In the office of East Lansing Mayor Mark Meadows is a glossy brochure available to the public praising the “trusting relationship” between the City of East Lansing and Michigan State University. This relationship has come under stress lately, a fact one can read on Meadows’ face, as he uses terms like “worst-case scenario.” In the last several years the university has already made $31 million in cuts and eliminated more than 300 jobs and 15 academic programs. And now the future of the College of Human Medicine, with a $74.8 million budget, 200 faculty members and 434 students, is in doubt as MSU ponders moving it to Grand Rapids.

Meadows

Meadows said he first learned about the plan about six weeks ago, when someone gave him a copy of an October 2003 article that ran in the Grand Rapid Press. Around the same time, MSU President Peter McPherson had given a speech at Lansing’s Rotary Club, after which he was asked about the rumor and couldn’t deny it.

According to rumors circulating in the Lansing area medical community, MSU was offered between $600 million and $700 million to relocate the medical school to Grand Rapids. David Van Andel, chairman of the Van Andel Institute, told Grand Rapids television station WZZM-TV that his city badly needed a medical school and would like to woo Michigan State University with an offer. A statement issued by the research institute’s board pointed out that the move would improve collaboration between MSU and the Van Andel Institute. “The potential relocation of Michigan State University’s College of Human Medicine to Grand Rapids presents an excellent opportunity for the school, the Van Andel Institute, Grand Valley State University and area health care organizations. For Grand Rapids, a community that constitutes the western anchor of the Life Sciences Corridor, the medical school would serve as a vital … asset to the existing one and emerging efforts.”

Bruce Hoffman, the spokesman for Spectrum, a Grand Rapids-based non-profit health care organization, confirmed that Spectrum officials were discussing with MSU ways to “raise their profile” in the Grand Rapids area. Spectrum has nine hospitals. “The discussion of them increasing their presence here in Grand Rapids is part of a natural evolution. We’ve been discussing this for many years,” Hoffman said.

MSU spokesman Terry Denbow avoids the word “move,” preferring the notion of an “expanded presence.”

Denbow said the college already had a small presence in Grand Rapids and that the discussions weren’t budget-driven. “We’re talking about a medical school for the 21st century and about what the best approach is for the College of Human Medicine and for the state of Michigan.” Currently there are 54 medical students in Grand Rapids-area hospitals, all of whom are third and four-year students. Third- and fourth-year medical students already study in hospitals across the state, but first- and second-year students remain in East Lansing for training. One of the many decisions to be made with the new proposal is whether to send some, or all, of these first- and second-year medical students to Grand Rapids.

Denbow said three reasons make Grand Rapids an attractive location for expansion: “There’s a wide array of hospitals, there’s a population base twice the base of this area, and there’s the Van Andel Research Institute.”

Denbow said that no matter how the expanded service in Grand Rapids develops, clinical services in mid-Michigan will not be reduced.

Final decisions regarding the possible move will likely be announced in May.

Meadows said that the more optimistic rhetoric of “expansion” hasn’t given him much of a sense of relief. He said he will continue to worry about the future of area medical jobs until the university clearly states it is not interested in moving. “No one has said to us we’re not moving the school. Until that happens, we’ll continue to operate in a worst-case scenario,” he said.

If MSU students no longer receive their primary training in East Lansing, this would produce a “net reduction in the ability of this region to deliver growing health care to its residents,” Meadows said.

The mayor said that there was a great synergy between the two MSU medical schools — the College of Human Medicine and the College of Osteopathic Medicine — and that this would be lost if one of the two were to be moved. “You can go into virtually every hamlet of this state and you will find either a D.O. or an M.D. who’s been through the College of Medicine. Every resident of this state will receive over their lifetime about 95 percent of their health care from family practice physicians.”

A smaller percentage of care requires specialization, Meadows said. He believes MSU is driven by the desire to move the College of Human Medicine into some of those sub-specialties, and it’s for this reason they’re exploring their options in Grand Rapids.

