The University The University of Nevada of Nevada School of School of MedicineMedicine

The University of Nevada The University of Nevada School of Medicine’s Report School of Medicine’s Report

to Governor Guinn’s to Governor Guinn’s Commission on Health CareCommission on Health Care

James E. RogersJames E. RogersChancellor, Nevada Chancellor, Nevada

System of Higher System of Higher EducationEducation

John A. McDonaldJohn A. McDonaldVP Health Sciences and VP Health Sciences and

DeanDean

A First Step In The Dialogue:A First Step In The Dialogue:Medical Education: A Quick PrimerMedical Education: A Quick PrimerThe Core Problem: The State’s Health The Core Problem: The State’s Health Care NeedsCare NeedsCurrent Snapshot Of The University Current Snapshot Of The University Of Nevada School Of MedicineOf Nevada School Of MedicineWhat Does The State Need Us To Be?What Does The State Need Us To Be?Our Emerging Vision: The University Our Emerging Vision: The University Of Nevada Health Sciences CenterOf Nevada Health Sciences CenterQuestions And DiscussionQuestions And Discussion

Medical Education: A Medical Education: A Quick PrimerQuick Primer

Nationally, 126 schools of medicine Nationally, 126 schools of medicine graduated 16,648 students in 2004, graduated 16,648 students in 2004, average class 132average class 132

University of Nevada School of University of Nevada School of Medicine has a graduating class size Medicine has a graduating class size of 52of 52

The University of Nevada School of The University of Nevada School of Medicine is small, focused on primary Medicine is small, focused on primary care, with limited specialty training care, with limited specialty training programs and limited researchprograms and limited research

The state needs us to be a complete The state needs us to be a complete medical schoolmedical school

Graduate Medical Graduate Medical Education (Residencies Education (Residencies and Fellowships)and Fellowships)

Three to ten years post-MDThree to ten years post-MD Regulated by the Accreditation Regulated by the Accreditation

Council on Graduate Medical Council on Graduate Medical Education (ACGME)Education (ACGME)

70% of physicians practice where 70% of physicians practice where they completed their final trainingthey completed their final training

Residency and fellowship programs Residency and fellowship programs are the most efficient way to build a are the most efficient way to build a state-wide physician workforcestate-wide physician workforce

Building a new Building a new residency programresidency program

Year 7 or 8Year 7 or 8

Years 3 and Years 3 and 44

Year 3Year 3

Recruit Faculty and Staff; Recruit Faculty and Staff; Create Curriculum; Prepare Create Curriculum; Prepare Program Information Form; Program Information Form; apply for site visit apply for site visit

First Class FinishesFirst Class Finishes

First Class StartsFirst Class Starts

Provisional Accreditation; Provisional Accreditation; Advertise for residentsAdvertise for residents

Program Site Visit, RRC ReviewProgram Site Visit, RRC Review

Years 1 and 2Years 1 and 2

Year 4 or 5Year 4 or 5

Nevada’s Nevada’s Physician Physician Workforce Workforce CrisisCrisis

Nevada ranks 48th in the Nevada ranks 48th in the nation in physicians per nation in physicians per 100,000 population100,000 population

This severely limits This severely limits access to care for access to care for NevadansNevadans

UNSOM: Our Heritage and UNSOM: Our Heritage and Current StatusCurrent StatusIn sum: We are not what we need to be. Nevada’s population and their health needs are growing and changing; UNSOM (and the other health professional schools at UNR and UNLV) need to grow and change accordingly

Founded in 1969Founded in 1969 Among smallest of medical Among smallest of medical schools in the nationschools in the nation

Limited Graduate Medical Limited Graduate Medical Education programsEducation programs

NIH Funded Research NIH Funded Research Rank: 101 out of 126 Rank: 101 out of 126 schools, due to small size schools, due to small size and scope of facultyand scope of faculty

Rural health rotationRural health rotation

Plastic and Plastic and Reconstructive Surgery: Reconstructive Surgery: Restoring hope where Restoring hope where there was nonethere was none

