Call to Order and Roll Call
Joint Committee on Education was held onMonday, July 12, 2010, at<MeetTime> 10:00 AM, in Room 131 of the Capitol Annex. Senator Alice Forgy Kerr, Co-Chair, called the meeting to order, and the secretary called the roll.
Members:Senator Alice Forgy Kerr, Co-Chair; Representative Leslie Combs, Co-Chair; Senators R.J. Palmer II, Elizabeth Tori, Johnny Ray Turner, and Ken Winters; Representatives C. B. Embry Jr., Tim Firkins, Jim Glenn, Reginald Meeks, Jody Richards, Tom Riner, Carl Rollins II, Charles Siler, and Addia Wuchner.
Guests: Becky Gilpatrick and Jennifer Toth, Kentucky Higher Education Assistance Authority.
LRC Staff: Ken Warlick and Lisa Moore.
Overview of the School for Osteopathic Education
Dr. William T. Betz, Senior Associate Dean for Osteopathic Education, Pikeville
College School of Osteopathic Medicine, reported that osteopathic medicine was founded by A.T. Still, M.D., in the late 1800’s. Dr. Still founded the Kirksville College of Osteopathic Medicine in 1892. He said osteopathic medicine is a total health care system emphasizing the body’s innate ability to regulate and repair itself through prevention and wellness.
Dr. Betz said there are over 67,000 Doctors of Osteopathic Medicine (D.O.s) in
the United States. The D.O.’s comprise approximately seven percent of total United States physicians and 18 percent of family physicians. He said nearly 20 percent of all United States medical students are enrolled in colleges of osteopathic medicine.
Dr. Betz reported that osteopathic physicians are fully licensed for the complete
practice of medicine and surgery in all 50 states and many foreign countries. He said D.O.’s practice in all medical and surgical specialties and subspecialties, placing an emphasis on primary care. Dr. Betz noted that 41 percent of D.O.’s are in family medicine, 10 percent are in internal medicine, 5 percent are in pediatrics, and 35 percent are in non-primary care.
Dr. Betz said the osteopathic medical curriculum parallels the allopathic (M.D.)
curriculum including all basic science and clinical disciplines. In addition, osteopathic students receive training in Osteopathic Principals and Practices (OPP) including Osteopathic Manipulative Treatment (OMT), integrated throughout their medical education. The education is four years in length. The first two years is didactic emphasis, and the last two years includes clinical training in hospitals, clinics and doctors’ offices. He noted graduates are conferred the degree of “Doctor of Osteopathic Medicine” (D.O.). All graduates then complete residency (specialty) training for a minimum of three years. The United States currently has 29 accredited colleges of osteopathic medicine.
Dr. Betz said the Pikeville College School of Osteopathic Medicine (PCSOM) had
its first class of 60 students enrolled in August 1997 and graduated in May of 2001. Its current class size is 75; total enrollment is 303 students in four classes. He said PCSOM’s mission is to provide men and women with an osteopathic medical education that emphasizes primary care, encourages research, promotes lifelong scholarly activity, and produces graduates who are committed to serving the health care needs of communities in Eastern Kentucky and other Appalachian regions. The number of applicants has risen steadily over the past ten years. PCSOM has one of the highest ratios of applicants per available seat of any school of osteopathic medicine.
Dr. Betz said the Kentucky Osteopathic Medical Scholarship was created by the
Kentucky legislature with coal severance funds. The fund provides financial assistance to Kentucky students attending an accredited school of osteopathic medicine in the Commonwealth. The scholarship fund also requires a primary care service commitment in Kentucky for every year the scholarship is awarded. Since the scholarship’s inception in 1998, nearly $13 million has been awarded to 461 osteopathic medical students.
Dr. Betz reported that over 600 students have graduated since May 10, 2001, with
the degree of Doctor of Osteopathic Medicine (D.O.). Over three-fourths of PCSOM graduates have entered primary care specialties, including family medicine, general internal medicine, pediatrics and ob/gyn. He noted 44 percent of graduates are practicing in federally designated medically underserved areas.
Dr. Betz said the PCSOM has been ranked in the top 20 of all United States
medical schools in rural medicine. PCSOM currently ranks fifth in the percentage of graduates entering primary care residencies (69 percent). Dr. Betz noted that the Pikeville College Board of Trustees has announced plans to construct a new building to house the medical school, which will expand classroom, laboratory and office space. Upon completion in May 2012, the new building will accommodate an increase from 75 to 125 students per class.
