State: Striving to meet standards

TALLAHASSEE -- It has a faculty and 30 eager students. It has cadavers for anatomy lessons and a strong basic sciences program. It has teaching contracts with hospitals in Pensacola, Tallahassee and Orlando.

And, beginning in March, the College of Medicine at Florida State University will move from three cramped trailers behind the School of Nursing to better quarters.

As the nation's first new medical school in 20 years, FSU casts itself as the perfect complement to the state's oldest medical school, at the University of Florida, and boasts of producing doctors who will work among the disaffected, the rural and the aged.

But the school has much to overcome before the boasts become reality. The medical school did not win accreditation this month -- a failure that surprised FSU officials. Its future funding sources are not assured. Still, it must build a faculty and a student body.

Dr. Joseph E. Scherger, dean of the College of Medicine, says the challenges are simply part of being new.

"We're committed to being the best rural health medical school in the nation, and we're committed to being the best geriatrics medical school in the nation," said Scherger, a nationally respected expert in community health who migrated from the University of California-Irvine. "And we're committed to spending more money for those (things) than any other medical school in the nation."

Where that money comes from has been cause for concern. Last week, when the Liaison Committee on Medical Education denied the school's provisional accreditation, the committee wrote that the school lacks a diverse income and relies too heavily on the Legislature's largess.

Particularly, the committee noted, FSU has no faculty practice plan, in which faculty generate revenue by seeing patients. The practice plan is a staple at each of the nation's 125 other medical schools, and typically provides about one-third of the budget.

FSU provost Larry Abele, who led university efforts to open a medical school, said it doesn't need a practice plan. Plus, starting an FSU physicians group would have jeopardized relations with Tallahassee's medical community, which would have seen it as competition. The school badly needs support from local doctors to help train its students.

"This is a small area, and it would have been hard on everyone to bring in a large number of new physicians and unnecessary since there are excellent physicians here who love to teach," Abele wrote in an e-mail to the Times.

Three-quarters of this year's budget, or $14.6-million, comes from the state, with another $6-million from contracts and gifts. Next year, when the student body grows from 30 to about 70, the school expects about $20-million from the state.

Once it reaches its full complement of 480 students, which is expected around 2008, the school has been promised $34-million annually by the Legislature. That's the same per-student funding the state gives Florida's two other public medical schools: at the University of Florida in Gainesville and the University of South Florida in Tampa.

State funding, including tuition, eventually will account for about one-third of its total budget, Abele said. He said he expects the rest to come equally from grants and contracts, as well as from gifts and endowments.

That is an aggressive goal. According to the American Association of Medical Colleges, medical schools on average rely on state funding and tuition for just 19 percent of their budgets. Grants and contracts contribute 27 percent, and gifts and endowments add a mere 3 percent.

Because of FSU's emphasis on rural health, the school is well-positioned to win government grants for improving health care in poor areas, experts agreed. But Dr. Larry Daugherty, dean of the USF College of Medicine, said it's impractical for a new school to count too much on gifts.

"Starting out new, that's going to be very difficult," said Daugherty, whose school collects less than $10-million a year from gifts and endowments. "We're 30 years old, and our alumni are just now arriving at middle age. It takes a long time to build up an alumni that can make major contributions."

Dr. Glenn Davis, dean of the College of Human Medicine at Michigan State University, the model for FSU's medical school, said education costs often outpace inflation, but state budgets usually do not.

"You'll find that the budget can't do what it was set out to do in five years," he said. "Usually the way medical schools offset that is with (faculty) practice plan income."

Dr. Frank Simon, secretary of the accrediting committee, said schools need a mix of incomes.

"We understand the circumstances under which FSU was established, and a practice plan is not the only source of diversification," Simon said.

The first class

Sixteen of the 30 students in FSU's first class started college at a community college, a rarity for medical students. "Most medical schools would look askance at that," Scherger acknowledged.

At the University of Florida, its medical students typically see the inside of a community college only during high school, to take courses for early college credit.

But FSU officials and experts in community medicine say the key to training doctors to work in underserved areas, such as rural Gadsden County or inner-city Miami, is recruiting students predisposed to working there.

That means finding students from those areas who may be less affluent, less likely white and less likely to come from educated families than most medical students, associate dean Myra M. Hurt said.

