1

2007 Annual Report2007 Annual ReportThe University of Nevada School The University of Nevada School

of Medicine, of Medicine, oror

How to grow a medical school How to grow a medical school with limited resourceswith limited resources

2

OverviewOverview

• Where is UNSoM in comparison to Where is UNSoM in comparison to peers?peers?

• What do we aspire to be?What do we aspire to be?

• What challenges do we face and how What challenges do we face and how do we prepare ourselves?do we prepare ourselves?

• QuestionsQuestions

3

UNSoM’s position in the universe of UNSoM’s position in the universe of medical schoolsmedical schools

• 125 U.S. accredited M.D. granting schools of 125 U.S. accredited M.D. granting schools of medicine in 2007 medicine in 2007

• No single objective measure of qualityNo single objective measure of quality– Quality of education (board scores, surveys, Quality of education (board scores, surveys,

graduate outcomes, etc).graduate outcomes, etc).– NIH Ranking, citation index, productivity per NIH Ranking, citation index, productivity per

investigator.investigator.– Reputation amongst public, peers, opinion Reputation amongst public, peers, opinion

leaders.leaders.

4

We fare well amongst our peers in undergraduate

medical education

5

Undergraduate Medical EducationUndergraduate Medical Education

• Strong student body with solid GPA and Strong student body with solid GPA and MCAT scoresMCAT scores

• Strong basic science educationStrong basic science education

• Solid performance on national boardsSolid performance on national boards

• Excellent success in securing positions in very Excellent success in securing positions in very competitive residenciescompetitive residencies

• Good feedback on our student’s performance Good feedback on our student’s performance as residentsas residents

6

Undergraduate Medical Education Undergraduate Medical Education ChallengesChallenges

ChallengeChallenge SolutionSolution

Dependent upon volunteer Dependent upon volunteer faculty for much of specialty faculty for much of specialty and subspecialty educationand subspecialty education

We are expanding our full-time We are expanding our full-time facultyfaculty

Limited research opportunities Limited research opportunities and M.D./Ph.D. programand M.D./Ph.D. program

Grow research across Grow research across campuses and collaborativelycampuses and collaboratively

Enrollment limited to in-state Enrollment limited to in-state and WICHE studentsand WICHE students

Expand enrollment, consider Expand enrollment, consider accepting out of state studentsaccepting out of state students

Students must train in two Students must train in two locations to complete core locations to complete core clerkshipsclerkships

Expand clinical programs to Expand clinical programs to support clerkships in both Las support clerkships in both Las Vegas and RenoVegas and Reno

7

ResearchResearch

• Strong commitment to preclinical educationStrong commitment to preclinical education• Nationally and internationally recognized Nationally and internationally recognized

investigators and research programsinvestigators and research programs• Well funded on a per lab or per individual Well funded on a per lab or per individual

investigator basisinvestigator basis

But…But…• Limited scopeLimited scope• Antiquated and cramped facilitiesAntiquated and cramped facilities• Underrepresented translational researchUnderrepresented translational research

