To the editor:

In response to the April 14 commentary on expansion of the medical school:

To put the issue of a Health Sciences Center in balance, it may be helpful to understand why the university regents unanimously and enthusiastically endorsed the concept of an integrated Health Sciences Center with a strengthened School of Medicine at its core.

Nevada has an acute shortage of physicians, dentists, nurses, physical therapists, pharmacists, audiologists and speech pathologists. Indeed, across the board, in virtually every category of health care professional, our state's current and projected needs cannot be met by graduates from existing training programs. This leaves us vulnerable at a time when our state's population is increasing and aging much more rapidly than most. Nevada's usual solution, to recruit physicians and other health care workers trained elsewhere, won't work.

Recent data reported by the Agency for Healthcare Research Quality ranks Nevada:

-- 41st in colorectal cancer deaths per 100,000.

-- 30th in percent of adults who have had their blood cholesterol checked in the past five years.

-- 49th in percent of women receiving prenatal care in the first three months of pregnancy.

A vibrant, more complete medical school with excellent faculty is at the heart of a Health Sciences Center. Clearly this is a high-priority need for our state. Consider these facts:

-- Nevada ranks 46th in the nation in physicians per 100,000 population, severely limiting access to care.

-- Nevada lacks residency training programs in critical specialties such as anesthesiology, dermatology, radiation oncology, emergency medicine, neurology, neurosurgery, radiology, ophthalmology, orthopedics, cardiothoracic surgery and urology.

-- We have the lowest number of physicians in residency training per population among all states with medical schools.

Shortages in health care providers affect the most vulnerable members of society: the poor, mentally ill, young and old. Care is sought late, or not at all, leading to higher priced, emergency room care and worse outcomes at a higher cost to society. Despite having the smallest state medical school in the country, our physicians provide vital care for this vulnerable population.

The state's population is 2.3 million. By 2016 it is projected to increase to 3.4 million. Even if the number of new medical students were to quadruple, Nevada, with 23.5 physicians per 100,000 people would still fall below the national average of 26.6 physicians per 100,000.

The fact that both the Cleveland Clinic and the University of Pittsburgh decided not to enter the Las Vegas market was an issue of finances. The Cleveland Clinic faces pressing internal financial matters among its already established practices. It never seriously considered establishing a clinic in Las Vegas. Most importantly, the initial model did not include education or research. The University of Pittsburgh would have been happy to establish a presence -- with a guarantee of $250 million from the city to cover start-up costs.

The initial focus of the medical school expansion is adding faculty to train additional residents and students. This emphasis on residency training follows from the fact that the majority of physicians completing residency training in our state remain here to practice medicine. In fact, despite the small number of residency training positions -- the lowest in the nation for any state with a medical school -- the retention of physicians completing residency training is the third-highest in the country. Unfortunately, almost half of the graduating seniors this year chose residency training in programs not available in state. Thus, we educate outstanding physicians, and export them to other states because we lack residency programs.

We are paying a high price for not keeping up with 19 years of the fastest growth in the country. Maintaining the status quo is an invitation to a full-fledged health care crisis. An integrated health sciences center would position us to take advantage of future medical research opportunities ensuring that Nevadans have access to quality, cutting-edge health care protocols without having to leave the state to receive treatment. It will train health care providers -- physicians, nurses, pharmacists and others -- in a patient-centered, team-orientated care environment.

The School of Medicine provides Nevada with skilled health care providers trained in patient-centered, evidence-based medicine; accessible, affordable care for underserved and rural patients; and a group of highly trained researchers and clinical faculty that prime the economy by attracting significant research funding and generating for-profit enterprises benefiting the school and state. The cost to the public is minimal, as the School of Medicine receives less than 18 cents per dollar of its total budget from the state. In addition, there are tangible economic benefits, including the fact that the school's $127 million budget, $27 million of which is state support, is recycled into salaries, local purchases, medical care and has a dramatic multiplier effect on our local and regional economies.

A Health Sciences Center will accelerate the economic benefits and provide a common home for existing medical and health professional education programs currently based on distinct campuses. It creates efficient models of education and patient care, and a coordinated vision for serving the health needs of our citizens. It does not "replace" the existing medical school or other health education programs. Indeed it helps fill the pipeline of non-physician health care providers such as nurses, pharmacists, dentists and physical therapists.

We have a fiduciary and moral responsibility to citizens of Nevada and future generations to make investments in medical education, health-related services, cutting edge medical research and community outreach programs. The best hope to accomplish this is through the creation of a Health Sciences Center.

Dr. John McDonald

LAS VEGAS

THE WRITER IS VICE PRESIDENT OF HEALTH SCIENCES AND DEAN AT THE UNIVERSITY OF NEVADA SCHOOL OF MEDICINE.