Sanford School of Medicine: Back to the Future
Robert E. Van Demark, Jr., MD
SDSMA President

Last fall, I started reading a history of medical education in South Dakota. Committed to Care [1] commemorates 100 years of medical education in South Dakota. The history of our medical school is fascinating; it is a testimony to vision and perseverance. The two-year College of Medicine began in 1907 with two students (both South Dakota residents), based on the model of the Rush Medical College in Chicago – completing the first two years at Rush and two final years of clinical study at other schools in Chicago. Yearly student tuition was $60. Premed educational requirements for the South Dakota College of Medicine were unique: in 1907, a high school education was required. Later the prerequisite requirements increased to one year of college (1908) and later to two years of college study (1909). In 1908, there were four first-year students and seven second-year students. There were two women in the school with five transfer students joining the school from the recently closed Sioux City Medical School (who knew there was a medical school in Sioux City)!

In 1909, the Flexner Report reviewed the state of medical education in the U.S. At that time, there were 155 medical schools with a variety of educational prerequisites. There were only six two-year medical schools and 20 states without a four-year medical school. The South Dakota College of Medicine was unique – it was one of 16 schools that required a minimum of two years of college for admission. In 1921, the College became the School of Medicine with an enrollment of 30 students. That same year, Medical School Dean Christian Lommen predicted the need for a four-year school. By 1925, the school was transferring students for their final two years.

In 1935, the AMA stated that two-year medical schools were not adequate for medical education. In 1938, the Association of American Medical Colleges placed the school on probationary membership. The probation period lasted until it received full accreditation in 1949. Between 1943 and 1947 multiple attempts were made to start a four-year medical school. They included: 1) A state hospital as a teaching facility; 2) A four-year school with the first two years in Vermillion and the last two clinical years in Sioux Falls, Yankton and the TB sanatorium in Custer. The estimated cost for this proposal was $400,000; and 3) A medical school building in Sioux Falls. All proposals failed due to a lack of funding. By 1944, there were only three two-year medical schools: North Dakota, South Dakota and Dartmouth. In 1953, the Lee Medical building was opened at the cost of $868,000. In 1971, Gov. Richard Kneip formed a Task Force on Medical Education. At that time, a three-year MD program was recommended with the purpose of training family medicine physicians. The bill died in committee. In 1972, the Board of Regents recommended a four-year medical school. That bill also died in the legislature.

In 1973, the medical school began to have problems transferring students for their last two years and the concept of the “school without walls” became a viable solution for South Dakota. On Feb. 15, 1974, Gov. Kneip signed legislation creating a family practice, degree-granting medical school. The first four-year class began in 1974. Of the sophomore class of 1975, 36 students stayed in South Dakota and 29 transferred (determined by a student lottery). The first four-year class graduated on May 24, 1977. Dr. Karl Wegner, Dean, summarized the state of affairs in 1973: “I have not meant to appear in the role of a super advocate for a degree-granting medical school. I have simply, like so many others, after considering the alternatives, decided that this is the best one for South Dakota. I find it difficult to believe that we would allow our two-year school to close and I find it equally difficult to consider sending our students and $3 million or so in South Dakota tax money out of state if (a) we feel we can give them a good education here, and (b) we have already shown that by educating them out of state we simply do not get them back. These comments of course represent an over simplification of a complex problem. I do not mean to sound flippant or glib. I have arrived at them cautiously over an extended period of time, and after considerable thought and reading. I share the concern, of you and others as to the difficulties of such a task.”

Today we are fortunate to have a successful medical school. The cost of this education is expensive: in-state tuition is $32,279 per year. The estimated total cost for one year is $56,235. The average debt for a 2017 graduate is $223,940. The SDSMA Foundation provides scholarships for medical students. To help these students, you may contribute at sdsma.org. Your contribution will help the next generation of physicians.

References
1. Grauvogl A, DeJager-Loftus D. Committed to Care: A Century of Medical Education in South Dakota. Sioux Falls, SD: Pine Hill Press; 2007.