Two universities are eyeing the chance to be the first to build a medical school in one of the few states without one. The jockeying of the two schools to open campuses in Montana — one a nonprofit, the other for-profit — highlights the rapid spread of for-profit medical learning centers despite their once-blemished reputation.
What’s happening in this Western state triggers questions about how future doctors will be trained in the U.S., how that training will be paid for and whether a rural, sparsely populated state can sustain either a nonprofit or for-profit medical school, let alone both.
For more than 100 years, for-profit medical schools were banned across the United States because of the early 20th-century schools’ low educational standards and a reputation of accepting anyone who could pay tuition.
Then, a 1996 court ruling forced accrediting agencies to take another look at for-profit medical schools, prompting a resurgence over the past dozen years. Their advocates argue that these institutions meet the same standards and requirements as every other medical school and often are established in communities that otherwise couldn’t fund such institutions.
But those assurances don’t quiet the concerns of skeptics, who warn that the problems of the past will inevitably return.
A ‘recipe for predatory behavior’ or an opportunity to train more doctors where they’re needed?
For years “there has been a sense that we should not risk going back to where the supply of doctors and the quality of doctors is in the hand of for-profit providers,” says Robert Shireman, director of higher education excellence and a senior fellow at the Century Foundation, a progressive think tank that released a report in 2020 critical of for-profit medical schools. “But now essentially we have investment vehicles that are owning for-profit medical schools. That is a recipe for predatory behavior.”
The debate landed on Dr. Paul Dolan’s turf when he read in the Billings Gazette on Feb. 23 that a for-profit institution, Rocky Vista University College of Osteopathic Medicine, was planning to open a satellite campus in Billings. Dolan, the chief medical information officer at Benefis Health System in Great Falls, has been working for at least a year to bring a nonprofit medical school to Montana and its population of just over 1 million people.
“There was some irritation locally here,” he says, “because it felt like this was our opportunity and these guys were trying to edge us out.”
Dolan responded quickly, and that same day, the Billings Gazette posted news about another possible med school moving to the state. This time the story featured Dolan’s health system and its efforts to bring a satellite nonprofit medical school to Great Falls, 220 miles from Billings. It would be anchored by the Touro College and University System, a not-for-profit private institution with campuses across the U.S. and abroad, including multiple medical schools.
Rocky Vista University declined an interview request for this story. But Dr. Alan Kadish, president of the Touro College and University System, says the question of whether Montana can handle multiple medical schools isn’t the issue. “The real thing is that the area needs more physicians and there is an opportunity to train them.”
What was behind the ban, and the resurgence
Over a century ago, the U.S. banned for-profit medical schools after criticism that large numbers of commercial medical schools were proliferating and overproducing “under-educated and ill-trained medical practitioners,” according to a Carnegie Foundation report first published in 1910.
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In the 1970s, though, for-profit medical schools started to pop up in the Caribbean. Those enrolled often included U.S. students who had been rejected for admission by traditional, domestic medical schools. Then, that 1996 lawsuit regarding accreditation of a for-profit law school opened the door for other for-profit, postsecondary training institutions to enter the U.S. market, including Rocky Vista.
Yife Tien, son of the founder of a Caribbean for-profit medical school, used this model to establish Rocky Vista, which accepted the school’s first class in 2008 in Parker, Colo. The school gained full accreditation in 2012 from the Commission on Osteopathic College Accreditation. In 2013, the Liaison Committee on Medical Education, which accredits allopathic medical schools, eliminated the accreditation standard that schools be not-for-profit.
Students in osteopathic and allopathic medical schools study a similar curriculum and participate in much the same clinical training but take different licensing exams. Graduates with an M.D. or D.O. degree are all fully licensed physicians, with the same rights and responsibilities.
Rocky Vista remained the only for-profit school in the U.S. for seven years until another opened in California in 2015. Since 2015, five more for-profit medical schools have opened, and a sixth is scheduled to open in Utah later this year. (All but one are osteopathic.) For-profit medical schools have also been proposed in Missouri and Maryland.
