Strategy is needed to avert primary health professional shortage.
Two recent items from the University of Minnesota offer a timely reminder that this state's medical future is closely linked to its higher education institutions. The news:
•The first of five new buildings comprising the "Biomedical Discovery District" on the Twin Cities campus has been officially open for barely more than a month, but already the complex is delivering on its promise to be a magnet for medical research talent.
The opportunity to design their own state-of-the-art laboratories was reportedly crucial to recruiting two leading lights from the prestigious Cleveland Clinic, cardiologist Gary Francis and neurologist Jerry Vitek. The new facilities also helped lure Joseph Metzger from the University of Michigan to head the integrative biology and physiology department.
Those hiring coups indicate that the state's $233 million bonding commitment to medical research in 2008 is on track to produce a big payoff, said Frank Cerra, senior vice president for health sciences at the university.
"Curing Alzheimer's, curing diabetes, making new hearts to replace diseased ones -- that's what this investment will make possible," he said. A state that's eager to control medical costs and improve people's lives does well to make that investment, even -- or especially -- during lean times.
•A more ominous word came from a university task force examining the likelihood that support for higher education will shrink in the next several state budgets. "The university's compact with the state of Minnesota to prepare the next generation of leaders in health and other professions is at risk," the Future Financial Resources Task Force told the regents in a fall report. "For example, at the same time the state needs more doctors, nurses, pharmacists and dentists to care for an aging population, the resources from the state and from patient care are diminishing."
In fact, a shortage of primary care providers has already hit much of the state. All or parts of 45 of the state's 87 counties are designated as "health professionals shortage areas" by federal standards.
Elsewhere in Minnesota, the recession may have staved off a looming shortage of nurses, nurse practitioners, pharmacists and primary care doctors -- but only temporarily, warns Mark Schoenbaum of the Minnesota Department of Health's office of rural health and primary care. By 2020, a number of analysts say, Minnesota and much of the nation will be noticeably short of those first-line care providers. That in turn will push costs up and quality of care down.
The reasons a shortage is forecast are only partly related to higher education's output of medically trained graduates. But raising that output is key to a remedy. And that won't be easy to do if the state is cutting support to public higher education at the same time.
The high cost of providing medical education augurs against its expansion during times of institutional retrenchment. Meanwhile, the debt most medical students incur -- an average of $140,000 per student at the University of Minnesota Medical School -- steers them into high-income specialties, not less lucrative primary care.
Strategic action on the part of both educators and public policymakers is in order, if Minnesota is going to avoid the problems associated with too few primary health care providers.
At both the University of Minnesota and Minnesota State Colleges and Universities, proposals are in the works for reprioritizing existing resources and leveraging modest new state investments to big advantage. Among the ideas: Loan forgiveness, scholarships and special programs for immigrants who earned medical degrees in other countries, in exchange for commitments to practice in medically disadvantaged Minnesota communities for a period of years.
Those ideas illustrate that even during tight times, Minnesota can take steps to produce the future it wants. A healthy population, and a healthy economy, in years to come depend on paying strategic attention to medical education and research now.
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