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ByRebeccaBoone TheAssociatedPress BOISE, IDAHO For-profit medical schools are start- ing to pop up around the country, promising to cre- ate new family doctors for underserved rural regions. Rural states like Idaho need more general practi- tioners, with the baby boom generation aging and ex- panded insurance coverage under the Affordable Care Act making health care more accessible. But critics of the new schools ques- tion whether companies can properly train the na- tion'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 tax- payer dollars, said Dr. Ted Epperly, who runs a family practice residency program in Boise, 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 produc- ers." 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 Col- lege of Osteopathic Medi- cine, notes for-profit hos- pitals also were once stig- matized 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. Thirty-one new medical schools opened in the coun- try between 2002 and 2014, according to an article in the New England Journal of Medicine. Most were non- profit or public. For decades, for-profit medical schools were rel- egated to foreign shores, with U.S.-based compa- nies like DeVry launching medical schools in the Ca- ribbean. But that changed in 2007 when Rocky Vista University College of Osteopathic Medicine opened in Parker, Colo- rado. Several for-profit medi- cal schools have opened in the years since, including California Northstate Uni- versity School of Medicine and the Burrell College of Osteopathic Medicine in New Mexico. Rocky Vista recently announced plans to expand into Utah. Justin Rose was part of the first group of students to graduate from Rocky Vista in Colorado. Though the Idaho native applied to several schools in the West, he wasn't accepted to any state-run programs. "The for-profit part never played a part in it," Rose said of his decision to at- tend Rocky Vista. "The big- gest concern was I'm going to a new med school that had no background affilia- tion or anything." In retrospect, he said, it was the best choice because the school was under pres- sure to prove its first crop of graduates would succeed. "It made them especially motivated," he said. After completing an emergency medicine resi- dency and an ultrasound fellowship at the Univer- sity of Kentucky, Rose is preparing to begin his ca- reer as a doctor in Boise. He said the job will allow him to continue chipping away at his $350,000 in student loan debt. That's nearly double the average debt carried by medical school graduates, according to the Associ- ation of American Medi- cal Colleges. And because Rose attended a for-profit program, he's not eligible for many federal loan-for- giveness programs. Even with the high debt load, the for-profit med school was worth it, Rose said. Opening state pro- grams is costly, and for- profit schools are a good answer for America's ru- ral health care shortage, Rose said. His one con- cern is that the number of schools will grow faster than the number of resi- dency programs. Like their public and nonprofit counterparts, for-profit med schools face pressure to ensure their graduates get the valuable residency positions. At least 98 percent of grads from an osteopathic school must be placed in a residency or equivalent program or the school risks losing accred- itation, Hasty said. Medical schools must make their residency place- ment numbers available to the public. That account- ability — and the fact that would-be doctors must pass medical board exams and meet state requirements before they can start prac- ticing — should help hope- ful medical school students make good choices about where to attend, said Clau- dia Goldin, a Harvard eco- nomics professor who has studied for-profit educa- tion models. "If they're not providing the requisite training and hands-on work, then it's going to be public infor- mation that these students didn't pass those exams," Goldin said. "It's sort of a good thing to have some ex- ternal review." The differences be- tween for- and nonprofit schools aren't always ap- parent, Goldin said. Sala- ries for staff at nonprofits and public schools often are higher than for-prof- its, for instance. And reg- ulators have stepped in to stop some nonprofit schools from taking steps deemed undesirable, such as when Yale was told to stop plans for an on- line physician's assistant school. "I've always tried to think about for-profits with- out the jaundiced view of them that we all now seem to have," she said. "I always try to enter this with the notion that there are good training programs all over the place, and the nonprof- its have some pretty lousy places." The for-profit schools are not without risk. Dade Medical College in Florida abruptly closed last year amid major fi- nancial troubles, its 2,000 health care stu- dents arriving on cam- pus to find doors locked. The school received more than $100 million in tax- payer-funded Pell grants and student loans since it opened in 1999, accord- ing to the Miami Herald. Investors are looking for a return on their invest- ment, said Hasty, dean of the new Idaho school. But the ultimate goal is to cre- ate safe, competent physi- cians. He sees Idaho, Montana and other rural states in the region as the epicenter of a nationwide family physi- cian shortage. "It's not a donation — I mean, I'd love for them to donate lots of money for our scholarships," Hasty said. "This is really part of a so- cial mission." NATION For-profitmedicalschoolsspringingup ASSOCIATEDPRESSPHOTOS Dr. Robert Hasty, the dean of the for-profit Idaho College of Osteopathic Medicine, talks with Idaho State University Meridian Health Science Center employees Chris Wilson, center, and Nancy Carpenter in Meridian, Idaho. Dr. Robert Hasty, the dean of the for-profit Idaho College of Osteopathic Medicine, in a cadaver lab at Idaho State University's Meridian Health Sciences Center in Meridian, Idaho. The for-profit school has an agreement that will alllow its students to use the public university's facilities when ICOM opens in 2018. PLEASE RECYCLE THIS NEWSPAPER. By Mary Nugent mnugent@chicoer.com @ER_MaryNugent on Twitter CHICO It's uncomfortable. It feels nosey, inappropriate and often sad. Yet, accord- ing to Rebecca Senoglu, talking about death and dying would fix so many things. "We'realldying.Everysin- gle one of us. It's universal, yet we don't talk about it," said Senoglu, co-founder of the Alliance for Support and EducationinDyinginDeath, CancerSupportProgramco- ordinator at Enloe Cancer Center, and a community minister who performs wed- dings and funerals. Senoglu and her friend Malama MacNeil have be- gun the Death Café to ad- dress what they consider a healthier approach to what is not generally discussed in American culture. "Death Café started in the UK in 2011 by a guy named Jon Underwood who invited people,mostlystrangers,toa venue to gather to eat cake, drinkteaanddiscussdeath," Senoglu explained. "The ob- jectiveasstatedontheirweb- site is 'to increase awareness of death with a view to help- ing people make the most of their (finite) lives'. "The idea has caught on like wildfire and there have been over 3,000 death ca- fés reported on their web- site since it started." This summer, the Alli- ance for Support and Edu- cation in Dying and Death is offering opportunities for the community to gather and share at three Death Cafés in Chico. "We thought for the Death Café, let's not make it about funeral homes and hospice. Let's start sharing out stories before it's right in our face. It is a casual en- vironment, where we drink tea and eat cake. Maybe we just listen," Senoglu said. The idea is not necessar- ily people's personal situa- tions, but it can be. 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