2007 Annual Report The University of Nevada School of Medicine

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2007 Annual Report The University of Nevada School of Medicine

  1. 1. 1 2007 Annual Report2007 Annual Report The University of Nevada SchoolThe University of Nevada School of Medicine,of Medicine, oror How to grow a medical schoolHow to grow a medical school with limited resourceswith limited resources
  2. 2. 2 OverviewOverview • Where is UNSoM in comparison toWhere is UNSoM in comparison to peers?peers? • What do we aspire to be?What do we aspire to be? • What challenges do we face and howWhat challenges do we face and how do we prepare ourselves?do we prepare ourselves? • QuestionsQuestions
  3. 3. 3 UNSoM’s position in the universe ofUNSoM’s position in the universe of medical schoolsmedical schools • 125 U.S. accredited M.D. granting schools of125 U.S. accredited M.D. granting schools of medicine in 2007medicine in 2007 • No single objective measure of qualityNo single objective measure of quality – Quality of education (board scores, surveys,Quality of education (board scores, surveys, graduate outcomes, etc).graduate outcomes, etc). – NIH Ranking, citation index, productivity perNIH Ranking, citation index, productivity per investigator.investigator. – Reputation amongst public, peers, opinionReputation amongst public, peers, opinion leaders.leaders.
  4. 4. 4 We fare well amongst our peers in undergraduate medical education
  5. 5. 5 Undergraduate Medical EducationUndergraduate Medical Education • Strong student body with solid GPA andStrong student body with solid GPA and MCAT scoresMCAT scores • Strong basic science educationStrong basic science education • Solid performance on national boardsSolid performance on national boards • Excellent success in securing positions in veryExcellent success in securing positions in very competitive residenciescompetitive residencies • Good feedback on our student’s performanceGood feedback on our student’s performance as residentsas residents
  6. 6. 6 Undergraduate Medical EducationUndergraduate Medical Education ChallengesChallenges ChallengeChallenge SolutionSolution Dependent upon volunteerDependent upon volunteer faculty for much of specialtyfaculty for much of specialty and subspecialty educationand subspecialty education We are expanding our full-timeWe are expanding our full-time facultyfaculty Limited research opportunitiesLimited research opportunities and M.D./Ph.D. programand M.D./Ph.D. program Grow research acrossGrow research across campuses and collaborativelycampuses and collaboratively Enrollment limited to in-stateEnrollment limited to in-state and WICHE studentsand WICHE students Expand enrollment, considerExpand enrollment, consider accepting out of state studentsaccepting out of state students Students must train in twoStudents must train in two locations to complete corelocations to complete core clerkshipsclerkships Expand clinical programs toExpand clinical programs to support clerkships in both Lassupport clerkships in both Las Vegas and RenoVegas and Reno
  7. 7. 7 ResearchResearch • Strong commitment to preclinical educationStrong commitment to preclinical education • Nationally and internationally recognizedNationally and internationally recognized investigators and research programsinvestigators and research programs • Well funded on a per lab or per individualWell funded on a per lab or per individual investigator basisinvestigator basis But…But… • Limited scopeLimited scope • Antiquated and cramped facilitiesAntiquated and cramped facilities • Underrepresented translational researchUnderrepresented translational research