SavingSaving Hannah’s Hand Hannah’s Hand

SavingSaving Hannah’s Hand Hannah’s Hand

Nevada’s Gap in Medical Education

StatStatee

PopulatioPopulation n

(millions(millions))

MedicMedicalal

SchooSchool l

ClassClass

ResidencResidency & y &

FellowshiFellowship p

ProgramProgramss

Total Total ResidenResiden

ts &ts &FellowsFellows

FacultFacultyy

State State PovertPovert

yy

NMNM 1.91.9 7676 3737 479479 617617 17.517.5

UTUT 2.52.5 104104 3838 534534 906906 9.69.6

AZAZ 5.95.9 107107 4141 348348 645645 13.813.8

NVNV 2.42.4 5252 1212 194194 189189 10.210.2

PROGRAM NEVADA NEW MEXICO ARIZONA UTAH

Family PracticeInternal Medicine

SurgeryOB/Gyn

PsychiatryPlastic Surgery

DentistryAnesthesiology

DermatologyDiagnostic Radiology

Radiation OncologyEmergency Medicine

NeurologyNeurosurgery

Occupational MedicineOphthalmology

OrthopedicsOtolaryngology

PathologyPediatrics

Physical Medicine/RehabPreventative Medicine

Cardiothoracic SurgeryUrology

Vascular Surgery

Nevada’s gap in Nevada’s gap in residency training residency training programsprograms

Nevada’s gap in Nevada’s gap in fellowship fellowship trainingtrainingPROGRAM NEVADA NEW MEXICO ARIZONA UTAH

Hand SurgeryTrauma

Critical CareFam. Med. Sports Med.

Fam. Med. ObstetricsCardiology

Cardiac SurgeryGastroenterology

EndocrinologyChild/Adol. Psychiatry

Child NeurologyForensic PathologyGeriatric Psychiatry

Geriatrics/GerontologyHematology/Oncology

Integrative MedicineInterventional Radiology

Infectious DiseaseNeonatology

NephrologyNeurology

NeurosurgeryNeurological Radiology

Pain ManagementPediatric Pulmonary

Nevada’s physician Nevada’s physician “pipeline” is the “pipeline” is the smallest in the USsmallest in the US

Nevada has the lowest number of postgraduate medical trainees per population amongst states with medical schools

0 10 20 30 40 50 60 70 80 90

New York

Illinois

Louisiana

North Carolina, Tennessee,

Wisconsin

Alabama, Utah, Washington

Arizona, Maine, Oregon

South Dakota

Idaho

Medicare residency slots/100,000 residents

NV

Expanded Graduate Expanded Graduate Medical Education Medical Education Requires ResourcesRequires Resources

Direct Costs: Salaries and Direct Costs: Salaries and hospital-based costs typically hospital-based costs typically funded by Federal Government funded by Federal Government (CMS) or Veterans (CMS) or Veterans AdministrationAdministration

Major Issue: CMS funded “slots” Major Issue: CMS funded “slots” are cappedare capped

School of Medicine also incurs School of Medicine also incurs costs and needs resources to costs and needs resources to support expanded educationsupport expanded education

Infrastructure (space, Infrastructure (space, technology, support staff)technology, support staff)

FACULTYFACULTY

What Does Nevada What Does Nevada Need Its Medical Need Its Medical School to Be?School to Be?

A key part of the solution to the State’s A key part of the solution to the State’s healthcare workforce shortagehealthcare workforce shortage

A source of primary and specialty care A source of primary and specialty care physicians trained to work in teams physicians trained to work in teams with other health care providerswith other health care providers

A contributor to the Nevada’s economic A contributor to the Nevada’s economic development through biomedical development through biomedical researchresearch

A partner for innovative private-public A partner for innovative private-public partnerships – Ruvo Institute, Lili partnerships – Ruvo Institute, Lili Claire, Center for Chronic Fatigue Claire, Center for Chronic Fatigue Syndrome, NVCI Syndrome, NVCI

What Does Nevada What Does Nevada Need Its Medical Need Its Medical School To Be?School To Be?

