Osteopathic Medical College Exploration

A feasibility study prepared by Tripp Umbach, a leading consulting firm in medical education, evaluated a variety of factors such as market demand, economic impact, and the capacity and commitment of healthcare providers to support clinical placements – a vital component of medical education.

The most important reason is simply that Colorado needs more doctors, specifically in underserved areas, and hospital systems that serve Northern Colorado communities have called on UNC to act. According to the U.S. Health Resources and Services Administration, only 34.6% of the state’s need for physicians is met. As a result, physician shortages are already negatively affecting access to care, which is felt most acutely in rural and other underserved communities. The COVID-19 pandemic has helped to focus attention on the problems inherent in the limited capacity of our healthcare systems. The shortages Colorado encounters today are projected to get worse. The state’s booming population growth over the last decade – at double the national average – coupled with Colorado’s high percentage of active physicians aged 60 or older who are expected to exit the workforce in the next few years – one-third of all active doctors will be older than 65 in the next decade – are driving factors. Nationally, the Association of American Medical Colleges predicts a shortage of as many as 139,000 physicians, including as many as 55,000 primary care practitioners, by 2033.

While this is a challenge facing most of the state, especially rural and underserved communities, UNC’s hometown of Greeley has been and will continue to be the fastest growing city in Colorado and one of the fastest growing cities (actually, 4th fastest!) in the United States. The population of the Greeley metropolitan statistical area increased by 30.1% between 2010 and 2020, so the need to meet local and regional needs for physicians is going to continue to grow significantly right in UNC’s backyard.

The benefits to the health, strength, and growth of local communities and others across the region and state are many—and UNC is excited to move forward in partnership with stakeholders at each level. Developing a College of Osteopathic Medicine in Northern Colorado will have a positive impact on the quality and accessibility of health care and will have direct and indirect benefits to the regional and state economy. It will draw upon UNC’s existing strengths in the sciences and health sciences, developing synergies with programs such as nursing, behavioral sciences, public health, audiology, speech-language pathology, biology, and chemistry to enrich the curriculum—and reinvesting in programs that expand UNC’s capacity to support positive health outcomes for Colorado. As a result, we anticipate that the University of Northern Colorado College of Osteopathic Medicine will improve quality of life in communities across Colorado by growing the capacity of the healthcare system—expanding numbers of highly qualified doctors who have local and regional connections and interests, as well as by enhancing access to healthcare, especially in rural and other underserved communities.

Diversity in healthcare matters and currently only 5% of practicing physicians are African American and < 6% are Latinx. UNC serves large numbers of underrepresented, first generation, and Pell-eligible students and is projected to be federally recognized as a Hispanic Serving Institution in the coming years. As a result, the College of Osteopathic Medicine is being developed with careful attention to providing academic pathways for underrepresented minority students to pursue medical degrees—and, through their success, produce a pipeline for achieving greater diversity in the physician workforce.

The feasibility study from summer 2021 also projects UNC’s proposed medical school will contribute as a major driver of the local, regional, and state economy, creating jobs and generating tens of millions of dollars in economic impact to the region. When the school is fully operational, it will generate $66.7 million in total economic impact per year (direct, indirect, and induced impacts) and will add $2.7 million in state and local government revenue. In addition, by 2035, the economic impact will grow to $78.9 million as communities in Northern Colorado will begin realizing health-care benefits and additional economic impact because graduates locate in the region. Assuming that 25% of graduates from the college practice in underserved communities, Tripp Umbach estimates that by 2035 these new primary-care physicians will also yield real savings, as emergency room utilization declines and quality of care improves. These savings are expected to total $136.8 million annually by 2035.

The University of Northern Colorado is uniquely positioned to leverage existing programs to amplify positive outcomes for healthcare access and quality across the state. Of tremendous benefit to the success of the project, UNC has long had strong programs in the sciences and health sciences, including nursing, public health, behavioral sciences, biology, chemistry, audiology, speech-language pathology, and other fields. UNC is already exploring ways to leverage synergies among programs to enhance the osteopathic medicine curriculum and students’ academic experience in these other fields. For example, there is potential for making a significant impact on mental health outcomes by preparing osteopathic primary care physicians—the leading area of practice for D.O.’s—with greater knowledge, skills, and competencies in the behavioral sciences. A recent study by the Robert Graham Center found that primary care physicians were responsible for providing a majority of the care for depression, anxiety, serious mental illness, and other mental health needs prior to the COVID-19 pandemic; unmet mental healthcare need has only increased as a result of the pandemic. UNC will also leverage revenues to reinvest in growing existing programs to amplify its capacity to support the health and strength of communities across Colorado.