  8. 8. 8 Extramural Funding of Medical Schools, 2005 0 50,000,000 100,000,000 150,000,000 200,000,000 250,000,000 300,000,000 350,000,000 400,000,000 450,000,000 500,000,000 Total Awards Johns Hopkins USC U Conn Syracuse Nevada
  9. 9. 9 Rank School Funding 74 UNIVERSITY OF SOUTH FLORIDA COL OF MED $40,566,549 75 LSU SCHOOL OF MEDICINE IN NEW ORLEANS $39,030,054 76 UNIVERSITY OF OKLAHOMA COLLEGE OF MED $36,472,342 77 MEDICAL COLL OF GEORGIA SCH OF MEDICINE $34,916,505 78 RUSH MEDICAL COLLEGE $34,595,208 79 UNIV OF NEBRASKA COLLEGE OF MEDICINE $34,352,951 80 SAINT LOUIS UNIVERSITY SCH OF MEDICINE $33,995,130 81 UNIVERSITY OF KANSAS SCH OF MEDICINE $33,411,839 82 MEHARRY MEDICAL COLLEGE SCH OF MEDICINE $30,332,145 83 MOREHOUSE SCHOOL OF MEDICINE $27,000,979 84 SUNY AT BUFFALO SCHOOL OF MEDICINE $26,716,279 85 TEMPLE UNIVERSITY SCH OF MEDICINE $25,640,224 86 UNIVERSITY OF PUERTO RICO SCH OF MED $24,314,528 87 DREXEL UNIVERSITY COLLEGE OF MEDICINE $23,127,814 88 NEW YORK MEDICAL COLLEGE $22,621,817 89 LOYOLA UNIV CHICAGO STRITCH SCH OF MED $21,632,861 90 SUNY HLTH SCIS CTR BROOKLYN COL OF MED $21,045,766 91 UNIV OF HAWAII JOHN A BURNS SCH OF MED $20,010,436 92 CHARLES R. DREW UNIVERSITY OF MED & SCI $19,783,371 93 TEXAS A & M UNIV COL OF MEDICINE $18,943,756 94 UPSTATE MEDICAL UNIV COLLEGE OF MEDICINE $18,213,522 95 HOWARD UNIVERSITY COLLEGE OF MEDICINE $17,812,517 96 MEDICAL UNIVERSITY OF OHIO AT TOLEDO $15,956,877 97 GEORGE WASHINGTON UNIV SCH OF MEDICINE $15,715,685 98 UNIV OF MISSISSIPPI SCH OF MEDICINE $14,674,999 99 UNIVERSITY OF COLUMBIA SCH OF MEDICINE $14,314,883 100 LOMA LINDA UNIVERSITY SCH OF MEDICINE $14,019,443 101 UNIVERSITY OF NEVADA SCH OF MEDICINE $13,749,001 To reach the bottom of the 2nd Quartile will require us to triple grant funding
  10. 10. 10 Total Expenditures in 2007 of $14.3 million $3.73 million are generated by faculty over the age of 60
  11. 11. 11 ResearchResearch ChallengeChallenge SolutionSolution Inadequate basicInadequate basic biomedical researchbiomedical research facilitiesfacilities Building a new center forBuilding a new center for molecular medicine on Renomolecular medicine on Reno CampusCampus Limited researchLimited research opportunities for facultyopportunities for faculty and staffand staff Grow research acrossGrow research across campusescampuses Very limited translationalVery limited translational researchresearch Recruit new faculty; partnerRecruit new faculty; partner with basic scientists and otherwith basic scientists and other entities (LRBI, NVCI, WPI)entities (LRBI, NVCI, WPI) Inadequate researchInadequate research support in Las Vegassupport in Las Vegas Add local pre- and post-awardAdd local pre- and post-award support; create dedicatedsupport; create dedicated facilitiesfacilities Mature facultyMature faculty Identify and commit resourcesIdentify and commit resources for recruitmentfor recruitment
  12. 12. 12 Trends in medical education affectTrends in medical education affect our programsour programs • Medical school enrollments are projected toMedical school enrollments are projected to increase by 30% (increased 2.3% in 2007;increase by 30% (increased 2.3% in 2007; several new schools planned)several new schools planned) • Increased emphasis on structured educationIncreased emphasis on structured education with measurable goals and objectiveswith measurable goals and objectives • Increased emphasis on multidisciplinaryIncreased emphasis on multidisciplinary learning and simulationlearning and simulation • Increasing popularity of certain specialtiesIncreasing popularity of certain specialties presents challenges filling primary carepresents challenges filling primary care residenciesresidencies
