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Dec. 17, 2012
KANSAS CITY, Kan. The people who run the state's only medical school say its national accreditation will fall in jeopardy or be lost, if money isn’t raised for a new, $75 million structure at its Kansas City campus.
“If you're not an accredited medical school, your students can't take board examinations. Your graduates cannot get into residency programs that are accredited. And in most jurisdictions if you can't sit for your boards and you don't graduate from an accredited residency program, you can't practice (medicine), you can't get a license. So accreditation is a huge deal,” said Dr. Glen Cox, the dean in charge of keeping the school OK with the Liaison Committee on Medical Education, the national group that certifies medical schools.
The current education building on the school’s Kansas City campus was built in 1976 and officials here say if it isn’t obsolete it is nearly so, especially given the changes happening in the ways doctors and other health professionals are trained.
“A building built in the 1970s just can't fit the technology needs of today,” said Dr. Steven Stites, acting executive vice chancellor of the University of Kansas Medical Center, which includes the medical school. “We have a structural problem and we can’t renovate it. It would cost more to fix it up than it would to replace it.”
Lecture halls, even in the first year of study, now are considered less important to learning than small practice rooms that allow for simulations that mimic the conditions students — as doctors — will face when they encounter real patients. Also, with growing emphasis on coordinated care within the health care industry, schooling now focuses increasingly on teamwork, not just among fellow medical students but also drawing in nursing students and other health-care trainees.
The school has some spaces for that sort of teaching by doing in small groups, but not enough, according to the people in charge. The accreditation process is so meticulous, as described by Cox, that it even dictates how much private space and storage must be allowed for each resident.
Cox said he is among the few people at the medical school to remember the accreditation problems it experienced in the 1990s, a years-long ordeal he said he would prefer not to live again. And that was before he was the administrator tasked with keeping those things in order.
Besides warding off accreditation woes, a new school would allow for training more doctors, KU officials said. Experts across the country for years have warned of doctor shortages that have since arrived and are growing and of the need to expand medical schools to slow or reverse that trend.
KU between 1998 and 2007, according to medical school statistics, graduated an average of about 165 medical students per year and 41 percent (an average of about 67 graduates per year) stayed in the state.
The new building would allow the school to have 25 more students per class year in Kansas City and — after counting graduates from expanded satellite campuses in Wichita and Salina — the state should see 96 new KU-trained doctors a year practicing in the state by 2016, according to projections prepared by KU. That would be a net gain of almost 30 doctors a year.
With a generation of baby-boom doctors retiring or soon to retire, many Kansas towns struggle to recruit new doctors. A disproportionate number of the doctors working in the state’s rural and underserved areas are KU graduates.
There are about 259 doctors per 100,000 U.S. residents. In Kansas, however, there are only about 213 doctors per 100,000 residents. The state also is below the national average when it comes to primary care doctors.
According to KU estimates, the state will need 213 new doctors a year by 2030 just to maintain the state’s current below-average ratio. To match the national average, it would need about 285 new doctors a year by 2030.
It’s been known since Coronado traipsed the Plains that gold doesn’t always turn up in Kansas. And, unfortunately, Dr. Glen Cox did not win the Lottery last week (he said), so KU is struggling to come up with a way to pay for the school building that KU and other higher education officials say it must have and that the state needs.
KU officials are proposing that the state pay for about $30 million of the building’s expense with bonds that would cost about $3 million a year for 10 years to service starting in 2016 or 2017, depending on when the ball gets rolling on the project. KU would come up with $22 million through private donations.
After several years of haggling, the state has recouped about $30 million from the federal government in income withholding overpayments taken from KU residents’ earnings over an extended period. KU officials said they would like to get half of that to also help pay for the building. The medical center would cover from its operating budget remaining costs not covered by its desired share of the so-called FICA windfall, the bonds and private donations.
The University of Kansas, parent of the medical school, and the Kansas Board of Regents, which oversees the state’s entire higher education system, including community colleges and vo-techs, have endorsed this plan.
But budget office officials are saying yes to little or nothing that would require additional state spending and they have rejected KU’s request and the subsequent appeal of the rejection by the regents. Gov. Sam Brownback earlier this year signed into law the biggest tax cut in state history. It becomes effective Jan. 1. As a result, the state faces a projected revenue shortfall of almost $300 million and it remains unclear how that will be handled.
A rejection from the budget office often is a matter of course even in years when the outlook is less dire and it remains to be seen if the medical center’s request will be included in the governor’s spending recommendations when they are presented next month to the 2013 Legislature. School officials met last week with Lt. Jeff Colyer and said he told them not to count on it.
KU officials have already begun inviting small groups of legislators to the medical school for tours, lunches and presentations on the need for the new building. More lobbying is planned in the weeks ahead, school officials said.
The medical center’s overall budget has grown significantly over the past 10 years from $188.3 million in fiscal 2003 to $350.8 million this fiscal year, but the percentage of state support has been in decline. State dollars in 2003 accounted for more than half the medical center’s budget. Now, they are less than a third. Increasingly, the medical center has relied on research and tuition dollars to finance its operations and school officials say they have pretty much hit the limit on what they can charge for tuition. Most medical students already graduate deeply in hock. Inspection teams consider that debt ratio when schools come due for re-accreditation. If too many KU medical students owe too much that would count against the school, Cox said.
Using tuition money to offset declining state support has come to be the norm at Kansas’ universities and at public institutions around the country, said Andy Tompkins, chief executive of the Kansas Board of Regents.
“I think there will be some times we'll get some (state) general fund increase in the out years,” for higher education, Tompkins said, which means maybe some day. “But right now, that's not the case. Tuition has been handling fixed-cost increases and in some instances minimal salary increases” for faculty.
KU officials say they could count on private donations and fees raised from continuing education classes to help pay for a portion of the new building’s cost. But that won’t be enough.
“We don't have the type of deep pockets that private medical schools have in terms of their benefactors,” Cox said. “You can work as hard as possible through your endowment organization but ultimately the philanthropists are going to decide where they want to see their resources go.”
Cox said donors these days find it “sexier” to write checks for research aimed at finding cures for diseases or even for scholarships but that there is far less interest in underwriting seemingly mundane infrastructure needs.
“There have been very focused attempts to get philanthropy interested in building a new medical school building,” he said. “People are not interested in bricks and mortar these days.”
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