By Aaron Stiles
Construction has become part of the Las Cruces landscape and while it may bother some, it’s nothing new to people in the New Mexico State University community.
Since April 2015 construction has been a common sight at the northeast corner of the intersection of Wells and Arrowhead Drive. The project: the Burrell College of Osteopathic Medicine, southern New Mexico’s first medical school.
Construction has now been completed. While the school is awaiting its first class to arrive in fall 2016 and for faculty to arrive in the summer, the school is the daily haunt of more than 75 staff members, such as George Mychaskiw, the school’s founding dean and chief academic officer, and Justin McHorse, BCOM’s assistant dean for multicultural affairs, marketing, and communications.
What is osteopathy?
Osteopathy was developed by Andrew Taylor Still, who founded the American School of Osteopathy—the first osteopathic school in the world—in 1892.
The difference between osteopathy and its traditional medicine counterpart—allopathy—is mostly in name. So doctors of osteopathic medicine (DOs) and medical doctors (MDs) vary little, aside from the fact that DOs take 200 additional hours in learning osteopathic medical treatment (OMT), which “involves using the hands to diagnose, treat, and prevent illness or injury. Using OMT, (an) osteopathic physician will move your muscles and joints using techniques including stretching, gentle pressure and resistance,” says Osteopathic.org.
Construction of the NMSU-adjacent college is estimated at $105 million.
The school is the brainchild of Dan Burrell, originally from New York, who now lives in Santa Fe and is very involved in New Mexico business. He founded and serves as CEO of the Burrell Group, LLC, among whose business holdings include a garnet mine and cattle ranch near Alamogordo and a Santa Fe-based real estate business, which recently partnered with Hong Kong-based Gemini Investments Limited in August 2015.
Burrell and his wife, Katherine, also founded the New Mexico Leadership Institute, a training/mentorship program for high school students. A competitive program, the NMLI selects 30 students per year, who upon completion of high school are automatically accepted into either NMSU or UNM and receive grants of $15,000.
Announcement of the forthcoming construction of BCOM and NMSU’s partnership with the college were announced in the summer of 2014, but the college and NMSU started negotiations a year earlier, when eventual BCOM Dean George Mychaskiw, DO, contacted Kevin Boberg, vice president for economic development at NMSU and co-founder and inaugural CEO of Arrowhead Center, NMSU’s business development service.
Boberg says that when Mychaskiw met with him and told him about osteopathic medicine and that he and Dan Burrell wanted to build a college of osteopathic medicine, Boberg became interested.
One of the tenets of osteopathic medicine—“providing care in rural and urban underserved areas,” according to the American Association of Colleges of Osteopathic Medicine’s website—aligns perfectly with NMSU’s mission as a land-grant university.
As New Mexico’s land-grant university, which was given to the state as part of the 1862 Morrill Act—allotting 30,000 acres of land to be sold and the proceeds used to fund education in agriculture and “the mechanical arts—Boberg says the partnership between NMSU and Burrell is a furtherance of the ultimate goal of the Morrill Act: to provide education and aid to all social classes.
Not Burrell’s only osteopathic college
Among Burrell’s other business ventures are two additional proposed osteopathic colleges.
As late as December 2015, Burrell was negotiating with Montana State University officials to open another college like the one located on NMSU property. That proposed college, however, has evidently been struck down.
“After concerns expressed by some physicians in the state, it has become evident that MSU’s involvement in these conversations is not resulting in the careful consideration this proposal deserves,” the Bozeman Daily Chronicle quoted MSU President (and former NMSU interim president) Waded Cruzado as saying in a press release. “We acknowledge that, for this or any other medical school to be successful, the participation of local and regional physicians is an indispensable component. Therefore, with due respect to all parties involved, MSU is withdrawing from these conversations with the Burrell College of Osteopathic Medicine.”
With negotiations currently at least on hold for Montana, Burrell then proposed building an osteopathic school in Idaho to Governor C.L. “Butch” Otter, which has apparently been met with more support than the Montana college, as an open date for 2018 has already been set and between $110-$125 million offered by private investors, The Bozeman Daily Chronicle reported in February.
Why in New Mexico but not Montana?
Why did plans for an osteopathic college succeed in New Mexico but not in Montana, which, like New Mexico, is facing a physician shortage and which, like New Mexico, already has an established medical school in the Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) program?
