A deal to improve medical education

The recent announcement that higher education leaders have signed a major agreement calling for an expansion of the University of Nevada School of Medicine has generated considerable discussion and some controversy.

It is important for all readers to know that the agreement’s fundamental purpose is to expand and improve public medical education across the state.

Nevada ranks toward the bottom of many measures of health and health care when compared with other states. These poor rankings can be attributed partly to inadequate investment in the medical school, resulting in medical student and residency training programs that are limited in size and scope, and weak clinical research programs.

The new agreement, described as historic by some, addresses those deficiencies.

The agreement responds to a directive from the Board of Regents to develop a plan for full campuses in both Reno and Las Vegas, and continued and expanded service to the “third campus” of rural communities. It also describes the conditions under which separate schools of medicine sponsored by the University of Nevada, Reno and the University of Nevada, Las Vegas eventually will evolve. But the agreement’s fundamental purpose is to enhance the quality and quantity of public medical education and to improve the quality of health and health care across Nevada.

The question that has been asked since the medical school’s early development in the 1970s and ’80s is, “When will Las Vegas have a school of medicine?” UNR was the dominant and most appropriate higher education institution to host the state’s medical school at the time it developed. Las Vegas’ explosion as a population center could not have been anticipated, nor could the state have waited for UNLV to develop so it could host the state’s single school of medicine. The result has been years of tension and political conflict that have served the state poorly with regard to the full development of the University of Nevada School of Medicine as the source of an adequate number of high-quality physicians in a broad range of specialties.

Faculty and staff members have labored with heroic commitment to develop an outstanding set of educational and research programs for a school and a state of this size, but without the broad support of the state political and higher education systems. It is time to resolve that tension.

The agreement addresses what I believe is the unsustainability of the current structure of the medical school, which cannot come close to addressing the state’s health care workforce needs. A school of medicine that is based on having the first two years of medical education in one city and most of the last two years in a city that is 448 miles away cannot develop to the extent necessary to serve the state.

The split-campus arrangement has hampered the state’s ability to develop a full portfolio of residency and fellowship training programs. State support for expanding the size and quality of the school’s teaching and research programs has lagged because of the political tension over where the school is based. Reno does not have the full campus, including clinical teaching capacity, to adequately serve its constituents. Las Vegas does not have the full campus, including academic facilities, to adequately serve its constituents.

This agreement addresses the statewide need for an expanded and more diverse physician workforce. It calls for the creation of a full academic medical center in Reno, built on new partnerships with community physicians and local hospitals and health care facilities; the development of equally strong partnerships in Las Vegas to support the creation of a full campus with appropriate academic facilities; planning for the substantial incremental funding and the accreditation requirements that will eventually support a split into separate schools of medicine affiliated with UNR and UNLV; and expanded residency and fellowship training programs to meet state health care needs

This agreement is long overdue. It is urgently needed to improve the quality of health and health care in Nevada far into the future, by properly positioning the University of Nevada School of Medicine to serve the entire state.

Thomas L. Schwenk, M.D., is vice president of the Division of Health Sciences and dean of the University of Nevada School of Medicine.