UM System seeks funding to train doctors, nurses

Missouri has a shortage of doctors, dentists, nurses and pharmacists, a problem that is straining the health care system and is predicted to worsen during the next decade as baby boomers enter their elder years.

But Gov. Matt Blunt and the General Assembly are disinclined to increase funding for the University of Missouri, which trains most of the state’s health care providers.

So, the University of Missouri System is proposing a creative solution: allocating $38 million to enable schools to increase enrollment for medical and nursing students—and separating the funding from the core operating budget. It’s an easier sell for legislators because it targets a specific and widespread problem and also spreads the money around the state by including community colleges. The medical and nursing schools in Columbia would get $9 million of the funding.

Gordon Lamb

Interim university system president Gordon Lamb calls his plan “unique”—and it may be in state higher-education history because it links the funding requests of almost all of the state institutions.

The shortage problem stems in part from decisions made 14 years ago.

In 1993, the University of Missouri-Columbia slashed the size of its entering class of medical school students from 112 to 96 in conjunction with an academic overhaul. The academic aspect worked: Students had top-flight results when they took their licensing exams.

But last year, the Association of American Medical Colleges reversed its own position and branded the decision to reduce medical school graduates—and future doctors—a clear mistake.

“It is now evident that those predictions were in error, in part because of the assumption that managed care would drastically change the way that health care is organized and delivered,” the AAMC said in its report. “Mounting analytical work, as well as anecdotal evidence, suggests that current trends will culminate in a shortage of physicians.”

Managed care was designed to reduce access to physicians by eliminating “doctor shopping” for primary care and limiting the freedom of individuals to visit specialists. In 1997 Missouri, like many states that responded to reports of abuses, rolled back the ability of managed-care networks to deny care.

“Managed care is not going to solve the problem,” Lamb said with a laugh.

But Lamb is deadly serious about the initiative he is heading that would increase the number of health professionals graduating from Missouri public institutions by more than 900 over five years. Columbia would enroll an extra 16 medical students and 27 nursing students next year under the plan.

The initiative called Preparing to Care proposes spending $38.3 million next year for the first phase at 26 four-year and community colleges, including the $9 million at UMC and $23 million system-wide. Eventually, the state would increase the number of such health-profession graduates by 20 percent.

The problems for Missouri already are evident. Lamb said 95 percent of the state’s counties lack enough physicians, although some simply don’t have enough residents to support doctors.
The raw numbers don’t hint at a problem. According to the Missouri Board of Registration for the Healing Arts, the number of Missouri-licensed resident physicians rose from 11,376 in 1993 to 14,224 this year, or by 25 percent.

Missouri ranked No. 7 in the country in the total number of medical school graduates in 2000 and No. 10 for its per-capita health workforce. Missouri also has medical schools at St. Louis and Washington universities, whose alumni may tend to relocate out of state more often than graduates of MU’s Columbia and Kansas City schools.

Missouri’s number of resident physicians, however, peaked in 2005 and then fell.

But Missourians will grow increasingly older and need more health care in the next few years as baby boomers begin retiring and physicians begin scaling back or ending their practices. Missouri already ranks 14th in the country for its senior population. It’s predicted that by 2020, baby boomers will have swollen the population age 65 or older by 44 percent, while the overall population will have grown only 9 percent since 2000.

Missouri’s older residents are likely to be sicker than their counterparts in other states because the state has higher rates of cancer-related and heart-disease-related deaths, as well as higher rates of smoking and obesity.

Lamb’s initiative will restore Columbia’s medical school enrollment to its pre-1993 levels and add a similar number at the Kansas City campus.

But physicians form only part of the picture. Of Missouri’s 114 counties, 93 percent have shortages of dentists. By 2012, Missouri may have a shortage of 700 pharmacists.

More than half of the expected increase in the number of health-profession graduates will be in nursing, but those numbers are expected to fall short of demand by 20 percent by the year 2015. Lamb also envisions nurses developing into physician assistants and nurse practitioners to help alleviate the rural doctor shortage.

Columbia’s share of the plan also would add students in physical, respiratory and occupational therapy as well as nursing and medical technology.

The Missouri Coordinating Board for Higher Education, noting limited state funding for new items, ranked only two increases for spending in state colleges and universities in the budget the legislature will consider next year.

After Gov. Matt Blunt cut a 13 percent funding increase to 4.3 percent in his budget last year and indicated the 13 percent should extend over three years, the Coordinating Board for Higher Education forwarded only another 4.3 percent recommendation that would help fund raises and cost increases.

The board then approved the Preparing to Care initiative.

The initiative focuses possible attention on the UM System medical schools, which suffered last year because of legislative resistance to any funding that could be used for stem-cell research. Columbia lost an $88 million health sciences research center and a $2 million business incubator.

Lamb told the Columbia Business Times that he’s not hesitant about pushing for a program that would place the UMC medical school front and center, despite the possibility that legislators could try to use the appropriation to limit medical research and instruction.

“I’ve talked with legislative leaders, and they haven’t mentioned [limiting research]. I don’t think it will attract any attention,” Lamb said.

Lamb already has promoted the funding before the Springfield Chamber of Commerce, and he is scheduled to appear in Warrensburg, St. Joseph, Maryville, Kirksville, Columbia, Kansas City and St. Louis.