“It is unrealistic to consider that a corresponding number of residency positions can be created in Montana to accommodate the additional osteopathic students,” University of Washington School of Medicine (which has a 44-year partnership with Montana and MSU specifically in recruiting medical students) CEO Paul Ramsey wrote. “Increasing residency education in the state requires having sufficient numbers of clinical training sites for residents; these will be significantly limited by increased numbers of osteopathic students.”
Only time will tell if Burrell’s plans for an osteopathic school in Idaho, which is also part of UW’s WWAMI program and has a lower population than New Mexico’s but higher than Montana’s, come to fruition.
Prevalence of osteopathic colleges
There are currently 33 accredited osteopathic colleges in the United States, according to the American Association of Colleges of Osteopathic Medicine (AACOM), the accrediting body.
“These colleges are accredited to deliver instruction at 48 teaching locations in 31 states,” AACOM’s website says.
Of these 33 osteopathic colleges, two are accredited with for-profit models. The Burrell College of Osteopathic Medicine is one such for-profit.
The stigma of for-profit colleges
While the concept of benefiting from higher education has been around for decades, if not centuries, much of the controversy and indeed stigma surrounding for-profit institutions propagated as a result of for-profits’ humongous proliferation during the 2007-08 recession.
“As enrollments soared, regulators took notice of high tuition costs and poor student performance,” the L.A. Times reported in August 2015. “For-profit colleges on average charge more than four times as much as community colleges, according to the College Board, and cost significantly more than the in-state tuition at public four-year colleges.”
As the recession wore off, the frenzy of students enrolling in these institutions dropped severely, particularly as a result of repeated investigations by the U.S. Senate, the Securities and Exchange Commission, the Federal Trade Commission, the U.S. Consumer Financial Protection Bureau, state and federal Departments of Education, and dozens of state attorneys general, among other entities.
These investigations continue to examine “questionable job placement rates and deceptive marketing practices,” the L.A. Times said.
Education Management Corporation, which owns several chains of for-profit colleges—among them, Brown Mackie—settled a lawsuit from 2011 in 2015 and paid more than $95 million to former employees, who alleged the corporation paid recruiters based on the number of students they enrolled. By so doing, EMC “was able to tap into billions of dollars in federal student aid,” the Times reported.
Earlier this year, the now-defunct Corinthian Colleges had to pay more than $1 billion to former students after a San Francisco judge ruled the colleges “provided untrue or misleading statements about graduates’ job placement rates, duping both students and investors, and that the Santa Ana-based company unlawfully used U.S. military seals in advertisements, among other claims,” the Times reported in March 2016.
Given these facts, which arguably put for-profits as a whole in a bad light in the minds of current and potential students, should the NMSU community be concerned about a partnership with a for-profit?
Sheridan Chaney, associate vice president of media relations at the American Osteopathic Association, says no.
“(For-profit) Medical schools are unlike other for-profit institutions because their outcomes are concrete and highly documented through mechanisms such as performance on the COMLEX and USMLE exams, as well as the percentage of students who are placed in graduate medical education (most commonly referred to as a residency),” Chaney said.
The AACOM considers licensing exam scores and match rates for graduates and residency programs in its criteria for accrediting for-profit medical schools, Chaney said.
“The same is not true of for-profit institutions offering degrees in fashion, merchandising, general business, and the like, so comparisons don’t really make much sense,” she said.
No matter the business model, medical schools are educating future physicians with standards set by the U.S. Department of Education.
“(This ensures) that every medical school graduate receives adequate education and training to become a fully licensed physician,” she said.
BCOM, a blessing to southern New Mexico?
“According to a 2014 study by the nonpartisan Commonwealth Fund, New Mexico ranks last in the nation for health care affordability and access,” says Think New Mexico.org.
This has been backed up by the New Mexico Healthcare Committee, which in October 2015 published their annual report, which stated that New Mexico has been facing a doctor shortage in recent years and it doesn’t seem to be improving.
Most of New Mexico has a “mild shortage”—more than 10 providers per county—while Valencia and Lea Counties are facing “severe shortages”—less than 10 providers.
“New Mexico only has 1,908 primary care physicians,” reported KOAT7 News in Albuquerque on the committee’s annual report. “When you put that number up against the state’s population, there is only one primary care physician for every 1,099 New Mexicans in the state.”
The news station also reports New Mexico’s primary care physician numbers are below the national standard by 145, below the national standard for nurse practitioners by 197, and below the national standard for psychiatrists by 109.
