School of docs
The 2015 Nevada Legislature approved funding for two full-fledged medical schools in the state, but there’s more to the story between the (bottom) lines
“It’s a Rebel Day in Nevada, isn’t it? Yeah!” said Governor Brian Sandoval, echoing the cheers of the dozens of people who’d crammed into the loft of the UNLV Student Union on June 11 to watch him sign a series of bills allocating funds for various programs at the university, including a new school of medicine. “We’ve all heard the talking points — that this is the largest metro area in the United States of America without a medical school. We have to have that. … And it takes an investment. In this budget, there is close to $27 million for this medical school. That is quite an investment.”
Sandoval paused to laugh as the audience cheered some more. Sitting in the row of VIP seats before him, Barbara Atkinson smiled, too. The planning dean of the UNLV School of Medicine, hired a year ago to get the project off the ground, had landed the amount of startup funding that she’d been saying all along she needed.
But for much of the spring, Atkinson probably wasn’t so happy when she thought about Sandoval. His proposed budget for the two-year 2016-’17 fiscal period earmarked only $8.3 million for the UNLV School of Medicine, with the idea that admissions could start in 2018, a year later than UNLV planned. The existing University of Nevada School of Medicine didn’t appear to be in much better shape. Whereas higher education officials asked for more than $5 million to expand UNSOM’s programs up north — in order to make way for the new UNLV medical school down south — the governor had granted it just shy of $2 million.
Then, the first week of June, the state Legislature made a move that might have surprised some, considering the Republican majority in both houses: It fulfilled higher education’s budget requests for both UNSOM and the UNLV School of Medicine — $5.5 million and $26.7 million, respectively. Carson City observers credited Senate Majority Leader and strong Sandoval ally Michael Roberson, a Republican from Las Vegas, with going to bat for his constituents to make Southern Nevada’s med-school dreams a reality.
Whatever political maneuverings led to the Legislature’s generosity, the headline funding figures don’t tell the whole story. Beneath them is an additional boost for graduate medical education that will be shared with private medical schools — but also a continued disparity in north-south funding, leaving UNLV’s Atkinson with the biggest gap to fill.
Besides the $32 million-plus in funding for the two public medical schools, the governor proposed, and Legislature approved, $10 million to help create fellowships and residencies at hospitals and private clinics around the state. This resulted from a couple years of work by a statewide committee representing UNSOM and UNLV, as well as private medical schools Touro University Nevada and Roseman University of Health Sciences. It’s been arguing — and few in the medical field disagree — that graduate medical education is at least as important to increasing the number of doctors in the state as the schools themselves, because it fosters a rewarding research environment and because graduates often stay where they do their fellowships and residencies. An advisory committee that has yet to be appointed will help the governor’s office spend the $10 million.
UNSOM, meanwhile, will use its $5.5 million to develop full teaching capacity in Reno. Right now, UNSOM is the state’s only public medical school, and it’s effectively split between Reno, where students do their first two years in the classroom, and Las Vegas, where they do the last two years’ clinical work. The new funding will go toward creating third- and fourth-year programs up north and in rural areas, says Thomas Schwenk, dean of the University of Nevada School of Medicine.
“That means recruiting community physicians out of the practices to take on teaching responsibilities; the administrative support to make that happen; faculty development — teaching physicians how to be teachers and incorporate students into their structure,” Schwenk says. In addition, UNSOM will set up Project ECHO, a tele-health system that will connect UNSOM faculty with primary-care providers in rural areas.
Schwenk will have much more than the $5.5 million in question to work with, too. That amount is on top of the University of Nevada School of Medicine’s biennial operating budget of $72.5 million — more than twice the amount allocated to UNLV’s fledgling medical school.
Atkinson is sanguine about the discrepancy. “Well, we’re at the stage of just beginning to grow,” she says, “so we have to grow at the speed we can. I’m happy for the amount we got. And we’re also going to be asking private donors for quite a lot.”
Some have already stepped up. This spring, the UNLV School of Medicine launched a scholarship called “60 by ’16,” indicating its goal of raising enough money to cover tuition for its entire first class of 60 students by 2016. Right away, the Engelstad Family Foundation pitched in $2.5 million to fund 25 scholarships; local businesses, doctors and community members donated enough to pay for another 15. Then, the Engelstad Foundation gave an additional $7.5 million for 25 students in each of the second, third and fourth entering classes.
“This means we’ll have four years of really good students coming in,” Atkinson says. “We’re already getting calls from prospective students, though we don’t have permission to talk to them yet.”
That’s because she’s still in the process of getting the school accredited and hiring faculty and support staff. That’s where much of the $27 million granted by the Legislature is going, along with curriculum development. For the first couple years, students will take classes at partner facilities, such as the VA Hospital. Then, they’ll move to the school’s first new building, which a memorandum of understanding with the county says will be on Shadow Lane in the City of Las Vegas’ medical district. Atkinson initially estimated it would cost $75 million. She now thinks it will be closer to $100 million. Still, she only plans to ask the state for the base amount it received this year, with additions proportionate to student body growth ($30.3 million for the next biennium).
“The decision was made early on that we would just ask the Legislature and the state to pay for the educational costs … and that we’d ask philanthropists to pay for the building and the programs,” she says. Their pitch includes this enticing promise: a $1.2 billion economic impact and 8,000 new jobs by 2030. Together with the City of Las Vegas’ medical district, those numbers rise to $3.6 billion and 24,000 jobs.
But Schwenk says it’s a mistake to see the Legislature’s funding as having isolated impacts on Northern and Southern Nevada.
“The way to frame this is not, ‘Las Vegas gets a medical school,’” he says. “Now, we have a statewide vision, not just for Reno and Las Vegas, but for the rural areas as well. This is perhaps the first time — I wouldn’t want to claim that for the entire 45 years (of UNSOM), but possibly the first time — the state has had a convergence of vision around public medicine and education and had it backed it up with financial support.”