Commentary: After 4 years of the official campaign to create another medical school (allopathic) by UNT administration and some local business and community, it seems that the proponents are resigning to the fate that the proposal of a second medical school may not come to fruition at the second legislature session.
However, the tone of the proponents of second medical school is more conciliatory this time around as the dismissal of President Scott Ransom had revealed another side of Scott Ransom that the media used to be impressed with. At the last session, State Senator Nelson was called out by Star Telegram for failing to support the MD bill. The local media also realized that TCOM is “gem” in the medical profession that the turmoil that TCOM and UNT Health Science Center have had to endure for the past 4-6 years. It recognizes that TCOM graduates are mostly loyal to the Tarrant County by practicing in the area.
Furthermore, UNT Health Science Center and TCOM have a considerable impact on the local economy with $ 600 million per year. It has finally recognized the legitimate concern and opposition to the second medical school in Fort Worth by the osteopathic community.
Hopefully, the two sides will reach to a consensus to expand the existing programs at the Health Science Center instead of pursuing an ill-conceived business plan of $25 million for the new MD school without any local resident support.
Time has come to recognize the quality of medical education provided by TCOM, which should deserve the full support from the local community and business leaders to transform the Health Science Center into a top medical destination.
March 3, 2013
Prospects of approval for an M.D. program in Fort Worth, which failed during the 2011 Legislature, remain a long shot at best this session as lawmakers approach a crucial bill filing deadline this week.
The 3-year-old proposal to create an M.D. program at the University of North Texas Health Science Center is a top priority for Fort Worth and UNT officials and the business community. But it has also come under fire from osteopathic doctors who fear that it could undercut the health science center’s nationally recognized Texas College of Osteopathic Medicine.
Despite a push by UNT leaders to stoke momentum for the proposal, no bill had been filed late last week to authorize the M.D. program.
Friday, the 60th day of the 2013 Legislature, is the deadline for filing all legislation and joint resolutions except for local bills, emergency appropriations and issues designated as an emergency by the governor, according to the Texas Legislative Council.
“I don’t think it’s going to happen this session,” said Rep. Charlie Geren, R-Fort Worth, whose district includes the health science center. Geren, a top member of House Speaker Joe Straus’ leadership team, said he would support any move to “grow” the health science center but warned that the state must first create needed residency slots before funding additional medical schools.
Geren said that he would “be happy” to support the proposal in the future and would also embrace efforts to graduate more osteopaths. “Any way that we can grow [the health science center], I’m for,” Geren said.
Sen. Jane Nelson, R-Flower Mound, chairwoman of the Senate Health and Human Services Committee, also questioned whether the proposal could clear the Legislature this session. Nelson, whose support is considered crucial to the effort, has repeatedly said she wants assurances that an M.D. program would not undermine the osteopathic program before she fully commits to the effort.
In an interview last week, Nelson said she senses a more conciliatory tone on the issue under the interim health science center president, Dr. Michael Williams, who is an osteopathic physician, an M.D. and a TCOM graduate. “It may not be this session but if there’s going to be a medical school in the Metroplex, we want it to be in Fort Worth and we want it to be an affiliate of the University of North Texas,” she said.
Williams, who became interim president after his predecessor, Dr. Scott Ransom, was fired in December, said in a statement Friday that UNT officials are continuing to hold discussions on the issue.
“It is possible that this proposal will be considered this session as the State looks for ways to expand graduate medical education,” Williams said in an email. “The Legislature may authorize other new medical schools elsewhere in Texas and we will ask them to consider the needs of Fort Worth and our local hospitals in that process.”
The UNT System regents endorsed the proposal in 2010 and unsuccessfully pushed for approval in the 2011 Legislature.
Mayor Betsy Price, the Fort Worth Chamber of Commerce and other local leaders have rallied behind the effort this year by trying to sell the M.D. program as a major asset to both Fort Worth, saying it would complement rather than impair TCOM.
“We believe having a medical school alongside an osteopathic school would enhance Fort Worth as a medical destination,” said Matt Geske, director of governmental affairs for the Fort Worth Chamber of Commerce.
