Regent’s idea for Las Vegas-based medical school has merit and drawbacks, observers say

By Paul Takahashi

Published Thursday, March 28, 2013 | 2 a.m.

Updated Thursday, March 28, 2013 | 9:15 a.m.

Regent Mark Doubrava's proposal for a new medical school at UNLV likely will exacerbate longstanding north-south tensions in higher education amid a fierce debate over equitable funding for Nevada's seven colleges and universities.

Doubrava — a local ophthalmologist who specializes in cornea transplants — recently announced his plans for Nevada's higher education leaders to explore the possibility of a second state-funded medical school that would exclusively serve Southern Nevada.

Currently, four-year medical students at the University of Nevada School of Medicine — located at UNR — complete their classwork in Reno during their first two years of study. Some students then move to Las Vegas to complete their medical clerkship at University Medical Center during their final two years.

Despite recent efforts to increase the medical school's presence in Southern Nevada — from purchasing a house in Las Vegas for Dean Tom Schwenk to proposing a $220 million academic center near UMC — the Nevada System of Higher Education hasn't done enough for the medical and patient communities in Southern Nevada, Doubrava said.

A medical school at UNLV would help solve Las Vegas' doctor shortage and improve the quality of health care in the state's population center, Doubrava said. In a city marred by a hepatitis C scandal and substandard hospital care, a dedicated medical school also would help train and elevate the local physician community, he added.

"It's difficult for a Reno (medical school) program 450 miles away to service the needs of and integrate in the (Las Vegas) community," Doubrava said. "Because of its clinical activity at UMC, the Reno school of medicine has a foot in Clark County. But it has no legs, no heart, no vision (in Las Vegas)."

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When the University of Nevada School of Medicine was created in 1969, there was much debate over where the state-sponsored medical school should be located.

At the time, Las Vegas had a population of about 300,000 while Reno had a population of about 120,000. Because UNLV was just 15 years old at the time, the decision was made to open the medical school at UNR, the state's land-grant university founded in 1874.

However, as Las Vegas continued to add population exponentially and became the economic engine of the state, the lack of a medical school dedicated to Southern Nevada became troublesome, Doubrava said.

Las Vegas, which today has a population of 2 million people, is the only major U.S. city of its size without a traditional public, M.D.-granting medical school. The closest public medical school is in California, at University of California's Riverside campus. (Touro University Nevada, with its campus in Henderson, is a private medical school that grants doctor of osteopatic medicine degrees.)

"Those of us who have lived here can see the deficit," Doubrava said. "We can see what is happening with the anxiety, just among the citizenry, that they feel like they can't get good medical care here."

Doubrava insists there are good physicians practicing good medicine in Las Vegas. However, the medical community in Las Vegas is just too fragmented, he said.

A UNLV medical school can provide a more "hands-on approach" to health care in Las Vegas "instead of an almost absentee-landlord approach that sometimes comes down from the North," Doubrava said.

Medical schools are often a positive catalyst for the communities they serve, he said. They spawn innovations in health care as a result of university medical research. They often have free or low-cost clinics that boast equipment normally too specialized and expensive for local physicians' offices.

"It would be a boost in the arm (of the local medical community) as far as national reputation," Doubrava said. "The medical school would help shine light on the bar of what the standard of care is supposed to be."

A UNLV medical school could also be a shot in the arm of Las Vegas' struggling economy, Doubrava said.

The school could attract biotechnology companies and other medical companies to Southern Nevada. A UNLV School of Medicine also could bring more federal research dollars to the state.

Nevada ranks near the bottom of the nation when it comes to the amount of federal research grants from the National Science Foundation, the National Institutes of Health and the federal Centers for Disease Control. A comprehensive, four-year medical school in Las Vegas — where a burgeoning retirement community could be served by research in geriatric medicine — could help capture more federal funding, Doubrava said.

A medical school that can provide "tertiary care" — specialized consultations and surgeries — could help keep more patients in Nevada, Doubrava said. Now, many Las Vegans go out of state to places such as the UCLA medical school and the Mayo Clinic in Scottsdale, Ariz., for specialized care, he said.

Medical tourism could be the next big economic boost for Las Vegas, already an entertainment destination for millions of people around the world.

"That's pretty much a no-brainer," Doubrava said.

A medical school in Las Vegas also may help more local students become doctors and surgeons, said Doubrava, an UNLV graduate who went to the University of Nevada School of Medicine.

By forcing medical students to relocate between Northern and Southern Nevada, the current system puts a financial strain on students attending classes in Reno and completing their residency in Las Vegas. That's especially true for many Southern Nevada students from low-income families.

"If they don't have the financial means to relocate to the smaller metro area in Northern Nevada, it puts a burden on potential students," Doubrava said. "That makes it difficult to attract high-quality applicants who have an option to go to another institution."

