Taking Medical Education and Healthcare to the Next Level in Nevada – IM #046



welcome to another edition of inside medicine I'm your host Doug kinder the CEO of Las Vegas heals and we're here in the studio today with Paul embark of trip loom Bach and dr. mark Penn who you've seen on the show many times before the founding dean of the Roseman University College of Medicine we're going to talk a little bit about an event that we just exited for those of you that are new to inside medicine we broadcast live here in the studio typically on Thursdays at 10:00 o'clock today we've got a special edition for you so stay tuned if you do happen to miss this you're going to be able to catch it on YouTube on let's get this iTunes roku stitch use stitcher or Spotify and of course you can always go to Las Vegas heels org and catch a copy of it later we'd like to bring in the leaders and innovators of healthcare here in Southern Nevada those that are doing good things to advance medicine deliver better quality care to our population and today we're gonna talk a little bit about academic medicine and what's going on in that world with Roseman University gentlemen welcome to the studio nice to be here good to see everybody in and Paul you're from Pittsburgh Pennsylvania my own hometown and where we both have some roots yep it's a great place it's nice to meet up with you and thanks for inviting us today yeah so before we get started tell our audience primarily provider-based those people that are interested in improving the quality of health and southern nevada but we're kind of a little bit of an echo chamber many may or may not be familiar with triple box so if you could take a few minutes tell us a little bit about the triple Bock and the type of work that you do all right thank you Doug and mark nice to be here with you as well trip on Bock started about 30 years ago in Pittsburgh but we're in all 50 states and we've been able to do several thousand projects around the country and we're experts in academic medicine we've developed most of the new medical schools and the kind we also work in community health and we also work in economic design which is sort of like the economic impact of health and those three things come together where medical schools of which is a big part of our practice are really about community health and they're about economic development and they're about innovation so all the things that trip on back works on kind of comes together in our medical school practice and obviously healthcare ties so closely to economic development you can't have one without the other so it's it's important and you this is not your first run in Las Vegas we met each other what five years ago maybe six years ago right we had worked with folks that were starting the UNLV School of Medicine we have worked with the Lindsay Institute we did a project with the Board of Regents and and had a statewide program for advancing medical education and we're working now with Roseman College of Medicine and Roseman University really to take that message further to say that even though a Medical School has started and Tauro of the osteopathic school has been here for many years there still a need and there's so much more to be done and rosemond's college plans are right at the cusp of getting implemented and so we're here really on this visit and in this engagement to see if we can really get more energy around medical education and the economic impact is a big part of what we study perfect I'm dr. pan you're not here you're not new to the show you've been on several times we're a huge supporter of the Roseman University College of Medicine but for viewers that are just joining us are folks that may not be aware it give us a high level of Roseman University and specifically the College of Medicine well thank you Doug and first of all thank you for allowing us to come and be a part of this program it's been it's been great to have the outreach into the community so they get to know a lot of these issues that you talk about and thank you Paul for also being here appreciate you coming rosemon University just by background is a very very strong Health Professions University right now it started out of need for pharmacy and was built around the need of pharmacy and into a College of Pharmacy in 1999 from 1999 onward they were able to add not only pharmacy they added nursing as well as a dental school they also do some residences in dental training like orthodontics and also they've just added a general dentist II Dentistry program they also have an MBA program that is focused on the health care professions so they've added all those together they have say a campus up in South Jordan Utah but they started in Henderson here in Nevada so they're born in Nevada and what they wanted to do a few years ago is to kind of expand into the need of medicine and so as they began to look meaning the board in our president as well as the leadership began to identify there's just no question there's a great need here in Nevada and so they want to bring on a college of medicine so we've been working about four to five years now trying to bring this College of Medicine to fruition that maybe a little bit different than what Paul has been used to where he comes in probably at the very very beginning we began and we started a process and we've laid a lot of foundation with the College of Medicine with a lot of community engagement service activities and we've also added a clinical practice not too long ago so those things are very very important laying a foundation as far as that Community Connection and then kind of moving forward together and they're well on their way this we've worked with new medical schools all over the country I think we've had thirty experiences Roseman has all the pieces in place including a faculty practice I've been involved with Graduate Medical Education they have a university infrastructure to build from there close to being able to launch and it's really exciting to see all the work that's been done their facilities their infrastructure and a lot of community support we just recently did a project where we interviewed people from throughout the community and at the presentation just today we had representatives from the other medical school there we had representatives from the board of regions from government from health systems and there wasn't a person in the room that wasn't very very supportive and excited about getting this a new medical school off the ground I'm gonna take a line that I'm not sure which one of you provided at the release this morning but it was this is different because it's a medical school that is growing out of a Health Sciences University so 80% of that infrastructure already exists and that's what makes Roseman different can you expand upon that because I think that was very important for the audience to hear this morning mark why don't you go ahead well I can I can start by saying that we're in situations where someone has an idea to have a medical school or a university that's never had any experience