Realistic Plan

This week I laid out a realistic plan for medical education in the state that works now.  It makes sense, saves money and capitalizes on the little that we have done right.  In the future these separate tracks may well split into separate medical schools, but that is a decision for another day.  Today we can continue the petty bickering and pointless discussion that has marked this subject for forty years or actually get something done.  You know me – I am for action now.  We can use our limited resources wisely, engage donors, show southern Nevada that we mean business and make a difference.  Or we can continue talking for the next decade and be no further down the road.

A Plan We Can Do TODAY

Yesterday I talked about building full medical school tracks north and south.  While serving their respective regions, this approach would avoid the many bureaucratic barriers to exchanging medical students, developing joint research programs, and sharing clinical and academic expertise. Instead of each school going its own way, as UNLV and UNR by and large do now, there could be organized collaboration to avoid wasteful duplication of programs and research.  This is a plan we can do TODAY without the necessity of separate costly and lengthy accreditation.

Medical Education

To expand medical education in Southern Nevada will require a major academic facility, likely built on the UMC campus,  that has all the teaching and research facilities you would expect to see in a full medical school, including an auditorium, conference rooms, research and anatomy teaching laboratories, and library facilities.  There is nothing like this in Las Vegas now but major efforts are underway to plan this expansion.   The two main advantages in this approach are the ability for both campuses to easily collaborate in teaching and research, and the cost efficiency of having a single statewide leadership structure, with local campus administrative autonomy.

The Right Plan

The fundamental issue facing public medical education in Nevada is how to better serve the state, and in particular Las Vegas, in improving the quality of its health care, and increasing the number and breadth of physicians who train and practice in the state.  For my money – and my wife Beverly and I have pledged our support to this critical project – the current Dean Tom Schwenk has the right plan.  He proposes that we develop full four-year campuses in both Reno and Las Vegas rather than the split programs that we have had for the last forty years.  We will explore this idea in the coming days.

Medical School In This State At UNLV

Last week I talked about the ridiculous discussion to build a second medical school in this state at UNLV.  
Of course there is no budget, no identified donors, and an unbelievable estimate of the start-up costs that I have heard bandied about.  But what does that mean for Southern Nevada – should we be forced to stumble forward with some of the worst health care in the nation?  This week I will explore how we can work with our current structure to provide the kind of quality health care that this community deserves.

The University of Texas at Austin is in the process of creating the Dell Medical School which will be accepting its first class of 50 students in 2016.  The following is a summary of the funding plan for this newly-created school of medicine:

1-    $250 Million from Seton Health Care for a new teaching hospital.

2-    $50 Million gift from Michael and Susan Dell.

3-    $35 Million from Central Health. 

4-    $25 Million from University of Texas System Board of Regents annually, plus an additional $5 million annually for 8 years for recruitment and support.

  

The initial investment for the development of a new medical school to educate 50 students each year is no small amount--$360 million.

The entire operating budget for UNLV is about $500 million a year.

Tell me where UNLV is going to get $360 million to build a Las Vegas medical school.

Still Looking

I’ve laid out a plan for the minimum requirements to adequately fund Nevada’s medical school.  It requires at least one donor of one hundred million, at least two donors of fifty million each; and at least ten donors of twenty-five million a piece.  That is just the beginning of the funds required.  To date, not one Nevadan, with the exception of my wife Beverly and me has stepped forward to commit at least twenty-five million.  After ten years, I’m still looking for the second donor.

Not Capable Of Competing

I’ve had years of problems with the medical school in Reno.  It was the nightmare of my tenure as chancellor.  But the solution to its problems is not to build a second medical school at UNLV.  That doesn’t mean that UNLV should never have a medical school.  But until it can raise a half a billion dollars from sources other than the state, it had better stay out of a game in which it’s not capable of competing.

98% Short

The budget of the University of Nevada Medical School is a drop in the bucket compared to the hundreds of millions necessary to build even a mediocre medical school.  I don’t know where Doubrava gets his figures on the pittance he believes will support a UNLV Medical School.  I can tell you one thing:  he’s about 98% short of what it will actually take.

Doubrava

Dr. Tom Schwenk, the Dean of the University of Nevada Medical School must be pulling his hair out as he sees the ridiculous positions taken by those who believe that it is immediately possible for UNLV to develop a medical school.  I don’t know what goes on in Regent Mark Doubrava’s mind because I’ve always found him to be reasonable and logical.  But at this point, his inflexibility in pushing for UNLV to build its own medical school, when no one on earth would even begin to believe that UNLV has even the smallest down payment necessary to start such a medical school, leads me to conclude that Doubrava simply has not rationally and fully examined the situation.

