If you’ve been missing out on some local news events lately, it’s likely because local news is increasingly underreported. A report from the University of North Carolina found that between 2005 and 2020, the U.S. lost 2,100 — or roughly one-quarter — of its local community newspapers. Four years later, this trend toward “news deserts” continues unabated. In Virginia, many local papers have reduced both their number of print editions and full-time journalists. Having spent more than 30 years in the newspaper industry, I saw the beginnings of this firsthand, but never thought the downfall would come this hard or this fast.
The consequences of this unraveling of local newspapers are increasingly obvious in an age of misinformation.
As then-”Meet the Press” host Chuck Todd interjected during an interview with Trump White House counselor Kellyanne Conway in 2017, “Alternative facts are not facts — they’re falsehoods.”
Similarly, last year, Fox News reached a $787.5 million settlement agreement in a lawsuit brought against the network by Dominion Voting Systems for airing false claims that the companies’ voting machines had rigged results in the 2020 election. Fox acknowledged the claims to be false without granting an apology, seeming to indicate that some media news outlets may not have the best interests of their audience or American democracy in mind.
While it’s unimaginable that our nation’s Founding Fathers would have been so naive as to think that lies couldn’t come from the lips of politicians or be promulgated by newspapers, they did envision our free press as a primary and essential check on the integrity of our democracy. There is a reason why the First Amendment comes first. As the saying goes, “The pen is mightier than the sword.”
Behind our founders’ reliance on robust news reporting was the assumption that those efforts would be supported by equally robust advertising. This too has changed. Tech titans like Google, Meta and X (formerly Twitter) are arguably today’s biggest publishers. Make no mistake: Big tech is in the business of content and advertising, with artificial intelligence-powered algorithms making content curation decisions about what viewers do — and don’t — see. The growth of news deserts demonstrates what happens when local talent is scraped away by tech companies. Local news becomes the proverbial baby thrown out with the bath water.
Congress introduced a bipartisan bill in July 2023 addressing the issue somewhat. The Community News and Small Business Support Act would provide local newsrooms with funding over five years to support hiring and retaining reporters. Additionally, small businesses could receive tax credits of up to $10,000 over five years for advertising in local news outlets. However, that bill is still making its way through Congress, and legislators haven’t taken action to regulate how big tech firms can use local news content. Meanwhile, Canada and Australia have grappled with forcing social media companies to pay for republishing local news, with mixed results.
If all of this sounds pretty dark, that’s because it is. On the other hand, dark clouds can have silver linings. At Virginia Business, our audience is the commonwealth’s business community. As others have pulled back from business reporting, we’ve leaned in and added to the magazine’s staff and coverage over the past few years. Both subscribers and advertisers are heading in our direction.
After a couple of decades of going down digital and social media rabbit holes, advertisers are tiring of measuring bots instead of people. The tech titans have frequently proven to be unstable in both measurement methods and leadership temperament. The quality of the context in which brand messages appear really does matter. Quality is defined by truthful, factual, timely and careful reporting.
As we enter 2024, Virginia Business remains strong. We thank you for your loyal readership and your unflagging advertising support. As always, we are committed to our mission of being Virginia’s source for business intelligence. Our hope is that the rest of the local news will also find its way to you. It is essential to our democracy.
In Assistant Professor Michael Albert’s MBA data science class at the University of Virginia’s Darden School of Business, students analyze historical usage data for a bike-sharing service to determine a bicycle maintenance schedule. In the past, they would tackle this simulation by writing code in the Python computer programming language — a pain point for many since their interest lies in business, not computer science.
But now that generative AI can produce syntactically correct code based on a plain- language prompt, the assignment has transformed from a technical coding problem into an exercise in articulating analytical goals. The assignment now, Albert says, is more about developing critical thinking skills.
“They’re not engineers or mathematicians; what our students care about is effective decision-making — being able to look at a complex …multidimensional problem and come away with the insights that will allow them to make the right decisions,” he says. “I view ChatGPT as a way to accelerate our students’ ability to make those decisions.”
Since the public debut of OpenAI’s ChatGPT generative artificial intelligence platform in November 2022, business leaders have been avidly exploring the benefits and potentials of generative AI. And business schools have accordingly come to see the need to integrate AI training into their curricula to ensure graduates are prepared to succeed in fast-changing workplaces where generative AI may be here to stay.
“I see that generative AI is transforming work across the board, and I think that it has the ability to increase the efficiency and productivity of workers,” says Paul Brooks, department chair and professor in information systems at the Virginia Commonwealth University School of Business. “In order for our students to be competitive in the workforce, they’re going to have to know how to use this technology.”
