A Virginia-based medical school’s plan to develop a Vero Beach campus hinges on approval by the State of Florida to increase the number of available student training slots and establish a residency program at Cleveland Clinic Indian River Medical Center.

Though both the medical school and the Vero hospital say they are committed to making that happen, even if it means building and accrediting a new medical school from scratch rather than establishing a satellite campus of the Virginia school here, success is not certain.

Changes made to Florida law in 2024 via a sweeping 232-page reform of healthcare training and licensing prioritize medical training slots for students and graduates from a pre-approved list of 10 schools located in Florida.

The list is a mix of Florida’s big public universities that have medical schools, and established private medical schools operating in Florida. The Edward Via College of Osteopathic Medicine or VCOM is not on that list.

Millions of dollars in state Medicaid funding that go to compensate hospitals for doctor training are tied to that list, and these residency slots, under the 2024 law, are regulated by a panel of doctors representing these Florida medical schools.

In 2023, prior to the new law, VCOM began negotiating with the Indian River County Hospital District for a district-owned three-story building just steps from Cleveland Clinic’s Vero emergency department entrance.

In its October 2024 lease, VCOM committed to its landlords at the Hospital District that the school would invest at least $5 million in the facility by 2029 in lieu of rent, and agreed to achieve a timetable of benchmarks leading up to a full, four-year medical school and residency program in Vero by Oct. 1, 2030.

VCOM wanted to purchase the five-acre parcel outright, but since the valuable land on which the aging 1980s-era building sits belongs to the taxpayers, Hospital District trustees would only lease it to VCOM for 20 years, leaving the door open to a purchase once the medical school’s Vero Beach campus was fully operational, accredited and hopefully supplying doctors to Indian River County.

A $1 million lease clause

The first major investment of at least $1 million in the Vero facility is due by the end of this month. But other than reimbursing the Hospital District for roughly $50,000 in building maintenance, no capital improvements have been completed. The district’s attorney, Jennifer Peshke sent VCOM leaders a letter on July 29 reminding them of its contractual obligation.

“VCOM's first capital investment, comprised of a minimum of $1,000,000.00, is due on or before September 30, 2025. As the due date for this initial investment is quickly approaching in approximately sixty (60) days, IRCHD requests that VCOM provide a plan, no later than September 1, 2025, detailing how it will fulfill this first requirement (of Section 4.e.) and any foreseen hindrances to satisfying the obligation,” Peshke wrote.

The Sept. 2 response from VCOM’s head of communications did not provide specifics, or artist renderings or the name of a selected architect or contractor, taking a wait-and-see posture while it ponders the impacts of the new law on student training.

“Despite the change in Florida law from the 2024 Senate Bill 7016, which has not yet specified the methods for implementation, VCOM remains committed to leasing the building and beginning the remodel of areas of the building,” the VCOM response said.

“We are eagerly awaiting the interpretations and regulations of this law to assure the continued clinical training for our students in the state which will define the purpose for use of the building. VCOM has well over 400 alumni currently practicing in the state of Florida, and we remain committed to providing more physicians (especially primary care physicians) for the state.”

VCOM specializes in training doctors who practice family medicine, internal medicine, pediatrics, obstetrics, gynecology and emergency medicine, and attracts students who want to work in rural and high-demand locales like Florida.

Most of VCOM’s Floridian students now attend classes on its Spartanburg, S.C., campus.

“The state of Florida presently is among the top five states supplying VCOM with students. There are currently Indian River State College graduates and students at VCOM who desire to return to Florida for residency and subsequent medical practice,” VCOM President Dr. Dixie Tooke-Rawlins said.

“We await the interpretation of this law for colleges (such as VCOM) that currently have Florida students in medical training in the state. Our commitment to the program for third-year and fourth-year clinical rotations remains steadfast, as does the commitment of Cleveland Clinic Indian River Hospital.

“Additionally, our collaboration with the Cleveland Clinic Indian River Hospital includes the ongoing exploration and planning for future residency programs. This collaboration for medical student and residency training will help us determine the best remodel for the building, and will ensure that all needs are met in the plans for the remodel,” VCOM said.