Made As Complicated As Possible

Academic politics is a phenomenon different from any other political game.  Its participants are all very bright, intellectually successful individuals who mistakenly believe that every issue must be made as complicated as possible, examined as thoroughly as possible, and debated until every aspect of the issue is resolved.  Academics, by there very nature, can make the simplest issue complicated beyond solution.  The medical school of the Nevada higher education system is forty years behind where it should be and yet, the academics involved continue their petty infighting that ensures that Nevada medical education will never succeed.

Give It Another Shot

The Nevada Board of Regents is arguing about the incorrect issues that affect Nevada medical education.  Whatever the results of their arguments, those results are controlled totally by a refusal of the state to fund medical education.  As chancellor, I worked for five years to improve Nevada’s medical education.  I failed, but I’m going to give it another shot.  I hope that this time all those petty, small thinking, selfish individuals who have been involved in medical education will make it a new day with new aspirations and new success in training medical professionals.  I’ll keep you informed.

Doctors

Doctors, in spite of their high intelligence and their ability to work with unmatched intensity, fight like little children over the division of medical revenue in Southern Nevada.  That pettiness coupled with the inaction of the medical school has made us a medical education community that is equal to none other.  We are in a category of inadequacy and ineptitude that is all our own.

Forty Year Jump

For thirty years Bill Raggio put a protective wall around the University of Nevada Reno Medical School and in effect told its faculty that it need never worry about being kidnapped and taken to Southern Nevada.  During that thirty-year period, the University of Arizona, the University of New Mexico and the University of Utah medical schools got a forty year jump on Nevada’s School of Medicine.  I have doubts that Nevada’s medical school, even with strong legislative support, could ever even become a spot on the rear view mirrors of our surrounding state medical schools. 

Bullet Proof

Speaking to the University of Nevada Reno Medical School faculty is like hollering into space.  Your thoughts and your voice are lost forever.  For more than thirty years, Bill Raggio, who I believe did more to harm Nevada’s education system than any other single person or group, told the University of Nevada Reno Medical School that its faculty was bullet proof because he would protect them from outside forces.  He did a hell of a good job.

Reputation

If reputation is as effective as fact (and I’ve come to the conclusion it is), than the University of Nevada Medical School has two problems.  First, it must change its reputation, and second, it must change what it actually is.  A bad reputation takes longer to cure than a bad performance record.  The UNR Medical School, for forty years, has had little or no respect from every other university medical school across this country. And the sad part is, it doesn’t seem to care. 

Starting Over

It would be nice if we could tell all of our governmental agencies that one year from now they will all be dissolved; that all the administrators will be replaced by new administrators; and that the product of that agency, whatever it may be, must prove to have value to the entire economy.  That appears to me to require a solution that we dismantle our present government structures and that we come as close as possible to starting over.

Standards Of Production

Businesses are successful in part because they have standards of measurement to determine the productivity of each of their employees.   The measurements are easily analyzed and the problems are quickly solved by the elimination of positions in the organization or elimination of employees who do not carry their fair share.  Government has no standards of production.  Its answer to every problem is not to test the productivity of its employees, but rather, to simply add more employees to pick up the shortfall in production.

Bullet Proof

At random I could call a hundred individuals employed by any endeavor that creates a product.  By the time I’m at the second sentence, I know from the attitude of the person with whom I’m talking whether they understand that they must produce to survive in their jobs, or whether they believe they’re bullet proof because they work for a governmental entity.  
 

Government Employees

When one owns a business and begins to notice that the cost of doing that business exceeds what that business receives, it hardly takes a Rhodes Scholar to understand that if you can’t control income, you’d better control expenses.  Businesses, often in a period of 30 to 60 days, develop plans—though radical as they may seem—to cut their costs by eliminating their workforce and by requiring that those employees still involved in the operation do more.  Government employees are never faced with this type of decision-making.  Before government can adapt to the present situation, it first sucks the last drop of blood out of the businesses and individuals who sustain it.

Burden

If necessity is the mother of invention, and the recovery of the economy proves that to be true, that principle has no relationship to solving the problems created by an ever-increasing government.  I’m a liberal and I believe in helping those who have not been as fortunate as my wife and I.  However, our belief in helping one another has nothing to do with allowing a government to increase in size while accomplishing less and while continuing to become a burden we can’t afford.