The UC Health Sciences System

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1 The UC Health Sciences System A Look at Current tchallenges and New Initiatives Cathryn L. Nation, M.D. Associate Vice President Health Sciences UC Office of the President May 2012

2 California s Master Plan: Implications for the Health lthsi Sciences Instruction ti California s i Master Plan for Higher Education delegates to UC, exclusive responsibility in public higher education in dentistry (DDS), medicine (MD), optometry (OD), pharmacy (PharmD) and veterinary medicine (DVM) Master Plan responsibilities for doctoral education also apply to UC for professional degrees in nursing (PhD) and public health (PhD, DrPH) In response to health workforce needs, the California State University system was recently granted authority to offer doctoral education in audiology (Aud) and physical therapy (DPT)

3 UC Health Sciences Instructional Programs: What and Where Are They? Medicine: Davis, Irvine, Los Angeles, San Diego, and San Francisco Medical education programs at Berkeley, Fresno, Riverside, and the Charles R. Drew School of Medicine and Science Efforts are underway and ongoing to transition the Riverside program to a fully independent UC medical school Nursing: Davis, Irvine (program), LosAngeles Angeles, andsan Francisco Dentistry: Los Angeles and San Francisco Optometry: Berkeley Pharmacy: San Diego and San Francisco Public Health: Berkeley and Los Angeles Veterinary Medicine: Davis

4 UC Health Sciences Instructional Programs: The Statewide Context UC plays a major role in medical education. Current enrollment totals more than 3,100 medical students and more than 4,400 medical residents and fellows Medical students and residents represent roughly two thirds of all UC health sciences students California leads the nation (ranked first among U.S. states with medical schools) in physicians retained from undergraduate medical education (62% statewide/68% from UC); and ranked second in the country in physicians retained from graduate medical education (69%)

5 So What s the Problem?? California ranks at the bottom of all states in the number of medical students enrolled (in the state) on a per capita basis (13.5 students per 100,000 versus a national average of 28) The h state already faces shortages of practicing physicians in primary care and some specialties and these vary across communities Shortages will increase with health reform andwill be exacerbated as growing numbers of practicing physicians plan for retirement In2010 California ranked second amongall states in thepercentage of In 2010, California ranked second among all states in the percentage of practicing physicians who are age 60 or older (31%)

6 Making Matters Worse The California State Budget May Revise identifies an overall budget gap of $15.7 billion Shortfall is $6.5 billion higher h than projected Major cuts proposed for health and social services Relative protection for higher education $250M trigger cut for UC if November ballot initiative fails Federal Deficits Medicare program (including funding for GME) is a major target for cuts NIH funding is also at risk Health Reform Extreme pressure to decrease costs and improve quality regardless of what happens in the courts

7 How this Translates for Students Soaring Educational Costs Multi year budget cuts and corresponding fee increases have accelerated the rate of rise in fees For many professions, including medicine, total charges now exceed UC s public comparison institutions Rising Debt Levels Increasingly, students are reporting that concerns about educational debt are influencing their thinkingabout futurecareer choices Tremendous Uncertainty Inability to predict annual increases in tuition and other charges for students have created unprecedented uncertainty about the total cost of attendance at UC

8 Medicine (Residents) University of California Total Estimated Required Charges Professional Campus Student Degree Based Fees Services Supplemental Health & Other Estimated Tuition Tuition Tuition Insurance Charges TOTAL Berkeley $11,220 $972 $18,636 $2,211 $643 $33,682 Davis $14,604^ $1,052^ $18,636 $2,191 $1,537 $38,020 Irvine $11,220 $972 $18,636 $2,043 $800 $33,671 Los Angeles $10,686** $972 $18,636 $2,117 $370 $32,781 Riverside $11,220 $972 $18,636 $1,825 $973 $33,626 San Diego $11,220 $972 $18,636 $1,708 $542 $33,078 San Francisco $11,220 $972 $18,636 $2,593 $201 $33,622 * l h l d d f l l l lh *Total charges include: Tuition, Student Services Fee, Professional Degree Supplemental Tuition, Health Insurance, and Campus Based Fees ^ UC Davis Medicine Total Charges include Summer fees/tuition ** UCLA MD students are exempt from the Fall Semester 2011 portion of the July 2011 Tuition increase

9 Medicine (Non Residents) University of California Total Estimated Required Charges Professional Campus Student Degree Based Fees Services Supplemental Health & Other Estimated Tuition Tuition Tuition Insurance Charges TOTAL Berkeley $23,465 $972 $18,636 $2,211 $643 $45,927 Davis $26,849^ $1,052^ $18,636 $2,191 $1,537 $50,265 Irvine $23,465 $972 $18,636 $2,043 $800 $45,916 Los Angeles $22,931** $972 $18,636 $2,117 $370 $45,026 Riverside $23,465 $972 $18,636 $1,825 $973 $45,871 San Diego $23,465 $972 $18,636 $1,708 $542 $45,323 San Francisco $23,465 $972 $18,636 $2,593 $201 $45,867 *Total charges include: Tuition Student Services Fee Non Resident Professional Degree Supplemental Tuition Total charges include: Tuition, Student Services Fee, Non Resident Professional Degree Supplemental Tuition, Health Insurance, and Campus Based Fees ^ UC Davis Medicine Total Charges include Summer fees/tuition ** UCLA MD students are exempt from the Fall Semester 2011 portion of the July 2011 Tuition increase

10 Comparison Institutions for UC Medical lsh Schools ( ) 2012) RESIDENTS (Public) University of Colorado $29,990 University of Michigan $28,118 University of North Carolina $14,448 University of Oregon $36,099 University of Pittsburgh $39,555 University of Washington $23,049 PUBLIC AVERAGE $28,543 UC AVERAGE ~ $34,000

11 Comparison Institutions for UC Medical lsh Schools ( ) 2012) RESIDENTS/NONRESIDENTS (Private) Harvard Medical School $46,729 Johns Hopkins University $42,782 Stanford University $45,042 University of Pennsylvania $47,196 University of Southern California $47,072 Washington University at St. Louis $48,800 PRIVATE AVERAGE $46,270 UC AVERAGE for will 13 increase to $??,???