Meadows says he has nothing against such plans, but he doesn’t believe it’s a wise decision to cut ties to the existing health community in the Lansing area, which serves more than 400,000 patients. “The type of medical research that you might be able to encompass in Grand Rapids can be easily done here as well.”

Meadows also asks whether it’s wise to spend public dollars for the creation of opportunities in one jurisdiction by robbing the future of another jurisdiction. He said the situation could be compared with that in the manufacturing industry. “Particularly in this state, we’re worried that what we have here is a migration of medical care-related employment opportunities to the Grand Rapids area from the capital region. Using public dollars to create those opportunities is not a good public policy decision.”

The medical community’s response

Nigel Paneth, an associate dean of research at the Department for Human Medicine and Epidemiology, agrees with Meadows. Moving the school to Grand Rapids would hurt the community in so many ways, Paneth said, that he hesitates to even imagine the scenario.

In addition to the exodus of medical school faculty members, it would inevitably reduce medical care in the region, because the community would no longer be able to attract the same quality doctors.

He said a move would also reduce medical research. “If you move the entire complex to Grand Rapids, the research productivity would be tremendously impaired, because it’s taken away from its scientific roots in the university. That’s a very risky thing to do.”

But Paneth believes MSU could expand its presence in Grand Rapids without hurting the Lansing area economy or the quality of local health care. “MSU can provide a medical school for the Grand Rapids region that will satisfy that area’s needs. But it doesn’t have to abandon its Lansing area medical school to do that. I think it should rather develop a plan in which two kinds of medical schools are operative, really complementing each other. That would be ideal.”

Howard Brody, a family physician and professor at MSU’s Center for Ethics and Humanity in the Life Sciences (and a columnist for City Pulse), said that given the massive cutbacks in state funding, the possibility of improving funding by expanding to West Michigan was “awfully attractive.”

Brody said that one third of the state’s support has been cut over the last 10 years. Most faculty members believe that finding viable private partners would be the best for the school to keep from stagnating. “If people come along with hundreds of millions of dollars, a lot of us will find this exciting. Medical research and education are expensive.”

There’s nothing wrong with the College of Human Medicine wanting to acquire support, Brody said, but he voiced concerns that it would lose its independence and reputation as a community-oriented program if it had to depend (more like the University of Michigan’s medical school) on a large “cash-cow.”

Brody believes that Grand Rapids’ main interest in the College of Human Medicine is tied to the Van Andel Institute, which has hired several top-notch medical professors in the last three years, and is seeking an affiliation with a major university to lure even more medical experts into the area. “The research will then take off, and all the new life science and genetics jobs start spinning off, jobs are being created, and the local economy booms,” Brody said.

Paneth, however, thinks that the private health care institute’s role in this issue is overrated, since it is only a small-scale research operation. “It’s a fine cancer-oriented molecular research institute, but it’s not in the position to serve as the core scientific element of a new medical school, even if it wanted to.”

A medical school would have to teach its students a range of basic sciences — physiology, pharmacology, and biochemistry among others — which are not all represented at the Van Andel Institute.

Paneth said he had enormous respect for the institute, but one must also see things in perspective. While the Van Andel Institute received $250,000 from the National Institutes of Health last year, this was still less than 1 percent of what MSU received ($36 million).

The associate dean, who came to East Lansing in 1989, agreed with Brody that MSU has established a reputation for taking medical teaching very seriously. If the administration decides to establish a separate medical school under its auspices in Grand Rapids, “we would definitely have to make sure that it would also have the same quality of teaching that we pride ourselves on here. No doubt about it.”

Paneth pointed out that he believes the university could establish two different schools with slightly different focuses. He thinks that the East Lansing campus could remain oriented towards primary care and continue to send medical students out to other campuses in Flint, Marquette, Kalamazoo and Saginaw, while Grand Rapids would be more research oriented. “I don’t want to impose one model onto another. I’d like to have both. You’ll have some students who are drawn to one model, others to another. They will enrich each other. Whatever we will do, the important thing is to build and not destroy.”