Brooks’ analytics students use AI for assignments such as analyzing historical data to figure out how many orders a vendor should prepare, a process that requires critically assessing AI’s output and refining prompts to improve the result. Such tasks are going to become ubiquitous as these tools evolve and penetrate all aspects of business operations.
“I can’t think of one corner of the world of work that will not be impacted by this,” says Phillip Wagner, a clinical associate professor at William & Mary’s Raymond A. Mason School of Business. “I think there’s a call for every industry and academic domain to be thinking about it. Without reservation, all business schools need to be doing this.”
Closing the AI gap
While employers around the world move quickly to embrace AI, there is a disconnect between leadership perspectives and employee actions and capabilities. An August 2023 Gallup survey found that 72% of Fortune 500 chief human resources officers anticipate AI will transform their companies’ staffing needs within the next three years. Yet 70% of employees say they never use AI tools, and more than half don’t feel capable of doing so.
Business schools need to help fill this gap. An early formal example of this is Northwestern University’s MBAi Program, an AI-focused degree program run jointly by the university’s Kellogg School of Management and McCormick School of Engineering. But in most cases, business schools are just beginning to integrate AI lessons and concepts into their curricula informally or on a case-by-case basis within the context of faculty discussions.
In October, the University of Virginia’s Darden School of Business received the largest gift in its 68-year history from alumnus David LaCross and his wife, Kathleen. Their $94 million donation, among the 10 largest gifts ever received by any business school, is aimed in part at helping Darden become a pioneer in researching and teaching about artificial intelligence.
In June, the university’s Generative AI in Teaching and Learning Task Force reported that 42% of U.Va. students currently use generative AI tools to assist with coursework. The task force recommended that schools and units within the university mandate syllabus statements around expectations on AI usage. The business school has been holding monthly seminars for faculty covering issues connected to AI, and faculty members who are interested in integrating AI into their courses can consult with instructional designers.
Kushagra Arora, Darden’s chief digital officer, emphasizes that the business school has been using other forms of AI in courses for a decade, so the advent of generative AI need not change anything fundamentally.
“We still want to do things in ways that are ethical and current, and to manage risk and security,” he says. “Almost every business unit at Darden at this point is using AI in some way or another.”
Evolving responses
Generative AI’s “potential is quite exciting,” says Karen Conner, director of academic innovation at William & Mary’s Mason School of Business. “I think we’re living in great times.” Photo by Mark Rhodes
Like at U.Va., other Virginia business schools are proceeding with plans for AI with much discussion, information-sharing and education but with relatively little emphasis thus far on formal policies governing its use.
Creating blanket policies for AI usage is fraught because it can impinge on academic freedom and faculty autonomy, some experts say, and such policies can also become outdated quickly as technology changes at lightning speed. As a result, most schools are focusing on providing information and guidance on how faculty can integrate AI while maintaining intellectual rigor, ethical standards and academic integrity.
“You don’t want to make a firm response and then have that become immediately outdated,” says Benjamin Selznick, associate professor and adviser of postsecondary analysis and leadership at James Madison University’s College of Business. “You want a dynamic, flexible context that’s going to evolve as the technology itself rapidly evolves.”
Meanwhile, some schools are proactively ensuring that faculty are well-versed on generative AI and equipped with needed resources.
William & Mary’s Mason School of Business has created a task force and a community of practice around generative AI. The school’s Academic Innovation team is publishing information about AI in its newsletter and is teaming up with the school’s McLeod Business Library and Center for Online Learning to hold virtual office hours for faculty on the topic. The team also created an online AI toolkit for faculty and presents updates on generative AI at every faculty meeting.
The overriding message is that faculty should play a key role in helping students learn to make the most thoughtful and effective use of AI tools.
“We need to expose our students to this technology so they can understand its limitations, its biases and the knowledge to critique what they have received as an output,” says Karen Conner, director of academic innovation at the Mason School.
Part of the AI-focused conversation at business schools revolves around how to maintain rigor, assessment standards and honor codes. It’s important for MBA programs to confidently certify that their graduates possess requisite skills, but assessing that can require creativity in a context where there are no effective filters to identify AI-generated output.
“Everyone’s handling it in their own way,” says Selznick at JMU. “It’s important to acknowledge that effectively collaborating with AI is going to be a valuable skill, but I’m also hearing about instructors who are saying, ‘I’m going back to pen-and-paper final exams because that’s the only way I’m going to know’” students aren’t cheating by using AI to complete assignments.
VCU’s Brooks says some faculty are turning to oral exams or asking students to report on their work in ways AI never could, such as by completing a task and then explaining their thought processes.
“It’s been very much disruptive to the way we’ve been doing things,” he says. “It’s caused us to rethink how we deliver the materials.”
Wagner, at William & Mary, believes that kind of rethinking can be good for faculty and their students. While he recognizes that some classes may have a stronger need for verifiable assessment than others, he encourages professors to reconsider how to appraise students’ learning.
