King College President Envisions Medical School Mecca

BRISTOL, Tenn. – Imagine the transformation of this region into a mecca of medical education and research by the year 2020.

That’s the vision of King College President Greg Jordan, who is circulating a plan to establish a new medical school with campuses in both Bristol and Kingsport,
Tenn. Plans call for the school to eventually graduate about 2½ times the number of physicians that come out of the Quillen College of Medicine at East Tennessee State University in Johnson City. ETSU officials are skeptical of King’s ambitious plan.

Jordan claims the endeavor would fill a growing chasm of too few physicians treating too many patients, while at the same time breathing new economic life into the region.

Wellmont Health System and Holston Medical Group – the same partners that helped fuel the expansion of King’s College of Nursing from 40 students in 2000-01 to more than 400 today – are already on board.

Plans call for establishing campuses close to Wellmont’s two flagship tertiary care hospitals – Bristol Regional Medical Center and Holston Valley Medical Center in Kingsport – and HMG providing instructors and clinical training opportunities.

The missing component, Jordan said, is public financial support.

The $150 million cost is steep in a time of economic recession. And local governments are being asked to provide two-thirds of that funding. But Jordan and other proponents claim the benefits – better health care, a substantial influx of jobs and regional economic stability – far outweigh the challenges of paying for bricks and mortar.

“Our research indicates their [governments] return on investment would be quite significant,” Jordan said in a phone interview. “That $100 million investment would likely generate an annual return of $350 million, and that could extend up to $1 billion a year. By 2035, it could be more than $2 billion a year.”

Those figures come from a King-funded study conducted by Pittsburgh, Pa.-based research firm TrippUmbach and are predicated on such factors as direct employment by the medical school, tuition and living costs of its students, and the impact of those dollars on the existing local economy.

In the longer term, projections include attracting a significant commercial research component and businesses that directly serve the medical community.

“We know the region and the nation needs more physicians. But the research, bio-medical and medical manufacturing that would follow a medical school – the economic impact of that would be transformational for this region,” Jordan said.

Jordan and consultant Paul Umbach recently received a warm reception from the Kingsport Board of Mayor and Aldermen when they presented details of the plan.
“We are already engaged in a pretty comprehensive approach to higher education as it is,” Kingsport spokesman Tim Whaley said. “We’ve got about $18 [million] to $20 million committed to our regional center for health professionals – for nursing and medical education – and the higher ed center. So this seems to be a fit and would be a step above what we’ve already done.”

The meeting was the first of a series of presentations before local taxing authorities. College officials also received a warm welcome when they made a similar pitch May 18 to the Sullivan County Commission. They are scheduled to go before the Bristol Tennessee City Council in June.

Jordan also has been making the rounds of state and federal officials, trying to gauge and solicit support.

Making the case

So exactly how and why has a small, private college with an enrollment of 1,700 authored such a seemingly ambitious plan? Jordan said it represents the latest in a series of carefully calculated growth steps, based on long-range strategic planning.

In the past decade, the college has conducted a multimillion-dollar fundraising program to bolster its endowment fund; expanded its campus; added schools of education, business and nursing; and seen its enrollment nearly triple.

Last year, the college established a private, tuition-based high school in a former church and plans to erect a new facility to house those students.

After hearing about the growing national need for more doctors, King officials commissioned a feasibility study.

“Our research shows there will be a [national] shortage of about 200,000 physicians over the next 10 to 12 years,” Jordan said. “And the AAMC [American Association of Medical Colleges] has called for an increase in the number of physicians nationwide. They are encouraging existing medical schools to graduate 30 percent more medical students in order to address the need.”

King’s feasibility study, which was completed in late 2008, states that about 6,500 new doctors will be needed within a 150-mile radius of the Tri-Cities within 11 years. Such a shortage would further complicate the problems of an area that already lacks sufficient health care and registers cancer, obesity and diabetes rates above national averages.

“The feasibility study also indicated that 40 counties in the five-state area – Eastern Kentucky, West Virginia, Southwest Virginia, Western North Carolina and East Tennessee – were already [medically] underserved. There are not enough physicians and health care providers in this market now,” Jordan said.

Another medical school?

Meanwhile, those at the Quillen College of Medicine at ETSU – operating in Johnson City since 1978 – are not enthusiastic about the King concept.

“I’m very apprehensive and concerned. I have to be,” said Phillip Bagnell, Quillen’s dean. “The issues are obvious. No. 1 is funding, especially if state funding is involved. Dr. Jordan was clear that any state money would be development money, not education money, but from my perspective the money comes out of one big pot.”

The state currently supports medical schools in Johnson City and Memphis, but both at levels below the state’s own formula, Bagnell said.

