Since Augusta University President Brooks Keel first talked about the initiative during a visit to Statesboro two years ago, the university and its Medical College of Georgia have moved forward with efforts to speed more doctors to the state’s rural and underserved areas.
Keel, Ph.D., who was president of Georgia Southern University for five and a half years before leaving in 2015 for the Augusta University position, was back in Statesboro for a visit again Thursday.
Overall statistics on the challenge he described in a fall 2019 interview, the short supply of doctors in Georgia and especially in its rural areas, haven't changed much. With 24,194 practicing physicians, Georgia has 230 doctors per 100,000 people, according to the latest Georgia Board of Health Care Workforce dashboard update. That compares to 277.8 physicians per 100,000 people nationwide in an Association of American Medical Colleges, or AAMC, report from November 2019, which ranked Georgia 39th among the 50 states, the District of Columbia and Puerto Rico in availability of physicians. As of 2019, eight of Georgia's rural counties had no doctors at all.
“I don’t think it has changed much," Keel said. "The last time I looked there were nine counties in the state of Georgia that don’t have a practicing physician. It changes from year to year but has hovered around eight or nine for the last couple of years.”
A 3-year med school
But the Medical College of Georgia has taken some steps he previously outlined, which were only plans two years ago.
Effective with med students arriving at its Augusta campus in June 2020, MCG tightened its traditional four-year basic curriculum to three years, creating the MCG 3+ program. Traditionally after four years at a medical school, beginning doctors enter a residency program, for supervised experience in treating patients, that lasts at least three years for primary care fields and longer for some specialties.
“That’s the beauty of this," Keel said. "Instead of having a fourth year of medical school, they’ll go right into the residency program in that fourth year, which means they will start practicing medicine a year sooner than they would have before we changed the curriculum, and it eliminates 25 percent of the debt, which is a big piece of this program as well.”
Even at MCG, which as Georgia's only public medical school has lower tuition than any of those affiliated with private universities, a medical student can accumulate sizeable debt, he acknowledges. An AAMC report from October 2020 stated that 75% of graduates of public medical colleges surveyed nationwide had education debt, with an average debt of $199,391, while 71% of private medical school graduates had education debt averaging $219,829. Keel had mentioned a typical range of $150,000 to $200,000.
“For a young student that graduates having to carry that sort of debt load with them, there’s not much incentive for them to be able to set up a practice in a part of the state where the payer mix is not all that good," Keel said.
In other words, debt can be a barrier to doctors wanting to practice primary care in rural and underserved areas and a motivation for them to choose higher paying places and specialties.
So the other part of MCG's initiative is a scholarship program providing free tuition to doctors who commit to practice medicine, especially primary care medicine, in rural or underserved areas of Georgia.
"We’ll be eliminating that debt altogether for these to make it a whole lot easier for them to want to practice in rural, underserved Georgia, and we think this will go a long way toward not only placing them there, but keeping them there in the communities in which they start serving," Keel said.
The goal for this program is to eventually enroll 50 medical students at a time who make the commitment and are chosen through a competitive process. Students would in effect be forgiven one year of tuition, up to the three years total, for each year they serve in the rural or underserved area. Those who leave for other work before completing the commitment would have to pay the difference in tuition.
In 2020, Peach State Health Plan, a care management organization that is a subsidiary of the Centene Corporation, provided a $5.2 million gift to launch this program. This was then matched by the Georgia General Assembly with $5.2 million in state funding approve during the 2021 session. So, MCG now has a $10.4 million endowment for this MCG 3+ Scholars program.
The first cohort of eight students applied and were selected from among students already at MCG and entered the program in June 2020.
"We have eight students now that have committed to this particular program, and when they finish their degree, now in two years – they’ve already been in the program a year – they’ll do a residency program in the state of Georgia and then they’ll commit to serve in rural or underserved Georgia year for year for the amount of tuition that we’ve covered," Keel said.
Meanwhile, all of the students who have started at MCG's Augusta campus from June 2020 forward are in now in the shorter, three-year curriculum. They can choose a number of pathways for what to do with their fourth year, including taking specialized medical courses, obtaining a master's degree in a field such as business or devoting the year to research. Going directly into a primary-care residency is just one of the options.
Currently the 3+ program applies only to the MCG Augusta campus, which has 200 entering-year students. MCG also operates through an Augusta University-University of Georgia Medical Partnership campus in Athens, which for now retains a traditional four-year medical school curriculum.
MCG also has branch campuses in Savannah, Brunswick, Albany and Rome and is developing a branch campus in Atlanta and a partnership with a hospital in Dalton. These provide more practice sites for medical students working with patients, Keel said.
Before the interview, Keel and Augusta University Executive Vice President for Administration Russell Keen and Associate Vice President of Government Relations Margie Miller met with state Sen. Billy Hickman, R-Statesboro, and Rep. Jan Tankersley, R-Brooklet. They and House Majority Leader Jon Burns, R-Newington and Rep. Butch Parrish, R-Swainsboro, had all supported funding the MCG 3+ Scholars program.
"It's great just to visit with the legislators and say thank you," Keel said.