“Instead of dwelling in the land of anxiety, I think it’s an invitation,” he says. “If your courses are ones where your students could plug your homework prompts into a machine and get an output, maybe it’s not necessarily the students’ problem alone. It’s that your teaching method needs some refreshing.”
Generating conversation
For all kinds of educators, grappling with AI is overall a question of how to combine the possibility and disruption of emerging technology with the age-old tradition of cultivating critical thinking skills.
“Essentially, for me, this goes back to liberal arts education,” says Kenneth Kahn, professor and dean at Old Dominion University’s Strome College of Business, where faculty are focused on helping students understand the potential pitfalls of AI, such as the technology’s tendency toward hallucinations and biases, as well as exploring promising ways that AI can enhance productivity. “You have to have that critical thinking to evaluate what the output is, to decide whether or not it’s important. That’s where our MBA students and our business schools need to go.”
For some MBA faculty, using AI to further a liberal arts education means using the tools to encourage open conversation and robust self-reflection. Tracy Johnson-Hall, a clinical associate professor at William & Mary’s business school, requires her MBA students to explain how they used generative AI on each assignment.
“First and foremost, by encouraging open discussion of the use of generative AI, I want to reduce the perception of any prohibition around it and instead focus on open conversations about where it is useful and how best to leverage it for productivity,” she says. “Asking them to explain how they use it generates conversation.”
William & Mary’s Wagner began requiring his MBA students to use generative AI in the fall 2023 semester, both to teach best practices for its use, but also to offer them opportunities to reflect on the process and on themselves.
For a course called Diversity in the Workplace, he has students conduct a dialogue of at least 30 messages with a generative AI tool on the subject of “a diversity hang-up,” such as friction between diverse beliefs and religious convictions. The process allows students to learn “to ask better questions and to be questioned, which makes us better, more well-rounded critical thinkers,” he says.
For William & Mary MBA student Skander Lakhal, who spent 10 years in the oil and gas exploration industry before returning to school, such facilitation of critical thought is the most promising aspect of generative AI. He uses AI to help with research, summarize long articles, process recordings and slides from lectures, prepare for exams and generate examples of difficult concepts from his classes.
“Through these experiences, I’ve learned that AI is more than just a tool for efficiency,” he says. “It’s a catalyst for deeper understanding and innovative problem-solving.”
Great possibilities lie in generative AI tools that enable intellectual exploration and new ways of thinking and working, say business school professors who are approaching the tools with an attitude of curiosity and enthusiasm.
“The potential is quite exciting, I think,” says Conner of William & Mary. “I think we’re living in great times.”
Elena Schlossberg has spent the past three-and-a-half years fighting against what some say is soon to become the world’s largest data center complex.
The Haymarket resident estimates she’s participated in at least 100 Zoom calls, town halls and Prince William County meetings to protest the project, while wearing a series of T-shirts voicing her opposition with slogans like “Data centers destroying communities.”
The Prince William Digital Gateway project — which Schlossberg alternately calls the “digital gateway to hell” — is set to transform 2,100 acres alongside the historic Manassas National Battlefield Park into 23 million square feet of data centers after county supervisors approved its rezoning Dec. 13, 2023, after a 27-hour meeting and public hearing that saw as many as 200 people testify for or against the project.
Proponents say the project will support 30,000 construction jobs and could generate $500 million in annual tax revenue during the next 15 to 20 years, money that could go toward schools and public safety. It would nearly quadruple the $101.42 million in tax revenue Prince William’s existing data centers brought in for 2022, a figure that has grown from $6.2 million in 2012.
“My goal was always to bring in commercial tax revenue. We’re a county that tries to keep up with the Joneses,” says outgoing Prince William County Board Chair Ann Wheeler, adding that she was trying to relieve pressure on the county’s residential tax base through her support of data centers, which may have cost her re-election to the body. “It’s really hard to do without the same kind of commercial tax base like Fairfax and Loudoun.”
But critics like Schlossberg view the spread of data centers in Prince William as a noisy, looming catastrophe with unsustainable energy demands and high environmental risks that clash with the county’s Community Energy and Sustainability Master Plan, which aims to cut greenhouse gas emissions by 2030 and become carbon-neutral by 2050.
That opposition has led to lengthy battles before the county’s planning commission and supervisors, including meetings that have stretched overnight and pitted residents against the industry, placing elected officials in the crosshairs. Also addingto the controversy is the lame-duck board’s approval of Digital Gateway and another development, the 270-acre Devlin Technology Park, near Bristow, in late November 2023, before new members could be seated, leading to complaints that the developments were jammed through.