in health science well the faculty and the student body and the relationships you know health science university already has relationships with health systems and hospitals and whether it's a pharmacist or a nurse or a dentist they already have those relationships and when you're working with a college or a university it doesn't have any relationships you have to build everything from the ground up and then you also have to create the culture within the institution about care and about health care and biological and health science well those things are already in place so there's no other university in Southern Nevada that would be in a position to start a medical school a private medical school and Roseman is the one that will be doing that dr. pan it's and I always like to comment on this rosemon that Roseman campus has the finest set of assets in town it's that we're blessed to be a tenant at Roseman but my gosh those buildings are spectacular and what you have there is amazing but the relationships that you've built throughout the valley over the course of the last 20 years is remarkable absolutely and I think that gets into what kind of assets are in place you know we talk about the relationships we talk about the fact that Rosa has these other colleges with other faculty members that you can work with and they had these relationships already built and then of course we come on we have to build relationships that matter to medicine sometimes they are the same sometimes they're a little bit different and then when you talk about the buildings those are phenomenal you know it's one of those things that it's it's not always easy to walk into a place that has those type of buildings in order to build a college of medicine around it in a sense we have one building it's called the the Ingolstadt research building and that building was one of the first buildings of course that we acquired and that's where our College of Medicine is actually going to be located that's where our educational program will be will be doing premiere research because we have 24 it's just phenomenal laboratories there and then the basement we're going to be putting in our simulation lab as well as we're going to be putting in an anatomy lab there with cadavers and so forth so when you talk about building a medical school probably one of the biggest cost is going to be or your physical facilities we have physical facilities but we're gonna also need to build out so that's one thing I would remind our viewers is that you know we don't have everything in place yet but there is a certain amount of dollars that we need of course and we're going to need to put toward the building out of our classrooms the things I just mentioned in our basement and so forth so but it's it's very unusual to have that too you know when you're walking in the door to say here we have this build it from this kind of a standpoint and just so people know it's about one dollar for every dollar that you put into the building there's another dollar or more sometimes it has to go inside and it's the technology the labs the simulation Suites just those simulation mannequins alone can cost hundreds of thousands of dollars the IT alone can be millions of dollars so a medical school is one of the most expensive and most technologically advanced buildings you can build so so when you look at it from the outside you might say oh they have their medical school building up but more dollars are needed on the inside so this morning you brought together some of the most major leaders of this community I looked around that room and you had the likes of Shelley Berkley you had the likes of Don Schneider just a hundred of the top leadership of Las Vegas what were you hoping to accomplish and clearly I think you accomplished bringing the right people into the room but talk to us a little bit about this morning and what you wanted to lead or provide to those leaders well one of the major things in partnership with Trip Baumbach it was a matter of first of all evaluating where we are and can we move to the future and what are the recommendations moving forward so one of the questions is is of course do we have what we need in order to move forward and if we don't then how do we meet those needs above it all do we need another medical school and you know I wanted to have that answer coming from an external expert and Paul was be able to provide that information second of all in my mind it was what about Roseman is it the right University with what we've been talking about to lay that foundation for a medical school and then do we have the right team from the College of Medicine to kind of move this forward then the other part of this is economic impact to kind of speak to that issue as well so I was hopeful to your question to understand that better from his perspective as an expert but the other just that I would just summarize that I was hopeful to get out of this because I was hopeful that the answers were going to be yes this is the right Medical School this is the right University this is the right location all those things and if it was my point being is I wanted it to be an encouragement the word I would say is an encouragement to our university to stay the course to our college of medicine to stay the course as far as continue to do the hard work to get this off the ground and it's also an encouragement to our community because one of the issues when you go through processes like this bring all the medical schools we talked about in the meeting today it's very complex and it's also very expensive and sometimes you get there quickly depending on your resources sometimes it takes a while so it's very important along the way to have moments where you have celebration or that you have encouragement and just you have that persistence and patience that's got to be there as well so that's what I was hoping to take away today and I really felt it strongly that the community support was there getting to your point it was just wonderful to see these people and one last thing that I would say is is that when I entered entered the auditorium and I looked at the group I just met I made this comment when I first came here five years ago I didn't know pretty much anybody in that room but since then I know pretty much all those people in that room and it's just heartwarming to me to know them to know that they came to support this process they took of their time to listen to the story so yeah I felt the same way and I've been in situations where it hasn't felt like that in the room and I've been in other communities where it's been really a struggle and there's a lot of dissension I've been in communities where other medical schools wouldn't have come to the presentation I've been in communities where we'd had people from other medical schools come and disrupt the the presentation it's great to see this spirit of oneness and collaboration and it's needed because without that there's no way that Southern Nevada will ever be able to have the physicians and the quality of health care and the economic