Despite rocky start, medical school presses on

[Source: Ken Alltucker, The Arizona Republic ] - Arizona leaders see the new University of Arizona medical-school campus in downtown Phoenix as an anchor of a biomedical hub that will train more doctors, foster cutting-edge research and spur the state's economy.

But as 48 students usher in the Phoenix college's second year of instruction, much has changed from the original vision.

The medical school's leadership is being overhauled. Plans for a new downtown teaching hospital have stalled. And the school's Tucson faculty members have raised questions about whether the Phoenix campus will take away limited resources.

University officials acknowledge a rocky start in some respects for the nearly 2-year-old Phoenix campus.

"Any new concept will have some growing pains," said Robert Bulla, a member of the Arizona Board of Regents and a regents committee overseeing development of the biomedical campus.
"I am not disappointed that it has been slow, but it has taken a little longer than I hoped to get things in place," Bulla added.

Still, no one doubts the University of Arizona College of Medicine-Phoenix in partnership with Arizona State University has made significant strides since its official October 2006 dedication.
The school has assembled its curriculum, hired faculty and welcomed the first two classes of medical students. It also has secured funds to pursue an ambitious expansion that will add a new educational and a state-of-the-art research lab that will be shared by the state's three public universities.

The school is a key part of the state's strategy, pushed by Gov. Janet Napolitano and others, to build a research-based economy and improve medical care.

Phoenix and the state have invested millions to develop and expand the medical school and to launch bioscience research facilities such as the Translational Genomics Research Institute to attract top-tier scientists. At the downtown campus, medical students rub elbows with top-notch genetic researchers who are developing advanced medical treatments.

Among the goals are to graduate more doctors in a state with one of the lowest per capita figures of physicians and to expand the state's access to clinical trials and other treatments.

Changing visions

The Phoenix medical school's challenges are not unique.

Expanding medical schools often must grapple with changes in funding, staffing and training locations for students, said Sarah Bunton, a senior research analyst with the Association of American Medical Colleges.

"There are no formulaic answers to increasing class size," said Bunton, who added that administrators must be flexible when planning medical-school expansions.

Some factors that slowed the pace of the Phoenix medical school's progress over the past two years:

• The dean of the medical school in Phoenix resigned in April after his title was changed to vice dean by Tucson's medical dean. The Tucson dean later resigned as part of a restructuring orchestrated by UA President Robert Shelton. UA hired a new vice president for health affairs, William Crist, who will be in charge of both medical campuses as well as the university's other health schools.

• Plans for a new downtown teaching hospital are on hold. The university no longer is soliciting new bids for hospital partners, and the newly appointed Crist sees no immediate need for a new hospital.

• A committee report issued this spring revealed fresh evidence that some UA faculty are concerned that the Phoenix campus is "draining human and financial resources" from the Tucson campus.

• The campus is building-rich but budget-challenged. A $470 million stimulus package will fund the buildings needed to expand the campus at the same time the state's budget cuts have forced administrators to scale back hiring new faculty and staff. And private fundraising has been slow to materialize.

Leadership shakeup

Perhaps the downtown medical school's most pressing need comes at the top.

The Phoenix campus has not had a permanent dean since Edward "Ted" Shortliffe stepped down this spring. Shortliffe resigned his position after the Tucson-based dean, Keith Joiner, changed Shortliffe's title from dean to vice dean.

At the time, Joiner cited confusion of having two deans on separate campuses, but Joiner was not long for his position at the time, either. He relinquished his deanship as part of a restructuring orchestrated by Shelton.

Shelton created a single position responsible for UA's vast health-sciences area, including both medical campuses. Crist was hired for the $650,000-a-year position of vice president for health affairs. He expects to start Oct. 31.

Many factors brought about the leadership change. The Committee of Eleven, which investigates faculty complaints, issued a report in April that revealed low morale and concerns about the direction of the medical school. Faculty expressed worry about decision making, academic freedom and other factors. Some faculty members said they were worried about the emergence of the Phoenix medical school.