  13. 13. 13
  14. 14. 14
  15. 15. 15 Graduate Medical EducationGraduate Medical Education ChallengeChallenge Proposed SolutionProposed Solution Limited number ofLimited number of residencies andresidencies and fellowshipsfellowships Expand full-time faculty toExpand full-time faculty to expand clinical educationexpand clinical education Limited training sitesLimited training sites Partner with new LasPartner with new Las Vegas VA Medical CenterVegas VA Medical Center Few hospitals aspire toFew hospitals aspire to be teaching hospitalsbe teaching hospitals Demonstrate tangibleDemonstrate tangible benefits of integrated carebenefits of integrated care Compete for highestCompete for highest quality candidatesquality candidates Continually improveContinually improve residency trainingresidency training programsprograms
  16. 16. 16 AccomplishmentsAccomplishments • Recruited new leadersRecruited new leaders • Expanded faculty and programsExpanded faculty and programs • Formed new relationshipsFormed new relationships • Begun new research and educationalBegun new research and educational facilitiesfacilities • Increased the class sizeIncreased the class size • Begun to improve efficiency ofBegun to improve efficiency of administrative functionsadministrative functions
  17. 17. 17 Recruited new leadershipRecruited new leadership AdministrationAdministration Chief of staff – Ann MischissinChief of staff – Ann Mischissin Chief operating officer – Blain ClaypoolChief operating officer – Blain Claypool Chief financial officer – Jean ReganChief financial officer – Jean Regan Chief counsel – Thomas J. RayChief counsel – Thomas J. Ray Associate Dean for GME – Miriam Bar-onAssociate Dean for GME – Miriam Bar-on Communications Director – Mark LevineCommunications Director – Mark Levine Director Medical Library & IT Services – Jim CurtisDirector Medical Library & IT Services – Jim Curtis Director of Clinical IT – Jon GoetzDirector of Clinical IT – Jon Goetz Director of Development – Stefanie ScoppettoneDirector of Development – Stefanie Scoppettone
  18. 18. 18 Recruited new leadershipRecruited new leadership Clinical ChairmanClinical Chairman Obstetrics and Gynecology, Las Vegas – PaulObstetrics and Gynecology, Las Vegas – Paul StumpfStumpf Internal Medicine, Las Vegas – Daniel M.Internal Medicine, Las Vegas – Daniel M. GoodenbergerGoodenberger Pediatrics, Reno – Nevin WilsonPediatrics, Reno – Nevin Wilson Emergency Medicine – Dale CarrisonEmergency Medicine – Dale Carrison Family Medicine, Las Vegas – Elissa PalmerFamily Medicine, Las Vegas – Elissa Palmer Family Medicine, Reno – Daniel SpogenFamily Medicine, Reno – Daniel Spogen Mojave Mental Health – Coni Kalinowski (MedicalMojave Mental Health – Coni Kalinowski (Medical Director)Director)
  19. 19. 19 Growing clinical programsGrowing clinical programs Pediatric Surgery, Las Vegas – Dr. JohnPediatric Surgery, Las Vegas – Dr. John GoscheGosche Endoscopic Bariatric Surgery, Las Vegas – Dr.Endoscopic Bariatric Surgery, Las Vegas – Dr. James LauJames Lau Nevada Neurologic Consultants merger withNevada Neurologic Consultants merger with UNSoM, Las VegasUNSoM, Las Vegas Expanded subspecialty programs in internalExpanded subspecialty programs in internal medicine, Renomedicine, Reno Sports medicine fellowship in family andSports medicine fellowship in family and community medicine in Reno and Las Vegascommunity medicine in Reno and Las Vegas
