Friday, June 29, 2007

Needle Stick! The Latex Gloves Come Off...

Apparently Some Duplications are OK
(Children's Hospitals),
But Not Others (Medical Schools)?

`When I use a word,'
Humpty Dumpty said,
in rather a scornful tone,
`it means just what I choose it to mean
-- neither more nor less.'

The potential new medical school, a joint effort between St. Thomas and Allina, has been the subject of earlier posts. See for example:

Earlier Thoughts of BigU Administration Concerning
Possibility of St. Thomas/Allina Medical School

The frustration level of BigU's administration at not being consulted on the matter seems to be surfacing.

(Mr. Bonzo thanks a friend for calling this post to his attention.)

From the Minneapolis/St. Paul Business Journal:

U official questions UST medical school

Minneapolis/St. Paul Business Journal
June 29, 2007

by Lauren Wilbert

The University of St. Thomas and Allina Hospitals & Clinics' idea to jointly build a new medical school in the Twin Cities is generating some concern in the local health care community, particularly within the University of Minnesota's medical program.

St. Thomas and Allina's proposed school would produce primary-care physicians in family practice, internal medicine and pediatrics, areas where doctors are projected to be in increasingly short supply. The organizations this week hired Pittsburgh-based Tripp Umbach to oversee their summer-long feasibility study of the new school. Tripp Umbach is a consulting firm with a Minneapolis office that has led studies for several startup medical schools nationwide.

Some health care leaders, including Dr. Frank Cerra, who leads the University of Minnesota's Academic Health Center are skeptical that producing more graduates would solve the looming shortage.

Instead of building a new school, he said, the health care community should focus on solving issues of reimbursement for primary-care doctors and how to pull other medical practitioners, such as nurses and pharmacists, into the mix.

"Just increasing the capacity to train physicians isn't really an answer to the problem," Cerra said. "There is a work force issue, yes. But we need to wrestle with the cost of medical education and the debt incurred."

Cerra said he would rather see the U's hospital work with Allina's Abbott Northwestern Hospital, for example, to coordinate their primary care residencies. A new school might only duplicate programs that already exist. [Apparently this argument does not apply to children's hospitals.]

Mary Brainerd, CEO of Bloomington-based HealthPartners, agreed with Cerra that other options should be studied besides training more doctors.

She is skeptical that a primary care physician shortage is due to too few students entering that field. It could be that the aging population is simply creating a need for more doctors who can be a "quarterback for the care you get," Brainerd said.

"I'm not sure what that quarterback role will look like," she said. "Maybe it's more nurse practitioners working with specialists. With the shortages, we'll have to get creative."

But Tom Rochon, St. Thomas' executive vice president of academic affairs who is a co-leader of the feasibility study, disagreed. "It's very clear that our region needs more doctors, and it needs more doctors in family practice," he said.

The demand for more physicians will be one of the main issues addressed by the feasibility study. If it finds the school wouldn't help the community, it won't be built, he said.

The study also will look into the cost of opening a new school, recruiting faculty and students and space needs of a new school.

"One of the challenges we'll face is [determining], 'How do we make sure we're filling this gap we've identified and not just producing more researchers?' " Rochon said. The school, instead, would aim to put more practicing physicians in the Twin Cities and rural Minnesota.

"We don't think we're competing against or detracting from the [programs at] the University of Minnesota," he added. "Hospitals accept residents from multiple medical schools.

Rochon acknowledged that the partnership with Allina makes for a sensitive situation with the U of M, which sends medical students to Allina hospitals for training.

But the new school and partnership with St. Thomas would not mean fewer residency spots at Allina for U of M students, said Dr. Penny Wheeler, Allina's chief clinical officer.

For its latest clinical training program, university medical school graduates filled only 45 of Allina's 142 primary care residency positions. As talks of a new school go forward, Allina might be able to create additional spots, said Allina spokesman David Kanihan.

Wheeler is working to schedule meetings with various officials at the U of M to talk about how the new school would affect their long-standing relationship, and Allina CEO Dick Pettingill has met with Cerra at least twice so far, she said.

"[The proposed school] is meant to be complementary, not competitive," Wheeler said.

Still, some from the university feel left out of the planning process.

"We've offered to help Allina and St. Thomas in any way possible," Cerra said. "We have 150 years of experience with schools, and so far, they haven't asked for that information." [What is this about? See above. Looks like Dr. Cerra has met with Allina CEO "at least twice so far."]

St. Thomas and Allina's focus on primary care comes as some Minnesota schools are showing a drop in students going into that field. Figures from the U of M's annual residency match program, which places medical students in practice areas, show that internal medicine and family practice have the highest participation.

But those numbers have dropped while class sizes have stayed relatively flat. In 2005, 50 students entered an internal medicine residency and 40 went into family practice. By 2007, those numbers dropped to 39 students in internal medicine and 35 students in family practice.

As Mr. Spock would say: "Interesting."


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