Dean’s Reflections: The formation of an integrated health system – An update

News & Events

Composote of masked physicians and researchers

 

Integrated academic health systems bring together three complimentary initiatives - patient care, research and medical education - and meld them into a single mission, each enhancing the others synergistically. The University of Nevada, Reno School of Medicine (UNR Med) has successfully managed these complementary missions as a relatively independent institution, with various educational affiliations that have come and gone, and sometimes come again over the years.

This approach is unlikely to be fully successful in the future.

Medical education - for medical and physician students, residents and fellows - depends on access to large and high-quality clinical programs. Clinical research, which is the way health care changes and improves, depends on access to large populations of patients who will volunteer for clinical studies. Both depend on investment in new clinical programs, new facilities, new equipment, and subspecialists and physician-scientists who will contribute to a full set of integrated primary and subspecialty care medical services.

Based on currently available resources, UNR Med, the Nevada System of Higher Education (NSHE) and the State of Nevada have limited ability to make those investments, create those programs, recruit those subspecialists and scientists, build those facilities and buy that equipment.

I believe it is time to do something similar to what nearly all medical schools in the U.S. have already done - to join forces with the largest community-governed, not-for-profit health system in northern Nevada, to become the integrated health system that will allow us to not only survive but thrive and achieve our goal of contributing to outstanding health care in Nevada.

Thousands of collective hours of work have moved UNR Med and Renown Health to a near-final draft Definitive Agreement that describes a complex and synergistic relationship, a relationship that will ultimately lead to an integrated health system in northern Nevada. The Board of Directors of Renown Health and the Board of Regents of the Nevada System of Higher Education are being briefed on the details of this integration, hopefully leading to an endorsement in the near future.

I have considerable personal experience with these types of powerful clinical and academic enterprises. The University of Michigan established the first university-owned hospital in the U.S. in 1869, in order to provide their medical students with direct patient experience under the supervision of experienced attending physicians. Just slightly more than a century later, I graduated from the University of Michigan Medical School, and joined the faculty a few years after that.

As professor and chair of the department of family medicine, I saw firsthand the benefits an integrated health system provides to learners, teachers, patients and researchers. Perhaps most importantly, the community they all share is the greatest beneficiary. We can do the same thing for Reno and northern Nevada.

But this proposed venture cannot be about me, and it isn't. Over time, UNR Med colleagues, as well as University, NSHE and state leaders, must come to understand the power and value of this integration. It represents a transformational change, not only for the School of Medicine, but for the entire medical community. It comes with both opportunity and uncertainty, as do all ambitious and far-reaching proposals.

UNR Med can continue in its present form, and we might be able to achieve our missions in a modest way - and mostly through the extraordinary continued commitment of so many faculty and staff members, community physician faculty members, donors and friends.

But we could be so much more. The benefits of bringing our teaching and research missions together with Renown's clinical delivery system are huge.

Every integrated health system is unique and addresses local circumstances in unique ways. With Renown Health, our model will markedly increase our capacity for clinical teaching and clinical research, and support the possible expansion of our medical school class size and creation of new residency and fellowship programs.

We will have the opportunity to grow high-quality clinical, teaching and research programs because of the synergism. The most outstanding cancer or cardiovascular centers have robust clinical research. The most outstanding clinical research programs attract top physician-scientists to provide the most up-to-date clinical care. And both top physician-scientists and outstanding clinical care programs contribute to training the next generation of primary care and specialty physicians and other health care professionals.

We can do all of that and more. But the development of a true integrated academic health system is not something ever before seen in the Silver State.

When UNR Med became Nevada's first medical school in 1969, Reno didn't have a hospital that could provide the school with a true academic partnership. As a result, our medical students stayed in Reno for two years of classroom education, and then moved on to out-of-state medical schools to complete their clinical training. Since physicians tend to practice where they complete their training, it wasn't ideal for a state in need of doctors to send away their best and brightest.

Less than a decade later, in 1977, the Nevada Legislature approved our school's conversion from a two-year, classroom-based program to a four-year, medical degree-granting institution. To support our students' clinical training, the School of Medicine needed to find additional training opportunities beyond what could be provided by what was then Washoe Medical Center and a small cohort of community physicians.

Our search for a new partner led us to the Southern Nevada Memorial Hospital in Las Vegas. Our first four-year class - the Class of 1980 - was now able to remain entirely in state, completing two years of classroom instruction in Reno and two years of clinical training in Las Vegas. Southern Nevada Memorial Hospital changed its name to University Medical Center in 1986 to better reflect its role as a teaching center which offered complete medical care.

When UNR Med's Las Vegas campus transitioned into the clinical and teaching platform for the UNLV School of Medicine, we created an entirely new clinical campus in northern Nevada, thanks to a wide range of local hospitals and community physicians. Our students now experience all four years of medical school in Reno.

However, I never believed that this type of community-based clinical teaching program was our final state. A community-based medical school has tremendous advantages for giving students real-world, hands-on experiences. An integrated health system provides state-of-the-art clinical research and teaching programs that contribute to new subspecialty care not currently available in the community.

I believe we are now in a position to have the best of both.

We are at a turning point where we can think seriously about how we're constructed, how we're organized and how we operate. I believe we have the opportunity to more completely and successfully fulfill our destiny, mission and vision - and influence medical care in northern Nevada in new and exciting ways that go beyond what we can do with our current community-based model.

These discussions are not about a merger or an assimilation of one partner by the other. UNR Med must remain a state-funded, accredited public medical school governed by the Nevada System of Higher Education so as to remain accessible to Nevada residents. We are not becoming a private medical school - that would be counterintuitive to our land-grant mission and unaffordable to many future students.

The draft Definitive Agreement has a hundred pages of detailed descriptions of purpose, structure, governance, funds flow, joint leadership roles and faculty positions, and operational management. More importantly, it lays out a 50-year plan for how medical care in northern Nevada will be transformed. We are joining together in a completely new approach, combining the clinical practice, clinical teaching and clinical research programs of both institutions to become more efficient, more effective and more productive.

The potential integration does not at all reduce our need for the incredible contributions of our community-based volunteer faculty members, nor does it restrict access to Renown Health by those physicians who have it now - in fact just the opposite. Instead, it contributes to Renown's desire to create a clinically-integrated network across the Reno-Sparks metropolitan area.

Renown Health is not becoming a closed-staff hospital that is accessible to only a small academic faculty. They, too, have a best-of-both opportunity to continue to serve the community as they have always done, but also to develop new subspecialty care programs not currently available in our community, to reach out widely to rural communities as a referral resource, to expand their clinical research and connect to our outstanding basic science research, and to expand the pipeline of primary care and specialty physicians, physician assistants and other health care professionals.

The investment to create a such an integrated health system is not small, but the return is significant, perhaps incalculable.

There are always risks and anxieties about the threat of change. However, we need to think equally hard about the risks and anxieties inherent in not changing. I believe now is the time to make this transformational change and become the School of Medicine we aspire to be. The School of Medicine our community needs us to be. The School of Medicine we were always meant to be.


Media Contacts

Julie Ardito, APR
Senior Director, Advancement and Engagement
Office: (775) 784-6006

Tessa Bowen, MPA
Communications Manager, Advancement and Engagement
Office: (775) 682-9254

The University of Nevada, Reno School of Medicine, Nevada's first public medical school, is a community-based, research-intensive medical school with a statewide vision for a healthy Nevada. Established in 1969, UNR Med is improving the health and well-being of all Nevadans and their communities through excellence in student education, postgraduate training and clinical care, research with local, national and global impact and a culture of diversity and inclusion.

Released: Monday February 1, 2021 @ 4:00 PM