  20. 20. 20 Despite significant resourceDespite significant resource limitation, UNSoM has grownlimitation, UNSoM has grown significantly over the past 5 yearssignificantly over the past 5 years
  21. 21. 21 UNSoM Budget 2001-2006 Revenue $ by Category $0 $20 $40 $60 $80 $100 $120 $140 $160 2001 2002 2003 2004 2005 2006 Millions Year Tuition and Fees Government Appropriations Grants and Contracts Practice Plan/Medical Service Gifts and Endowments Medical School Programs/Affiliations Miscellaneous Revenue Total Revenue Total Expenses and Transfers
  22. 22. 22 UNSoM Budget 2001-2006 %of Revenue 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 2001 2002 2003 2004 2005 2006 Year Tuition and Fees Government Appropriation Grants and Contracts Practice Plan/Medical Service Gifts and Endowments Medical School Programs/Affiliations Miscellaneous Revenue Clinical practice revenue is an increasingly important revenue source
  23. 23. 23 UNSoM Employee Growth 2002-2007 0 50 100 150 200 250 300O ct-02 O ct-03 O ct-04 O ct-05 O ct-06 O ct-07 Date Number Academic Administrative Classified Residents Postdoctoral Poly. (Postdoctoral) Poly. (Administrative) Poly. (Classified) Poly. (Academic) Poly. (Residents)
  24. 24. 24 Ratio of Various UNSoM Employees Has Remained Constant 2002-2007 0.0 0.2 0.4 0.6 0.8 1.0 1.2 O ct-02 O ct-03 O ct-04 O ct-05 O ct-06 O ct-07 Date Ratio Residents/Academic Faculty Classified/Academic Faculty Administrative/ Academic Faculty
  25. 25. 25 UHS Practice Plan Employee Growth 0 100 200 300 400 500 600 2003 2004 2005 2006 2007 Year Number MSAN MSAS NFPRP Total
  26. 26. 26 UNSoM/UHS Combined Employee Growth 0 200 400 600 800 1000 1200 1400 2003 2004 2005 2006 2007 Year Number Practice Plan UNSoM Total
  27. 27. 27 The Faculty Practice Plan is anThe Faculty Practice Plan is an economic engine driving our growtheconomic engine driving our growth and sustains education andand sustains education and scholarshipscholarship
  28. 28. 28 Academic Medical Centers Face Difficult TimesAcademic Medical Centers Face Difficult Times A two-part article in Tuesday's issue of The Oregonian reports that:A two-part article in Tuesday's issue of The Oregonian reports that: ““Oregon Health & Science University's losses on laboratoryOregon Health & Science University's losses on laboratory research and doctor education are growing far faster thanresearch and doctor education are growing far faster than anticipated and are projected to reach $50 million this year.”anticipated and are projected to reach $50 million this year.” Those losses mean tough choices for the university, which hasThose losses mean tough choices for the university, which has ambitious plans to treat more patients, expand its scientific researchambitious plans to treat more patients, expand its scientific research and build a world-class medical school that will train new doctorsand build a world-class medical school that will train new doctors for Oregon. The article further reports that OHSU President Joefor Oregon. The article further reports that OHSU President Joe Robertson told the paper "that the university has sufficientRobertson told the paper "that the university has sufficient resources for the next 20 months, but that its current financialresources for the next 20 months, but that its current financial course is 'not sustainable.' Robertson declined to speculate how thecourse is 'not sustainable.' Robertson declined to speculate how the university might address the growing losses or say whether cost-university might address the growing losses or say whether cost- cutting alone could close the gap."cutting alone could close the gap."