development that comes from health and higher education unless it was a team effort and to see the deans from the other schools and leadership that's unique and I think that that's something that we need to underscore for your viewers and listeners that there is a collaborative spirit around healthcare and I want to give a compliment to Las Vegas heals because without that infrastructure and without you folks being that glue and that cheerleader for the region I don't think that that would have happened and so your organization being part of the ecosystem it's maybe an encourage or in the ecosystem is very important as well thank you for that compliment let's touch on a couple of the points from the presentation this morning and I'm gonna have the group bring up some slides and we're not going to do the whole presentation but we picked out a couple that seemed to really make a little bit of sense let's look at Nevada's Health Rankings it's a little scary we aren't where we want to be and obviously bringing on another Medical School will help us get to where we should be so let's touch a little bit about on this Paul well I think that what you find when you look at community health and health status Nevada like so many states have quite a disparity the folks that are unhealthy are exceptionally unhealthy and the folks that are healthy are exceptionally healthy and income race culture so many things that that pull communities and people apart leave very vulnerable populations and the sad thing here in Nevada over time has been that those with means and with access to transportation and dollars can leave and go to other places but those who can't and the underserved populations really look to this health care system in this community for those needs and that's where really the rubber meets the road in the need for higher quality and and stronger medical education and in health and health reform but what you find is that so much of it is based on just numbers number of primary care physicians public health funding the the amount of resources that go into Public Health just nowhere no way that you could ever climb that mountain unless the community would work together and and start addressing this as a community and not as each individual Hospital or provider trying to take that on what people don't realize what all is involved in building academic medicine what the medical education pipeline really looks like it's not like we say hey we need more doctors in tomorrow we're gonna have more doctors the process takes a while we've spent a lot of time building some infrastructure in Nevada dr. pan you and I worked very hard on the GME expansion and I think we're all starting to see some of the the fruits of that effort but talk to us a little bit about the pipeline and where we are and why this is important well medicine is one of those disciplines where research shows that around seventh grade or even fifth grade is when folks start to be interested in maybe becoming a doctor but at seventh grade or fifth grade if they don't start getting into a curriculum in grade school or middle school or junior high that gets them directed towards science basic science and and math and and what we call stem the all those different things and let's say they don't get into that at that point their chance of going to an undergraduate college either Community College or four-year college and be successful in the basic biological and other sciences and then at that point they have to apply for medical school and not just pass the test but they have to have the resume that they're gonna be successful in medical school so we lose so many folks along the way that never even go to college and then we lose so many more that would never be able to go from college into Medical School and that's not even the end of the story because once they're in medical school for four years they still have to complete a residency and if they go far away for that residency if they take that residency in Ohio or Pennsylvania or Florida their chance of staying where there do their residency in that phase four really predicts the most on where they're going to be so if we back that up what do we do well we have to identify the young people and I would say folks from different minority and and and underserved populations particularly because that's where the need really is the the underserved population will be better served by folks that represent their community so then we have to say what are we doing for seventh graders and can we have a program through the medical school that goes into the schools and gets them ready can there be a health science high school or junior high like there are around the country in fact there are several medical schools that have health science high schools I'm working in Compton in in Los Angeles County and Martin Luther King Hospital Health Center and there's also a king prep High School right on the campus of Charles drew University of Health Science which is a similar University to two Roseman and they're already working on this and then after medical school we have to create and you had mentioned that you and Mark had been working on Graduate Medical Education development without residency's in the community the chance for these folks to stay is very very low but we can actually turn that around and create a pipeline that puts medical students from the region with now three medical schools in in the region with Toro and UNLV and now Roseman into these residences and then into practice and now you got something really special because that engine once it starts every year residents come out every year they go into practice and you could start seeing 50 new physicians a year or more maybe a hundred physicians a year in a factory of physicians that know Southern Nevada that love this community that have agreed to spend their career in this community and that's so different than what you have now with so many physicians coming and going into the market and then out of the market they're not from the market and and that affects quality of care so if you have different physicians every time you go to the doctor your care quality goes down so much and if you are in a situation where you can't even find a doctor well now what's your doctor emergency room and the ambulance that you called to come to your house so so an upward spiral through that pipeline is so important I think a great statistic and then we're gonna jump over to Roseman that I saw was a Nevada ranks number nine in terms of retention from ume undergraduate medical education through GME so if we build that pipeline rights and it sounds like we're already doing it but we just need to strengthen the or widen it a little bit and let's talk about the role that rosemon is going to play in this expansion so let me bounce off a little bit of what we were just talking about and then build to that about three or four years ago data that looks at the people that are applying to medical school across the country and we're talking about now from Nevada students from Nevada that