In response to a question from Senator Kerr, Dr. Betz said students are taught
standard osteopathic manipulative treatments. Osteopathic manipulative medicine is utilized as a modality that is combined with other modalities to treat the whole patient. It is used typically in place of regular treatments such as pills, muscle relaxants, and injections. He said specific techniques include: muscle energy; strain and counter strainer; cranial sacral and high velocity low amplitude.
In response to questions by Representative Riner, Dr. Betz said there are many
nationwide programs currently conducting research on the benefit of manipulative medicine in increasing or improving the body’s ability to defend itself. He said D.O.’s receive one full semester dedicated in the second year of school to learning about nutrition. He said the population in the United States needs to be properly taught about smart food choices and nutrition. If not, the population will continue to become sicker, more obese, and demand more resources for healthcare. He emphasized this downward spiral needs to be changed dramatically.
In response to questions from Senator Kerr, Dr. Betz said physical activity and
exercise is important in treating diabetes. He said more doctors should look at the bigger picture when dealing with the healthcare needs of the citizens. He also said the students of PCSOM are active in the P-12 schools and educate the students on nutrition and hygiene. He said the program could be more involved with the students in the P-12 system.
In response to questions from Representative Glenn, Dr. Betz said Pikeville
College tries to get students involved at a young age to get interested in healthcare and medicine. Representative Glenn stressed that children need to be educated early in the school years to realize their careers and prepare for them. Dr. Betz said Pikeville College has also just started another program that allows high school graduates to be accepted immediately into medical school if certain requirements are met. He also said Pikeville College does not have a PH.D program in nursing, but he believes there is a shortage of healthcare practitioners throughout the Commonwealth.
Representative Combs commented that Pikeville College does have an associate’s
program in nursing and there has been a serious consideration to implement a bachelor’s program in nursing in the near future. She explained her background with Pikeville College and the history of the implementation of the medical school. She described real life success stories of patients with osteopathic doctors and said the University of Kentucky is looking at treating their athletes in this manner because it is a quicker healing process.
In response to questions from Representative Richards, Dr. Betz said that he does
not have the exact numbers of how Kentucky fares to surrounding states. He stressed the goal of the program at Pikeville College is to increase the number of doctors in the Appalachia area. The program also strongly encourages medical students to specialize in primary care. Dr. Betz said reimbursement issues can lead the doctors to leave primary care and enter into specialty areas. He said the system needs to support primary care doctors.
In response to a question from Representative Firkins, Dr. Betz said all the spots in
the classroom could be filled with students outside of Kentucky, but that is not the goal. He said 55 to 60 percent of the students in the program are Kentucky residents. Total applications for the program are up ten percent from last year, and he would like to see a ten percent growth in applicants from Kentucky as well. He believes that students trained from rural Kentucky are more likely to stay in rural Kentucky to practice medicine.
In response to a question from Senator Kerr, Dr. Betz said admission into the
medical college includes a 3.5 grade point average, an average score of 25 on the Medical College Admission Test (MCAT), and an interview with each individual candidate. He believes it is important to analyze the whole person instead of just admitting someone based on a certain test score. He also said there is a 35 to 1 ratio of students wanting into the program per available seat. This is the reason the PCSOM is expanding the program from 75 to 125 students and building a new facility. The program is not currently teaching acupuncture to students, but believes it can be a source and a capacity for healing.
Postsecondary Education Financial Overview
Mr. Robert King, President, Council on Postsecondary Education (CPE), reported that Kentucky’s postsecondary and adult education system is comprised of 8 four-year public postsecondary institutions; 16 community and technical colleges; 20 independent colleges and universities; 120 adult education providers, 255,000 college and university students, and has more than 30,000 faculty and staff. He noted the state budget increased 33 percent during the period of 2000-2010, while spending on Medicaid, Corrections, and P-12 education increased significantly more than funding for postsecondary institutions. There have been 11,000 new students added into postsecondary education and no new state funding. Some believe the price of higher education has increased more than any other sector of the economy, including healthcare. Specific graphs can be found in the meeting materials located in the Legislative Research Commission (LRC) library.
