“Should all health science schools in Nevada’s university system break away from their universities and be governed by an executive reporting directly to the chancellor?”
Yes, It Would Lead to Progress in Healthcare
by Ronald Kline, M.D.
It is clear to most thoughtful people that Nevada has serious unmet healthcare needs. Partly due to our rapid growth, we are 46th and 49th in the country in per capita physicians and nurses, respectively.
We are near the top in the percentage of our citizens who lack health insurance and near the bottom in most measures of health status and healthcare. As Nevadans – not as northerners or southerners – we must ask if there is a better way to organize our healthcare schools to better provide for our needs. Clark County Medical Society’s (CCMS) proposal for a president of health sciences, reporting to the chancellor, and overseeing the University Schools of Medicine (UNSOM), dentistry, nursing and other allied health professions, was designed to achieve exactly that.
The vigorous debate in Southern Nevada about an academic medical center (AMC), has spurred ongoing discussions about improving healthcare and health education. Nevada is one of only five states without an AMC. UNSOM is so weak and ineffective, and with such a limited presence in Southern Nevada, that the University of Pittsburgh can seriously consider setting up shop in our backyard while our medical school watches helplessly from the sidelines, trying to cut itself the best side-deal it can.
Our belief is that the fragmentation of healthcare education between UNR and UNLV, with both university presidents appropriately focused on the best interests of their own institutions, causes a lack of coordination and a wasteful duplication of efforts our state cannot afford. We believe this hinders progress towards improved healthcare.
UNSOM’s failure to devote adequate resources to Clark County (where 71 percent of Nevadans live) results in its perception as a “Northern Nevada” rather than a “Nevada” institution. This prevents UNSOM from receiving the philanthropic support from the Southern Nevada community other medical schools routinely get from their communities.
Furthermore, because the administrative direction of UNSOM comes from UNR, it is not the integral part of the Southern Nevada medical community it should be. It has been marginalized when it should be a leader. Similar criticism can be directed at UNLV for aggressively moving forward with allied health programs and “biomedical research” at its Shadow Lane campus, the proper purview of UNSOM. CCMS strongly believes that a president of health sciences, experienced in the unique and broad range of skills necessary to provide leadership in healthcare education, would be an important step forward in improving the quality of life in our state.
No, It Would Be Costly and Inefficient
by Chancellor James E. Rogers
If the Nevada System of Higher Education were to create a stand-alone health sciences university, we would have two choices: We could strip those health disciplines, including the medical and dental schools, from our two universities and slap them together to create a new institution; or we could duplicate some of those programs in a stand-alone institution.
Neither model works.
If these disciplines are duplicated – for example, if nursing programs are offered not only at the health sciences university, but also at other research universities in the same system – then such an arrangement is a wasteful duplication of facilities (in this case, clinical labs for nursing) at all institutions.
If programs are not duplicated, then it is more difficult to take advantage of either academic synergies or organizational efficiencies that can be very easily achieved in a comprehensive research university. The loss of potential academic synergies is a particularly serious shortcoming of segregating the health sciences from other academic disciplines. Health science universities generally do not include such disciplines as social work, anthropology, animal and plant biochemistry and biotechnology, biological engineering, family counseling, and environmental health and safety – all commonly found in comprehensive research universities.
By including these disciplines as well as the traditional health disciplines, comprehensive universities are more easily able to pioneer interdisciplinary areas that can lead to exciting new discoveries, thereby enhancing health and healthcare in our society. This is the sort of breakthrough that happens, for example, when an engineer collaborates with a plastic surgeon to design better cosmetic prostheses, or when a computer scientist creates a better system for storing and transmitting health information.
Another shortcoming of the health sciences university model relates to the loss of organizational efficiencies. In the comprehensive research university, we can take advantage of volume discounting in such areas as library subscriptions, office and laboratory supplies, telecommunications services, information technology, and administrative and student services such as purchasing, research, basic human resources, payroll, registration and the like.
We simply do not have unlimited resources for higher education in Nevada. We need to concentrate our funds on our students and teachers, rather than in creating a new layer of administrators. We need to commit ourselves to the existing programs at UNR and UNLV and enhance those programs rather than “divide the pot” into three shares, all of which will, in the end, be weaker.
In my opinion, comprehensive research universities with embedded professional schools provide a more robust and cost-effective model for advancing healthcare and meeting the healthcare challenges of Nevada, now and in the future.