Does a “win-win” situation have a winner?

Meadows said he has no reason to object to MSU’s expansion plans in Grand Rapids, as long as they don’t also mean relocating large parts or the entire college.

Meadows has helped to establish a new group, called the Executive Response Team, whose purpose is to prevent such an event from happening. Members of the group include Lansing Mayor Tony Benavides; William Sepic, president of the Lansing Regional Chamber of Commerce; and Jack Davis, chairman of the Retain GM Committee established when David Hollister was mayor of Lansing.

Meadows said the objective of the group is to offer the university a way to make it economically more viable for them to remain here as opposed to relocating the medical school to Grand Rapids.

But what incentives could local governments offer Michigan State University?

Meadows said that increasing the number of patients would be one way of making Lansing-area health services more competitive with Grand Rapids. “By that I mean creating such an attractive medical model within the Lansing region that people will come from all over the place to receive their patient care. You have to remember, the Mayo Clinic is in a cornfield in Rochester, Minn., but people travel from all over the world to receive medical care there.”

The group has also hired the Lansing-based Health Management Associates to conduct a study exploring two questions: “Is there a positive educational reason for MSU to move its medical education to Grand Rapids? And two, will there be an impact on the ability to deliver medical services in this region, and if so, how should we plan this out for the next 20 years?” Meadows said several members have pledged their financial support for this study, which is not to exceed $10,000.

While Meadows said he’s hopeful that they will manage to create a “synergy” between the two regions, so that neither loses economically and both are able to improve their health care, other sources City Pulse spoke with said they wonder whether this can be a “win-win” situation.

Michigan State University health care economist John Goddeeris said that while people often like to talk about “win-win” situations, in reality there are rarely situations where everybody wins. “For the Grand Rapids Community and MSU as a whole, there might be a way for it to be a win-win situation, as both those parties might gain. But if there’s some sort of move to Grand Rapids, there will be individual people who feel like they haven’t won.”

His colleague Charles Ballard added that if MSU moves the college to Grand Rapids, this wouldn’t only mean that the Lansing area loses medical jobs. It could also have a ripple effect. “If you lose one job, this can tend to multiply somewhat, because there will be less demand for wrenches at the hardware store, and movie tickets, groceries and oil changes in the Lansing area,” he said.

Ballard said this effect could be much smaller if some faculty and staff decide to continue living in the Lansing area, and commuting to their jobs in Grand Rapids.

Is the medical school’s accreditation at risk?

How might these expansion plans affect MSU’s nationwide accreditation?

In the United States, the accreditation status of medical degree programs are determined solely by the Liaison Committee on Medical Education, which, in a cycle of seven years, evaluates the medical programs of 126 M.D.-granting institutions in the United States. MSU’s next evaluation is scheduled for 2006.

Frank Simon, an executive at the organization’s home base in Chicago, said he has been informed about the discussions of a move. Simon said his organization would need to be formally notified if the College of Human Medicine makes an official decision to move its main institution.

Depending on the amount of information received, the organization’s staff might then decide to “come out on a focused visit to look at what the preparations are for the move.” Simon said they would also investigate the continued resources provided for MSU’s College ofOsteopathic Medicine. The two colleges have a joint faculty. If osteopathic medicine stays in East Lansing, the two colleges will have to explain how they will handle the faculty they used to share jointly, Simon said. During its special visit the committee would also evaluate whether the school had the appropriate faculty, buildings and equipment to achieve its educational and medical goals.

Dorothy Gonzales, an MSU trustee, doesn’t think the expansion plans in Grand Rapids pose a threat to Lansing’s regional economy. Gonzales argues that partnering with entities like Spectrum or Van Andel becomes necessary in times when budgets are tight. “The cost of health care delivery has become exorbitant. I think partnerships are very important. Really, who has all the money at this point in time?” Gonzales, who is the director of Wayne County Health and Human Services, said no one should be concerned about job losses. “This is all about sharing resources. And if you’re able to have these partnerships, it ensures that people will have a place at the table.”

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