12 Average 4 Year Cost of Attendance California i Medical lsh Schools ( ) 2010) Medical School Average Cost UC Davis $187, 615 UC Irvine $195, 780 UC Los Angeles $199,730 UC San Diego $196,698 UC San Francisco $198,805 Loma Linda University $230,126 Univ. of Southern California $273,485 Stanford University $294,259

13 Distribution of Debt at Graduation UC Medical School Graduates Figures Do Not Include Undergraduate Debt % 15% 10% 5% 0%

14 Other UC Health Professions Total Estimated RequiredCharges for

15 University of California TtlEti Total Estimated tdrequired dcharges Dentistry (Residents) Professional Campus Student Degree Based Fees Services Supplemental Health & Other Estimated Tuition Tuition Tuition Insurance Charges TOTAL Los Angeles $11,220 $972 $24,160 $2,128 $1,852 $40,332 San Francisco $11,220 $972 $25,068 $2,604 $186 $40, Nursing (Residents) Davis $11,220 $972 $5,730 $2,116 $913 $21,001 Irvine $11,220 $972 $5,730 $1,982 $770 $20,674 Los Angeles $11,220 $972 $5,730 $2,056 $370 $20,348 San Francisco $11,220 $972 $5,730 $2,532 $183 $20,637 *Total charges include Tuition, the Student Services Fee, Campus Based Fees, Professional Degree Supplemental Tuition, and Health Insurance

16 University of California TtlEti Total Estimated tdrequired dcharges Optometry (Residents) Professional Campus Student Degree Based Fees Services Supplemental Health & Other Estimated Titi Tuition Fees Titi Tuition Insurance Charges TOTAL Berkeley $11,220 $972 $14,674 $2,150 $643 $29,659 Pharmacy (Residents) San Diego $11,220 $972 $18,354 $1,647 $542 $32,735 San Francisco $11,220 $972 $18,354 $2,532 $207 $33,285 Veterinary Medicine (Residents) Davis $11,220 $972 $15,216 $2,166 $3,401 $32,975 *Total charges include Tuition, the Student Services Fee, Campus Based Fees, Professional Degree Supplemental Tuition, and Health Insurance

17 University of California TtlEti Total Estimated tdrequired dcharges Public Health (Residents) Professional Campus Student Degree Based Fees Services Supplemental Health & Other Estimated Tuition Fees Tuition Insurance Charges TOTAL Berkeley kl $11,220 $972 $6,758 $2,150 $643 $21,743 Davis $11,220 $972 $6,810 $2,166 $2,561 $23,729 Irvine $11,220 $972 $5,612 $1,982 $770 $20,556 Los Angeles $11,220 $972 $6,811 $2,056 $370 $21,429 *Total charges include Tuition, the Student Services Fee, Campus Based Fees, Professional Degree Supplemental Tuition, and Health Insurance

18 Health Sciences Educational Initiatives New initiatives in nursing education Launch of UC IrvineProgram in Nursing Science (2005) Re establishment of baccalaureate nursing program at UCLA (2006) Establishment of a new UC Davis School of Nursing (2009) UC nursing enrollment totals more than 1,400 ( ) 12) Active cross campus planning effort focused innovation and resource sharing New initiatives in medical education Steady enrollment growth in UC PRIME programs (2004 ongoing) Active efforts are ongoing to establish the sixth UC medical school at UCR New initiatives focused on sharing of best practices Creation of UC Center for Health Quality and Innovation (2011) Steady efforts to expand successful use of telehealth and other technologies

19 The UC PRIME Initiative The UC system wide PRIME initiative includes six innovative medical education programs that are focused on addressing the needs of medically underserved communities Core Elements Clear Program Identity Focused Student Recruitment Admissions Curricular Enrichment Clinical Training Dedicated Faculty Mentorship

20 Anticipated Total PRIME Enrollment Campus Program Focus Class Size Total Five Year Enrollment UCD Rural Health/ Telemedicine Date by When Steady State Enrollment Will Occur 12 Students 60 Students UCI Latino Health 12 Students 60 Students UCLA/UCR/CDU Diverse 18 Students 90 Students Disadvantaged 10 (UCLA) Communities 4 (UCR) 4 (CDU) UCSD Health Equity 12 Students 60 Students UCSF/UCB Urban Underserved Communities 15 Students 11 (UCSF) 4 (UCB) 75 Students UCM/UCD San Joaquin Vll Valley 5 Students t ~25 Students t Estimated Total Enrollment: ~370

21 UC System wide PRIME Initiative Fall 2011 Race/Ethnicity: UCD UCI UCLA UCSD UCSF TOTAL Native American/Alaskan Native Black/African American MexicanAmer/Chic/Other Hisp/Lat Pacific Islander Multiple race/ethnicity (URM) Total URM's & Other Hispanic/Latinos (32%) (80%) (65%) (39%) (63%) (57%) Asian American White/Caucasian Other/Non-Reporting TOTAL ENROLLMENT

22 Impact on UC Medical Education Growth through PRIME marks the first expansion of educational opportunities for UC medical students in more than 40 years Development of PRIME programs has generated a renewed focus on health disparities, cultural competence, and the public service mission of medical education PRIME has produced a level of student diversity that is much needed (but rarely seen) in U.S. medical education

23 PRIME Urban Underserved First Year UCSF PRIME Class (2008)

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