A new rural medical college for Minnesota didn't open as scheduled in fall 2018, but the project has a pulse.

Leaders of the proposed Minnesota College of Osteopathic Medicine in Gaylord, Minn., have taken key steps this year to advance the project — buying a former public school complex to serve as the new campus, gaining tax relief from the city of Gaylord to finance renovations, and reaching agreements with undergraduate colleges to prepare future medical students.

"We're on target to open in the fall of 2020," said Dr. Barbara Ross-Lee, who will serve as dean after holding similar roles in osteopathic schools in Ohio, New York and Arkansas.

Renovation of the former Sibley East school campus is slated to start in January, along with construction of an adjoining student residence hall.

The project would be part of a wave of new osteopathic medical schools in the U.S., which are opening in response to the projected national shortage of doctors, especially in primary care. Osteopathic colleges give training that is similar to conventional medical schools, but with an emphasis on prevention and holistic medicine. Most graduates end up in primary medical care as a result. Osteopathic physicians are less common in Minnesota than in other states.

New schools, or new branches of existing osteopathic schools, have opened in 16 states in the past five years, according to the American Osteopathic Association. The 28,981 osteopathic medical students last year represented an 85 percent increase from enrollment in 2017, the association reported.

Ross-Lee said the Minnesota college is seeking pre-accreditation from the association, which it must earn before it can enroll students.

Meanwhile, five undergraduate institutions in Minnesota are creating "pipeline" programs to prepare students for osteopathic training, but Ross-Lee said she isn't worried about recruiting. The school's first class will be 75 students, but future classes will have 150.

"There are three qualified applicants for every medical school seat in this country," she said.

Medical school is only one step. Graduates must complete on-the-job residencies like other medical students. A federal cap on residency slots has prevented existing programs from training more doctors, whether they be ODs or MDs. However, the cap does not prevent new programs from forming.

As a result, a dozen small hospitals in Minnesota and one in South Dakota have agreed to start residency programs in coordination with the new medical school, Ross-Lee said, because they struggle to recruit practitioners.

"If you can't recruit them," she said, "grow your own."