President King said the CPE approved tuition increases for fiscal year 2010-2011. Tuition was increased at the community colleges four percent, five percent at the comprehensive colleges, and six percent for the two research campuses. He noted the projected new revenue in fiscal year 2011 is estimated at $43 million. This is predicated on no enrollment growth and common increases for in-state and out-of-state graduate and undergraduate students. He said even with the tuition increases, the campuses will absorb almost $53 in reductions for fiscal year 2011. The campuses are making these reductions through their internal budgetary decisions.
President King said the Kentucky Educational Excellence Scholarship (KEES), the College Access Program (CAP), and the Kentucky Tuition Grant (KTG), have remained at fairly consistent levels, with KEES being the largest category of funding. He said the average tuition cost per student, including fees and books, is $7,335.
President King said the CPE general fund appropriation was $49.9 million for 2009-2010. He said 49 percent, or $24.2 million is allocated for the Kentucky Adult Education program. Pass-through funds comprise 39 percent, or $19.4 million, and $6.2 million, 12 percent, is allocated for staff support for statutory duties. He said CPE’s effective budget cut is 5.3 percent in fiscal year 2011 and 6.3 percent in fiscal year 2012. CPE’s general fund is about 20 percent lower than in fiscal year 2008, and the CPE staff has been reduced by 19 positions, or a 19 percent cut since fiscal year 2008. President King said CPE is assessing the impact of another 1.5 percent cut in fiscal year 2011 and other efficiency measures. CPE received $4.6 million in fiscal year 2011 and $1.8 million in fiscal year 2012 for Senate Bill 1 implementation.
President King discussed House Bill 1 that was passed by the General Assembly in 1997 and how Kentucky is doing after a decade of reform. He said undergraduate enrollments; graduate enrollments; bachelor’s degrees; six-year graduation rates; associate degrees; graduate degrees; minority degrees; and research and development expenditures have all increased during the ten-year period. Specific percentage increases for each category can be located in the meeting materials in the LRC library.
President King said funding challenges will include enrollment growth with no state support. He said innovative thinking will be required to secure additional sources of revenue other than tuition increases to maintain reform momentum. He discussed deferred maintenance and capital renewal versus new capital projects. CPE’s goal is to produce a better educated workforce, stimulating economic development through research, while containing costs.
In response to a question from Senator Kerr, President King discussed South
Korea’s emphasis on higher education. He said other countries are faring much better than the United States with its populations attaining baccalaureate degrees. He said Mark Tucker, from the National Center on Education and the Economy, traveled around the world studying the most effective K-12 school systems and tried to understand what they were doing that was different from the United States. In his report, “Tough Choices or Tough Times”, he lists some recommendations of what the United States can do better in terms of delivery of its education system to get better results at a price that is affordable and reasonable. President King said students showing up for college who do not need remediation, are persisting to graduation at significantly higher rates, around 70 percent. He said the importance of getting K-12 fixed is critical to the success of higher education. He also stressed it is important for higher education to adequately prepare and support teachers throughout their careers. President King said he would send a copy of the “Tough Times or Times Choices” report to Senator Kerr.
In response to a question from Representative Rollins, President King said
financial aid is not included in the CPE’s calculation of state share of cost of postsecondary education. He said Kentucky is a national leader in distributing lottery funds into financial aid. Representative Rollins mentioned the possibility of giving lower subsidies to higher income students. He also asked for CPE to provide a state share of cost calculation that included state funding for financial aid. President King said he would get the information to Representative Rollins.
In response to a question from Representative Combs, President King discussed
private versus public tuition rates. He agreed with Representative Combs that innovative ideas are needed to help people and universities to stretch their dollars.
In response to questions from Representative Richards, President King discussed
the other countries and the progress they have made in enrolling students into higher education. He even mentioned that some smaller countries, such as Finland, pay their students stipends to attend college. President King said 50 percent of Kentucky’s colleges and university budgets are state supported. He noted private giving is improving, but cautioned that state support could continue to decrease as campuses start raising more private money through philanthropy.
Representative Wuchner discussed studying abroad and how students in other
countries enter college prepared and do not require remediation. She is hopeful the United States can become as efficient as other countries in the future.
Senator Kerr expressed disappointment to President King that the university
presidents were not in attendance at the meeting. President King said he would relay her message to them.
With no further business before the committee, the meeting adjourned at 12:20