Should Cash-Strapped California Support New Med Schools?

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The University of California is planning two new medical schools -- at UC-Riverside and UC-Merced. Because of the fiscal crisis the state faces this year and dim prospects for financial recovery anytime soon, the state Legislative Analyst's Office last month suggested California phase out its support of all UC professional schools.

The new medical schools are planned to help alleviate a shortage of primary care physicians in California -- a shortage expected to grow more problematic as many older physicians retire in coming years.

How should California legislators navigate this dilemma? Should the state pull away from subsidizing professional schools or should it follow through with efforts to bolster the ranks of medical professionals?

California Healthline sought responses from six institutions and individuals. Three -- UC-Merced, Sen. Robert Dutton (R-Riverside) and Sen. Gloria Romero (D-Los Angeles) -- declined. Three responded:



Cutting Support Would Be Short-Sighted
Dev GnanaDev
President, California Medical Association, medical director and chief of surgery at Arrowhead Regional Medical Center in San Bernardino County

Everybody knows times are tough. But one reason California is a global leader today is because it has invested in its educational infrastructure for generations.

To cut state support to UC-Riverside and UC-Merced's proposed medical schools would sacrifice significant long-term benefit for a short-term gain. The two schools would be the first University of California medical schools to open in 40 years and would help fill a growing shortage of physicians in the state.

I am a member of the UCR School of Medicine Advisory Board and have been advocating for the increase in ethnic diversity among California's physicians. Doctors from these minority communities tend to practice in their neighborhoods -- where supply is in great need. Placing two new medical schools in the heart of these areas and emphasizing service to local regions will help retain students who come from near and far. It is disappointing that after a decade of work, California could backtrack on training much-needed, underrepresented minority students.

A recent study on physician supply found that only 14 of California's 58 counties currently have an adequate number of primary care physicians. Primary care physicians are the linchpin of a functioning health care system. For patients without access to primary care, minor health problems can quickly become major ones that require a trip to the emergency department or hospital. That's not good for the patient -- or the system, because it is drastically more expensive than a routine primary care visit.

The two schools also would help keep medical school costs down and boost the ranks of primary care physicians -- issues the California Medical Association has worked hard to advance.

The bottom line is, without these two medical schools, California will have a difficult task meeting the needs of its health care system. In order for California's future to remain bright, it must have a vibrant corps of practicing physicians and a capable health care system. State lawmakers must look at the big picture.


New Public Medical School Smart Investment for California
Phyllis Guze
Acting vice chancellor for Medical Sciences and dean, UC-Riverside School of Medicine

The health of California's population is fundamental to the quality of life and economic prosperity of the Golden State. For this reason, state leaders -- while dealing with the financial crisis at hand -- should also remain mindful of the University of California's obligation to train future health professionals to meet the state's health care needs.

Eliminating state support for training new doctors is not only shortsighted, but it is also a counterproductive approach that will harm California for many years to come. It would drive even more California students interested in medicine to train -- and ultimately practice medicine -- out of state. Public medical schools would be forced to privatize, burdening students with even greater debt and compelling them to choose higher-paying medical specialties over family medicine, internal medicine and general pediatrics, where they are so desperately needed. The result will be an even greater public health liability as medical care is deferred, leading to more costly treatments due to delayed diagnosis and complications that could be averted with early medical intervention.

According to a recent report prepared for the California HealthCare Foundation, 40 of California's 58 counties -- including Riverside and San Bernardino counties -- have fewer than 60 MD physicians per 100,000 people, much lower than the number of physicians considered sufficient to meet demand. This presents a grave threat to the health of Californians because primary care physicians comprise the foundation of preventive medicine. Furthermore, the state's physician work force does not reflect the ethnicity of the population, and health disparities in underrepresented minority communities are well-documented. The state's next public medical school, planned to open in 2012 at UC-Riverside, will help tackle this medical crisis by expanding and diversifying the physician work force, with particular focus on medically underserved populations.

To be sure, there will be severe sacrifices by all as we weather this economic crisis. But this crisis won't last forever, and a public investment is critically needed to train more physicians for the future health and wellness of Californians.


Higher Fees Would Wither Primary Care Ranks
John Stobo
Senior vice president of Health Sciences and Services for the UC System

The Legislative Analyst's Office recently suggested that the state of California phase out its support of all UC health professional schools, specifically UC schools of medicine. This would have disastrous consequences for UC's ability to educate high-quality physicians, particularly those who practice in primary care.

If the state withdraws support of UC medical schools, a limited number of alternatives would exist for replacing the lost revenue.

One would be to seek more philanthropic support, which is unlikely to succeed in this financial climate. Another is to increase student tuition and fees. Our concern with this approach is that it will further exacerbate differences between what the physician work force will look like and can provide and what society needs.

For example, while 25% of the U.S. population is underrepresented minorities, only 12% of physicians are from underrepresented backgrounds. Raising fees will make it more difficult for these students who usually come from economically disadvantaged backgrounds to afford medical school.

To best serve the health care needs of a diverse society, it is important that the physician work force look like the population it serves.

Moreover, underrepresented minority physicians usually come from underserved areas and are four times more likely than their colleagues to return to practice in underserved areas.

Raising fees will further increase the high debt facing medical students, which is roughly $140,000 for public medical school graduates. Facing increasing debt, graduates are more likely to select careers in higher-paying specialty fields, further intensifying the need for primary care physicians.

In California, only 34% of physicians are engaged in primary care. The primary care shortage is even more problematic in medically underserved areas, such as the Inland Empire and Central Valley.

The Inland Empire and Merced and several of its surrounding counties have fewer than 60 primary care physicians per 100,000 population -- the number that is considered minimally sufficient to meet demand. The proposed medical schools at UC-Riverside and UC-Merced are designed to train primary care physicians and will generate a diverse physician work force to provide needed health care services to these underserved areas.

Absent state support, existing medical schools will find it difficult to retain students who can meet the health care needs of California. Furthermore, not providing state support to the proposed medical schools at Riverside and Merced will be detrimental to the heath care needs of these already disadvantaged areas.

Robert Lewis
Absolutely not. It is time to halt spending on all but the most basic services. There are more than enough doctors now--so many in fact, that they advertise for patients and find reasons to order tests, scans and other examinations. Persons who say we have two few doctors are hospital and medical group representatives who really mean that there is room to strip even more money from the system.

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