Outsourcing Medical Education from Nevada: Costs and Consequences

1. 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

2. Requirements Outsourcing • A product of value • A geographic transfer • Location of origination • Destination • A cost to location of origination/benefit for destination

3. 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

4. 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

5. A Geographic Basis for a New Medical School

6. A Geographic Basis for a New Medical School

7. A Geographic Basis for a New Medical School

8. A Geographic Basis for a New Medical School

9. A Geographic Basis for a New Medical School

10. A Geographic Basis for a New Medical School

11. A Geographic Basis for a New Medical School

12. A Geographic Basis for a New Medical School

13. A Geographic Basis for a New Medical School

14. 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.

15. 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)

16. 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%

17. A Funding Basis for a New Medical School

18. A Funding Basis for a New Medical School

19. A Funding Basis for a New Medical School

20. 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)

21. A Funding Basis for a New Medical School

22. 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

23. 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

24. A Funding Basis for a New Medical School

25. A Funding Basis for a New Medical School Since 2010, NIH funds to new medical schools, excluding Cleveland Clinic/Lerner School exceeds $57 million In 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

26. A Funding Basis for a New Medical School

27. A Funding Basis for a New Medical School

28. A Funding Basis for a New Medical School Additional Types of Funding – HRSA

29. 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

30. 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

31. 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)

32. THANK YOU