Addressing and remedying physician shortages in New Mexico is one of BCOM’s goals, says Mychaskiw.
“We started this project wanting to improve healthcare in the borderlands, (and) we brought the college here knowing that a college was the best way to do it,” he says.
Addressing physician shortages is also a tenet of osteopathy as a whole.
“The mission statements of the majority of osteopathic medical schools state plainly that their purpose is the production of primary care physicians,” says the American Association of Colleges of Osteopathic Medicine’s website.
BCOM has created 108 new residency positions in the region, and over the next decade another 600 residency positions are expected to develop, said Mychaksiw.
BCOM has identified several “recruitment hubs” in addition to Las Cruces: Albuquerque, El Paso, Tucson, and Ciudad Juárez.
“All of our hubs will have residencies,” Mychaskiw says.
Creating residencies is part of BCOM’s accreditation, Mychaskiw says.
Burrell separating itself from other for-profits
Mychaskiw was once a vocal opponent of for-profit colleges, even for-profit medical schools, having written a number of letters to the editor of the Journal of the American Osteopathic Association.
The fundamental difference between for-profit and nonprofit colleges and governmental agencies like NMSU, Mychaskiw argues in one 2008 letter to the JAOA, is how these institutions spend excess revenue: on research, in nonprofits’ case, and as returns to investors, in for-profits’ case, otherwise neglecting research.
“My previous opposition to for-profit medical education was based on a very different model, motivation, location and time in history,” Mychaskiw says.
He says the for-profit business model was decided on for BCOM by both Burrell and the Rice Management Company—Houston’s Rice University’s foundation—as “the most reliable way” of accomplishing BCOM’s ultimate goal: to improve the health of southern New Mexico.
“Times change, economies change,” Mychaskiw says. “It makes sense here. It may not make sense everywhere. It could be that a different model might work somewhere else.”
Rice University, which owns the majority of BCOM—Mychaskiw estimated between 51 and 53 percent—while Burrell himself owns the remainder, “only invests in long-term, credible ventures consistent with their mission of higher education.”
Burell and Rice, however, “have full shared fiscal governance” and their operations are overseen by a local board of directors, Mychaskiw says, which includes: himself, Burrell, Jaime Aguirre—investment director for private equity and venture capital with the Rice Management Company—John Hummer—BCOM’s co-founder, executive director, and president—banker John Jetter, Burrell’s father, Chet, Angela Throneberry—senior vice president for administration and finance at NMSU—John Cruickshank—a DO and CEO of Lovelace Medical Group—NMSU Chancellor Garrey Carruthers, Susan Martinez de Gonzales—CEO of La Clinica de Familia—Denten Park—CEO of MountainView Regional Medical Center—John Harris—CEO of Memorial Medical Center—and Bill Baker—family DO and NMSU physician for athletics.
“Finally we have a strong accreditation agency that holds all osteopathic schools to consistent high standards, so we believe that, given the substantial number of checks and balances built into the system, we have done the most credible job of opening the best possible medical school, regardless of ultimate business model,” Mychaskiw says.
Mychaskiw says research will not be neglected at BCOM as a result of the Burrell Institute of Health Policy & Research, a 501(c)(3) nonprofit organization housed within BCOM.
“Our mission is to provide accurate and timely information regarding health characteristics, risk factors, behaviors, health care practices and programs to facilitate health policy changes for improving the health status of the Southwestern U.S. and Mexico–U.S. border population,” the website says. “The Burrell Institute conducts a variety of policy-oriented research projects and provides position papers to legislators, decision-makers, and the media. Our research activities are focused at reducing health disparities, improving access to care, and assisting the policymaking process at local, regional, national, or international levels (particularly at the US-Mexico Border region).”
Mychaskiw said the institute is in “the best position” to offer unbiased input on health matters and conduct research that “serves the public good.”
Both Mr. Burrell and I see this as a responsible use of our resources to meet our research mission and serve the public,” he says. “While this may lower the ultimate profit margin, our mission is to improve health.”
Still BCOM will benefit investors.
“Our investors will get a fair return and also serve the public,” he says. “Had they wanted to maximize profit, they likely would have opened a different business. As dean, my job is assure the best quality education and responsible use of resources. I have never, however, been asked by either Rice or the Burrell group to limit spending or worry about profit, and I suspect I will not be asked. Their sole concern has been quality of the institution.”
