Q: This fall, the School of Medicine will open its third rural primary care program site. Clearly, that 10-year-old program has been successful.

A: That program gives our students the opportunity to work in and contribute to small rural communities, and it provides medical care for the residents of those communities. We started the program in Winnsboro. In 1998, we opened the second program site in Kershaw. This year, we are in the final phases of organizing our third program in Bennettsville. We hope to develop two more in the state. We've made it a philosophical point that we don't go into a community without the complete support of the medical community, political leaders, hospital systems, and business leaders. Orchestrating those interactions takes a lot of time and energy. The program is very popular with our medical students. Our third-year medical students have an eight-week mandatory clerkship in family medicine where they spend four weeks in Columbia and four weeks in a site around the state. They participate in the life of the community and get to know the residents. For many students, it is a career-changing experience.

Q: Why do some School of Medicine students train in the Greenville Hospital System?

A: Since 1991, 12 of our third-year students and 12 of our fourth-year students have received all of their clinical training in the Greenville Hospital System. It's a voluntary program where students spend their last two years in Greenville: they live there, and they take all their clinical experiences there. The Greenville Hospital System is the largest in the state, and it offers our students many learning opportunities. The collaboration has worked out extremely well, and our students are happy with the experience. They have equivalent experiences to what they would have if they were in Columbia. We have a lot of contact with faculty up there to coordinate and make sure they are equivalent programs. It also gives the hospital system more exposure to medical students than in the past, and it has helped them recruit medical students into their graduate medical programs. For third-year students, there are six, eight-week-long, required clerkships: family medicine, internal medicine, pediatrics, surgery, ob-gyn, and psychiatry. Students spend this time at the bedside taking care of patients. Part of the time is spent at hospitals, part at clinics. That has been one of the changes in recent years in medical education: students have more than just hospital experience. Now they also have outpatient and ambulatory care experience.

Q: Would you address an issue that has been a recent point of discussion: Does South Carolina need two medical schools?

A: I've talked about this a lot in the past few months. Here's the issue in a nutshell: if you take a look at the medical workforce in South Carolina, you'll find that South Carolina has fewer medical students, fewer residents, and fewer physicians than the average southern state, and certainly the average state in this country. The State Budget and Control Board says that for the foreseeable future, South Carolina will have a significant shortage of primary care doctors, a geographic maldistribution of physicians, and an inadequate number of minority physicians. This is fairly common for most states in the country. The Dean's Committee on Medical Education, which is a subcommittee of the Commission on Higher Education, has concluded that we have about the right number of medical students and the right number of house staff in South Carolina given these workforce issues. The evidence suggests that South Carolina needs 210 to 225 medical students per year (which is how many we have: the School of Medicine has 70 to 75; MUSC has 140 to 150). The dilemma is that it is very difficult for any one location to educate 210 medical students. It could not be done right now without additional faculty and facilities. Not only that, it would be very difficult in the third and fourth years to educate that many students at one site. The limited number of patients at any one site virtually dictates that you must have more than one campus. The only way to have one site is to dramatically cut the number of medical students, which would negatively affect workforce issues. So the simplistic idea of eliminating one medical school is not a responsible idea. In a relatively short time, you'd create a physician crisis in South Carolina. Not many people realize that even though the total budget of the School of Medicine is $105 million, we receive only about $25 million in state funds. The rest is generated through research grants and clinical practice. Also, essentially the facilities cost USC and South Carolina nothing. The basic science campus is leased to USC for $1 a year from the Veterans Administration. And the clinical campus located by Palmetto Richland Hospital was bought, financed, and improved by revenue generated by the school's practice plan. Since 1974, we've received $350,000 worth of capital improvement bond funds. During that same time, MUSC has received about $80 million. In fact, no academic unit in this state has received less facilities money than the School of Medicine. From a facilities standpoint, you'd be hard-pressed to find a better bargain in South Carolina. Merging the state's two medical schools is a theoretical possibility. But you'd still have to have two campuses, and it would take a huge administrative process to orchestrate this change. It could be done, but it wouldn't be easy, and it wouldn't be cheap.