applied to medical school was somewhere around two hundred and forty students two hundred forty one-third of them got into medical school somewhere two thirds did not so the point is to underscore we need to do a better job but first of all we need more students that are interested in medicine right we we will continue with our medical schools as we expand we will have more seats that we can offer to the students here that say hey you know I see that as an opportunity here maybe I want to apply and so forth with you and –lv coming on that number now is over three hundred is my point that number is still way too low when you have kind of look at you know our population growth over time so what brosman has been doing the College of Medicine in particular just to kind of underscore is that you had the word pipeline up there is that while we're working toward our accreditation process my team has really really gotten into the community with community engagement activities as we would call them and one of those activities basically is broken down into the first part of the pipeline that you're talking about we have reached down into the elementary the junior high and the high schools around us and provided programming to kind of introduce a concept of medicine to those students and so we're able to do it with some of the private medical schools we're now able to work with some of the public schools which is great because we really want to have a bigger outreach but we want to grow the interests on the part of the students as well as the parents and so we introduce students to maybe come for a full day and they learn about what it takes to become a physician as an example and so it's really been very positive as far as across the community when we've done those type of programs so that's one of the things that we really need to do moving forward the other part of the equation we're building a curriculum that's built around driving the student into the community more to understand the community we we have a lens program which is a longitudinal experience in neighborhood service and what that is is that students from their very first year are going to be planted into communities and they'll go to like a place where they're seeing patients but as opposed to most traditional type of teaching they won't just go there and just see the patients and go home and do nothing with it they have to do that part learn how to run the practice in a sense I'm going to learn the front office the back office is that practice but then they have to learn about the community I'll be like about a mile radius around that that clinic they're going to be challenged with what's going on in that community what are what are the health problems within that community what's the access issues around that community and so we're gonna be kind of looking at the idea of and the underserved for example will be a real big part of that because we really need to build and bridge that part the other thing I there's dad just to add into the the other part because it's a pipeline before it's during Medical School and it's after Medical School the GME part we've already as you and I have done and we have been a part of and I really appreciate your efforts working on the GME working with the other medical schools to bring on more GME because we really need a lot more those kind of things are very important necessary I'm gonna spend a little time about the economic impact of the College of Medicine and what that looks like it's it's an economic driver it's not just building a Medical School there's and impact the entire community benefits from that so let's if you could spend a little bit of time telling us about that Paul well for really the whole thirty years of our company we've been on the forefront of measuring the economic impact of medical schools and universities and hospitals and and what we found is as we've gone further down the road it's not just the school itself the school will have about a half a billion dollar economic impact just the school just the medical school and then you have all the other components and pieces that come out the research the commercialization the healthcare industry growth and in in Southern Nevada you can have a multi-billion dollar impact just by keeping care in the state that leaves the state every year but then even beyond the medical school and all those other things that come out of the economic impact we have the impact of physicians that are trained and stay in the community we have the impact of Graduate Medical Education we have the impact of cost savings when folks get better care and were able to get care more appropriately so in Marc's example of putting the physicians out in the community they're going to be actually helping save healthcare costs because folks that interface with those students will be less likely to go to the emergency room for care they'll be more likely to have access to a doctor they'll be more likely to get into a care plan where the cost of care is so much lower so there's an enormous amount of pieces of the economic impact so in a project like this it's easy to say that in 20 years in 2040 directly and indirectly the school and everything that it touches will have about a 1 billion dollar economic impact on Southern Nevada that's probably overly conservative it could be much higher let's say that this medical school helps improve health and health status even more than we thought well it's easy to come up with some very big numbers when people have their utilization of health care go down and even more so when they become more healthy and more productive and the best economic development thing you can do is be healthy yourself and in fact I've read just recently that walking and walkability is a new economic development indicator so if we can show that people are walking and more active that is an economic indicator for a community and that's not even measured in my chart gentlemen I hate to say this our shows coming to an end we barely touched on a lot which the good part is we're gonna have to have you back on the show okay when is this report gonna come out and maybe we could coordinate it to have you back on the show when the report comes out when is this report going to be out there for the public to see in July we'll have the public report and maybe sometime in July would be nice to come back I know it will be hot but we could walk here thank you very much yeah thank you for being on the show and I look forward to having you back and I look forward to being able to release this report out there because we all know that we need another medical school here in town and you have the full community support I know you know you've got Las Vegas he'll support and we look forward to having you back in a few weeks for those of you that joined us a little bit late we look forward to seeing you on the show next week and sometime in July when we have Paul and Bach and dr. Mark Penn back on the show Thank You Ann you all have a great day today

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