Hurt said some of FSU's students may not have the academic backgrounds of students at other schools, but that doesn't mean they're less qualified. The average entrance exam scores of FSU's students are slightly lower than those of their peers at USF and Florida.

"We pick out students to interview who have the academic profile predictive of academic success in medical school, and then we pick the ones who have the characteristics patients value in their physician: good listening and communication skills, warmth and empathy," she said.

FSU is one of 21 community-based medical schools, including USF, East Tennessee State and Mercer University, which opened in 1982. Such schools lack a central teaching hospital, such as Shands at UF, relying instead on clinics and local hospitals to train third- and fourth-year students.

FSU's is modeled after the Michigan State University medical school, which also focuses on family medicine. Students spend the first two years at the main campus in East Lansing, then spend their third and fourth years at six regional campuses around the state.

Florida State also plans to send third- and fourth-year students to train at regional campuses. The school has contracts with Tallahassee Community Hospital, three hospitals in Pensacola and two hospitals in Orlando.

As enrollment increases to 120 students per class, FSU aims to add hospitals in Jacksonville, Sarasota and possibly Fort Myers. Mollie H. Hill, director of community clinical relations, said each campus will have a full-time assistant dean, a board of directors and physicians who will organize training.

Key to the plan is recruiting local doctors who will each take a student. They will be paid $500 each week they have a student, Hill said.

"We're not just plopping students into a community and saying, 'Here, teach them,' " Hill said. "We're providing all of the support . . . for them."

How it all started

FSU's medical school did not materialize from scratch. From 1971 until last May, the university ran a first-year medical program called PIMS, whose graduates were automatically admitted as second-year medical students at the University of Florida.

PIMS, or Program in Medical Science, was established to expand the number of medical students in Florida and increase their diversity. It had 30 students. The program ended when the medical school opened last May, but its curriculum provided the foundation for the first year.

By the time FSU's second class arrives this June, the medical school will have moved from the hodgepodge of trailers and science classrooms to a renovated high school on the FSU campus. It will serve until a $60-million medical school is built next door at Call Street and Stadium Drive.

The Legislature has allotted $45-million for it, with the rest to come from donations and other sources, Abele said. Construction is scheduled to start by January, and completion is expected by early 2005.

Students say they don't mind FSU's newness or its lack of accreditation. They say they like the emphasis on family medicine, as well as a curriculum that allows them to observe doctors at work as as they get to school.

Joda Lynn, 23, is attending on a scholarship provided by the hospital in his hometown of Perry. For every year the hospital pays his $10,000 tuition, Lynn must work a year there after he finishes his residency.

For a young man who wanted to be a doctor in his hometown, it was an unbeatable deal. He didn't apply anywhere else.

"I knew in my heart this was where I wanted to go," Lynn said. "The emphasis here is on training physicians to practice in rural areas. Like Perry."

Medical students must graduate from an accredited school to continue into a residency program. With the first graduation ceremony still three years away, FSU's failure to win accreditation this month may have few real consequences.

But it could hurt recruitment and may hamper its hunt for federal funding.

The school's creation was marred by a nasty fight over its need and motives, and FSU badly wants to avoid any appearance that it's faltering.

FSU plans to appeal the accrediting committee's ruling at an April meeting of the committee in Chicago. In addition to the questions about financing, the committee said the school lacked enough full-time faculty and questioned its ability to attract quality students.

Scherger and his staff roundly dispute both points: The committee did not count professors employed by the FSU College of Arts and Sciences, who teach some of the science courses, and it now has 30 full-time faculty members, he said. That's expected to grow to 70 in the next few years.

Applicants for the incoming class of 2006, which will have 40 spots, have surpassed 900.

The committee praised the new school's mission, recent administrative and academic hires and the students that its members met.

Abele said he thinks FSU wasn't accredited because school officials didn't adequately address concerns the committee expressed after four members visited FSU in December.

Given the chance to explain its position, Abele said, he's confident the committee will find FSU worthy. If the appeal fails, FSU will reapply in August and hope for accreditation by this time next year.

"We believe we have earned it," Abele said. "We have done the work necessary, we have gotten the support from the Florida Legislature, and we believe that come April, we will get it."

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Lucy Morgan

From the Times state desk