The previous county board — with Democrats holding five seats to Republicans’ three — was divided mainly along party lines, with Democrats supporting the project and Republicans opposed. Ultimately, the project passed Dec. 13 on a 4-3 vote, with one Democrat, Kenny Boddye, abstaining.
“This is big money, big tech, big business,” says Dr. Steve Pleickhardt, president of the Amberleigh Station Homeowners Association, and a former Republican candidate for delegate. He’s not anti-data centers, he says — he just doesn’t want them near his home, or national parks. “Citizens don’t stand a chance against any of that.”
Attracting data centers
Bordered on the east by the Potomac River and home to Marine Corps Base Quantico and the FBI Academy training and research complex, Prince William has transformed from a farming community into a burgeoning life sciences corridor with the 2022 opening of the Northern Virginia Bioscience Center in the county’s Innovation Technology Park, a 1,500-acre research park anchored by George Mason University’s College of Science.
It’s also become an attractive destination for data center developers, lured by cheaper, more available land and better tax incentives than tech companies can find in other Northern Virginia counties.
Prince William has 42 data centers, totaling 7.78 million square feet, and another 4.5 million square feet were under development as of November 2023. That’s still a fraction of the industry’s presence in Loudoun County, Prince William’s neighbor to the northwest, which is home to the world’s greatest concentration of data centers.
Loudoun has more than 200 data centers comprising more than 26 million square feet, with an additional 4 million square feet under development. It’s home to Data Center Alley, a 6-square-mile area in Ashburn that handles more than 70% of the world’s internet traffic. Loudoun officials estimate data centers will generate about $570 million in personal property taxes in 2024. That’s about half of the local tax base, prompting Loudoun’s Board of Supervisors in November to approve a $70 million-plus revenue stabilization fund for its data centers to cover fluctuations in data center tax revenues in years when revenues are lower than anticipated.
Data centers are a growing, tax-rich business in Virginia, where the industry contributed $54.2 billion to the state’s gross domestic product from 2017 to 2021, according to a September 2023 PricewaterhouseCoopers study. Amazon.com alone invested $52 billion in building data centers in Virginia between 2011 and 2021, and the e-commerce giant expects to spend $35 billion more on data centers in the commonwealth by 2040, fed by increasing demand for cloud-based services like artificial intelligence tools and streaming media.
In Prince William, the county designated 9,500 acres as an overlay district in 2016, allowing data centers to develop in certain parts of the county without a special use permit. In 2022, county supervisors voted to open more than 2,000 acres for data center development use — an ongoing expansion effort prompted in part by a county study that found the overlay district is running out of marketable land.
Prince William’s fiber optic network and other infrastructure, as well as its initial data center tax rate of $1.25 per $100 of assessed value, added to the allure, says Wheeler.
Supervisors voted to raise that rate to $2.15 last spring to generate more revenue to cover county expenses and avoid spikes in real estate tax bills. That increasedoesn’t appear to have impacted developer interest.
Loudoun County’s data center tax rate is $4.15 per $100 of assessed value, but Wheeler says Loudoun is running out of land, and what it does have, it needs for housing. “[Data center developers] started looking close by, and we were here and had the fiber backbone already starting to go in,” Wheeler says.
As of early December 2023, there were at least 23 pending applications covering 14 data centers in Prince William that seek to rezone acreage from agriculture to business or modify building heights, according to the county planning office.
Those applications span data center projects over more than 1,000 acres. Among the largest are University Business Park, which would rezone about 117 acres in the county’s Brentsville District and allow for up to 3.8 million square feet of data centers, and Hunter Property, which would rezone roughly 196 acres in Brentsville.
One pending case deals with amending a zoning ordinance to address possible impacts of data center uses. Another is a review that could include amendments to the overlay district map.
Christina Winn, the county’s executive director of economic development, has previously said the county isn’t targeting data centers but considers the industry key to Prince William’s growth. Winn denied interview requests for this story.
The next “bull’s-eye” for data center development in Prince William is Sanders Lane, a two-lane, 4-mile road located near the Digital Gateway and surrounded by high-power transmission lines, Schlossberg says.
Similar to landowners near the Digital Gateway project, Sanders Lane residents are considering selling their properties to data center developers. A potential buyer for the Sanders Lane property hasn’t been disclosed and no application has been submitted yet.
“The Digital Gateway is just a microcosm of what’s happening in the state of Virginia,” Schlossberg says. “If people don’t wake up, we’re going to be sliced and diced and industrialized for the benefit of the world. And I don’t approve of that.”
