What's up -- docs?

Preliminary plans that would turn out more North Carolina-trained doctors are worth a closer examination

North Carolina needs to train more doctors to cure what ails an aging and ever-expanding -- in more ways than one -- population. So goes the thinking behind costly proposals to expand the state's two public medical schools.

In addition to enlarging medical school classes at UNC-Chapel Hill and East Carolina University, preliminary plans call for starting new physician training centers in Charlotte and Asheville, and perhaps in Eastern North Carolina too.

The plans are worth considering. Increasing the number of medical school graduates, and extending medical education to new sites, might mean that more newly minted doctors would take up and remain at posts in rural and poor areas. There, residents' health problems are often acute, and physicians have been hard to attract. Having more home-grown and home-trained physicians could help.

All this, however, requires careful, realistic analysis by university higher-ups and by the legislature before final plans are approved and money appropriated. Filling unmet medical needs isn't as simple as opening the doctor-training tap wider. Advocates of expansion must show that this is an effective way to address growth and the underserved areas.

At Chapel Hill, medical school officials are thinking about adding 70 students to each entering class.

That would increase class size to 230, among the largest in the nation. A welcome component of the plan is that 50 medical students would complete their final two years at new facilities linked to hospitals in Asheville and Charlotte. That reduces the need for construction on the Chapel Hill campus and spreads the new doctors around.

In Greenville, the plan calls for increasing the first-year class at ECU's Brody School of Medicine from 73 to as many as 120. And there could be a regional campus or two in the eastern part of the state.

The sums involved are staggering. Facilities associated with the UNC-Chapel Hill expansion alone would cost an estimated $239 million to build, and there would eventually be an extra $40 million a year in costs for faculty and staff. That's a cool quarter of a billion right there. Meantime, the university is expected to ask the legislature for $247 million for a biomedical imaging facility at Chapel Hill, and hospital expansions on campus could lead to requests for hundreds of millions more in state funds.

Is this the best use of the state's medical education dollars?

It's true that doctor shortages are forecast both nationwide and in North Carolina. In our rapidly growing state the four medical schools (Duke and Wake Forest are the others) graduate around 440 medical students each year, a figure that hasn't increased lately. Medical school applications have been rising. So some expansion seems logical.

Expansions or not, through sheer supply and demand affluent areas will get their fill of physicians and medical specialists, maybe more. The trick will be to make the two UNC system schools' plans count for the rest of North Carolina. Plans to turn out more doctors should be evaluated with a close eye on how much real improvement they're likely to bring to Tar Heels' health care.