Those pushing an expansion of the Medical College of Georgia School of Medicine in Augusta, Athens and Savannah want the green light to proceed, and they could soon get their answer.

But even if the University System of Georgia Board of Regents approves the plan, the real detailed planning must begin. If the University of Arizona and its satellite medical campus in Phoenix are any guide, the political grumbling and negotiating won't end even after the new campus opens.

Consulting firm Tripp Umbach delivered the summary of an expansion plan to the Regents last week. The Regents are expected to vote on it Monday.

"That's really the go-ahead we would need to begin that next phase of planning for implementation," said MCG School of Medicine Dean D. Douglas Miller. "With the Board of Regents review and approval, if it occurs on Monday, that would give us a green light to begin to set up a phasing plan and a timing plan for all of the aspects of this project, which are numerous and involve everything from curriculum to facilities and other things."

The consulting report Tripp Umbach presented is a 48-page executive summary of three months of intensive study by the Pittsburgh-based group, which has consulted on a number of medical school expansions, including Arizona's. The report projected a shortage of 2,500 doctors by 2020 in Georgia if nothing is done. MCG would need to expand to 1,200 students, about 300 a year, to keep pace.

The report did not take into account the private medical schools in Georgia -- at Emory and Mercer universities, Morehouse School of Medicine and the Philadelphia College of Osteopathic Medicine campus in suburban Atlanta. Those schools have plans to increase enrollment by more than 100 students a year total in the coming years and would have more than 1,500 medical students once those expansions take place. But Paul Umbach, the founder of Tripp Umbach, told the Regents that MCG would still need to reach 1,200 or the state would face "a crisis in 2020."

His report recommended MCG expand with a 40-student medical school class in Athens in conjunction with the University of Georgia, beginning in 2009 or no later than 2010. The class size would reach 60 a year, or 240 students overall, in 2012 when the school moves onto the 58-acre campus of the Navy Supply Corps School once it is vacated.

The Augusta campus would increase from 190 students per class to 240 once a new $99 million medical education building is completed, which will share some services with a new School of Dentistry building to save about $20 million.

The MCG clinical campus in Albany would increase to play host to 30 third- and fourth-year students for their clerkships. By working with St. Joseph's/Candler health care systems in Savannah, MCG would establish a similar system for about 30 other third- and fourth-year students.

Tripp Umbach recommended allocating $10 million a year to MCG for expansion support each of the 12 years covered by the plan and urged increasing overall medical education funding from $75 million annually to $116 million a year in 2020. Georgia Gov. Sonny Perdue included $7.2 million for MCG expansion in his 2009 fiscal year budget request, which when added to a recurring $2.8 million for expansion added last year would be the first $10 million installment.

MCG PRESIDENT DANIEL W. RAHN said officials know they will have to make their case for the money.

"The plan does involve significant incremental investment so we will have to, I believe, demonstrate both the effectiveness and the wisdom of the proposed strategy if we're going to be able to secure enhanced investment," he said.

That's one reason Mr. Umbach said "the Navy school property is a wonderful opportunity for the state of Georgia for very little money." Nationally, the average cost of educating a medical student is $240,000 a year, but the projected cost in Athens would be about $100,000 by taking advantage of the property and other assets, he said. MCG's cost is about $140,000 per student per year, so "already Georgia has a very efficient program for educating medical students," Mr. Umbach said.

The report also advocated spending $210 million in capital projects that would include:

- The $99 million medical education building in Augusta

- A $41 million health sciences campus in Athens

- A 6,000-square-foot medical education building in Savannah for $2.4 million

- A 6,000-square-foot medical education facility in Albany for $2.4 million

The report calls for the Savannah and Albany funding to come in 2009. It recommends $140 million to fund both the Augusta and Athens construction in 2010. That is the earliest those projects could make it through the Board of Regents capital request process and be approved, Dr. Miller said.

"It is my goal that the state of Georgia in 2010 will make the move to have a large capital year for medical education," Mr. Umbach said. "It will be critical that that happens to fuel the facilities for this plan. And I see that being important that both of those facilities in both of the communities happen simultaneously."

The plan also calls for $59 million in 2015 to fund research buildings on both the Athens and Augusta campuses. Though UGA and MCG have had a number of collaborations over the year, the medical school expansion should fuel that and increase both by 15 percent, Mr. Umbach predicted.

