Expanding MCG and educating doctors to serve the state

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AUGUSTA, Ga. (WJBF) – We are so pleased today to dedicate this broadcast to finding out what is happening at our very own Medical College of Georgia. Enrollment is on the rise, the physician shortage is being addressed every day. And life is being made a little bit easier for some of those med students thanks to the MCG 3+ program. We’re gonna tell you all about that with our friend, Dean David Hess. Dr. Hess is the dean of the Medical College of Georgia. He’s been on “The Means Report” many times, and we love having him.

Brad Means: Dr. Hess, this is the first time in months to I haven’t looked up and seen a politician on the other side of the TV screen, so thanks for breaking it up.

Dr. David Hess: You’re welcome, Brad. I’m happy to be here. Thanks for inviting me to be on.

Brad Means: Absolutely, we do appreciate it. My first question to you is just sort of a general one, pandemic related I guess. What does med school look like right now? Is it mostly virtual for you all?

Dr. David Hess: Well for most of the third and fourth year students it’s not virtual ’cause they really need patient contact. They’re spread, as you know, all over the state. They’re at Augusta University Health system. They’re really at many, many locations throughout the state, at all our regional campuses. And fortunately, with this pandemic, even when there’s been local outbreaks we’ve been able to move the students around. So they really haven’t lost much patient contact. Now the first two years, some of that is virtual, they’re small groups, and the new curriculum, which is the first year of, we had many more small groups than we had before. So the small groups are not done virtually, they’re done with social distancing. But the larger lectures that we gave, where we used to have the 200 students in a room, some of those are virtual.

Brad Means: What about, ’cause you mentioned patient contact, are you all playing a key role in the pandemic? Are some of those students working with patients when it comes to the coronavirus?

Dr. David Hess: Well we don’t, we try to avoid knowingly have them with a COVID-19 positive patient, but as you know you don’t always know if everybody’s positive. So you have to assume they are. But we will not put them in an intensive care unit with a ventilator patient. Now our residents have to do that, but we try to avoid unnecessary risk for our students. But, again, they’re out in clinics, and they’re seeing patients. And not all the patients have been tested, but you know, we’re taking precautions when they go to the that was have protective gear on them. So fortunately we’ve had very few students become positive by any kind of clinical or patient interaction.

Brad Means: Wow, that’s encouraging.

Dr. David Hess: The students that have become positive are mostly through social interaction. So it is really working. So we’ve had a very, very low rate of COVID-19 positive medical students, fortunately.

Brad Means: No, that is, it’s good news for sure. This is scary time for a lot of people. It certainly is an uncertain time for all of us. Has that uncertainty impacted a person’s interest in medical school? Do you see fewer people signing up and trying to get into this profession?

Dr. David Hess: Actually just the opposite. I was talking to Kelly Brawn, our outstanding admissions director, and she says this year looks like we’re going to have record applications to medical school. It’s much higher than it was last year. We have to go back in time, but it looks like it’s gonna be a record or near a record. So there’s, if anything an increased interest in medicine. And that may be because of the Tony Fauci’s and all the attention given to advances me need to make in vaccines, in new treatments for COVID-19 and other viruses. So I think there’s a resurgence of interest in infectious disease, for instance. And in some research aspects of medicine. So this is actually a boom time, I think, for being in a medical school and teaching in a medical school.

Brad Means: Yeah, your answer–

Dr. David Hess: Because we have a lot more interest, and as we’re gonna talk about, we’re increasing our class size.

Brad Means: We are gonna talk about that in depth. So that was my next question, is there an increased interest in infectious diseases because of the pandemic? You say “Yes, there is.” Let me go back to the virtual learning real quick. And I know that you said first and second year students do a good bit of it, third and fourth not as much. We’re still sort of in the learning curve, I’m sure, but how confident are you that virtual learners are gonna turn out to be just as good a doctor as their face to face counterpart like we used to do pre-pandemic. Are they getting the same level of education and experience? With medicine it seems like you have to be hands on 99% of the time.