Geske, however, conceded that time may be running out.
“I hope a bill comes up but right now it’s not looking like a bill will be filed,” Geske said. “We weren’t able to accomplish it last session, but even if it doesn’t come to fruition this session, it’ll still be a top priority going into the 2015 session.”
“They need to have had some progress made by this point, I think,” said Sen. Kel Seliger, R-Amarillo, chairman of the Senate Higher Education Committee.
The Texas Osteopathic Medical Association and the American Osteopathic Association both contend that a school of allopathic medicine, which awards M.D.s, would endanger the osteopathic college. A key lobbyist against the proposal is former Texas House Speaker Gib Lewis, a former state legislator from Fort Worth who sponsored the bill that created TCOM in the 1970s. The school’s library is named for Lewis.
“Anybody who came up with the idea of having an M.D. program [at the center] should have their head examined,” said Lewis, who is representing the Texas Osteopathic Medical Association. “Why don’t they just expand on the [osteopathic] program instead of having an M.D. program? It’s a bad idea.”
Williams, however, said the proposal includes a key assumption to “protect and enhance and continue to grow the Texas College of Osteopathic Medicine.” Williams, UNT System Chancellor Lee Jackson and other supporters also note that they have raised $25 million in private donations and would not have to ask the state for special startup money for the next five years.
Other medical schools
In addition to confronting well-organized opponents from the osteopathic community, the Fort Worth effort faces competition with other proposed medical schools.
The University of Texas System is pushing for a medical school at its flagship campus in Austin. UT System Chancellor Francisco Cigarroa has also advanced a proposal to create a multi-campus university in South Texas that would include a medical school. That proposal envisions the consolidation of UT Brownsville and UT Pan American in Edinburg.
“Those are the only two I know of right now that there’s any momentum behind,” said Dominic Chavez, spokesman for the Texas Higher Education Coordinating Board.
Another crucial factor in creating medical schools is a potential shortage of residency slots in Texas hospitals to accommodate medical school graduates as they go into advanced training before beginning a practice. “If we’re going to fund more medical schools, we need to create more residency slots before we do that,” Geren said.
Without an increase in first-year residency positions, beginning in 2014, at least 63 graduates of Texas medical schools will not have an opportunity to enter a Texas residency program, according to the Texas Higher Education Coordinating Board. The number will triple to 180 by 2016, the board predicted in a 2012 report.
Because of the shortages, say lawmakers and health officials, medical school graduates are forced to enter residency programs in other states, where they will likely remain to set up practice instead of returning to Texas.
“Lack of residency slots is kind of a deal breaker,” Seliger said. “Because if all we’re doing is training new doctors who will train out of state and practice out of state it’s not a very good investment of state funds.”
‘Our top priority’
UNT Chancellor Jackson, during a visit to the State Capitol this year, said that the M.D. program remains “our top priority” at the health science center, and that if it is approved, it would help Texas meet a growing need for new doctors.
The M.D. program would be offered along with the doctor of osteopathy training at TCOM, and Jackson predicted that “the two together can grow and expand.” Legislative approval is needed to lift a ban that prevents TCOM from granting M.D. degrees.
TCOM, founded in 1970, is one of five colleges at the 1,700-student health science center, which also includes a new Ph.D. program in pharmacy.
The osteopathic school, which has about 685 students, has repeatedly received national rankings for specialties such as primary care, family medicine, geriatrics and rural medicine. It has produced more than 2,800 alumni, many of them fiercely loyal to the Fort Worth school.
M.D.s and doctors of osteopathy, or D.O.s, use many of the same skills in their training and practice, health experts say. But D.O.s are also trained to perform “osteopathic manipulative treatment,” in which they use their hands to diagnose injury and illness “and encourage the body’s natural ability to heal itself,” according the Texas Osteopathic Medical Association Website. D.O.s focus heavily on preventive medicine and the whole body, rather than treating symptoms.
Opposition to the M.D. program surfaced even before it was officially proposed, underscoring the influence of the osteopathic community.