A side strategy with IRSC

Despite committing to a four-year medical school in Vero Beach in its lease with the county Hospital District, VCOM leaders negotiated a deal to educate first- and second-year medical students on the Indian River State College Port St. Lucie campus. This was announced with great fanfare in late August by Indian River State College, but the plans may have been overblown a bit by the college.

“It was reported that we will be starting a new medical school campus here in Florida within the next two years. This statement is inaccurate,” said Tooke-Rawlins.

“We are in the process of completing documents to ensure our clinical training will be approved under the new Florida state laws. Our current process is already aligned with these laws,” Tooke-Rawlins added. “Additionally, if VCOM were to establish a new medical school in Florida, it would take five years.”

In addition to its Virginia headquarters, VCOM has branch campuses in South Carolina, Alabama and Louisiana. “We do not believe another branch campus would be feasible,” Tooke-Rawlins said. “Rather, we believe that it would need to be a new medical school owned by the same foundation that VCOM is owned by at this time.

“If the Harvey W. Peters Research Foundation which owns VCOM, were to establish a new medical school, it would take approximately five years under the current accreditation rules. A newly proposed osteopathic medical school would require at least two years in Applicant Status and up to five years to move through Preaccreditation Status to Provisional Status. Often, these latter two phases overlap; however, the total process still would take roughly five to six years,” Tooke-Rawlins said.

The affiliation with IRSC could potentially help get VCOM on the state’s priority list by aligning and co-locating with an established Florida college.

“Indian River State College recognizes and supports VCOM’s objective outcomes for producing physicians to serve in medically underserved areas, as well as VCOM’s success in providing primary care physicians for the state of Florida, through our current clinical education program in the state,” Tooke-Rawlins said.

“Indian River State College and VCOM have an agreement whereby Indian River State College graduates who meet specific benchmarks are guaranteed interviews. This partnership or agreement helps to educate medical students who will address the unmet need for more physicians in the area.”

Vero hospital all-in on training

Cleveland Clinic Indian River Hospital says it’s still “fully committed” to bringing VCOM and its future doctors to Vero Beach.

“We currently have nearly 40 VCOM medical students rotating through CCIRH and the capacity to accommodate more over time,” Cleveland Clinic Indian River Hospital Vice President and Chief Medical Officer Dr. Richard Rothman said.

“Dr. George Mitchell continues to mentor VCOM medical students at Indian River Hospital. He is an experienced and respected critical care physician who also serves as the Lead Academic Officer for Cleveland Clinic Indian River Hospital,” Rothman added.

“Cleveland Clinic supports the students at Indian River Hospital with mentors from various departments, depending on the students’ career interests, and also with regional support from other Cleveland Clinic Florida locations.”

The training is also being supported and overseen by Dr. Joseph Iannotti, Chief of Research and Academic Officer for the Cleveland Clinic Florida Market. 

“Cleveland Clinic has a long tradition of medical education. We’re here to support the communities we serve in many ways – an important one is by lending our expertise and mentorship in nurturing new physicians and medical professionals in many disciplines.” Iannotti said.

Since VCOM’s students will need obstetrics and gynecology experience, it’s important that Cleveland Clinic and the Indian River County Hospital District work out a plan to keep Vero’s Labor and Delivery Unit open long-term by the time VCOM maneuvers regulatory changes and gets clarity on its Treasure Coast plans.

“We acknowledge VCOM’s initiative to expand to Y1 and Y2 medical student education and recognize that accreditation may require substantial time to complete. At present, we will continue collaborating with the VCOM 3rd and 4th year medical students. We are here to collaborate and support the next steps for 3rd and 4th year medical students,” Rothman said.

Supporting and cultivating future physicians is essential to advancing healthcare in Indian River County and across the nation, Rothman said. “We will assist in allocating students across different locations as required to support their educational program’s needs,” he added.

“VCOM has a strong, unified relationship with the Cleveland Clinic. They have been a tremendous partner, and we value our relationship with them.  We would first strive to obtain as many clinical rotations as possible across the multiple Cleveland Clinic hospitals in Florida.  We currently also collaborate with the Federally Qualified Healthcare Center (FQHC) primary care centers in the community,” Tooke-Rawlins said.

VCOM Students receive outpatient clinic training under the supervision of doctors at Treasure Coast Community Health.