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Med school expansion: The major points Saturday, Dec 29, 2007 By Doug Thompson "Do we need a second medical school in Arkansas?" the state House majority leader asked in his blog a while ago. My first reaction was to wonder why the Legislature appropriated $1.9 million to the project without answering that question first. Let's deal with more practical objections, though, such as the expected $5 million to $8 million annual operating cost such a school would have after a few years. Rep. Steve Harrelson, D-Texarkana, keeps a blog called "Under the Dome," at www.steveharrelson.com/blog/. It's pretty good one-stop shopping for state issues, by the way, despite the obviously Democratic bent that comes from the author being the leading Democrat in the House. Harrelson never argues against Arkansas needing more doctors. Instead, he wonders why we can't just expand the existing medical school in Little Rock instead of opening a satellite campus in Fayetteville. In theory, the University of Arkansas for Medical Sciences can expand to whatever size is needed. Expanding the existing school would be a good argument if the bottleneck was the school itself. A bigger chokepoint - as it was explained to me long before the $1.9 million appropriation - is the amount of residents who can effectively be trained in Little Rock area hospitals. Any hospital can always use more residents, I suppose, but you can reach a point of diminishing returns in anything. Residents - med school graduates who are apprentice doctors, in layman's terms - are hard at work in Little Rock. Hospitals in Northwest Arkansas, however, remain an untapped resource for this kind of training. No other part of the state besides Little Rock operates as many hospitals as we do or possesses such potential for growth. If this decision was made solely on the residents issue, it would be a no-brainer. The argument Harrelson makes that cuts the most keenly is that more health care is needed in rural areas. The current health care mess started in small towns decades ago. Small town America suffered first from Medicaid programs that steered money to urban hospitals because urban areas had bigger clout in Congress. Small town America hurt the most when better benefits and insurance packages went to bigger businesses and not the small town, family-owned variety. Finally, to be severely blunt, small-town America suffered first from the fact that doctors, other medical professionals such as lab techs and nurses and their families couldn't find the lifestyle they wanted in small towns. The only thing that could help those shortage issues is having more doctors, wherever they're trained. If we bear down on the rural health care issue alone, however, then it's a slight argument in favor of Fayetteville. That's simply because the Northwest Arkansas boom doesn't sprawl much outside the I-540/U.S. 71B corridor. As we say up here, it's a different world on the other side of Beaver Lake. If the goal is to improve health care services to under-served, poor rural areas, then there's a larger area that's been under-served a lot longer that's within an easy drive of Fayetteville rather than Little Rock. Harrelson's next argument, frankly, doesn't help his case. He argues that even if we had $5 million to $8 million a year to spend, we should consider spending "the money on professional schools Arkansas doesn't currently have, such as a school of dentistry or veterinary medicine." I have more sympathy than most, and still winced. The dentistry school would at least help people. As for a vet school, I used to cover the state Livestock and Poultry Commission. I know a little bit about the severe need for big-animal veterinarians in this state. Not only are there too few vets, but they can make a lot more money in town taking care of beloved family pets rather than cattle. All the sympathy in the world wouldn't change the headlines: "Prize bulls or grandma: Arkansas debates health care priorities." There's no use talking about dentistry or animal doctors when there's not enough primary care physicians or vital specialists for them to refer patients to. So here's a little free public relations advice. If you want to argue that Arkansas has a bigger medical services need than another med school, argue for trauma centers. However, trauma will not remove the growing need for more doctors. If anything, trauma centers will demand more doctors with more specialized training. Now, for the big one: Is the proposed project worth $5 million to $8 million a year? That depends on whether there's a cheaper effective alternative. That will be debated thoroughly. That will also depend on whether the money can be found, something else I can't answer yet. --------- Doug Thompson is a Fayetteville-based reporter and columnist for the Arkansas News Bureau and the Morning News. His e-mail address is dthompson@arkansasnews.com. |
