primary care at the University of California Irvine, was chosen because of his extensive background in primary care and family medicine, and will be "a great role model," Hurt said.

Hurt said Scherger invited her to stay on as a teacher at the medical school, but she has not completed her plans.

Despite the emphasis on primary care, she said, the new school won't prevent students from eventually choosing another speciality. The college will demonstrate, however, that "family physicians can rise to the top."

"Being a family physician is a noble goal," Hurt said, adding that rural physicians can expect to earn comfortable salaries, though perhaps not as high as specialists like cardiologists or surgeons, particularly those in large cities.

With 25 years in the field, Scherger knows first hand what a primary-care physician can command in the way of salary.
"You don't go into primary care to get rich," he said in a recent interview. "When you choose primary care over a more lucrative speciality, you've decided to follow other goals in life. It's kind of all part of following your passion."

Idealism has a way of knocking heads with reality, however, and the new doctors may face other obstacles along the way.
"The economics of medicine is one of our problems in the early 21st century," Hurt explained. "We have a very high standard of living ... for those who can afford health insurance."

The lack of health care is a concern for Hurt, who adds that the medical establishment needs to focus on health instead of disease, and recognize that preventing illness through primary care is less expensive in the long run.

Despite the large number of uninsured among the communities served by rural or inner-city physicians, various grants and other resources are available for medical care reimbursement, said student affairs director Livingston.

"They are committed to providing pro bono services for this population," she added.
Livingston and Hurt agreed that the students' motives are "not about the money."

"I don't want to be a doctor because I can make a lot of money," said Lorna Fedelem, 24, of Naples. "I want to be a doctor because people need me."

Fedelem, a graduate of FSU (magna cum laude, '00), was one of about 15 students recently gathered at the nursing school's central student lounge.

The students busily hovered around a lopsided, decrepit-looking skeleton, one arm and one leg removed to reveal the inner torso, reviewing a gross anatomy lesson on muscular structure. Squeals of laughter pierced the discussion as students ribbed one another, the skeleton, or both.

Although graduation is four years away, the medical students aren't waiting to begin their mission of delivering medical care to the hinterlands of Florida.

Some of the students recently created a community service committee which will provide health-care services to migrants and indigents in the Quincy and Tallahassee area.

The students will work with volunteer physicians already serving the poor, and provide screening work such as taking blood pressures and medical histories, and educating patients on such health essentials as diet and medication.

The student-led initiative underscores the vision promoted by the university to "create a new model of medical education ... to train compassionate physicians" as it sets out to redefine the way medical care is delivered to the most frail among us.

That includes making house calls - that long-lost service most people associate with Norman Rockwell paintings but rarely with modern medical doctors.

The school will encourage the graduating physicians to visit their ailing patients, according to Livingston.

"Many students say they want to get back to that too," she said.

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