State Doctor 'output' To Soar--But Too Slowly

(SECOND OF THREE ARTICLES) Expansión moves soon will enable Michigan to turn out at least 30 per cent more doctors a year- but the demand for doctors probably will spurt even faster. Even without much population growth, medicare and other welfare type programs could sharply increase the cali for doctors and other health services. While worrying about where tomorrow's doctors will come from, education planners also must decide whether the state wants to encourage training of both medical doctors and osteopaths. "We have been told by the public - repeatedly so - that the field of medicine is und'er manned," said Dr. Ernest Gard ner, dean of Wayne State Uni versity's medical college. A study committee said il 1963 that just to keep up with population growth, Michigan probably should ad'd 175 new places in its medical school pro grams by 1971. The state is in a posmon to do exactly that- if an osteopathic college is counted as medical school. There is opposition to opening an osteopathic college in Michigan. But the House State Affairs Committee has approved a bilí to insure state backing for the proposed school. The bill still must be approved hy the House Ways and Means Committee and by the full House, and' the Senate, which already has passed the bill, must agree to House amendments. About 25 new places will open next fall when Michigan State University begins instruction at its new two-year College of Human Medicine. Witbin several years, MSU plans to accept 64 students a year into the college. Another 75 places will be available within three or four years as Wayne State University expands its medical school from a first-year class of 125 to one of 200 students. The University of Michigan plans to increase ollment from 200 to 210 within he next several years. Another 64 would open if the Michigan College of Osteopathic Medicine in Pontiac is able to arry out its plans to start intruction in September 1970. Dr. Stewart Harkness, the oseopathic college's associate ean, expects to know by the nd of the year whether federal matching funds will be available br construction. The college has sought state upport to pay operating expenses, "but state support is not going to determine whether this college goes up or not," Dr. Harkness said. The bill approved by the house committee would' créate a State Osteopathic College Authority to construct, opérate and maintain an osteopathic college. lts finan cial implications for the state though, still are unclear. "We feel that the Michi gan taxpayers who prefer to avail themselves of osteopathic physicians and surgeons. have as much right to expect thei tax money to be spent on train ing osteopaths as do citizen who prefer M.D.s said Rep Vincent Petitpren, D-Wayne, acting committee chairman. The committee action carne after a survey it conductec among osteopaths and medica doctors. It showed 5,010 out o 6,700 M.D.s favored putting os eopaths on equal footing with ; hem on the staffs of publicly i upported hospitals. Medical doctors generally oposed state support for an osteoathic college and favored malgamation of the two pro'essions. Osteopaths continue to avor the school and oppose malgamation. "Whether we merge or not won't add a single physician," said Floyd Brooker, the college's executive officer. "The basic problem is a growing shortage of physicians." Since 1952, the University of Michigan medical school has been taking in 200 students a year and graduating about 180. The 20 students who leave usually have not failed, but leave for other reasons, including illness, said Dr. John Tupper, associate dean. Last year, about 1,200 students applied for the U-M medical school, including 600 nonresidents. Dr. Tupper expects a similar number of applications this year. Some of the applications do not meet U - M standards and other students whose academie records are outstanding are ruled out on other grounds, perhaps for lack of suitable emotional qualities, he added. Wayne's medical school has had 900 to 1,000 applicants each year íor its 125 places. It ates about 115 M.D.s each year.l said Dr. Gardner. "The number of applicanlsj and their quality has been i creasing steadily," he said.j "We're about at the point wherej we're going to have to turn I down people who should be inl medical school." He said Wayne has started al i46 million building program which will enable it to expand by 200 students in three or four years. About half the building unds, he said, are provici:d by the state, with the rest coming f rom the federal government! and private sources. The school spends about $7.8 million a year to opérate, Dr. Gardner said, with about $2.8 million of that from the state. U-M officials said it would be difficult to separate funds for M.D. training from the budget of the entire U-M medical center. MSU's new medical program grew smoothly out of existing, programs in the biological and social sciences and medical technology. The school has estimated operating expenses will be $1 million a year at the start. For construction, MSU had the help of a $2-million federal grant for a new $5.2-million biochemistry building and $4.7million veterinary clinical and research building. The National Science daüon granted $1.2 million toward the biochemistry building and the Kellogg Foundation granted $1.25 million toward starting the over - all medical program. Dr. Andrew Hunt Jr., dean of the new school, said the excitement of starting a new program has made faculty recruitment easier. "Faculty selection is coming along very well," he said. "We should have no problem next fall." Graduales of the two - year program will have to transfer to other medical schoolá to complete two more years of work for their M.D. degree. Dr. Gardner has said Wayne could take all of them, and Dr. Tupper said U-M would be able to take some. The State Board of Education has called for cooperation among MSU, U-M and Wayne to keep these medical students in Michigan. It also has established a committee to investígate Michigan's medical education needs and prepare a plan to meet tl.m. If the state ever decides to [support a third degree-granting medical school, MSU officials say they will be vigorous applicants. But before a third four-year school is approved, U-M and Wayne say their programs must be fully supported. The deans of all three Michigan medical schools have told the House State Affairs Committee that a state - supported osteopathic college at Pontiac would be inefficiënt, expensive and unnecessary. The nation's five osteopathic colleges "are nothing more or less than poorly supported medical schools," Dr. Tupper said. (Just as medical schools, the osteopathic colleges have a fouryear program with basic sciences in the first two years and clinical training in the last two). Hugh Brenneman, executive director of the Michigan State Medical Society, said it would cost significantly less to expand the existing medical schools, which already have programs in the basic sciences. An osteopathic college, he said, would be starting from scratch. The 196S study committee declared "A preexisting gradúate program of education in the life sciences is essential as background for the development of a medical school. "Where there exists a gradúate faculty active in the life sciences, a great advantage to the university is oblained when a new medical school program is established," it added. Any medical school starting from scratch would need an vestment of about $50 million, Brenneman said. Because of the expense, the possibility of a private medical school opening in Michigan is remote, Brenneman said. "It would be wishful thinking that any source could come up with the money," he added. If there were to be a private medical school, one possibility mentioned has been Detroit's Henry Ford Hospital, which has a nurse training class of about 330 studenls, internships in dietetics and pharmacy and a master's degree program in medical technology through Wayne. It also has about 280 interns and resident physicians in a postgraduate medical training program. A spokesman said M. D. training at the hospital has come up for discussion, and "we would have a good base from which to work," but the hospital now has no plans to start such a program. "A major problem is financing," he added. "I don't think we would want to go into a venture like this unless we knew the financing was sound." The osteopathic college expects building costs of around $27 million to open its f i r s t stage, said Brooker. Members of the State Osteopathic Association have assessed themselves $3 million for capital outlay, he said, and other funds hopefully would come from private sources and from the federal government. "The last worry we have is filling the first class with qualified students," Brooker added. The association says osteopathy has its own distinct philosophy and that its unique contribution warrants having the two separate healing professions. One emphasis is on trying to help the body "in its own natural efforts to maintain health quite apart from the attacks on the disease-causing organism," says the American Osteopathic Association. The association adds, "t h e schism that separates the two remaining schools of medicine is not fundamentally educational, social, ethical, moral or economie, although each factor plays its part, but is one heretofore inadequately recognized - a divergence in basic philosophy." Brenneman maintined, though ''there is no such thing as two different practices of medicine - you either practice medicine or you don't. "There are no secrets in this profession," he added. An osteopathic college, he said, wouldn't be teaching any thing different. (Next: MSU's new medical program.)