On The Possibility Of A Fifth Medical School In NC

Flea once said on this blog, "Have you noticed there is an inverse relationship between one's perception of accuracy in news reporting and one's proximity to the subject covered in the story?"

Some nights at work are much harder to shake off than others. And Flea's comment came to mind as I watched the local news (in my current "burg") yesterday morning. Using a Gumpism, that's all I'm gonna say about that. Don't want to wind up like these folks.

I gotta say, though, I work with some great people who know their stuff.

And on that subject of doctors knowing their stuff, the Charlotte Observer reported that North Carolina may be getting another medical school . . . at CMC in Charlotte . . . through a back-door arrangement with UNC-Chapel Hill that increases the size of Chapel Hill's incoming class, and ultimately trains the extra docs in Charlotte. Proponents say this "dynamic process" could eventually lead (in 10-15 years) to the establishment of another medical school in Charlotte.

Such an endeavor would, of course, require truckloads of money to build the infrastructure and recruit faculty.

That's where I get a little skeptical . . . especially given CMC's track record of expensive "accounting errors" when, several years back, it was handed (by a clueless Department of Health & Human Services) what essentially amounted to control of North Carolina's "disproportionate share" program.

What resulted was a "dynamic" failure of oversight and a testimony to unadulterated greed.

North Carolina is already blessed with four medical schools (two public and two private) when some states don't have any. The state has a very high medical profile, as was demonstrated this week, when a UNC-researcher was awarded the Nobel Prize in medicine.

Of course, I stopped putting much stock in the Nobel Prizes when Yasser Arafat was given one for "Peace".

With Flea's observation in mind, I noted that the Observer's article pulled out all the stops on reasons to support another medical school, particularly emphasizing the predicted shortage of physicians (particularly in primary care and rural areas) in the near future.

But I have trouble with this theory (particularly as it pertains to rural medicine). As a Locum Tenens physician (for nearly ten years), I have practiced in rural areas . . . both in far Eastern and far Western NC . . . and I can tell you that, despite our four prestigious medical schools and all of the fancy doctor recruitment programs . . . these places are still revolving doors for physicians . . . often for young doctors in public service or FMG's in perpetual indentured servitude trying to work their way into permanent VISA status/citizenship (as opposed to those who just cross the border/break the law/start having babies to "anchor" their status).

We can train all the doctors that the powers-that-be like. But the issues are (1) What will they train to be, (2) Will they stay in NC, and (2) If they do stay in NC, where will they go? And that is about much more than building new schools and training more doctors.

I would submit that, instead of building expensive new medical schools, a good place to start might be to treat the physicians you already have just a little bit better than I was (in public service no less).

Tort reform would also be nice.

And I would suggest more accountability for "the suits" at some of these hospitals as well. As for me, it looks like I'm going to have to file a lawsuit over that . . . as the state of North Carolina (as represented by the NC Medical Board and Attorney General's Office . . . as lawyers to DHHS) doesn't give a rat's tail that two fine upstanding "non-profit" executives bold-faced lied under Oath to save some money and get their way (i.e stomping into oblivion the practice and reputation of a home-grown Pediatrician educated at one of our four fine in-state medical schools).

The State of North Carolina rarely does anything because it's the right thing to do . . . because a child's life was endangered and/or young physician's life and career got turned upside down . . . because a pair of executives thought they were above the law and behaved like common bullies & thugs.

The State of North Carolina has to be backed into a corner by the media (ala Nifong) or taken to court. Otherwise the plan is to just ignore you and let you rot.

What the hay. It's an election year. Let's ramp up the dialogue. Apparently, nothing works better to do that than a lawsuit.

Here's the other thing about CMC's plans. I could not help but chuckle as I remembered the great debate in the 70's about where the state's newest medical school would go. Charlotte fought tooth and nail to get it (and Duke/UNC, as I recall, expressed no joy over getting "competition" on their woefully under-served "turf" in Eastern NC). But common sense ultimately trumped greed (a rarity) and the school went to Greenville.

The school's emphasis is on primary care. I personally think that if any of the schools should get more public money and bigger classes, the Brody School of Medicine should. The kiddies coming into this game need to see the real world outside of the ivory towers and big cities.

Now, no one can argue that putting the school in Greenville was the right thing to do. My Mama's people hail from "Down East" and speak "High Tide". I can tell you that the Brody School of Medicine has made a world of difference in the day-to-day lives and healthcare of the citizens who live in that area. My own family benefited immensely from the closer proximity of the Greenville campus (as opposed to driving for hours to Chapel Hill or Durham). And in my own forays into practice in that area (again, especially in rural/impoverished places that don't even qualify to be "burgs"), knowing you can pick up the phone and get good help very fast makes all the difference.

There were a few times I was really grateful to see "the bird" fly in . . . and out.

And ECU's Telemedicine initiatives (especially in Pediatric Cardiology) were/are a God-send.

But back to the reason I chuckled: Since the "disproportionate share fiasco" (where no one was prosecuted while millions in federal funds were plundered), I've come to understand that what the big-city-suits in Charlotte want, the big-city-suits in Charlotte will eventually get.

It's politics baby.

And it's all for us.