A Plan for Medical Education in North Carolina Responding to North Carolina’s need for more practicing physicians March 6, 2007

Need: from UNC Tomorrow… North Carolina needs more physicians, especially in rural and inner city areas. Many areas of the state are experiencing provider shortages, especially among certain specialties: psychiatry, general surgery and providers that deliver babies. More primary care providers and community-based practices are needed. Current growth of providers will not keep pace with the state’s growing healthcare needs. The University System can help address this challenge by expanding medical education by expanding its medical schools in Greenville and Chapel Hill.

Aims of expansion strategy… Meet increased demand for physicians across North Carolina. UNC and Brody Schools of Medicine work together to expand capacity and improve medical education for all students. Build upon cooperative relationships across the state -- especially through AHEC. Develop a plan to increase the number of Residencies and Fellowships. Keep costs to the taxpayers as low as possible while providing an outstanding medical education.

Plan for Medical Education Highlights UNC Chapel Hill grows from 160 to 230 first year students with the additional 70 students completing their third and fourth year clinical rotations in Charlotte or Asheville. UNC Charlotte and UNC Chapel Hill will jointly plan collaborations to enhance research and related activities associated with the expansion of medical education in Charlotte. ECU expands its enrollment from 73 to 120 with additional students completing their third and fourth years at satellite training centers in eastern NC identified in consultation with AHEC.

Plan for Medical Education Highlights AHEC will develop an additional center in Elizabeth City and receive additional recurring funding to provide quality medical education for an increase in medical students and residents across the state. Develop a plan to increase the number of residency slots in North Carolina. AHEC and other institutions sponsoring graduate medical education must receive additional federal and state funding.

ECU and UNC: Collaborators in Health Care MOU between Lineberger Cancer Center and Leo W. Jenkins Cancer Center, designed to promote collaboration between the clinical and research programs of the two institutions. Many medical students from each institution do elective rotations at the other public medical school each year to enhance the medical education they receive at their home institution. Investigators focused on healthcare disparities are collaborating to determine why certain sectors of society receive care more or less than other sectors. Scientists from the two schools have collaborated on a proposal to the NIH for a Clinical and Translational Science Award. Both schools are committed to deepening and expanding these efforts.  

Medical education at UNC School of Medicine 160 students per class Preclinical years (1 and 2) Multidisciplinary courses in basic science All students in Chapel Hill Clinical years (3 and 4) Core clerkships (FM, Peds, Ob-Gyn, Med, Surg, Neuro, Psych) Advanced selectives Clinical Electives 60% of student rotations here, 40% at AHEC sites and elsewhere 39% of our students stay in NC for training

Overview of UNC SOM expansion strategy… Take first year from 160 to up to 230 First two years in Chapel Hill. Last two years at a satellite campus. Charlotte – 50 students per class Asheville -- 20 students per class Central management of curriculum will take place in Chapel Hill. Each campus will develop curricular innovations that will maximize the unique strengths of each region. UNC SOM will work with UNC Charlotte to develop research programs. The overall budget needs are $40 M in recurring funds and $239 M in non- recurring funds.

Charlotte Partnership with Carolinas HealthCare System (CHS) Carolinas Medical Center (CMC) 200 service delivery sites Currently operates 15 graduate education training programs for over 200 residents and fellows. Strong existing relationship with UNC SOM and AHEC. Work in partnership with UNC Charlotte to enhance and expand programs such as health services research, translational research and health informatics.

Asheville Partnership with consortium that includes: Mission Hospital Mountain Area Health Education Center (MAHEC) Western North Carolina Health Network Medical staffs of each organization Regional strategy builds upon AHEC network

Brody School of Medicine: The Mission The East Carolina University School of Medicine was established in 1975 by the North Carolina General Assembly with a three-part charge: To educate primary care physicians; To provide access to careers in medicine for minority and disadvantaged students; and To improve the health care services in eastern North Carolina.

Brody School of Medicine: Current status 72 North Carolinians enter each fall. Curriculum emphasizes primary care, rural medicine, and serving the local population. As with other community-based medical schools: Do not own the primary teaching hospital Community physicians heavily involved in teaching Do not have full complement of specialties

Brody School of Medicine: Contributing to resolving the crisis Expansion of the medical student class size will impact in two ways: Provide more primary care physicians with an interest in practicing in the east. Place physician faculty in the region in community clinical training sites.

Brody School of Medicine: Current contributions BSOM graduates practicing in North Carolina: 59% of graduates overall 34% practice primary care 28% practice in rural areas 75% of BSOM graduates who complete residency at Pitt County Memorial Hospital stay in North Carolina Class of 2007 was 28% African-American

Brody School of Medicine: The expansion plan Increase enrollment to up to 120 students. Continue Greenville as the base for clinical training for 80 students each year. Form satellite clinical training centers for the additional 40 students. Curricular and administrative oversight will rest in Greenville. Overall budget needs include $24 M in recurring funds and $150 M in capital expenses.

Brody School of Medicine: The expansion plan Seek community partners for producing primary care physicians and specialists committed to practicing in rural areas. Build on clinical experiences that all BSOM students now have at AHEC sites. Allows the use of innovative educational methods. Will enhance economic development locally and improving the healthcare available in the community.

The vital role of Graduate Medical Education (GME) Every medical school graduate progresses to a GME training program (residency program). Many residents practice near their residency training. Increasing the number of GME slots in NC is crucial. Most GME training slots are funded now by: Medicare, although a cap on slots was placed in 1997 The sponsoring institution, i.e., the hospital or AHEC New funding sources are vital.

Plan to Expand Graduate Medical Education Consistent with UNC Tomorrow, appoint a GME Task Force to plan the increase in residency positions for the State. By January 2009, report to the Board of Governors on a strategy for state and federal funds to increase GME slots to address the needs of the population. Must be aimed at the breadth and depth of specialists needed. Involve all four medical schools, Carolinas Medical Center, and AHEC. This budget needs to be developed.

Expand Capacity of AHEC Core Programs: Community-based student training Primary care residency programs Continuing education Library services Health careers and workforce diversity Critical for medical education curriculum and expansion Increase compensation in order to add high quality community physician preceptors for medical students throughout the AHEC system. Expand AHEC Center in Northeastern NC. This overall budget needs to be developed.

A Plan for Medical Education ECU and UNC-CH envision a partnership in which both state sponsored medical schools graduate physicians prepared to serve the people of North Carolina in the future. This will results in more physicians who are: Practicing primary care Practicing in underserved populations Drawn from minority and disadvantaged groups Dedicated to improving the health of North Carolinians