Lotteries, the ‘trifecta’ and parsing the “possible” for medical school expansion in Georgia
Georgia Lotteries
Lotteries have long been an alternative to taxation in the South, with the first Georgia lottery in 1785 contributing to hospital and poor house construction in Savannah. The first statewide lottery was sanctioned by New Hampshire in 1964, and state lotteries have rapidly expanded nationwide since. As the industry has grown, multi-jurisdictional lotteries offer greater prizes and related economic benefits. Since the Georgia Lottery’s inception in 1993, nearly $1 billion have been directed to education and more than one million students have been aided in attending colleges by Georgia’s HOPE scholarship.
Long before the modern Georgia Lottery era, MCG pursued a lottery process for placing its medical students in clinical education venues statewide. It began in the mid-1950s, when MCG’s surgery program could not accommodate all its educational needs in Augusta so surgical practices in Macon were provided with stipends to train MCG students. In the mid-1970s, when the class size grew to 175 students per class, the demand for student clinical clerkship sites drove the medical school to develop a significant community-based educational network. However, paying a stipend to all community-based teaching faculty across the state was viewed as cost-prohibitive, and the era of voluntary (i.e., unpaid) clinical faculty teaching began. MCG now has >800 such volunteers on its faculty roster who provide a truly invaluable service to their profession and to public medical education in their state.
Since the 1990s, the school has organized an annual February lottery to determine which students will pursue clinical training at the >70 community practice and hospital sites outside Augusta where many of these volunteers practice. Conversion of a noun into the verb, “lotterying”, reflects how MCG puts random chance and student preferences into action to distribute 22 percent of medical students into clerkship venues outside the Central Savannah River Area. Students expect and endorse lotterying and our statewide partners work hard to receive students into their communities and educate them effectively.
The national accreditation body for medical schools, the Liaison Committee on Medial Education, recently made its expected every 7-8 year visit to MCG. Given the high, 22 percent off-site clerkship figure, clinical “educational equivalence” was a LCME standard that received a good deal of the site team’s attention. The team left Augusta convinced of MCG’s commitment to doing whatever it must to maintain the quality and integrity of the statewide clinical training experience for its medical students.
Thus, these two important Georgia lotteries will continue to serve the state’s educational needs long into the 21st century.
The Trifecta
In horse racing terminology since circa 1974, a “trifecta” is a parimutuel bet in which the bettor must predict which horses will finish first, second and third in exact order. The word comes from the related betting term, “perfecta.” Odds of hitting a trifecta bet are long – averaging 250-to-1.
Trifecta also has become a slang term used to describe any successful or favorable phenomenon or characteristic that comes nearly simultaneously in threes. In 1979 at the age of 29, John Belushi hit a powerful trifecta few entertainers ever achieve –starring in the No. 1 movie (“Animal House”), appearing on a No. 1 rated show (“Saturday Night Live”) and holding the top spot on the music charts (with The Blues Brothers’ “Briefcase Full of Blues” album).
William Mallon is the national expert on medical school expansion at the Association of American Medical Colleges in Washington, D.C. He has written several comprehensive reviews of recent trends in medical school expansion and has been invited to Georgia on multiple occasions in recent months to help inform the process of expansion planning in this state. During one such visit, I asked Mr. Mallon if any medical school in history had ever attempted to simultaneously grow its class on a main campus, create clinical residential campuses elsewhere in the state and develop a new four-year branch campus. Upon reflection, Mr. Mallon replied that, “No medical school, to my knowledge, has attempted this… trifecta.”
This feat, a medical education expansion trifecta, is what MCG is contemplating undertaking to address the urgent shortage of physicians now recognized as a threat to Georgia’s health, health care and economy. A data-driven plan has been developed to determine the best approach to tackling this daunting task. But as in any high-stakes race, MCG and its partners will need a little good luck to accomplish this task on behalf of the state.
Parsing the “Possible”
Is it possible, with good luck and good management, to materially expand the state public medical school’s output of physicians to 300 per year by 2020? In this world nothing is certain except death and taxes (Benjamin Franklin in a letter to Jean-Baptiste Leroy, 1789); everything else is technically possible.
So, yes – if we start today, the LCME can technically accredit, and MCG can technically implement, a materially expanded M.D. education program designed to accept and educate 110 more students per class by 2017. And unlike a push bet in Las Vegas, the proposed partnership approach can possibly produce a “win-win-win” for all involved.
But unlike private university medical schools at which I’ve trained and worked, MCG is a public asset under the governance of the University System of Georgia Board of Regents that receives state funding. The opinions, and eventually the votes, of the regents and legislators, will be critical to launching and funding this expansion. In 1867, German Chancellor Otto von Bismarck proclaimed that, “Politics is the art of the possible”. If so, we can expect eventual approval of the plan to expand medical education statewide in partnership with UGA and several health systems.
It has also been said that, “Something once thought impossible achieves improbability, and through force of will summoned, becomes inevitable.” And if it’s true that, “You can make your own luck”, Georgia can indeed summon the force of will needed to act in its own best long-term interest and beat the long odds it faces.
The cautionary take-away from the information now at hand is that odds are, the need for doctors, the technical hurdles and the related expansion costs will all increase with each passing month and year before the plan is implemented. And we should remember – whether buying a lottery ticket or betting at the track – the time comes when the wickets close and it’s too late to get into the game.
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