The difference between for-profits and nonprofits
Unlike Mychaskiw, Carruthers doesn’t see as much difference between the two kinds of medical schools.
For-profit universities are by definition businesses, whereas applying that term to nonprofits and governmental agencies—NMSU—is more difficult.
In staff and faculty meetings, Carruthers has repeatedly emphasized that NMSU needs to be run like a business in order to become “a 21st-century university.”
“You need to restructure this great university for the 21st century,” Albuquerque Business First reported back in December. “We looked at staffing patterns, for example. We want to know how (we) stack up against other universities. We thought we may be overstaffed, so we hired someone to look at our staffing patterns. We were told that we were not overstaffed, but poorly organized. We also don’t minimize the layers of management the way you would in business, so we looked at that, too.”
In a November 2008 faculty retention report by professor emerita Christine E. Eber, anonymous former faculty cited former NMSU president Mike Martin’s “CEO-like management of the university” as contributing to their—the faculty’s—reasons for leaving NMSU.
“Mike Martin is a CEO,” a respondent said. “The money-based model that they follow doesn’t consider the broader quality of life of faculty, students and staff. It is reprehensible.”
“There are private universities and there are public universities,” Carruthers said in response to the criticism of the former president. “They provide the same service. Higher education almost across the country is now facing all kinds of deficits. Every university should be operated on good business principles. How you get those business principals implemented is key.”
Understanding the details of the partnership
NMSU Chancellor Garrey Carruthers spoke to The Round Up/Oncore Magazine to tell us how he became involved in the partnership.
When Boberg pitched the idea of the partnership to Carruthers, the chancellor was similarly intrigued.
Carruthers is no stranger to the business of healthcare: in 1993 he served as president and CEO of Cimarron Health Plan.
After meeting with Boberg, Carruthers gave the go-ahead for Boberg to travel to Chicago to make an early presentation to the Commission on Osteopathic College Accreditation to receive pre-accreditation in order for construction on BCOM to commence.
Carruthers and the NMSU Board of Regents agreed to lease the plot of land where currently the college sits to BCOM through the Arrowhead Center. BCOM then pays rent—$22,360.80 a month—for the 7.626 acres to Arrowhead, which then pays NMSU.
Carruthers stressed that BCOM is not NMSU’s college and that it would not be funded by a single public dollar.
BCOM is responsible for its own maintenance work—such as landscaping, heating and air conditioning, utilities, parking areas.
Benefits for students
“(BCOM) addresses a need for physicians and also will make New Mexico State more attractive to those students interested in health sciences,” Carruthers says.
One of the most visible benefits for current and future NMSU students as a result of the partnership is the Current Use Scholarship.
BCOM has arranged to gift NMSU $125,000 every December for the next four years. NMSU will then distribute this gift in the form of student scholarships.
“The ultimate decision on which majors to include will be the decision of the NMSU Foundation,” says Justin McHorse, dean of communications at BCOM. “However, we would envision that this would include all the health science-related degrees offered at NMSU and any major that a student would take along with a pre-medicine focus. For example, biology and chemistry as well as liberal arts and engineering are eligible majors whereby students are also pursuing a pre-medicine curriculum.”
After year four, when the overall amount gifted has reached $500,000, BCOM will continue with a yearly gift of 1.5 percent on that $500,000 each subsequent year.
Another benefit for NMSU students is the partnership’s pathway agreement, which specifies that BCOM will reserve a certain number of spaces for New Mexico students enter BCOM when they graduate from NMSU.
This is an extremely important facet, as it allows communities in New Mexico to aspire to greater heights, they can now tell their children in middle school and high school that if they want to have a career as a doctor, they have the resources to do so right in their home state.
BCOM students also benefit. Through their tuition to BCOM and student fees to NMSU, osteopathic students will have access to NMSU’s Campus Health Center, Activity Center, the Counseling Center, have access to Taos and NMSU housing at the same rate as NMSU students, among other amenities.
To compensate NMSU for these services, BCOM will pay NMSU an annual services payment dependent on: BCOM’s student headcount (x) NMSU graduate student seeking nine or more credits fee (x) two semesters (x) administrative cost factor (tentatively 1.12 percent).
McHorse estimated, based on this formula, that NMSU can expect to receive approximately $210,000 this first year.
“BCOM’s base tuition is $46,650 per year for academic year 2016/2017,” McHorse told The Round Up/Oncore Magazine. “It is important to point out that our tuition is lower than the national average of all other private osteopathic medical schools, of which 80 percent are private, not-for-profit. And we are offering this tuition with brand new facilities, amenities and outstanding faculty recruited from across the nation.”