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Representatives in higher education, the Legislature and the medical community seemed open to discussing Doubrava's proposal but expressed some skepticism over the cost and effort of starting a new medical school at UNLV.

Doubrava said he doesn't know how much a UNLV medical school would cost. The UNR medical school has an annual operating budget of about $160 million, about $30 million of which comes from the state.

A medical school at UNLV probably would need just as much money, if not more, to operate. Doubrava imagines a Las Vegas medical school to be larger — more hospital-based and have more specialists — than its Reno counterpart.

However, UNLV may not have to start the medical school from scratch, Doubrava said. There already are medical school staff in Las Vegas, and UNLV has a grant-writing and research department. UNLV would need new facilities and additional faculty to create the academic portion of the medical curriculum.

Board of Regents Chairman Jason Geddes said it would be difficult to ask the Legislature to fund a second medical school in the state. Gov. Brian Sandoval requested a flat budget for higher education over the next two years, and he didn't grant a $40 million request by regents to restore faculty pay that had been cut in the recession, Geddes said.

"We have a lot of needs in this state for higher education," said Geddes, a UNR graduate. "How do we balance all of those needs?"

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Chancellor Dan Klaich said serving the health care system in Southern Nevada was "absolutely critical" for the Nevada System of Higher Education. To that end, a "completely informed discussion" about Doubrava's proposal is appropriate, Klaich said.

Although Klaich agreed UNLV must be involved in improving medical education in Las Vegas, the UNR graduate questioned the need for a second medical school in the state after five years of severe budget cuts that saw massive tuition hikes and reductions in programs and faculty pay.

"The key question is: What do the people of Southern Nevada need and how do we serve that need in the most efficient and effective way?" Klaich said.

A proposal for a new medical school “is not the only priority in front of the board (of regents)," he added.

Schwenk said the idea of a UNLV medical school merited debate but said Doubrava "moved on to a solution before we've discussed the larger issue."

"I personally don't think it's the best answer," Schwenk said of Doubrava's proposal. "I think I can run an excellent school of medicine that can serve the whole state."

Schwenk favors one medical school with campuses in Reno and Las Vegas that complement each other. Although accreditation may be tricky, the two-campus solution would allow students to gain experience in both rural and urban medical settings, he said.

Earlier this year, Schwenk unveiled plans for a 280,000-square-foot academic center for the medical school that would be housed in a six-story building across the street from UMC. The proposed $220 million building would have just as much space as the four medical school buildings in Reno, which would prove to Las Vegans the medical school's commitment to Southern Nevada, Schwenk said.

Ideally, the Las Vegas campus would be open by 2018, but it's contingent on funding and approval from the Board of Regents and the Clark County Commission, which owns the land.

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Las Vegas needs more doctors, Doubrava said. But is a medical school the way to do it?

George Alexander, a local plastic surgeon and the president of the Clark County Medical Society, said the idea of a medical school in Las Vegas was "something worth exploring."

"Our goal is to improve health care in Las Vegas by attracting and retaining quality doctors to Las Vegas," he said. "If there was a medical school and, more importantly, more residencies, we are more likely to retain doctors."

State Sen. Joe Hardy, a longtime doctor from Boulder City who recently became a professor at Touro University, agreed with Doubrava that Las Vegas needed more doctors. However, building a medical school wasn't the way to do it, Hardy said.

"The way to get more doctors is to have more residencies," he said. "What we need is more clinical rotations."

Statistics show that cities only keep half as many doctors with a medical school, Hardy said. However, many doctors decide to settle down in the community where they serve their three- to seven-year residencies, he said.

However, by 2016, the number of medical students will outweigh the number of residency slots in Nevada, which means students will be forced to look out of state for residency opportunities, Hardy said.

"I don't think we need another public or private medical school in Southern Nevada as much as we need more residencies," he said. "We've already increased the number of medical students, but we haven't increased the number of resident slots. That's becoming a nationwide problem."

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Doubrava understands he may be bringing up simmering north-south tensions with his proposal but said he was adamant there needed to be a separation between Northern and Southern Nevada when it came to medical education.

"Why can't we have a southern campus with its own dean?" Doubrava asked rhetorically. "Because they're still calling the shots from (Reno), 450 miles away.

"Any potential research dollars and benefit that the Southern Nevada campus would generate gets funneled to Reno as credit towards their status as a tier-one university. What Reno will continue to do is browbeat UNLV and say, 'We're the flagship land-grant institution. We've got the med school.' That's got to stop."

Doubrava likened the north-south divide over medical education to the Hatfields and McCoys, the infamous family feud from post-Civil War Kentucky. This distrust between the north and south has impeded the School of Medicine from seeking donations.

Southerners are wary of donating to the medical school, fearing it will go to Reno. Northerners are skeptical of their donations going to Las Vegas, Doubrava said.

"It doesn't matter how great of a dean you have, in this current structure, it's not going to work," Doubrava said. "We don't get along because we don't have the same vision up north."