Both allopathic and osteopathic medical schools teach students the scientific foundations needed to become licensed physicians, but they take different approaches. Allopathic medicine focuses on diagnosing and treating medical conditions, while osteopathic medicine takes a more holistic, patient-centered approach and focuses heavily on prevention. According to the American Osteopathic Association (AOA)’s 2019 figures, nearly 57% of DOs practice in primary care specialties, 31% are family physicians, and 7% are pediatricians. By comparison, less than 30% of MDs practice in primary care specialties, 11% are family physicians or in general practice, and just under 7% are pediatricians (data from the Association of American Medical Colleges).

Graduates of allopathic programs receive Doctor of Medicine, or M.D., degrees. Graduates of osteopathic programs receive Doctor of Osteopathic Medicine, or D.O. degrees. After medical school, both M.D.s and D.O.s must complete residency training in their chosen specialties. They must also pass the same licensing examination before they can treat others and prescribe medication.

In order to open the University of Northern Colorado College of Osteopathic Medicine, it is estimated that UNC will need to raise nearly $200,000,000. UNC will raise these funds through a wide variety of means—principally through philanthropy, but we are also exploring opportunities for one-time state and local government support, partnerships, and other sources of funding. Once it is fully operational, the College is planned to be completely self-supporting, and will provide additional operating revenue that can be used to strengthen UNC’s existing programs in the sciences, health sciences, and beyond.

Construction Budget: $127.5 million
Physical plant costs including design, construction, and furnishings for the development of an osteopathic medical school facility will be at least $127.5 million to accommodate a medical school class size of 150 students per year. The projected cost could increase if additional space is planned to develop synergies with other programs in the sciences and health sciences or facilitate other programmatic opportunities such as workshops for K-12 students to explore careers in healthcare.

Start-Up Costs: $30 million
Total start-up costs over the three planning years and first two years of operations until tuition revenues are projected to match expenditures equal approximately $30 million.

Escrowed Funds Required by the Commission on Osteopathic College Accreditation: $42 million
The accrediting body, COCA, requires escrowed funds intended to fund teach-out agreements for the matriculated students in the event that the program fails during its initial years of operation prior to graduation of its first class of students. Estimates for the escrowed funds equal approximately $42 million.

Previously, the University of Colorado had exclusive authority in medicine, dentistry, pharmacy, and physical therapy education, as defined in CRS 23-20-101, “University of Colorado – role and mission – all campuses.” Senate Bill 22-056 amends the University of Northern Colorado’s role and mission (CRS 23-40-101) to include programs in osteopathic medicine and notes this exception to the University of Colorado’s exclusive authority in CRS 23-20-101. This change in statute was necessary for the University of Northern Colorado to proceed with the development of an osteopathic medical school. Senate Bill 56 was passed unanimously by the House and Senate with bipartisan support and was signed by Governor Polis on March 17, 2022.

Because UNC is still in the exploratory phase of the process, these are questions that do not yet have answers. Organizationally, the College of Osteopathic Medicine will likely stand alone as its own academic unit much like the other colleges. Physically, one potential location for the medical school is on the current site occupied by Bishop-Lehr Hall, where UNC has property and facilities that are not being fully utilized. This location has been explored in-depth in our program planning process.

The new college of osteopathic medicine (COM) and NHS have developed a collaborative relationship that is focused on mutual growth and support. Programs in NHS will continue to have their own faculty and staff to support its programs. Care is also already being taken to ensure that there are a sufficient number of commitments for clinical placements available so that NHS students and DO students will not have to compete.

Leadership from the College of Natural and Health Sciences serve on the college advisory board for the new COM as well as the research strategic planning team. Multiple initiatives have been identified that will synergistically benefit both colleges. These include development of learning opportunities in interprofessional education and the development of programming for students in 5th through 12th grade that allow them to explore careers in the health professions. Additionally, extracurricular opportunities for undergraduates have been provided through the COM, allowing students to learn suturing techniques as well as streamlining the process for undergraduates to shadow physicians in the community.