The interest in a medical school in the San Joaquin Valley has recently surfaced again – understandable, given that our region has only 48 primary care physicians per 100,000 people, far short of the recommended 60 to 80 physicians per 100,000 population.
More physicians are necessary to care for our growing and aging population, and just as importantly, more physicians are needed who understand the cultural issues of their patients.
For example, 38 percent of California’s population is Latino, but just 5 percent of doctors in the U.S. are Latino.
The important question at hand is whether a medical school alone will satisfy these needs. Medical school graduates cannot practice until they complete residency. In order for undergraduate medical education to address physician shortages, it must be coupled with growth in residency positions.
University of California, San Francisco – Fresno has been training resident physicians in Fresno for over 40 years. Current programs include eight medical specialties, one dental residency and 17 subspecialties. All residency positions are filled each year, and more than 50 percent of the graduates remain in the Valley.
Increasing graduates of a local medical school would simply displace trainees unless residencies also are expanded.
Furthermore, the most important predictor of where physicians will ultimately practice is where they complete their training. We know that if medical students graduate from one region but leave to complete their training elsewhere, they are much less likely to return.
Undergraduate medical education does provide many opportunities, such as the means to recruit students from specific backgrounds into medicine and provide them with the skills to work with unique populations.
The UC San Joaquin Valley Program in Medical Education (SJV Prime) is such a program. The SJV Prime, currently in its sixth year, is a collaborative of UCSF Fresno, UC Davis, UC Merced and UCSF to recruit students from the Valley or from similarly underrepresented backgrounds and train them specifically to better serve our populations.
SJV Prime students spend their first summer in Fresno or Merced, their third year gaining clinical training in Fresno and as much of their fourth year as they wish in Fresno. The program recently received enhanced funding from the California Legislature and will expand to 12 students per year.
SJV Prime leverages the clinical training infrastructure at UCSF Fresno and is an example of how UC is addressing the Valley’s health needs. Since its establishment in 1975, UCSF Fresno has developed into the Valley’s largest physician-training program, educating more than 300 residents and fellows and 350 medical students on a rotating basis each year.
UC Merced, the newest UC campus, is also working to address health needs in the Valley even as it expands to nearly double the physical capacity of its campus by 2020. Today’s physicians must understand and be prepared to engage in population health.
UC Merced has developed undergraduate and graduate programs in public health that prepare students for the workforce or for advanced training, including medical school. In addition, the campus is seeking answers to some of the Valley’s chronic health issues through research in areas like nutrition, lifestyle impacts on health and early childhood development.
In addition to physician training, health care redesign is needed to amplify the impact of physicians through creative use of health teams and telehealth. UCSF Fresno and UC Merced will continue to work together on research initiatives as well as explore creative models of care through the Health Sciences Research Institute at UC Merced and the Center for Vulnerable Populations at UCSF.
An example of this collaboration is the UCSF Preterm Birth Initiative, with an important site in Fresno.
While a medical school offers many advantages for a region, a host of related issues must be considered and addressed. As already mentioned, growth in medical school enrollment must be tied to an increase in residency positions if the goal is to increase doctors in the region.
Public and private funds are necessary. Establishing a high-quality medical school requires tremendous infrastructure, demands significant resources and is subject to external approval processes that are independent of the UC system.
These steps will take time, but the UC will continue to enhance health in the Central Valley by providing student pipelines to medical school with the Doctors Academy, offering internships and support to students with the Summer Biomedical Internship Program and Reaching Out to Aspiring Doctors, providing advising to undergraduate students, training medical students from other UC schools, and training residents and fellows to stay in the Central Valley.
The goal is continued expansion of training opportunities for medical students in the Valley, even as we remain focused now on addressing the health care needs of our region.
Michael W. Peterson, M.D., and Thomas W. Peterson are associate dean provost and executive vice chancellor of UCSF Fresno Medical Education Program University of California, Merced.