The Texas Osteopathic Medical Association set up a fund designed solely to finance opposition to the proposal, drawing contributions from across the country, Executive Director Sam Tesson said.
Dr. Mark Baker of Fort Worth, a TCOM graduate and a board member of the American Osteopathic Association, said efforts to protect TCOM reached well beyond state lines. Members of the association’s house of delegates, in their annual meeting in Chicago last year, signed a petition opposing the medical school, he said.
“TCOM is one of the finest medical schools in the nation,” Baker said. “You would think the leadership in the city and the county would be extremely proud of the institution they have and put the time and energy they have to advance TCOM.”
UNT Health Science Center must assess what’s in its best interest
Ousted as president of the University of North Texas Health Science Center in Fort Worth, Scott Ransom has called his firing “political.”
It might look like that, but is that an indictment or largely a description of reality?
Running public institutions of higher education requires astute politics. The key is to operate within that realm to help your institution achieve its mission on behalf of students, the surrounding community and the taxpayers whose dollars help fund the school.
The public may never be able to accurately assess whether the UNT Board of Regents’ dismissal of Ransom, clearly driven by Chancellor Lee Jackson, was justified or even necessary. But what Tarrant County officials and residents must assess is how the Health Science Center, on the edge of Fort Worth’s Cultural District, now moves forward as part of a university system that’s headquartered in Dallas with its flagship campus in Denton.
The regents’ abrupt action in December was the culmination of tensions that flamed during an initial look into merging UNTHSC’s administration with Denton’s.
That effort has been suspended. But much goodwill has been lost in the meantime.
Jackson in August asked Ransom and UNT Denton President V. Lane Rawlins to look at several questions regarding potential short-term and long-term benefits, obstacles and actions needed for a possible merger.
The idea was sparked when the University of Texas announced plans for a medical school as part of its Austin campus and Texas A&M University moved to combine its Health Science Center in Bryan with the flagship campus.
But UT and A&M are unique.
UT wouldn’t be trying to absorb a free-standing medical school with long-standing autonomy. Texas A&M is already a top-flight research university that still would face issues about funding, accreditation and short-term consolidation costs — some of the same considerations that arose for UNT.
An early draft of a report — dated Aug. 30 and attributed to “UNT Merger Task Force” — is highly negative toward a merger. It points out, among other things, the significantly different cultures on the Fort Worth and Denton campuses; the potential financial loss because of state funding formulas and the expected impact on community relations in the two cities.
That document assumed that the merger proposal was designed to boost UNT in the efforts among Texas schools to become Tier 1 research universities, and it outlines enormous costs of achieving that goal.
A Nov. 2 formal report — signed by Ransom and Rawlins — took a less negative tone but still said the study group “could not identify significant short-term benefits” and found long-term benefits hard to assess.
Resistance was compounded in November letters from the UNTHSC Foundation board and Board of Visitors.
BOV Chairman Ron Anderson, for instance, warned that the UNT System should make its “number one legislative initiative” securing an M.D. program at the Health Science Center, which under state law can grant only osteopathic medical degrees. Otherwise, he said, someone else will bring an M.D. school to North Texas, possibly UT or A&M, which would hurt UNTHSC graduates’ chances of getting clinical training spots.
Jackson blamed Ransom for the opposition.
During Jackson’s decade as chancellor, the UNT System has grown in size and stature, expanding its footprint in Dallas, including a law school scheduled to start classes in fall 2014.
The Health Science Center joined with the Denton and Dallas campuses in 1999 to form the UNT System but has retained its own distinct identity as it has grown to encompass five components: the Texas College of Osteopathic Medicine, School of Public Health, Graduate School of Biomedical Sciences, School of Health Professions and College of Pharmacy.
Reconstituting leadership must be the main focus. A multifaceted and experienced administrator — interim president Michael R. Williams, a D.O. who graduated from the school, may want to be considered — must be named and given time to form his or her own team. Other priorities, even the proclaimed goal of establishing an M.D. program, may have to wait.