Another public medical school in North Carolina?

The University of North Carolina at Wilmington recently petitioned the UNC system for a medical school. If approved, it would become the third medical school in the UNC system, joining the ones in Chapel Hill and Greenville. It’d be the eighth one in North Carolina.

The request makes sense from Wilmington’s perspective. Regional universities look for ways to deepen their impact on the rhythm and life of their localities. The southeastern corner of coastal North Carolina is growing. Many new residents arrive with significant healthcare needs.

Institutional aspirations are always relevant. Wilmington’s are understandably relevant since the chair of the UNC system’s board is a Seahawk alumna closely involved with her alma mater. Several board members reside in the Wilmington region.

What’s the question?

The question isn’t whether UNC-W is ambitious. It’s whether this solution—another taxpayer-funded medical school at this location—is the correct one. Data from the Sheps Center in Chapel Hill show that North Carolina has slightly fewer physicians per capita than the national average, in part due to the state’s recent growth spurt.

The real issues are maldistribution of physicians and residency opportunities.  

Two rural counties near Wilmington, Bladen and Pender, have 4,200 and 3,000 patients per primary care physician, respectively, compared to about 1,100 patients per physician in New Hanover county (Wilmington).

Five years after graduation, only 1.3% of NC medical students practice in rural, primary care in North Carolina.

Nearly 60% of physicians remain in the areas where they train as residents. There are limited residencies available in southeastern or rural North Carolina; the growth in nurse practitioners and physician assistants further crowds finite clinical training slots. 

Pumping out more MDs at great taxpayer expense who’ll end up in Atlanta or Charlotte doesn’t make sense.

A statewide perspective

The UNC system was designed to take a statewide view, to debate university priorities, and to bring the most strategic investments to the legislature. This planning process matters. It focuses not on local motivations, but on a broader public need.

Reacting to campus enthusiasm isn’t the way it’s supposed to work.

If campuses can petition the Board directly, if the system doesn’t work as a system and if institutional mission statements mean nothing, why do we need a university system?

A crowded landscape

North Carolina isn’t starting from scratch.

The state’s educational landscape includes six medical schools (seven by this summer) and a well-established Area Health Education Centers (AHEC) network, including SEAHEC in southeastern NC impressively involved in the recruitment, training, and retainment of healthcare professionals.

Carolina’s medical school in Chapel Hill has progressively increased its class size from 160 to 230, equivalent to another medical school. Their students spend core clinical rotations in Asheville, Charlotte, Greensboro, Raleigh, and Wilmington. The medical school at East Carolina spent $300 million for a new seven-story building to accommodate classes of 120 or more students.

Wake Forest last year announced an expansion of its medical school into Charlotte, the state’s most populous area, effectively adding a sixth medical school in North Carolina. Its new campus enrolled 49 medical students in its inaugural class.

And last week Methodist University announced that its new MD-granting Cape Fear Valley Health School of Medicine in Fayetteville, the seventh in North Carolina, received approval from the Liaison Committee on Medical Education, the accrediting body for US medical schools, to recruit an initial class of 70 students this summer.  

The cost

Medical schools are the most expensive academic investments a state can make. Beyond specialized facilities and faculty, accreditation requires robust research infrastructure and new Ph.D. programs in the clinical sciences such as physiology, anatomy, and biochemistry. 

By the time we stopped counting, the medical school at East Carolina required over $75 million to open in 1977, or nearly $500 million in today’s dollars.

None of this makes a new public medical school unjustified. It does raise the bar for its justification. The case for any new public medical school must be overwhelmingly compelling.

A pattern of dubious initiatives

The Wilmington proposal sits within a wider context of dubious initiatives from the UNC system. Some, like reduced tuition at continually under-enrolled campuses, have tried to spur demand. Others, such as NCInnovate, a half-billion-dollar program that awards research grants to institutions not known for their research, or making class syllabi searchable on Google, have sparked debate about their worth and consequence.

It’s past time to ask what the UNC system is contributing?

The bottom line

North Carolina faces healthcare challenges. Expanding capacity may be part of a solution, but there are many ways to expand. The principal issues aren’t about medical school graduates. They’re about residency opportunities and maldistribution of physicians. 

Ambition shapes institutions but strategy sustains them. Before committing to another fabulously expensive medical school, the UNC system has an opportunity—and an obligation—to ensure its decisions reflect not just ambition, but strategy.

Dr. Art Padilla served as a senior administrator at the University of North Carolina System headquarters and later at NC State, where he was chairman of the Department of Management. He has taught at UNC-Chapel Hill, NC State, and the University of Arizona, winning several teaching awards and recognitions, including the Holladay Medal, the highest faculty honor at NC State.