outsourcing medical education from nevada: costs and consequences
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Outsourcing Medical Education from Nevada: Costs and Consequences
John Hudak, Ph.D.
Fellow, Center for Effective Public Management
The Brookings Institution
29 September 2014
jhudak@brookings.edu
@JohnJHudak
Requirements Outsourcing
• A product of value• A geographic transfer – Location of origination– Destination
• A cost to location of origination/benefit for destination
Outsourcing & Medical Education
• Every state has healthcare needs• Every state has medical training opportunities• Every state has addition training capacity• Supply & demand of medical professionals– Surplus of medical professionals– Shortage of medical professions
• Results: importing or exporting of medical professionals
Outline
Part I. A Geographic Basis for a New Medical School
Part II. A Healthcare Basis for a New Medical School
Part III. A Funding Basis for a New Medical School
Part IV. Conclusions
A Geographic Basis for a New Medical School
A Geographic Basis for a New Medical School
A Geographic Basis for a New Medical School
A Geographic Basis for a New Medical School
A Geographic Basis for a New Medical School
A Geographic Basis for a New Medical School
A Geographic Basis for a New Medical School
A Geographic Basis for a New Medical School
Allopathic Medical Schools Founded 2000-2013
Medical SchoolYear of
FoundingCentral Michigan University College of Medicine 2013
Western Michigan University Homer Stryker School of Medicine 2012
Oakland University William Beaumont School of Medicine (MI) 2011
Frank Netter School of Medicine at Quinnipiac University (CT) 2010
Florida Atlantic University Charles Schmidt College of Medicine 2010
Hostra University North Shore-LIJ School of Medicine (NY) 2010
Virginia Tech Carilion School of Medicine 2010
The Commonwealth Medical College (PA) 2008
University of California-Riverside School of Medicine 2008
Texas Tech Univ. Health Sciences Center Paul Foster School of Medicine 2008
Florida International University Herbert Wertheim College of Medicine 2006
University of Central Florida College of Medicine 2006
Cleveland Clinic Lerner College of Medicine 2002
Florida State University College of Medicine 2000
A Geographic Basis for a New Medical School
Distance between New & Existing Medical Schools
New Medical SchoolYear of
FoundingNearest Existing Medical School Distance
Central Michigan University College of Medicine 2013 Michigan State University 68Western Michigan University Homer Stryker School of Medicine 2012 Michigan State University 51Oakland University William Beaumont School of Medicine 2011 Wayne State University 27
Frank Netter School of Medicine at Quinnipiac University (CT) 2010 Yale University 9Florida Atlantic University Charles Schmidt College of Medicine 2010 University of Miami 43Hostra University North Shore-LIJ School of Medicine 2010 SUNY-Downstate (Brooklyn) 20Virginia Tech Carilion School of Medicine 2010 University of Virginia 121The Commonwealth Medical College (PA) 2008 Penn State 113Univ. of California-Riverside School of Medicine 2008 Loma Linda University 12Texas Tech University Health Sciences Center Paul Foster School of Medicine 2008
Univ. New Mexico/TX Tech (Lubbock)
272/344
Florida International Univ.Herbert Wertheim College of Medicine 2006 University of Miami 12University of Central Florida College of Medicine 2006 University of South Florida 85Cleveland Clinic Lerner College of Medicine 2002 Case Western Reserve Univ. --Florida State University College of Medicine 2000 University of Florida 149
A Healthcare Basis for a New Medical School
A shortage of medical professionals in Nevada• Family Practice Doctors 47th out of 51 (states + DC)• Pediatricians 46th out of 51• Orthopedic Surgeons 51st out of 51• Ophthalmologists 48th out of 51• Psychiatrists 50th out of 51• OB/GYNs 40th out of 51• RNs 50th out of 51
**Research conducted by University of Nevada School of Medicine, rankings based on measure of medical professionals per 100,000 residents.
A Healthcare Basis for a New Medical School
A Shortage of Medical Training in Nevada• Fewest MD students per 100,000 residents* (Nevada: 9.5 / 100,000;
National Average: 25.8 / 100,000)• Medical residents/fellows per 100,000 residents, Nevada is 46th.