BCOM students will also pay NMSU student fees in order to access student services and amenities, such as athletic games. Their student fees, Boberg estimated, will amount to $700,000 or $800,000 a year.
“We are using a curriculum that has been tested and proven at other institutions, so we have a curriculum that we know results in the highest board scores,” Mychaskiw says. “The students have to take three sets of board exams during medical school: one set they take right after their first two years of training, that’s called the Part One, and that’s sort of the ultimate judge of how good your curriculum is.”
BCOM’s website outlines the curriculum:
“The curriculum uses several educational approaches, including: traditional lectures, integrative sessions (using electronic response systems), laboratory and skills instruction, active learning (adult and interactive techniques), team-based learning, large & small group sessions, directed study, and clinical case presentations,” the website says. “This variety of learning formats fosters comprehension, promotes the application of knowledge, emphasizes competency in osteopathic philosophy, develops clinical skills, and stimulates critical thinking and problem-solving skills.”
BCOM students should be able to graduate in four years. The first two years are spent on campus in classrooms, the next two years students spend in clinicals, done in BCOM’s training hubs throughout the region. After graduation, a student does a three-to-five-year residency.
Boberg said these four-to-nine years, depending on where students do their residencies, are important because it gives BCOM students time to acculturate to New Mexico, which is an important facet of providing health care to this area.
“After they get their degree, and they do their residency, they’re more likely to come back to a rural community than an MD (because of osteopathy’s focus on providing care in rural and urban underserved areas),” he said.
Osteopathy is “more suited to New Mexico,” he said.
Bottom line: Is it worth it?
Students must ask themselves if going to college, whether for-profit or not, will result in their landing a decent-paying job?
Mychaskiw said one of the reasons BCOM is a good choice for students is because of its accreditation.
“It’s an interesting model in for-profit medical education,” he says. “It’s very different than in other forms of higher education mostly because we are accredited by the same accrediting body as the not-for-profit medical schools. So today, if you count us, there are four for-profit medical schools in the United States: two MD schools and two DO schools. The MD schools are accredited by the Liaison Committee of Medical Association and we are accredited by the Commission on Osteopathic College Accreditation.”
This is important because it ensures that students can look at BCOM and compare it to other accredited schools to find the right fit. At the same time, having the same accreditation as the nonprofit schools creates a natural defense against unsavory practices.
“If, for instance we wanted to double the number of people in school just to make more money, the accreditors would have to sign off on that,” Mychaskiw says. “The accreditors don’t look at how much money you’re making, what they look at is, ‘Will you still deliver a quality education and will you be able to get (those students) jobs?”
Further accreditation details for BCOM can be found at: http://bcomnm.org/about-bcom/the-college/accreditation/
Mychaskiw also said the shared governance of the college between Burrell and the Rice foundation is an important check-and-balance, as one cannot make a decision without the other’s approval.
So how will BCOM achieve its goal of improving the health care accessibility of New Mexicans, and, in the larger picture, fill the physician shortage in the state with “culturally competent” New Mexico doctors?
First of all, where are most BCOM students from?
“The majority of applicants to BCOM, and all medical schools in our nation, historically originate from California, Florida, Texas, and New York due to sheer population,” McHorse said.
“As a brand-new medical school admitting our first class in August of 2016, we will measure our success in the development of pipeline programs and the recruitment and retention of New Mexico residents over the long-term,” McHorse said.
By McHorse’s estimation, about eight New Mexicans a year get into an osteopathic medical school.
“We will not have our first class finalized until this June and therefore we are unable to report BCOM’s final number of New Mexico residents,” he says. “However, we can easily report that we have already exceeded the historical number of resident admissions into osteopathic medical school from New Mexico.”
McHorse said eventually they want at least 97 percent of BCOM students to be from New Mexico, which UNM’s medical school has accomplished—though they had 75 years to do so.
“BCOM was created to address and solve a chronic physician shortage in our region of the United States and to improve the health care of the citizens we serve,” McHorse said. “BCOM’s leadership, owners, NMSU leadership, local physicians, hospitals, and community leaders recognized the need and implemented a solution. Addressing the physician shortage is not an overnight fix, as that would be unrealistic. Rather an improvement, incrementally, over the long term and in collaboration with all stakeholders.”