The not-quite-done deal to bring a new state medical school to Las Vegas is bound to be one of the year’s big media topics. But before you get buried in the barrage of breaking news, we offer this guide to what all the fuss is about.
Southern Nevada residents are the biggest stakeholders in the medical school debate, since having a successful public academic health care institution would improve the health of the community. That said, some specific parties have skin in the game:
The universities. UNR, UNLV and the University of Nevada School of Medicine, or UNSOM, would be most directly affected by the new medical school. The 45-year-old School of Medicine is based at UNR, where medical students get their classroom instruction and lab time. The medical school also has a clinical campus in Las Vegas, where students do rotations and other hands-on training. Dean Thomas L. Schwenk was the first to start talking publicly about a bigger, better medical school about a year ago. His plan involved growing both campuses of the medical school gradually, focusing on each one’s weaknesses, until the Las Vegas campus could be spun off as a separate institution.
The Nevada System of Higher Education. The System, as it’s called (or, less eloquently, NSHE), has assumed a more important role recently. On November 6 it signed a memorandum of understanding with the universities concerning the development of a new medical school. Although intentionally open-ended (the idea is to hammer out specifics going forward), the memorandum calls for two Nevada medical schools, one for UNR—ostensibly, the existing school—and one for UNLV. The system is supposed to shepherd the two universities through a collaborative process.
Philanthropists. Nobody thinks the state and/or universities will have enough money to do this on their own; big-time donors will be required. Unfortunately, there’s a north-south rivalry over the medical school, mainly because of funding, too much of which, Southern Nevadans complain, stays in Reno. In a December 22 op-ed in the Las Vegas Sun, Lindy Schumacher, the former director of Nevada giving for the Lincy Institute, wrote, “We know precisely what UNR is selling, and we are not buying a second UNR medical school in Las Vegas. … I believe Schwenk would find a pool of donors in Las Vegas if he were asking for gifts for a Las Vegas-based UNLV medical school and not simply a branch of the UNR medical school.”
Private Schools. Besides the University of Nevada School of Medicine, there’s another existing medical school in Las Vegas, at Touro University, and one on the drawing board, at Roseman University of Health Sciences. Whereas UNSOM is a public, allopathic (M.D.-granting) school, Touro is private, nonprofit and osteopathic (D.O.-granting). According to current plans, Roseman would be a private, nonprofit, allopathic school.
Money. Health care education is big business. Tripp Umbach, the consultancy hired last year by the Lincy Institute to assess the viability of a medical school in Las Vegas, estimates that a four-year M.D.-granting institution here could generate an annual economic impact of $1.2 billion by the time it matures in 2030. That includes $60 million in state government revenue. Of course, nothing’s free. For such a plan to come to fruition, the community, government and school would have to come up with $68 million for facility costs alone. In January, Schwenk told the Nevada Legislative Committee on Health Care that a new medical school in Las Vegas would cost taxpayers $30 million a year.
A brain trust. The November memorandum of understanding isn’t the only official document out there concerning the development of a medical school in Southern Nevada. Preceding it by several months was UNLV’s Tier 1 Initiative, part of the university’s strategic plan to become a top Carnegie Foundation-rated institution. Provost John Valery White says a medical school would help UNLV reach this goal, since medical schools are hotbeds of cutting-edge study and grant-generating powerhouses. And, he adds, it would be the center of gravity to pull together Southern Nevada’s disparate academic, clinical and research factions into one cohesive medical community.
Health care. It’s not so good here, and a big part of the problem is a lack of doctors. A 2010 report by the Association of American Medical Colleges put Nevada at 45th in the country for number of physicians per capita. Many people, both inside and outside the health care system, believe one reason we don’t have more world-class physicians here is that we don’t have a world-class medical school. (For more on that subject, see our Feb. 21, 2013, feature, “The Treatment.”)
Graduate medical education. What insiders call “GME” is simply a catchall term for the training that medical students do after their four years at med school; namely, fellowships and residencies. It’s important, because it’s during this phase that students become doctors and begin to specialize. Another reason for Nevada’s poor health care system is weakness in specialties (which explains why your friends and neighbors go outside the state for certain types of care and procedures).
A key thing to remember is that medical schools alone don’t create doctors; GME does, too. Most newly minted physicians stay and practice medicine where they do their residencies. Nevada’s doctor-to-resident ratio is low, and that has a lot to do with the dearth of medical residencies here. In other words, if what we want is more doctors, then what we really need are more fellowships and residencies. And, for a range of reasons having to do with high costs and low federal funding, getting more of them is going to be hard.
A coalition of representatives from Roseman, Touro, UNSOM and Nevada hospitals is working with state officials to come up with solutions. UNLV will undoubtedly be getting involved, too. After all, it would have to have someplace to put all those expected future med-school grads … before they leave the state for good.