Michael Cusanovich, who chairs the Committee of Eleven, said Tucson faculty members are worried that the Phoenix campus will divert financial resources and brainpower.

"The biggest concern is how much money gets diverted out of here (Tucson) to Phoenix," Cusanovich said, adding that the Tucson campus will have to share state funding and research grants. "Those are dollars, from a parochial point of view, that will not be available here."

Budget woes hit Phoenix

Valley residents believe a full-time dean at the Phoenix campus is important for many reasons, from sustaining relationships with area hospitals and doctors groups to fundraising.
Stuart Flynn has served as interim dean in Phoenix since Shortliffe stepped down, and he has piloted the campus through cuts that stripped 4 percent from this year's budget.
Flynn said the budget cuts have hurt the ability to add more faculty, but he said it has not affected services to the school's 48 first-year and 24 second-year students.

"It will slow down our ability to grow our faculty on this campus," Flynn said of the budget cuts.
Mining the Valley and out-of-state donors for charitable giving is an important role for Crist and the new dean. Such contributions support important things such as recruiting faculty and providing scholarships for students.

UA Foundation President Jim Moore said the university has secured some contributions but needs to attract more donors for the new Phoenix school.

Hospital plan on hold

While the students are busy learning the basics, the prospects for a downtown teaching hospital are less clear.

Plans for such a hospital have been on hold since talks between Banner Health and UA broke down over disagreements about the size of the proposed hospital and faculty salary. UA put out a request for information among potential new suitors last January. Only Maricopa Integrated Health System responded with a hospital plan.

Now, UA representatives say it will be Crist's job to sort out the hospital proposal, and he said there is no pressing need for a teaching hospital in downtown Phoenix.

Crist said he visited several Phoenix-area hospitals that already train UA students and chatted with executives. With several area hospitals such as St. Joseph's Hospital and Medical Center, Banner Good Samaritan, Carl T. Hayden Veterans Affairs Medical Center and others already training UA medical students, he doesn't see an immediate need to build a new hospital in downtown Phoenix to train students.

"I saw no obvious need, at my first pass level, for more teaching facilities," Crist said.
Maricopa Integrated's chief executive, Betsey Bayless, wants to continue talks with the university when Crist takes over.

"The (MIHS) board several years ago adopted a resolution that they want to build a hospital in conjunction with UA," Bayless said. "I think they are still interested."

Maricopa Integrated needs to replace its Maricopa Medical Center whether it is in tandem with UA or not.

Bayless said the district spends up to $20 million a year on repairs to the aging facility. She estimates it would cost the district $40 million a year in debt and interest payments for a new hospital.

Maricopa Integrated, however, must find the money to pay for such a hospital.
Bayless said the one potential source of money could be federal funds that help hospitals pay for uncompensated-care costs.

Arizona funneled $55 million, called disproportionate-share funds, to the state's general fund to support the state's program for low-income patients. Maricopa Integrated has appealed the state's decision to keep the money, arguing that it needs the money to support its role as a "safety net" hospital that provides care for the poor and uninsured.

Another potential funding source, Bayless said, could be a voter-approved bond to pay construction costs. The health district's board would need to approve a measure to pursue such a funding plan and has not done so yet.

"The (Maricopa Integrated) board has the capability of going to the ballot and going for a bond issue," Bayless said. "I know their preference has been to get the disproportionate-share money and get those funds that were intended for indigent patients so we could go ahead and build using that money."

Although no other Phoenix-area hospital has expressed interest in building a new hospital with UA, at least one government hospital shares a similar challenge with Maricopa. The VA hospital, built in 1951, faces high maintenance needs.

Executive Director Donald Moore said his facility will continue to be an important training ground for UA medical students, but he has not talked about the possibility of building a hospital jointly with UA or Maricopa Integrated.