(Nevada: 8.1 / 100,000; National Average: 25.4 / 100,000)• Medical residents/fellows per 100,000 residents in primary care roles,
Nevada is 47th. (Nevada 5 / 100,000; National Average: 12.2 / 100,000)
*Ranking based on states with existing allopathic medical schools
Note: All data drawn from 2013 State Physician Workforce Data Book from the Association of American Medical Colleges (AAMC)
A Healthcare Basis for a New Medical School
An Opportunity for Nevada Medical Training
Silver State Loyalty in Medical Training• 69.2% of Nevada residents in MD programs matriculate in state
• Among people who attend medical school & perform residency in NV, 79% stay to practice in state.– 5th Nationally– National mean: 66.6%
A Funding Basis for a New Medical School
A Funding Basis for a New Medical School
A Funding Basis for a New Medical School
A Funding Basis for a New Medical School
• GME Funding to the States–Medicare & Medicaid Programs– Assistance for Residencies and Fellowships– Largest Funding Source in US– Funding Levels Set by Congress– Bipartisan Reform Bills
• Tuition Dollars (Federal Subsidy)• Program Plans (Private Sources)• Philanthropy (Private Sources)
A Funding Basis for a New Medical School
GME funding per capita, 2005-2009
Year National Average Nevada Nevada's Rank (out of 46)*
2005 $16.06 $4.03 46
2006 $16.05 $4.65 46
2007 $16.43 $5.77 46
2008 $17.02 $6.96 45 (MS)
2009 $17.94 $8.55 44 (NM, MS)*Includes the 45 states with allopathic medical schools + DCNote: Data drawn from the Robert Graham Center [Graham Center Data]
A Funding Basis for a New Medical School
Results of multivariate analysis of GME
funding among all states
Among all states, every additional medical school graduate = +$527,000 in additional GME funds
Among all states, adding a medical school = $41.4 million in additional GME funds
Among all states, data suggests** the addition of a public OR private medical school is associated with a substantial increase in GME funds
**those results do not achieve statistical significance
A Funding Basis for a New Medical School
Results of multivariate analysis of GME funding among states with 3 or fewer medical schools
Every additional medical school graduate is associated with an increase in additional GME funding, though results do not achieve statistical significance
Every additional medical school = $26.1 million in additional GME funding
Every additional public medical school = $19.8 million in additional GME funding
Every additional private medical school is associated with an increase in additional GME funding, though results do not achieve statistical significance
A Funding Basis for a New Medical School
A Funding Basis for a New Medical School
Since 2010, NIH funds to new medical schools, excluding Cleveland Clinic/Lerner School exceeds $57 millionIn 2013:
FAU (2010): $2.25 million FIU (2006): $3.01 million
FSU (2000): $2.17 million CMU (2013): $337,431
UCR (2008): $4.40 million UCF (2006): $5.65 million
Cleveland Clinic/Lerner School (2002): $82.19 million
A Funding Basis for a New Medical School
A Funding Basis for a New Medical School
A Funding Basis for a New Medical School
Additional Types of Funding – HRSA
HRSA Funding per Capita, Mountain West RegionState Grant Dollars per CapitaMontana $139.12 New Mexico $106.93 Idaho $79.55 Wyoming $54.68 Utah $50.67 Arizona $45.09 Nevada $24.69
Note: Includes all active grants in FY2014. Data drawn from NHRSA website.
CONCLUSIONS
• Las Vegas among the most isolated cities in the US for medical training
• Population, healthcare needs, geography, funding levels all suggest a need for an allopathic medical school
• Training doctors in Las Vegas may limit medical brain drain
CONCLUSIONS
• ACA will increase healthcare demand in Southern NV, an area already facing shortages
• A new medical school can create tremendous federal, private market, and private charity opportunities for Las Vegas region
• A new medical school likely increases research-related private market activity and FTEs
CONCLUSIONS
• Federal healthcare funding to Nevada is among the worst in the nation, fitting a trend in federal funding to the state
• Expanded medical training will increase opportunities for research funding
• Reform proposals for Medicare GME funding will help states like Nevada (growing population, political clout)
THANK YOU
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