Dr. David Hess: You do. Well the third and fourth year you have to be hands on. And, as I said, that really hasn’t changed now than pre=pandemic. I think the only thing that’s changed is that we are doing more virtual talks. But what’s interesting in our curriculum is our curriculum has changed to more small groups. And in the past we had more large lectures. But the students didn’t necessarily always come to the large lectures. So they would often watch these on their time because back then, and what’s always been in medical school is studying, as we say, for step one. The step one was a numerical score until this year, when it is changing to a pass/fail system. So now it’s even gonna be more important for students to shine in small groups. That’s how we’ll differentiate them. And our new curriculum, ironically, we’re going the opposite direction. We are going to more small groups, into more case-based and patient-entered learning. So an example of case-based learning, you know, in the old days when I went to medical school, which seemed like a long time ago, we would basically be taught the kreb cycle and the urea enzyme cycle, the urea cycle, which most of us have learned in college. We were tested on that to the enzyme level. And we were also often tested in biochemistry classes where it was kind of road memorization. Now the way it’s taught is different. So case-based learning would, for example be here’s a 24-year-old woman who comes in with sleepiness, and her ammonia level is very, very high. And then from there you would learn well why would the ammonia level be high? And it’s because there’s a defect in the urea cycle. So then you would learn the urea cycle or the kreb cycle in relationship to how it effects a patient. That’s what we talk about case-based learning. And it’s really been shown that’s how students learn. You really learn patient by patient. Not kreb cycle by urea cycle by a biochemical textbook. Students don’t learn that way. So we’re doing that. We’re also doing what’s called patient-centered learning, where there’s earlier and earlier patient contacts. Now, with the pandemic, some of those contacts are by telehealth. So our students are gonna get trained very, very well in telehealth, that’s for sure.

Brad Means: I wanna touch, and excuse me, I know it’s difficult to sometimes speak back and forth via Skype, so I didn’t want the audience to think I was cutting you off. I do wanna talk about telehealth, time permitting, but I wanna ask you one quick pandemic-related question and we’ll move on. Have you had to add any pandemic-type curriculum because of what’s been going on in our world, or did that already exist in the infectious diseases category?

Dr. David Hess: No, that’s a very good question. We created a pandemic medicine elective back in March and April, which was the highest attended MCG elective of all time. We ran it three times, and the first time we had 185 students. And the second time it was less and less, but we ended up having over 260 students. And many faculty. And we did it by Microsoft Teams. And you can have a couple hundred students, and we had faculty. You know, I gave some talks. We had speakers from Georgia State, some virologists there. Chris Basilar. We had a lot of our experts. So it went off really well. And in addition to that, the students did a lot of volunteer hours as part of the elective. So one thing they learned was contact tracing from the public health department. So one of our students who learned that, Rebecca DeCarlo, learned that down at the Southeast campus, and then she taught us, including me, how to do contact tracing. She was actually honored at the White House, and went up to the White House a few months ago and was honored. And she actually wore her MCG regalia up there. So while we didn’t have a hooding ceremony, she did at the White House. So our students learned to do contact tracing, they learned a lot of interesting things with COVID-19, as I said. So yes, we, thanks to Dr. Doug Miller, Dan Rahn, a whole group of people worked on this. Dan Camenstein was actually nominated for a USG teaching award for developing this course. So we have it all recorded. Maybe we can let Brad Means take it. It is really a well done course. I learned a tremendous amount from it, and I could only go to some of the talks.

Brad Means: Yeah, it sounds extremely enlightening, and needless to say so timely, and it’s impressive to see MCG on the national stage, the world stage really. We’re gonna take a break right now with Dean Hess of the Medical College of Georgia. When we come back, we’re gonna talk to the doctor about the student body at MCG, and how it is growing by leaps and bounds. And why it needs to grow. Our conversation with Dr. David Hess on “The Means Report” in a moment.

Part 2

Brad Means: Welcome back to “The Means Report.” We’re talking to David Hess. He is the dean of the Medical College of Georgie, where things are changing, especially when it comes to enrollment at MCG. Dr. Hess, you are thinking about trying to basically, over the next five years, double the number of med students you all have on your campuses, 150 now, hopefully 300 then. Do we need doctors that badly?