Focused on the health needs of NevadansFocused on the health needs of Nevadans A training ground for physicians and A training ground for physicians and

residents trained in the most current, best residents trained in the most current, best practices for patient carepractices for patient care

A medical school that remains accessible and A medical school that remains accessible and affordable for the best of Nevada’s future affordable for the best of Nevada’s future physiciansphysicians

A source of A source of great pridegreat pride for Nevada for Nevada

Our Emerging Vision: Our Emerging Vision: The University of The University of Nevada Health Nevada Health Sciences CenterSciences Center

A Health Sciences Center is a A Health Sciences Center is a University-based, integrated set of University-based, integrated set of health professional education and health professional education and biomedical research programs, biomedical research programs, aligned with supportive patient aligned with supportive patient care programs and facilities. care programs and facilities. Health Sciences Centers, on a Health Sciences Centers, on a national basis, are highly diverse, national basis, are highly diverse, take many forms, and fulfill their take many forms, and fulfill their missions in a variety of ways.missions in a variety of ways.

A Health Sciences A Health Sciences Center is Center is not justnot just buildings. It is:buildings. It is:

Shared missions of health professional Shared missions of health professional education, biomedical research, patient education, biomedical research, patient care, and community health improvementcare, and community health improvement

A medical school and other health A medical school and other health professional schools (Nursing, Public professional schools (Nursing, Public Health, Pharmacy, Dentistry, etc.)Health, Pharmacy, Dentistry, etc.)

An aligned teaching hospital (or more than An aligned teaching hospital (or more than one), deeply committed to the success of one), deeply committed to the success of the academic programs and facultythe academic programs and faculty

Guided by leadership devoted to the Guided by leadership devoted to the common missions and working within an common missions and working within an organizational structure empowered to organizational structure empowered to make decisions and commit resourcesmake decisions and commit resources

Our Emerging Vision: Our Emerging Vision: The University of The University of Nevada Health Nevada Health Sciences CenterSciences Center

Quality faculty – with breadth and depth across the disciplines and Quality faculty – with breadth and depth across the disciplines and passionate career commitments to teaching and research – form the core passionate career commitments to teaching and research – form the core

of a Health Sciences Center.of a Health Sciences Center.

FACULTY

EDUCATION

PATIENTCARE

RESEARCH

COMMUNITYHEALTH

PHARMACY

NURSING

MED

ICIN

E

BASIC

SCIENCES

PHYSICAL

THERAPY

PU

BLI

CH

EA

LTHDEN

TIST

RY

What Will The What Will The University of Nevada University of Nevada Health Science Center Health Science Center Do for Nevada?Do for Nevada?

As Nevada changes, its health care As Nevada changes, its health care system needs to change. A robust system needs to change. A robust Health Sciences Center will:Health Sciences Center will:

Educate more physicians and health Educate more physicians and health professionals, improving access to professionals, improving access to carecare

Develop programs to improve the Develop programs to improve the population’s healthpopulation’s health

Bring research dollars and talent Bring research dollars and talent into the Stateinto the State

What Will The What Will The University of Nevada University of Nevada Health Science Center Health Science Center Do for Nevada?Do for Nevada?

Enhance the State’s access to Enhance the State’s access to research-based care and research-based care and preventionprevention

Anticipate and meet critical Anticipate and meet critical needs of a rapidly growing and needs of a rapidly growing and aging populationaging population

Build Nevada’s national Build Nevada’s national reputation as a state with reputation as a state with outstandingoutstanding health care for allhealth care for all

We need to work together to:We need to work together to:Articulate the major health policy Articulate the major health policy issues for the Stateissues for the StateDefine a process to solve these Define a process to solve these problemsproblemsAddress how to finance graduate Address how to finance graduate medical educationmedical educationImprove the health of NevadansImprove the health of NevadansDevelop a shared vision of the Develop a shared vision of the benefits of a health sciences benefits of a health sciences centercenter

Governor’s Governor’s Commission – Commission – UNHSC PlanningUNHSC Planning

Questions andQuestions andDiscussionDiscussion