Deshundra Jefferson’s opposition to the Prince William Digital Gateway project helped her oust Board Chair Ann Wheeler in the June 2023 Democratic primary. She will replace Wheeler on Jan. 2. Photo by Will Schermerhorn
Fever pitch
Debates over data center development in Prince William reached a fever pitch over the Digital Gateway and show no sign of abating, says Schlossberg, who founded the Coalition to Protect Prince William County in 2014 in response to a proposed transmission line to power an Amazon data center. The nonprofit focuses on smart growth and pushes back on the data center industry. It’s also one of more than 20 environmental and climate advocacy groups — including the Sierra Club and the National Parks Conservation Association — that banded together in December 2023 to ask the state legislature for regulatory oversight on data centers and a reexamination of the facilities’ impact on public health and the environment.
State Sen. Danica Roem, a Prince William Democrat who opposed the Digital Gateway, has said she plans to sponsor legislation that would allow the state more oversight of data centers.
Concerns over land constraints are already happening in Prince William County, too, along with skepticism over having the transmission capacity to meet the energy demand of the fast-growing sector.
Despite being the largest investor in renewable energy, the data center industry’s energy usage surpasses that investment, says Julie Bolthouse, director of land use with the Piedmont Environmental Council, which has organized against the centers in Prince William.
“The innovation on our renewable energy sector is not keeping up with the explosive energy demand that they are requiring,” Bolthouse adds.
Steve Precker, a spokesperson for Dominion Energy, assured planning commissioners during a Nov. 8, 2023, meeting that while the Fortune 500 electric utility can’t predict future impacts to the grid, Dominion would be able to handle the Digital Gateway’s initial buildout. Dominion Energy forecasts that electric demand for data centers in Virginia will more than quadruple from 2.8 gigawatts in 2023 to 13 gigawatts — roughly the equivalent of powering about 3.3 million homes — by 2038.
But Prince William Planning Commissioner Tom Gordy, a Republican who won election to represent the county’s Brentsville District on the Board of Supervisors in November on a platform of restricting data center growth, wasn’t convinced.
“Don’t sit here and tell me we have enough power. We don’t,” Gordy shot back. “We can’t keep doing this. … What is the breaking point for our county? When do we say enough is enough?”
That exchange was another volley in a yearslong political battle over data center demand that’s divided supervisors along party lines. Prior to that meeting, on Nov. 3, 2023, Digital Gateway’s developers, Dallas-based Compass Datacenters and Overland Park, Kansas-based QTS Data Centers, submitted a fifth round of application documents to the county. Planning staff recommended that the project be denied, complaining that the submission of thousands of pages of documentation less than a week before the planning commission hearing on the project did not leave enough time for review. The planning commission, which plays only an advisory role, also recommended denial.
After a more thorough review of the Digital Gateway, county planning staff still recommended the project’s denial in early December, saying the applications lacked critical information about site layout, elevations or blueprints.
Noting that more than 100 residents had joined to sell their homes for the Digital Gateway, a QTS Data Centers spokesperson said in a statement to Virginia Business that “QTS is grateful to Prince William County … for entrusting us with stewardship of the Prince William Digital Gateway. … QTS will continue to work diligently with county staff, elected officials and residents as it carries out its environmental and responsible development commitments. We are excited for this partnership to strengthen the Prince William community and bring increased local tax revenue and new job opportunities.”
The Digital Gateway controversy ensnared Wheeler, who faced a recall campaign in 2022 over her support for data centers — support that contributed to her ouster in June’s Democratic primary by Deshundra Jefferson, a media relations strategist and former broadcast journalist who opposes the Digital Gateway project. Jefferson will replace Wheeler as board chair Jan. 2.
It also led former Supervisor Pete Candland to resign his position in 2022, citing a conflict of interest because he was one of the homeowners who had agreed to sell their homes to the Digital Gateway developers.
Data centers have consumed so much political energy that residents and county officials say little headspace has been left to consider alternatives, says Supervisor Bob Weir, a Republican who represents the Gainesville district where Digital Gateway is located, and who has repeatedly voted against data centers.
Weir says efforts should instead be put toward supporting small businesses who “get the short shaft every time.” He expects litigation to follow the December Digital Gateway vote, which also poses an additional challenge to the incoming board, which will have to see the proposal through.
Jefferson says she’s heard from residents that tourism could be a welcome industry for the county to develop, but many remain more “fearful about what is in front of them.”
Wheeler sees opposition to data centers as a general resistance to development and growth, including housing, and an example of how misinformation proliferates.
“I just assumed that it would defend itself,” Wheeler explains. “And I was wrong.”
Associate editor Courtney Mabeus-Brown contributed to this story.
National Museum of the Marine Corps Photo courtesy Virginia Tourism Corp.
Prince William County at a glance
Founded in 1731 and located about 30 miles southwest from the nation’s capital, Prince William County is the second largest county in Virginia. Home to Quantico — a Marine Corps base and the main training facility for the FBI and DEA — the county known for its Civil War history and historic riverside towns. Prince William is also home to the state’s largest public research university, George Mason.
