The medical school at the University of California, Davis, is well-positioned for major changes, coming from the national Affordable Care Act and also from the looming retirements of the one-third of California physicians who are over age 60.
As medical school dean Claire Pomeroy moves on at the end of June after a decade at UC Davis, the medical school can build on her legacy of education and research.
As more people gain access to health insurance coverage under Obamacare starting in 2014, they will need a "medical home" with primary care health professionals. Yet the nation, including California, has an imbalance between primary care doctors and specialists. Today, California has 63 primary care doctors for every 100,000 residents, and 115 specialists.
That has to change. Medical schools will need to be at the forefront in addressing that imbalance.
Only one-third of active California physicians are primary care practitioners. In 1961, by comparison, half of U.S. physicians were in primary care. As the Council on Graduate Medical Education has noted, we get better health outcomes and health system efficiency "when at least 40-50 percent of the physician workforce is composed of primary care physicians."
The UC Davis medical school has the foundation to be in the forefront of the needed transformation to improve the numbers of health professionals devoted to primary care not just doctors, but also nurse practitioners and physicians' assistants.
Nearly one-half of graduating medical students at UC Davis choose their three-year postgraduate training residencies in primary care, while nationally the figure is less than 20 percent. A new medical school dean will have to make an even bigger push to recruit and nurture future primary care physicians, as well as the nurse practitioners and physician assistants who increasingly will perform work done by physicians.
A big plus is that 85 percent of UC Davis medical students volunteer at student-run clinics in Sacramento neighborhoods. Another is that the medical school has a highly rated program to train doctors for rural areas, including telemedicine.
UC Davis has been at the forefront of medical schools emphasizing a team approach. To that end, UC Davis has California's largest program for family nurse practitioners and physician assistants, which opened its doors in fall 2010, working with prospective doctors.
The health care reform law should help, too, with scholarships and loan repayments for those who commit to practice in areas where there are too few health professionals. That is expected to add more than 12,000 primary care physicians, nurse practitioners and physician assistants by 2016. The UC Davis medical school, for example, recently received a $2.5 million federal grant to provide scholarships to medical students who want to practice in underserved communities.
One area where a new dean could have a big impact would be in setting a priority for the medical school to explore new ways of compensating doctors.
The current "fee-for-service" model prevalent in the United States pays physicians based on the volume of care they deliver. Specialists who do more procedures get more reimbursement. Mayo Clinic in Minnesota, the Geisinger Health System in Pennsylvania, Intermountain Healthcare in Utah and Kaiser Permanente are well-known for alternative pay models. The UC Davis medical school should take a leadership role, too.
Of course, medical school deans traditionally have been judged on their ability to build large medical research enterprises focused on discovery and that is true for UC Davis. During Pomeroy's tenure, the medical school nearly tripled its outside research funding to nearly $200 million annually. That enterprise is solid.
But the real challenge will be for a new dean to step up the medical school's efforts to rebalance the health system to meet the need for primary care professionals.