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An opioid epidemic. High smoking rates. Health care provider shortages. Indiana faces serious public health challenges. Side Effects Public Media provides in-depth coverage of these issues and more.

Med School Classes Are Growing - But That Doesn't Mean More Doctors For Indiana

Rory MacLeod

On Sunday, Marian University in Indianapolis graduated its first-ever medical school class, handing out 133 Doctor of Osteopathic Medicine degrees. Next weekend, 331 Indiana University School of Medicine grads will collect their diplomas.

The combined classes represent a growing number of medical school grads across the state—a 60 percent increase since 2012.

Marian University officials have expressed hope the growing classes could make a dent in the state’s physician shortage by training more students interested in primary care—a D.O specialty. But filling that shortage may call for changes in the residency system, not just more graduating medical students.

Marian’s first graduates are getting D.O. degrees. Like an M.D., D.O.s, as they are called, are licensed physicians, but with an added training focusing on the musculoskeletal system and an emphasis on prevention and wellness than traditional M.D. holders.

Marian President Dan Elsener says that whole-person focus could be good news in a state in dire need of primary care physicians. A 2016 study by the consulting firm Avalere Health found one in four Hoosiers live in an area without enough doctors, and the state has more than 100 primary care physician shortage areas.

“We need more docs, but we need more primary care docs, family, pediatrician, O.B., internist,” Elsener says.

And he says a rapidly-aging population compounds that need.

“The population has grown much faster than the supply of physicians,” he says. “Moreover, demographically, baby boomers are now over 60, and people in their 60s go to the doctor a lot more than people in their 20s and 30s.”

But there’s a hurdle to getting doctors into Indiana hospitals and clinics—residencies. Once a future physician completes their degree, they have to complete a multi-year residency under a supervised physician before they can practice independently.

The National Resident Matching Program—commonly referred to as “the Match,” reports the number of applicants is fast outpacing the number of first-year residency slots. In 2016, the Match offered close to 28,000, first-year residencies, but the number of applicants that year was more than 40,000.

On a local level, Marian’s first class is 133 students. But in the last four years in Indiana, the Match—which is how the majority of grads find their residency assignments—has only added around 50 new residency positions.

Until there are more slots to accept new graduates—D.O. or otherwise—newly-minted physicians might be left going to other states to complete their training—and staying there.

Elsener says where someone completes their training has a big impact.

“Where you go to medical school and where you do your residency tends to be where you stay and practice,” he says.

Data from Association of American Medical Colleges backs Elsener up. According to the organization, close to 56 percent of students who complete their residency in Indiana continue to work here.

Funding for doctors’ training comes from the government, particularly funds collected through Medicare and Medicaid. But the federal government hasn’t offered an increase in medical residency funding for two decades.

States can fund their own residency programs with, for example, grant money, and other residencies for certain specialties can occasionally offset their own costs, so the number of residency spots has grown. But right now, there still aren’t enough residency spots for all the new graduates.

That means some of Marian’s first class of doctors are will be seeking residencies in other states. Class President Maureen McAteer says she would have loved to have a residency in Indiana, but found one in Ohio which offered the osteopathic manipulation pediatric training she was looking for.  

But she’s happy to be starting her career in medicine with the training she got at Marian. She says even though her mom is an MD, she sought out a DO program specifically.

“That was the way I wanted to practice medicine, patient-centered care,” she says.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

Reporter's note: A earlier version of this story referred to the Marian University degrees as "Doctor of Osteopathy" degrees. The correct designation is "Doctor of Osteopathic Medicine." The reporter regrets the error.