Population
486,943
Top employers
Prince William County Public Schools
S. Marine Corps
Prince William County government
Walmart
Amazon.com
Major attractions
Tourist attractions in Prince William include two national parks: Manassas Battlefield, where the first major Civil War battle occurred, and the 15,000-acre Prince William National Forest, which has 37 miles of hiking trails. You can dive into history at the National Museum of the Marine Corps, a 120,000-square-foot building that covers the Marines’ role in World War II, the Vietnam War and others. Farm Brew LIVE at Innovation Park is dubbed Northern Virginia’s “first destination brewery campus.” MurLarkey, a local distillery, is undergoing an $8.1 million investment to establish a 25,000-sqaure-foot building on Farm Brew’s campus.
Top convention hotels
Hilton Garden Inn Manassas 108 rooms, 1,500 square feet of meeting space (opening in 2024 with 43,000 new square feet)
Wyndham Garden Manassas 158 rooms, 5,500 square feet of meeting space
Hilton Garden Inn Haymarket 117 rooms, 2,570 square feet of meeting space
Dr. Aubrey Knight has spent his career listening to stories about the past. He’s talked to people who were miners during World War I. He’s spoken to Prohibition-era bootleggers. He’s heard endless stories of relationships severed then reconciled decades later.
That comes with the territory for geriatricians like Knight who specialize in treating older adults. A professor of family medicine and senior dean of student affairs at Virginia Tech Carilion School of Medicine, he says the joy and sense of accomplishment he associates with the specialty is what drew him to choose it more than 30 years ago.
With more than 56 million Americans now 65 and older, geriatrics is one of the specialties most in need of doctors due to a large population of aging baby boomers. But most of today’s medical students don’t feel the same pull for the specialty that Knight did.
The American Geriatrics Society estimates that the U.S. will need 30,000 geriatricians by 2030 to meet health care needs, but there are currently fewer than 7,300 geriatricians practicing in the nation.
The urgent need for geriatricians and other specialists shows how competing medical needs in an industry barraged with burnout and staffing shortages — especially among the primary care and behavioral health workforces — is leaving gaps in patient care.
It’s also creating a challenge for Virginia medical school leaders who want to encourage students to flock toward in-need specialties while making sure they also choose a career that will fulfill them.
Those two goals don’t always line up.
Family medicine, for example, is facing one of the most aggressive physician shortages in the U.S., but it’s not one of the most popular medical specialties — unlike dermatology, orthopedic surgery and anesthesiology, which are also among the most competitive residency programs to get into.
“What we don’t want is for a student to make the wrong decision, for a student to get into a specialty and to realize two or three years in, ‘This is not what I thought it was going to be,’” Knight says.
But no matter what specialty they choose, Dr. Lee A. Learman, VTCSOM’s dean since 2019, notes that graduating med school students are helping the health care industry battle an overall physician workforce shortage.
By 2034, the U.S. will be facing a shortfall of up to 124,000 physicians, according to projections from the Association of American Medical Colleges. Even surgical specialties, which are among the most popular and most competitive medical fields, are also facing severe shortages in rural areas and in the South. Nationwide, the AAMC projects surgical specialties could be short by up to 30,200 physicians
by 2034.
In a national address about the growing crisis in October 2023, American Medical Association President Dr. Jesse Ehrenfeld said, “While our current physician shortage is already limiting access to care for millions of people, it’s about to get much worse.”
A third-year medical student at Virginia Commonwealth University, Mathew Ciurash decided to specialize in anesthesiology after shadowing a resident anesthesiologist. Photo by Caroline Martin
Years in the making
Deciding on a medical specialty is a process years in the making, and it’s part of an additional three to seven years of residency that follows medical school before doctors formally join the workforce.
Medical students usually choose specialties after their third year of medical school, where as part of the core curriculum, they “rotate” or train in multiple specialties like internal medicine, general surgery, psychiatry or emergency medicine as part of an actual medical team.
Students then take what’s known as the Step 2 CK exam, a one-day test of clinical knowledge, such as treatments for given diagnoses. The exam determines a students’ competitiveness in applying to residency programs that train newly graduated physicians in specific medical specialties.
The more competitive the specialty, the higher a student needs to score on the exam to remain an attractive candidate, says Caila Bachmann, who is entering her fourth year as a medical student at the University of Virginia and plans to specialize in general surgery due to her love of hands-on work.
The fourth year of med school consists of electives that cater to a student’s expected specialty choice and can provide them a boost in their residency application process, which starts around September and is when they officially declare their desired medical specialty. Applicants are then matched with residency programs each March by the National Resident Matching Program. The number of applications submitted per person depends on the medical specialty.