The Johnson City school has a $110 million annual operating budget and receives about $30 million from the state, plus an additional $8 million from the TennCare bureau, Bagnell said.

During the past 27 years, Quillen has awarded about 1,400 degrees, and its average class size has remained at about 60 per year.

“That’s a comfortable number that works for us,” Bagnell said, noting that larger classes pose a number of challenges.

“One problem with moving forward is there are strict regulations governing clinical rotations. We’ve had a problem with patient volumes with pediatrics, with 60 students. The new children’s hospital is helping that, but we need enough patient volumes to provide an adequate educational experience,” Bagnell said.
School officials are working to expand to serve an average of 72 students “within two to three years,” Bagnell said.

Each year, ETSU typically attracts about 1,500 applicants for its medical school, with most living in East and Middle Tennessee. That level of regional interest, Bagnell conceded, seems to favor King’s potential for establishing and developing a medical college.

Bagnell also said he views King as potential competition for a limited number of medical residency slots at local hospitals. The federal government fully funds a number of residency slots at area hospitals – 38 in Bristol, about 45 at Holston Valley, 90 at Johnson City Medical Center and 85 at the Mountain Home VA Medical Center, Bagnell said.

Overwhelmingly, those slots are filled with residents in three- or four-year programs who’ve earned degrees from ETSU’s Quillen College.

“The number of residency slots is capped at the federal level,” Bagnell said. “Johnson City [hospital] pays us for more residents above their cap. If King starts to contribute to the physician community, Wellmont or other hospitals will have to pay above their cap or divide the funding between King College and us.”

Jordan said he understands the residency argument, but some slots currently are vacant and slots aren’t allocated “based on geographic location.”

Because King would be a new school, it could develop its own residency program and not compete with other schools for slots funded by the federal government or other sources, according to LeAnn Hughes, King’s vice president of marketing and development.

“We’ve had excellent discussions with Dean Bagnell and Dr. [ETSU President Paul] Stanton, and we continue having discussions about synergies and partnerships,” Jordan said. “The need is so great, this region needs all the physicians we can attract. What we are proposing to do would be a complement to the Quillen program.”

King’s plan would put a greater focus on specialization rather than family practice.

Dr. Jerry Miller, president of Holston Medical Group, said he hopes the two schools could work together.

“I see cooperation with Quillen, particularly in the first two years,” Miller said. “I hope they would share faculty and information technology – things like vital
records and telemedicine so they [students] could see real outcomes. I think every student should have a laptop computer so they could have access to patient records. We want them to become a real doctor during their training, especially the latter two years.”

King’s plans call for developing a program that eventually would graduate 150 new doctors each year – more than double the ETSU average. The beginning target would a class of about 50, Jordan said.

Clinical partners

King already holds letters of collaboration from Wellmont, which operates eight regional hospitals, and Holston Medical Group – a regional coalition of physicians with offices across Northeast Tennessee and Southwest Virginia.

That collaboration would essentially mean two things for the hospital chain, according to Wellmont Chief Executive Officer Mike Snow.“Our motivation is we
continue to see a shortage of physicians for this area,” Snow said. “When you look at the demographic of the physicians out there and the potential retirement rates – and the aging of the population – it’s creating more of a demand. When you put those factors together, it’s more than we can sustain through recruiting.”

Wellmont currently has 30 physician vacancies.

While health system officials have no plans to “write a big check,” Snow said, they can provide clinical teaching sites for medical students and access to patients.
“They need rotations through a hospital with real patients they can see,” Snow said.

Wellmont expects working with a King College medical school would have no effect on its existing relationships with ETSU or the medical school at Lincoln Memorial University in Harrogate, Tenn., Snow said.

HMG regularly recruits at medical schools across the U.S., but currently has 16 vacant slots for its operations in East Tennessee and Southwest Virginia.

“We have a good package for physicians, but it’s very difficult to recruit because there is a shortage of physicians,” Miller said. “And when I want to place a physician in Southwest Virginia, 80 percent of the applicants are foreign born. Now they’re very, very good, but we don’t have the ethnic culture and diversity
they’re looking for to locate their practice here.”

HMG typically invests $50,000 to bring in a general practitioner and about $75,000 for a specialist, Miller said. It currently employs only four graduates of ETSU’s Quillen College of Medicine.

“If we had a home-grown individual or a home-trained individual, I believe the likelihood of retaining them would be much, much better,” Miller said, adding that he hopes the King school would focus on enrolling people from this region.

The region’s need for surgeons, pathologists, radiologists and subspecialists already is acute, Miller said, but it is difficult to attract them. A high-quality program along the lines of those operated by Vanderbilt University in Nashville or the University of Virginia in Charlottesville would have a significant impact, he said.

