A Sam Houston State University proposal to open a college of medicine could receive the green light this month — despite receiving a ‘no’ from the state’s top higher education official and prompting a quarrelsome three-hour dispute at a July meeting.

To leaders of the Huntsville-based school, the doctor of osteopathic medicine program would draw primary care physicians to rural and medically underserved Texas communities — charging students almost three times more than other public schools, but without asking for any state funding.

But to some members of the Texas Higher Education Coordinating Board, an oversight agency that approves new academic programs, Sam Houston’s offering “falls short,” is premised on a “fallacy,” and has a business model that is “neither unique nor innovative,” according to comments made in July by Higher Education Commissioner Raymund Paredes and board chair Stuart Stedman.

A vote on whether to approve Sam Houston’s doctor of osteopathic medicine proposal was tabled at a Coordinating Board meeting last month after a cantankerous back and forth about the program, which seeks to enroll some 150 students at a Conroe campus starting in 2020. An alternative to a doctorate of medicine, the osteopathy track takes a holistic approach to healthcare, and proposal documents say its practitioners are less likely to be specialists and to practice in urban research hospitals than MDs.

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The proposal comes as Paredes and some lawmakers are suggesting the state is building too many medical schools at the expense of funding first-year residency positions. Sam Houston officials, and 22 legislators who wrote to the Coordinating Board in support of the program, point to a different trend, however: They say the school would combat a shortage Texas has long-faced in the number of doctors providing primary care in rural and ex-urban areas — and do so without tapping state coffers.

“We are bringing a unique program to you for consideration, to solve a Texas problem in a unique way without formula funding, without special items,” said Brian McCall, chancellor of the Texas State University System that includes Sam Houston, at the July meeting. The board did not adopt a recommendation from Paredes to deny the proposal.

As a handful of new medical schools have been proposed or erected in recent years, Paredes and some lawmakers have warned that continuing to do so will spread limited state funds too thin, compromise academic quality, and lead the number of graduates to outpace the available entry-level positions in the state. Students forced to complete their residencies out of state, critics warn, tend to settle there, doing nothing to boost the number of rural practitioners in Texas.

But even as Paredes has objected to the continued growth of medical schools, the state has seen a rash of new proposals:

  • A pending medical college at the University of Houston has named a dean, hired three associate deans and received a $3 million donation — enough to cover the tuition of its inaugural class — and other funding, despite not yet having sign-off from the Coordinating Board.

  • A partnership between the University of North Texas Health Science Center and Texas Christian University will temporarily offer doctor of medicine degrees bearing TCU’s name only; a private school, the Fort Worth-based university is not subject to Coordinating Board approval. The joint program is expected to enroll its first class in 2019, if it receives accreditation, and the University of North Texas Health Science Center's name may be added to the degree down the line.

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  • And Sam Houston has already received donations that cover the proposed medical school’s first three years of operating expenses, and was gifted the land in Conroe where the program will be based.

    “We’re not operating under the assumption that this won’t be approved,” said Texas State University System spokesperson Mike Wintemute. “We think it makes sense for the state.”

  • The Texas Tech University System, the University of Texas at Austin, and the University of Texas-Rio Grande Valley have also opened medical schools in the last decade.

Though Paredes is the state’s higher education commissioner and the Coordinating Board arbiter on what new academic programs are approved, the agency has limited regulatory authority and college leaders sometimes chafe at their suggestions. Lawmakers clipped the Coordinating Board’s wings in 2013, and it now oversees the state’s strategic plan for higher education, manages financial aid programs, and collects and maintains data from colleges in the state.

The tension became apparent at the July meeting, when Dana Hoyt, president of Sam Houston, said Paredes was recommending denial of the proposal without providing "substantiating data to support" his decision. “Is the weight of that opinion greater than the collective conclusions of accounting professionals, notable medical academics, graduate medical education experts, and our board of regents, not to mention the preponderance of verifiable evidence submitted in our supporting documents?” Hoyt asked.

Paredes took a hard tack against Sam Houston's proposal at the meeting — saying it was premised on the “fallacy,” that “if we produce more doctors, if they come from rural areas, if we try to train them in rural areas, they're more likely to practice in rural areas,” he said.

“Rural communities are dying,” Paredes said emphatically. “People don't want to live in small towns including recent medical school graduates.” He said the “best way” to improve healthcare in rural communities is to expand broadband internet access and, through it, telemedicine offerings — and to funnel resources to entry-level residency slots instead.

Of the dozen medical schools in the state, two offer osteopathic medicine degrees, and Sam Houston’s tuition and fee schedule would be comparable to that at the University of the Incarnate Word, a private school in San Antonio. That price tag — an estimated $55,000 a year for tuition and fees — is “not what public higher education should be about,” Paredes said in July.

The proposed program’s financial architecture is unusual among public institutions in Texas; it would request no added state funding and would instead rely almost entirely on students’ tuition and fees. The proposal shows no money allotted for students’ financial aid — school officials say they are hoping to line up donor-funded scholarships — and Coordinating Board documents cast doubt that the program would steer a majority of its graduates to practice primary care medicine in rural East Texas.

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“Graduates with high levels of debt may find it financially challenging to practice in a speciality and region where expected salaries are generally lower,” the Coordinating Board’s document says.

Wintemute, the Texas State University System spokesperson, said Sam Houston keyed to the “severe shortage of primary care physicians in rural and underserved parts of the state” in 2014, but quickly realized “that state funding for a medical school was not likely to be provided.” Using a “private school model, which does not rely on state support,” was found to be a “workable solution to that problem, with that problem being a shortage of primary care physicians.”

He said the proposed tuition “is in line with the tuition at other institutions that rely on a private school model,” and would not be a burden on students, considering their earnings potential and loan-forgiveness options.

Sam Houston’s proposal is expected to go before the Coordinating Board again next week. If approved, the university would then have to receive accreditation for the program.

Disclosure: Sam Houston State University, Raymund Paredes, Stuart Stedman, Brian McCall, the Texas State University System, Texas Christian University, Texas Tech University, the University of Texas at Austin and the University of Texas - Rio Grande Valley have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.