Because the process is getting more competitive, med students are individually submitting more residency applications in order to raise their odds at landing a desired residency slot, Bachmann says. Med students are also putting in more applications because most residency interviews are now conducted virtually, eliminating travel time and expenses that applicants used to incur before the pandemic.
Mannet Dhaliwal, a fourth-year U.Va. medical student who aims to specialize in psychiatry, says she’s applied to more than 50 residency programs. A friend who wants to specialize in dermatology has applied to roughly 150 residency programs due to dermatology programs being smaller and among the most competitive, Dhaliwal says. The easiest programs to get into are often the ones most in need of doctors and require fewer applications, she says.
“We need a lot more pediatricians, so that’s why it’s ‘easier’ to get that residency,” Dhaliwal explains.
Decisions, decisions
The average Eastern Virginia Medical School graduate has $250,650 of school debt, according to a 2023 AAMC report, while graduates of Virginia Tech Carilion School of Medicine and the U.Va. School of Medicine incur $204,515 and $161,322 in average school debt respectively.
“I make a lot of jokes about [the debt] because I find it’s on my mind a lot,” Bachmann says. “And it’s easier to laugh than cry.”
But interest, desired lifestyle, level of patient interaction and work-life balance play heavier roles in the specialty decision-making process than salary, according to Bachmann and others.
Though Dr. Ronald Flenner, vice dean for academic affairs at Eastern Virginia Medical School, has met students whom he thinks would make “fantastic” primary care physicians, they’ve been turned away from it as a career option due to their school debt loads, he says.
Work-life balance, however, was the top consideration for 85% of new physicians choosing a job in 2022, compared with 63% in 2018, according to surveys from health staffing consultancy CHG Healthcare.
It’s a reason why dermatology, a profession limited mostly to daytime work hours, has remained consistently popular and why anesthesiology is growing as another desirable specialty nationally and among Virginia’s med school students.
Nationally, more specialized fields like thoracic surgery, neurosurgery, plastic surgery and orthopedic surgery are much more competitive and are more likely to see high percentages of people not make it into those residency programs due to limited slots. These specialties are also among the highest paid.
A neurosurgeon can expect an average annual salary of $788,313, while a family medicine doctor makes an average of $273,040, according to a 2023 physician compensation report from medical platform Doximity.
Psychiatry is a specialty that’s slowly becoming competitive, too, which Virginia’s medical school leaders attribute partly to a growing behavioral health crisis across the U.S.
More than 2,100 psychiatry positions were offered in the 2023 residency match nationwide, the highest ever recorded, and the specialty had 99% of its residency program slots filled, says Donna Lamb, president and CEO of the National Resident Matching Program.
Lamb and Virginia’s medical school leaders say Virginia’s medical students mirror national trends.
Bearing witness to industry stressors is also influencing med students’ choices on whether to pursue a particular specialty, says Dr. Meg Keeley, a pediatrician and senior associate dean for education at U.Va.’s School of Medicine.
“I would say the biggest shift that we have all experienced — not just in my medical school but across the country — is a fairly dramatic drop-off of students choosing to go into emergency medicine,” Keeley adds, which is in part due to stories about how emergency rooms were overwhelmed as they fought on the pandemic’s grueling frontlines.
Prior to COVID, emergency medicine was one of the most popular and competitive specialties for students to get into. But in 2023, the emergency medicine specialty had just 82% of available residency slots filled, down from 92.5% in 2022, Lamb says.
Third-year clinical rotations offer another glimpse into the industry, which leads some physicians to pull away from less competitive specialties with high industry needs like internal medicine when they see how difficult those specialties can be day-to-day, says Dhaliwal.
“The residency is very brutal. You are just basically working like 14-hour days for four years, six days a week,” Dhaliwal continues. “I think a lot of people just don’t want that life for themselves.”
For Mathew Ciurash, a third-year medical student at Virginia Commonwealth University’s School of Medicine, shadowing a resident anesthesiologist his first year had the opposite effect. Seeing how happy and fulfilled anesthesiologists were in their jobs is what cemented his decision to pursue anesthesiology as a specialty.
The pressure to be certain about the specialty one chooses can be tough, Ciurash explains, “because there’s … not really a looking back. Once I start a new residency, I’m … locked into a field that I better enjoy because it’s the rest of my career.”
Doctors in demand
The paradox facing medical schools is that the medical specialties experiencing the greatest shortages of doctors aren’t always the specialties medical students tend to pursue — and the issues deterring students from going into those in-need specialties are sometimes out of their control.
Medicaid’s low reimbursement rates for pediatricians and other primary care physicians can make it challenging for some practices to retain staff and provide needed care for patients.