It's one reason UGA President Michael Adams said he is excited about the partnership, which he said he and Dr. Rahn began discussing in earnest two years ago.

"With that kind of partnership, we will have terrific opportunities for enhanced research," he said.

THE MCG EXPANSION would add about $350 million to Augusta's economy and account for about 3,000 new jobs and $172 million in new tax revenue by 2020, according to the report. The regional campus in Athens would generate $567 million in economic benefit if fully realized, the report said, and generate $17 million in new tax money. When taking into account new research funding and commercial applications spun off, and the impact of new physicians, the report optimistically projected that MCG would generate $3.2 billion a year in economic impact by 2020.

However, though it is detailed and thoroughly researched, it is still just a report, officials said.

"It does not include a step-by-step work plan that includes accountable individuals and timelines, months when dollars will come online and costs will be incurred, facilities and all of that," Dr. Rahn said.

"And at some point, it's not Tripp Umbach's report anymore," Mr. Umbach said.

"It's the Regents' plan," Dr. Rahn said.

At least one member of the Augusta state legislative delegation, Rep. Quincy Murphy, D-Augusta, said he was pleased by the outcome.

"The exciting part about this is Augusta will be the central point" for medical education in Georgia, he said.

BUT OTHER AUGUSTA LAWMAKERS remain opposed.

"The Umbach Report may have been fatally flawed from its inception," Georgia Sen. Ed Tarver, D-Augusta, wrote in an e-mail. Instead of looking at whether expansion to Athens was necessary, he wrote, Mr. Umbach accepts "without question that expansion to Athens is the only solution that would address Georgia's physician shortage. The report does not address whether or not Georgia could address the anticipated (2,500) physician shortage faster and at a lower cost to taxpayers by expanding MCG's existing facilities in Augusta and by utilizing abundant currently untapped resources."

But Mr. Umbach said the 240-student-per-year class in Augusta is the "maximum capacity." He insists that when he began the report, he first calculated the minimum level of students Georgia would need in 2020 -- 1,200 -- and then ascertained how much Augusta could do even with all of the hospitals participating.

"And it came out to about 900" medical students in Augusta, Mr. Umbach said. "And it was about 300 short."

That was what led him to look at the potential in Athens, not previous MCG and Athens planning, he said.

"I never actually asked for nor did I ever receive a plan from MCG," Mr. Umbach said.

Though she was "delighted" by the talk of expanding immediately in Augusta, state Rep. Barbara Sims, R-Augusta, said she was disappointed that it won't happen for a few years. And although expanding across the state might make sense for the future, she wondered, "Who is going to fight for Augusta? It's looking dismal. We have no one on the Board of Regents to fight for us. And that's where the fighting is going to be."

THE DISAPPOINTMENT and suspicion in Augusta will likely not fade even if the Athens campus opens, based on what the University of Arizona in Tucson has gone through in establishing a satellite of its medical school in the much larger and more influential city of Phoenix.

"There's no question that both then and now the primary concern in Tucson is that this is a zero-sum gain," said Keith A. Joiner, the dean of the university's College of Medicine. "And that the state Legislature in particular will send incremental funds to Phoenix literally at the expense of Tucson."

Part of the problem in Tucson is that the Phoenix campus is being established in conjunction with Arizona State University.

"The president, Michael Crow, has made it clear publicly that he has aspirations for Arizona State to be the biggest university in the country, so they have an enormous growth strategy," Dr. Joiner said. "And they're getting a lot of resources from the state. So there's not only a concern in Tucson that this is disadvantaging the U of A in Tucson, but also that it's advantaging ASU."

In the face of that criticism, Tucson officials have stuck to their guns in calling the new satellite what is best for the state.

"Within the (medical) college, we can make a case, and not everybody buys it, but I think it is true, that this is an all-boats-rise process," Dr. Joiner said. "And that by building these two programs in Tucson and Phoenix in a complementary way, trying to minimize duplication, trying to maximize synergies, that it will be mutually beneficial. I would say that at the University of Arizona more broadly, that argument doesn't carry a lot of weight."

Staff Writer Sylvia Cooper contributed to this report.