Dr. David Hess: Brad, yeah we do need doctors that badly. Georgia ranks about 40th in the country of physicians per capita. And in rural areas it’s really severe shortages. So actually we presently have this year 240 students. We went up 10 students this part year at our partnership campus in Athens. So, you know, our main campus here in Augusta has 190 students, and Athens has 50 this year. So that gives us 240. And then our regional campuses in Rome, Dalton, Albany, Brunswick and Savannah, where we send our third and fourth year students, mostly from Augusta is how we’re able to do that. But this coming year we plan to go up by 10 students in Augusta, from 190 to 200, and then 10 more in Athens to go from 50 to 60, for a class size of 260.

Brad Means: Wow.

Dr. David Hess: Yeah, that’s a big class size when the average class size of a medical school is about 145, so we’re already big. But we plan to go up then to 300. So about every year or so until, certainly by 2028, which will be our 200th anniversary, we will have 300 students. We’re presently about the ninth or tenth largest medical school in the United States. When we do that we’ll probably be number four or five in size. Now, you know, size isn’t everything. You wanna have a large medical school, but you wanna have a high quality medical school. And that’s why when we increased our class size we redesigned our whole curriculum that we call the 3+ curriculum to allow students to finish medical school in three years instead of four.

Brad Means: Yeah, I wanna talk to you about that. Let me ask you this real quick though, why is 300 a big number? When we think about class size, you know, I don’t know 1200 people go to my son’s high school, 20,000 people go to my other son’s college. Why is 300 a big number in the med school world?

Dr. David Hess: Well, the average size of medical schools is only 145. Johns Hopkins has only 125, so it’s very large. You know, you really can’t get too large ’cause training a doctor is like training a fighter pilot, right? You need a lot of contact with patients in a lot of areas. You need to get a lot of information, learn basic school information. And then you really just need the clinical contact with patients. And so, you know, there’s just so many patient encounters you can get throughout the state. So I don’t think we’re ever gonna get larger than 300 students, at least not for the foreseeable future. So that’s a large medical school.

Brad Means: Yeah, that’s helpful to hear. Tell me how you’re going to, and you started to answer this. Tell me how you’re going to get these young people out of school faster and encourage them to move into practice in those places that need them most? How can that program work?

Dr. David Hess: Right. Well traditionally the first two years of medial schools we call the pre-clinical years generally last 24 months. That’s the traditional length in most medical schools. But more medical schools now are finding they can compress that to 18 months. So we’re going to compress that to 18 months. So in the second year of medical school, halfway through, they’ll start their clinical rotations. Like for example in general surgery, in internal medicine and family medicine. And so we’ll save a lot of time there. So they’ll finish the basic curriculum in three years. They’ll have the same amount of credit hours they did in four, but it’ll be compressed in three. So shorter summer breaks, and just a more compact medical school, where we think we’ll have less waste and less wasted effort. And then the fourth year, if they decide to stay in Georgia, they have to stay in Georgia, they will star their primary care residency in Georgia, and that’s very broad. Family medicine, internal medicine, pediatrics, OB/GYN, general surgery, psychiatry, emergency medicine, OB/GYN. It could be any of those. And if they stay in Georgia, then their fourth year of medical school will actually be their first year of residency. And when you’re a resident you get paid. Not a lot, but you get paid. And you’re not paying tuition. So it saves them a lot of money. And then what we’re working toward is if you work in an underserved area of Georgia, your tuition will be paid by a scholarship your three years of medical school. Now we’re still working on the funding of that, but we’ve already started the curriculum chain. So this year students are already in the three-year curriculum.

Brad Means: Well I was gonna ask you about the funding for MCG as a whole. When you have more bodies, you have more students in your class, does that open doors for more money from the state and federal levels and grant money as well?

