HUNTINGTON - When Ryan Justice, a 26-year-old fourth-year medical student at the Marshall University Joan C. Edwards School of Medicine, made the decision to go to medical school, West Virginia schools were the only places he applied.
The Gilbert, West Virginia, native said he sees people in his hometown that need a resource, and he feels an obligation to serve his people.
"I'm really passionate about health, weight loss, smoking cessation, and doctors have the foremost role in that," Justice said. "As far as staying in West Virginia for school and to practice, it's just home ... There are some things other people would see as not attractive to come here. But people who live here know how wonderful the state can be and how wonderful the people can be."
His help will certainly be needed. As the baby boomer population grows older and with expanded insurance coverage under the Affordable Care Act making health care more accessible, rural states like West Virginia will see demand for physicians continue to grow.
A March 2015 report by the Association of American Medical Colleges projects that the United States will face a shortfall of 46,000 to 90,000 physicians by 2025. The physician shortage remains especially problematic in rural areas, where more than 20 percent of the U.S. population resides but only 10 percent of physicians practice, according to a position paper by the American Academy of Family Physicians.
One result - at least in part - of the projected shortage is that in other rural regions of the country, for-profit medical schools are popping up, promising to create new family doctors for under-served rural regions.
For decades, those types of schools had been mostly relegated to foreign shores, but that has changed in the last several years.
Not for-profit, the Marshall School of Medicine was born out of the need for more physicians in southern West Virginia, said Dr. Joseph Shapiro, dean of the School of Medicine.
"With West Virginia University being located in the north, it was not perceived as a source of physicians for the southern part of the state," he said.
"Fast forward to present, if you look at statistics, and I do, all three of the medical schools in West Virginia have worked pretty hard fulfilling the mission. It's not just Marshall out there on the front lines. We've got help. Both WVU and the West Virginia School of Osteopathic Medicine keep a fair portion of graduates in West Virginia and fair portion practice primary care."
Shapiro said 50 to 60 percent of Marshall graduates who were residents of West Virginia choose to stay and practice in the state. Less than 10 percent of out-of-state graduates, however, chose to stay in West Virginia, which is why the school emphasizes in-state students. Shapiro said the main reason students do not serve rural areas is money.
"Plain and simple," he said. "Our students graduate with considerable amount of debt. It's very expensive to (go to) medical school. We try to keep tuition as low as possible, but they still graduate with a fair amount of debt. You can't pay those loans off if you're working with four patients, but those four patients having a doctor willing to serve you on site is invaluable."
Justice said debt is his greatest source of stress.
"The loan burden and the cost of medical school is a huge issue, because it causes physician burnout," he said. "That is probably my biggest stressor in day-to-day life as a student. Not the academic component, not the timeline component, but the financial component with living expenses and things."
As the state continues cuts to higher education, including money for the medical school, it becomes harder for the school to keep tuition down.
As it stands, tuition is 2.5 times higher for out-of-state students than in-state, Shapiro said.
"I want to put out a plea to our community that supporting our students and minimizing their debt as much as possible goes hand in hand with getting them to stay here," Shapiro said. "We select kids who profess a desire to stay in West Virginia - that's why we are here. But understand the economic reality. If the kid owes $300,000 when they graduate, they can't think rationally about a job in a community that is very rural - and that's most of West Virginia. We are picking kids that want that life, want to be the next Sen. Ron Stollings, but we have to give them a chance."
In 2015, Marshall created an accelerated B.S./M.D. program for in-state students, which also includes a waiver for medical school that could save the student up to $20,000 or more. The program puts students on a pathway to earn their bachelor and medical degrees within the span of seven years.
Several for-profit medical schools have opened elsewhere in the country in recent years, including California Northstate University School of Medicine and the Burrell College of Osteopathic Medicine in New Mexico. Rocky Vista University College of Osteopathic Medicine, which opened in Parker, Colorado, in 2007, recently announced plans to expand into Utah.
Critics of the new schools question whether companies can properly train the nation's next crop of doctors.
"On face value, it looks like a pretty good deal" because for-profit schools promise to bring benefits without relying on taxpayer dollars, Dr. Ted Epperly told The Associated Press. Epperly runs a family practice residency program in Boise, Idaho, where a new for-profit school plans to start accepting students in 2018. "But it's a little bit like Wal-Mart moving into a small community with mom-and-pop shops - it damages the existing workforce producers."
Proponents contend challenges the new schools face are surmountable, and any stigma about for-profit medical training is born of fear, not fact. Dr. Robert Hasty, dean of the newly created Idaho College of Osteopathic Medicine, told The Associated Press for-profit hospitals also were once stigmatized but now make up about a quarter of all U.S. hospitals.
"We have such a need for doctors, and if we have to make this investment, it's worthwhile," Hasty said.
Shapiro said he couldn't say if a for-profit school would be good or bad for West Virginia. He said he always supports more opportunities for higher education and a school would bring economic stimulus to a region, but there still would not be enough post-graduate training positions.
"Go back 20 or 30 years; there were two graduate education positions for every U.S. graduate," he said. "Now that number is much lower. It's like 1.1 to 1.2 times the number of U.S. graduates."
Shapiro said graduate positions will become harder to obtain as doctor of osteopathic residencies merge with doctor of medicine residencies, which the Accreditation Council of Graduate Medicine plans to do by 2020.
Follow reporter Taylor Stuck on Twitter @TaylorStuckHD. The Associated Press contributed to this report.