  29. 29. 29 Role of the Practice PlanRole of the Practice Plan • Ensures access to diverse patient populationEnsures access to diverse patient population for students, residents, fellows and other healthfor students, residents, fellows and other health care providers in an educational environmentcare providers in an educational environment with supervised increases in responsibility ofwith supervised increases in responsibility of learnerslearners • Generates 42% of total annual revenue to theGenerates 42% of total annual revenue to the school of medicine, supports other missions,school of medicine, supports other missions, and provides the majority of clinical facultyand provides the majority of clinical faculty salarysalary
  30. 30. 30 University of Nevada School of Medicine Revenue 2005- 06 Miscellaneous Revenue 3%Medical School Activities at Hospitals 16% Gifts and Endowment Income 1% Clinical Practice 42% Grants and Contracts 17% State Appropriation 19% Tuition and Fees 2% Data from 2006 LCME Report
  31. 31. 31 Practice Plan OrganizationPractice Plan Organization Integrated Clinical Services Board NFPRP (Campus Pharmacy and Mojave Mental Health) Medical School Associates South Medical School Associates North University of Nevada, Reno Leadership Board of Regents UNSoM Leadership UNSoM Programs
  32. 32. 32 Practice Plan AssetsPractice Plan Assets Current AssetsCurrent Assets Cash and cash equivalentsCash and cash equivalents 12,920,77512,920,775 InvestmentsInvestments 1,327,5901,327,590 Patient Accounts Receivable, net ofPatient Accounts Receivable, net of estimated uncollectibleestimated uncollectible 7,509,0897,509,089 Other ReceivablesOther Receivables 1,123,3761,123,376 Prepaid Expenses and Other AssetsPrepaid Expenses and Other Assets 859,465859,465 Total Current AssetsTotal Current Assets 23,740,29523,740,295 Capital Assets, NetCapital Assets, Net 2,884,1342,884,134 Total AssetsTotal Assets 26,624,42926,624,429
  33. 33. 33 Practice Plan LiabilitiesPractice Plan Liabilities Current LiabilitiesCurrent Liabilities Current Portion of Long-Term Notes Payable andCurrent Portion of Long-Term Notes Payable and Capital Lease ObligationsCapital Lease Obligations 213,452213,452 Accounts PayableAccounts Payable 1,911,9381,911,938 Accrued Payroll and Employee Related ExpensesAccrued Payroll and Employee Related Expenses 1,650,0151,650,015 Other Accrued ExpensesOther Accrued Expenses 476,152476,152 Due To (from) Affiliates, NetDue To (from) Affiliates, Net 332,694332,694 Total Current LiabilitiesTotal Current Liabilities 4,584,2514,584,251 Notes Payable and Capital Lease Obligations, NetNotes Payable and Capital Lease Obligations, Net of Current Portionof Current Portion 405,989405,989 Total LiabilitiesTotal Liabilities 4,990,2404,990,240
  34. 34. 34 Practice Plan SummaryPractice Plan Summary Fund BalanceFund Balance UnrestrictedUnrestricted 19,369,49619,369,496 Invested in Capital Assets, Net of Related DebtInvested in Capital Assets, Net of Related Debt 2,264,6932,264,693 Total Fund BalanceTotal Fund Balance 21,634,18921,634,189
  35. 35. 35 UNSoM Clinical Revenues 0 10,000,000 20,000,000 30,000,000 40,000,000 50,000,000 60,000,000 2001-20022002-20032003-20042004-20052005-20062006-2007Year Revenue MSAN NFPRP MSAS TOTAL
  36. 36. 36 What do we aspire to be?What do we aspire to be? • A more complete medical school with the abilityA more complete medical school with the ability to educate the physician workforce for Nevadato educate the physician workforce for Nevada in Nevadain Nevada • A vibrant center of research, service andA vibrant center of research, service and learning that attracts a diverse group of thelearning that attracts a diverse group of the best and brightest faculty, staff and traineesbest and brightest faculty, staff and trainees • A valued partner for patients and other healthA valued partner for patients and other health care providerscare providers
  37. 37. 37 What must we do to succeed?What must we do to succeed? • Measure our performance against externalMeasure our performance against external benchmarks from peersbenchmarks from peers • Streamline our procedures and administrativeStreamline our procedures and administrative structure – “structure – “Faster, Better, Cheaper”Faster, Better, Cheaper” • Identify and maximize revenueIdentify and maximize revenue • Be focused and tenacious in pursuing ourBe focused and tenacious in pursuing our goalsgoals • Never sacrifice quality for speed or quantityNever sacrifice quality for speed or quantity

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