“If we can duplicate that here, we’ll improve the quality of health care, access to health care and lower the cost of health care,” Miller said.

The physicians group also expects its doctors would oversee programs and fill teaching positions in the new medical school, Miller said. In addition, HMG could provide clinical settings for training and work with the school to further research efforts.

“Holston Medical Group has an extensive clinical research division, with 110 clinical trials currently under way,” Miller said. “We see extending that into the medical school.”While teaching opportunities also would likely be available for Wellmont doctors, expanding the research component offers considerable potential, Snow said.

“We do a fair amount of clinical trial work today. In fact, that is a substantial segment of our business,” Snow said. “We think having a research component at a local school only enhances what we’re doing. We want to do more, particularly in the area of oncology.”

Currently, Wellmont is conducting more than 100 clinical trials involving about 1,100 patients.

ETSU attracted $4.6 million in grant funding for medical research during 2007-08.

Are others invited?

In the traditional medical school model, one hospital becomes the primary teaching affiliate. However, the future of the King medical school likely would require multiple hospital and physician organization partners – including tertiary care facilities, community hospitals and rural facilities, Jordan said.

Wellmont, despite its central role, had no voice in the design that seeks to establish campuses near its two largest hospitals, Snow said.

“That didn’t come from us,” Snow said. “We’re site agnostic. We said to put the facility where it makes the most sense for King College. We would be happy with the facility at either location. And the jury is out on what the final form is and how it actually would work.”

Jordan said each hospital has “core strengths” and offer more opportunities than relying on a single facility.

Under the plan, the first two years of classes would be conducted at one facility and the final two years at the other. A firm decision on the final arrangement hasn’t been determined.

Wellmont’s involvement with King also doesn’t exclude rival Mountain States Health Alliance or other health care providers from participating, Jordan said.

However, the Johnson City-based hospital chain has had no substantive discussions with King and has no plans to be involved, company spokesman James Watson said.

“We pretty deeply partnered with ETSU on the College of Pharmacy, College of Nursing and the medical school,” Watson said. “We also work with Pikeville College and LMU. A fourth medical school in our area would be a pretty tremendous use of resources. Since ETSU adjoins the JCMC [Johnson City Medical Center] campus, that’s where our focus has been and will remain.”

Delving into the dollar signs

The economic impact of such a new medical school and possibility of attracting significant research opportunities potentially represent thousands of jobs and billions of dollars, according to the TrippUmbach study.

Below are a few highlights from the report:

* Construction would generate about $200 million and support as many as 1,800 full-time regional jobs through the actual investment in building the facilities and the rollover impact on area businesses through wages paid to construction workers.

* The school’s medical educational employment is projected to total more than 400 by 2015 in the Tri-Cities, more than 1,000 in 2020 and 2,800 in 2035.

* Research employment is expected to be more than 480 in 2020 and almost 3,600 in 2035.

* Hospital partners and bioscience employment is forecast to be 226 in 2020 and 7,300 in 2035.

* In the Tri-Cities, the impact of jobs related to the medical school could be $46.8 million in 2020 and $312 million in 2035.

* The impact of Tri-Cities research jobs is forecast to be $36 million in 2020 and $298 million in 2035.

* The impact on hospital partner Wellmont Health System is expected to be $38.4 million in 2020 and $120 million in 2035.

* State tax revenue impact is forecast to be $21.9 million in 2020 and $162 million in 2035.

* Tax revenue for governments in the Tri-Cities is expected to be $17.5 million in 2020 and $129 million in 2035.

Those figures are based on five components, according to consultant Paul Umbach. They include the medical school and nursing education, a clinical skills education facility, a research facility, the commercialization of medical research and – in the case of the year 2035 numbers – eventually establishing a biomedical corridor linking Bristol and Kingsport with medical education and research facilities and programs in Knoxville, Chattanooga, as well as the new medical school at Virginia Tech in Blacksburg.

Establishing such a corridor where those schools and hospitals work together could impact as many as 20,000 jobs in a 150-mile radius, Umbach said.

“There are different levels of impact – direct, indirect and total. The average academic medical center – such as Vanderbilt in Nashville, Tenn. – has an average annual [total] impact of $5 billion,” Umbach said.

He also predicted that the focus on medical research could attract substantial grant funding from the National Institutes of Health, in addition to the private medical research industry.

“Given the size of the community and the viability in attracting researchers – they won’t be the only scientists in town – these numbers may be conservative,” Umbach recently told Kingsport leaders.

dmcgee@bristolnews.com | (276) 645-2532