FROM OUR READERS:
Medical school expansion wrong approach
Sticking it to taxpayers won't cure sickly business climate for doctors
To the editor:
The Board of Regents approved a plan March 17 that would expand Nevada's public medical school and other health education programs.
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This is an ill-conceived plan.
The idea of locating an academic medical center in Nevada is not new. Recently, both the Cleveland Clinic and the University of Pittsburgh, established centers of medical excellence, have declined to participate in the establishment of such a facility here. The reputation of these institutions necessitates that their judgments should be taken seriously.
Contrast that circumstance to the recent affiliation of the Joslin Diabetes Center with the Fremont Medical Center, a private medical facility in Las Vegas. The Joslin clinic is a world-famous center affiliated with Harvard Medical School. This important resource will contribute to the quality of our health care and was accessed at no cost to the people of Nevada.
We hear that this state ranks near the bottom in physicians per 100,000 residents. The proposal for the medical school expansion assumes that an increased number of Nevada medical school graduates or resident physicians will lead to an increased number of physicians staying in the state.
A better benchmark of the quality and quantity of health care is the number of health care providers available, which includes nurse practitioners, physician assistants and mid-wives. These are "physician extenders" who are well-accepted by patients, are able to deliver primary care at a much lower cost to third-party payers than physicians, and therefore preferable employees of managed care organizations.
Another source of health care providers will come from Touro University, the osteopathic school that recently opened in Henderson. It intends to graduate annually between 100 and 150 D.O. graduates, plus about 50 physician assistants. The osteopathic school costs the state nothing. The medical school costs taxpayers at least $27 million per year.
Nevada is experiencing enormous growth and its economy is booming. Doctors should be moving into this state to take advantage of these good economic times. Yet this is not so.
Reasons for the low ratio of physicians to residents in Nevada have more to do with the unfavorable business climate for the practice of medicine than the reduced number of potential health care providers. A March 23 article in the Las Vegas Review-Journal in which reimbursement by Anthem Blue Cross Blue Shield illustrates the financial plight of competing physicians. In some cases, reimbursements from private, third-party payers are less than those from government programs that serve the indigent.
Considering that medical students have at least $150,000 in indebtedness upon graduation, decreasing reimbursements from insurance companies makes the chances for successful private practice in Nevada tenuous at best. Unfilled positions of specialists and subspecialists in this state may well reflect the poor opportunity for financial success possible in medical practice here.
Starting new residency programs to train specialist and subspecialist physicians, anticipating that they will remain here to practice in an environment unfavorable for professional success, makes no sense.
Current proposals call for recruiting new faculty who will be partly supported by the state, and partly from income generated from patient care in direct competition with local physicians. This invited competition is a disincentive for community physicians to participate in medical school instruction and negatively affects the mission of the medical school.
Plans call for increasing taxpayer support from $27 million per year to $53 million per year in current dollars to allow the University of Nevada School of Medicine to increase the medical school class size from 52 to 96 by 2011; increase the full-time, statewide faculty from 189 to 500; and increase the number of total post-M.D. resident and fellowship positions from 194 to 444, using projected state needs for specific physician providers to tailor health education training programs.
Yet there is a concern among medical educators that because the applicant pool for admission to medical school is significantly decreasing, the number of qualified candidates for admission to medical school is also decreasing. There is also concern that qualified candidates for academic faculty appointments may not be sufficient to fill new positions.
Capital needs to support the growth of the medical school are estimated at between $300 million and $350 million in current dollars. This funding would be derived from both public and private revenue sources and also be phased in over 10 years. The source of private funding has not been identified.
We were unable to convince two world-famous medical schools to locate an academic medical center here, even after highly publicized and intense recruiting by Las Vegas Mayor Oscar Goodman. The investment environment has not changed since these reputable medical institutions declined participation. Prospects for new funding sources are, at best, uncertain.
While Arizona and New Mexico are cited as states comparable in size to Nevada that have "full service" medical centers similar to what is now being proposed for Nevada, we have not been advised of their financial health. Neighboring Utah and California, states whose proximity to Nevada often serves the basis for local innovation, are also involved in support and operation of university medical centers and have not been cited as worthy examples. Additionally, if neighboring states have "full service" medical schools, why does Nevada need to duplicate their efforts? Is this project an appeal to state pride? If so, it's an expensive indulgence.
Finally, the Board of Regents' ambitious plan assumes that the delivery of medical care will be a reflection of the present system. It's a bricks-and-mortar proposal. Rising costs, high malpractice premiums, scientific advances and a more computer savvy and Internet-literate populace are impacting the format of health care delivery. The intrusion of the federal government in the regulation and provision of medical care must also be addressed.
What is needed is an imaginative, cost-effective program that provides solutions that will contribute to improved health care. A comprehensive review of our medical school mission is in order before the taxpayers of Nevada are burdened by perhaps a half-billion-dollar commitment for the delivery of health care under a flawed assumption of the nature of future health care needs, delivery and training.