In Virginia, the result is that more than 60% of open physician roles are for primary care positions, and those are concentrated in metro areas, likely due to patients’ ability to pay rather than need for physicians, according to a preliminary study issued in 2023 by the Virginia Health Workforce Development Authority.
Nationally, during the past 10 years, family medicine has had the lowest number of residency program slots filled within primary care specialties.
But in some cases, political and social factors — such as health care policies and growing awareness of the social determinants of health — are in part prompting students to chase specialties with great need for doctors, says Dr. Arturo Saavedra, dean of the VCU School of Medicine and VCU Health System’s executive vice president for medical affairs.
One example is Swet Patel, a fourth-year U.Va. medical student who has chosen family medicine as his specialty. Patel says seeing how overworked physicians were in larger institutions led him to want to own his own independent practice so he could have greater autonomy.
Dhaliwal, the fourth-year U.Va. medical student pursuing psychiatry, says she was drawn to the intersections of race, class and gender that “come to light” in psychiatry after working closely with
social workers.
But despite the urgent need for psychiatrists and family physicians, there’s a cap on the number of federally funded residency positions — which means there could be interest but not enough spots for them.
“We need more doctors in this country,” Dhaliwal says, “and they make it so hard.”
Dr. Dena K. Krishnan, cardiologist, Bon Secours – Cardiovascular Specialists; director of Women’s Cardiovascular Disease and Prevention Center and director of cardiac rehab, Bon Secours Maryview Medical Center, Portsmouth
Other medical specialties: Internal medicine and a special interest in cardio-oncology
Education: Bachelor’s degree, Xavier University; master’s in biology and neuroscience, Bowling Green State University; medical degree, Lincoln Memorial University; internal medicine residency and cardiology fellowship, Genesys Regional Medical Center
Family: I’m married to an orthopedic hand surgeon, Dr. Shawn Wilson. We have two children, Jay and Jolie, and our bernadoodle, Yogi.
Career mentors: I was lucky enough to train with Dr. Patch Adams on a medical mission trip in Costa Rica. He taught me how to truly care or people. Also, my master’s thesis adviser, Dr. Lee Meserve, is the one who pushed me out of academics and into the clinical world.
First job: I worked at the concession stand in a movie theater starting at 15 years old! Later, I also waited tables at my parents’ restaurant.
Hobbies: I am crazy about gardening and love to cook what I grow!
There have been a lot of efforts to make women aware of their risk for heart disease in recent years. From your standpoint, is it working?
Yes, absolutely! Women are much more aware of their unique risk factors and symptoms.
What innovations in cardio treatment are you most excited about? Technology is rapidly advancing and evolving in our imaging techniques (besides ultrasound, we also have CT, MRI and PET scans). We have so many more noninvasive or minimally invasive ways to evaluate and treat cardiac problems than ever before.
The Tar Heel State may have been first in flight, but Virginia landed a first for the advanced air mobility industry in September 2023 when the U.S. Federal Aviation Administration granted conditional approval for the nation’s first public-use vertiport, a landing and launch site for electric vertical takeoff and landing aircraft — notably including air taxis — to be located at Allen C. Perkinson Airport, also known as Blackstone Army Airfield, in Nottoway County.
The roughly 600-acre airport, jointly owned by the Army and the Town of Blackstone, services civilian and military aircraft and includes a concrete runway and helipad.
Funded by an autonomous systems grant from the Virginia Innovation Partnership Corp., Floyd County-based Navos Air, which worked with the FAA to obtain approval for the vertiport, is developing what Matt Burton, Navos’ technical director, calls the “invisible infrastructure,” or a system of terminal instrument procedures and enroute infrastructure anchored by vertiports to enable safe navigation by the advanced air mobility industry. Navos will continue that research once the vertiport, which is slated for an unused taxiway on the airport’s north side, is up and running.
Initial work on physical infrastructure involves site improvements, including painting and marking a designated area, says Blackstone Town Manager Philip Vannoorbeeck, adding that he anticipates “an appreciable” amount of utility and concrete work to come.
As the FAA solidifies guidance for vertiport design and criteria, the airport will work with an engineering firm to continue work on the site, says Joe Allman, who manages services at the airport for the town and is also president of UAV Pro, a local unmanned aerial vehicle integration company. Infrastructure updates to support the vertiport could include taxiway guidance and charging facilities; the airport has an electrical charging station scheduled for installation in March.
State licensing for the vertiport is expected to come in January, says Greg Campbell, director of the Virginia Department of Aviation.
The state estimates that the AAM industry could generate up to $16 billion in new business and carry as many as 66 million passengers by 2045. While Campbell anticipates cargo will be the industry’s initial focus, shuttling passengers from places not traditionally served by large airplanes may not be too far behind.
“It will be an exciting decade or two,” he says, “as these technologies become more advanced and more proven.”
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