Dr. David Hess: Well the state, yeah the state has been a good partner in allowing us to expand our class. You know, even with COVID-19, where we got budget cuts like every state agency got, we decided that no matter what our cut would be, unless we were cut to zero, we were gonna do the 3+ curriculum, it is the most important thing in our medical school. So that was in violate. We did that even though we didn’t have as much funding as we wanted, and that’s just because the state budget was under pressure, so we understand that. But going forward, I think the state is committed to seeing this. We’ve had Trip Umbach, which does consulting for medical schools looked at the 3+ program, and for every dollar the state puts in the 3+ program they get $17.50 a year going forward. So it’s a great return investment. And that’s because you’re sending doctors to underserved Georgia. And studies show that if you have primary care doctors you actually save healthcare costs by preventing people from having to be hospitalized with very, very costly diseases. And then the doctors employ people. So having physicians in rural communities is a big economic boost to the rural communities. It also allows them to attract business. So we’re really focused on rural and underserved Georgia.

Brad Means: How long do they have to stay there once they set up their practice?

Dr. David Hess: It’s a year for year. Presently the way we’re looking at it it would be a year for year. So three years of medical school would be three years of working in underserved Georgia. Now, you can do this program and not get the tuition remission, then there’s no requirement to work in rural Georgia. But just by virtue of doing your residency in Georgia, the chance of the doctor staying in Georgia is about 70% to 80%. So we think this’ll keep doctors in Georgia.

Brad Means: So is it sort of a revolving door? And I don’t mean that in a derogatory way, but is it a matter of a new doctor coming in to those underserved spots every couple of years or so?

Dr. David Hess: Well we don’t want it to be that way, and that’s a very good point. You know we don’t wanna just have doctors go there for three years and leave. And that’s why you have to prevent a place from being what we call a physician dessert. You know, you’ve heard of food desserts, well there’s physician desserts. And the way we’re gonna avoid that is we have alumni all over the state who need help, who need doctors to come into their practice. So we’re gonna team them up with our alumni. We’re gonna work with what are called community health centers throughout Georgia, also called federally qualified health centers who need a pipeline of physicians. We’re gonna work with other healthcare systems. And as I said before, our graduates to team them up early on to make sure that it works. And you gotta work with the community. The community has to support the physicians. You know, they have to have good schools for their kids to go to. They have to have other financial inducements to stay. Some loans to help build up their practice. So we’re working on all that simultaneously. It’s a full state effort.

Brad Means: We only have a couple more minutes left. I wanted to ask you about telehealth. I told you we’d get back to it. Nine out of Georgia’s 159 counties have no physician. Nine out of 159. Is telehealth key, especially in those areas to make sure at least these patients can communicate with a doctor?

Dr. David Hess: Yeah, you know it’s key. And a lot of the primary care doctors need a specialist. And I thin one thing telehealth can do, particularly here, you know at MCG and AU Health we have a lot of specialists so the idea would be to use telehealth to help the primary care doctors avoid having to send their patients physically up here or anywhere else, particularly with the COVID pandemic. I think the other big area for telehealth would be telehealth in the home. But one of the things you gotta understand is we don’t have great broadband access in a lot of Georgia. And that’s a problem. That’s a national problem is better broadband. So we also need efforts to deliver broadband to areas of rural Georgia because in some of these telehealth consultations, while some things you can do on a cellular telephone network, in some you need a little beret broadband access to have a successful telehealth consultation with the physician.

Brad Means: My last question, Dr. Hess, and it’s just to deliver a quick message to any young people who may be watching. What do they need to do right now, whether it’s elementary school, middle or high, college, what do they need to do to become a doctor one day? Is it all about good grades and good SATs?

Dr. David Hess: You know, I would say it’s important to do that. But if you’re really committed you can do it. We talk about grit. Grit is a combination of passion, you know, a love for something and perseverance. I think any student in elementary school, if they have the desire and they persevere they can make it.

Brad Means: Well I think that’s well said. And I think some future doctors will be watching. And you all certainly are making it as easy as possible for them to get through your program and get out in this state where they’re needed. Dr. Hess, thank you for all you’re doing, especially on those front lines. And thank you for being here today.

Dr. David Hess: Thank you, Brad. We really appreciate you taking the time to interview us.

Brad Means: Absolutely. That’s Dr. David Hess, the dean of the Medical College of Georgia. We appreciate him so much. All our members of the healthcare industry.

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