8

Extramural Funding of Medical Schools, 20050

50,0

00,0

0010

0,00

0,00

015

0,00

0,00

020

0,00

0,00

025

0,00

0,00

030

0,00

0,00

035

0,00

0,00

040

0,00

0,00

045

0,00

0,00

050

0,00

0,00

0

Total Awards

Johns Hopkins

USC

U Conn

Syracuse

Nevada

9

Rank School Funding74 UNIVERSITY OF SOUTH FLORIDA COL OF MED $40,566,549

75 LSU SCHOOL OF MEDICINE IN NEW ORLEANS $39,030,054

76 UNIVERSITY OF OKLAHOMA COLLEGE OF MED $36,472,342

77 MEDICAL COLL OF GEORGIA SCH OF MEDICINE $34,916,505

78 RUSH MEDICAL COLLEGE $34,595,208

79 UNIV OF NEBRASKA COLLEGE OF MEDICINE $34,352,951

80 SAINT LOUIS UNIVERSITY SCH OF MEDICINE $33,995,130

81 UNIVERSITY OF KANSAS SCH OF MEDICINE $33,411,839

82 MEHARRY MEDICAL COLLEGE SCH OF MEDICINE $30,332,145

83 MOREHOUSE SCHOOL OF MEDICINE $27,000,979

84 SUNY AT BUFFALO SCHOOL  OF MEDICINE $26,716,279

85 TEMPLE UNIVERSITY SCH OF MEDICINE $25,640,224

86 UNIVERSITY OF PUERTO RICO SCH OF MED $24,314,528

87 DREXEL UNIVERSITY COLLEGE OF MEDICINE $23,127,814

88 NEW YORK MEDICAL COLLEGE $22,621,817

89 LOYOLA UNIV CHICAGO STRITCH SCH OF MED $21,632,861

90 SUNY HLTH SCIS CTR BROOKLYN COL OF MED $21,045,766

91 UNIV OF HAWAII JOHN A BURNS SCH OF MED $20,010,436

92 CHARLES R. DREW UNIVERSITY OF MED & SCI $19,783,371

93 TEXAS A & M UNIV COL OF MEDICINE $18,943,756

94 UPSTATE MEDICAL UNIV COLLEGE OF MEDICINE $18,213,522

95 HOWARD UNIVERSITY COLLEGE OF MEDICINE $17,812,517

96 MEDICAL UNIVERSITY OF OHIO AT TOLEDO $15,956,877

97 GEORGE WASHINGTON UNIV SCH OF MEDICINE $15,715,685

98 UNIV OF MISSISSIPPI SCH OF MEDICINE $14,674,999

99 UNIVERSITY OF COLUMBIA SCH OF MEDICINE $14,314,883

100 LOMA LINDA UNIVERSITY SCH OF MEDICINE $14,019,443

101 UNIVERSITY OF NEVADA SCH OF MEDICINE $13,749,001

To reach the bottom of the 2nd

Quartile will require us to triple grant

funding

10

Total Expenditures in 2007 of $14.3 million

$3.73 million are generated by faculty over the age of 60

11

ResearchResearchChallengeChallenge SolutionSolution

Inadequate basic Inadequate basic biomedical research biomedical research facilitiesfacilities

Building a new center for Building a new center for molecular medicine on Reno molecular medicine on Reno CampusCampus

Limited research Limited research opportunities for faculty opportunities for faculty and staffand staff

Grow research across Grow research across campusescampuses

Very limited translational Very limited translational researchresearch

Recruit new faculty; partner Recruit new faculty; partner with basic scientists and other with basic scientists and other entities (LRBI, NVCI, WPI)entities (LRBI, NVCI, WPI)

Inadequate research Inadequate research support in Las Vegassupport in Las Vegas

Add local pre- and post-award Add local pre- and post-award support; create dedicated support; create dedicated facilitiesfacilities

Mature facultyMature faculty Identify and commit resources Identify and commit resources for recruitmentfor recruitment

12

Trends in medical education affect Trends in medical education affect our programsour programs

• Medical school enrollments are projected to Medical school enrollments are projected to increase by 30% (increased 2.3% in 2007; several increase by 30% (increased 2.3% in 2007; several new schools planned)new schools planned)

• Increased emphasis on structured education with Increased emphasis on structured education with measurable goals and objectivesmeasurable goals and objectives

• Increased emphasis on multidisciplinary learning Increased emphasis on multidisciplinary learning and simulationand simulation

• Increasing popularity of certain specialties Increasing popularity of certain specialties presents challenges filling primary care presents challenges filling primary care residenciesresidencies

13

14

15

Graduate Medical EducationGraduate Medical Education

ChallengeChallenge Proposed SolutionProposed Solution

Limited number of Limited number of residencies and residencies and fellowshipsfellowships

Expand full-time faculty to Expand full-time faculty to expand clinical educationexpand clinical education

Limited training sitesLimited training sites Partner with new Las Partner with new Las Vegas VA Medical CenterVegas VA Medical Center

Few hospitals aspire to Few hospitals aspire to be teaching hospitalsbe teaching hospitals

Demonstrate tangible Demonstrate tangible benefits of integrated carebenefits of integrated care

Compete for highest Compete for highest quality candidatesquality candidates

Continually improve Continually improve residency training residency training programsprograms

16

AccomplishmentsAccomplishments

• Recruited new leadersRecruited new leaders• Expanded faculty and programsExpanded faculty and programs• Formed new relationshipsFormed new relationships• Begun new research and educational Begun new research and educational

facilitiesfacilities• Increased the class sizeIncreased the class size• Begun to improve efficiency of Begun to improve efficiency of

administrative functionsadministrative functions

17

Recruited new leadershipRecruited new leadership

AdministrationAdministrationChief of staff – Ann MischissinChief of staff – Ann MischissinChief operating officer – Blain ClaypoolChief operating officer – Blain ClaypoolChief financial officer – Jean ReganChief financial officer – Jean ReganChief counsel – Thomas J. RayChief counsel – Thomas J. RayAssociate Dean for GME – Miriam Bar-onAssociate Dean for GME – Miriam Bar-onCommunications Director – Mark LevineCommunications Director – Mark LevineDirector Medical Library & IT Services – Jim CurtisDirector Medical Library & IT Services – Jim CurtisDirector of Clinical IT – Jon GoetzDirector of Clinical IT – Jon GoetzDirector of Development – Stefanie ScoppettoneDirector of Development – Stefanie Scoppettone

18

Recruited new leadershipRecruited new leadership

Clinical ChairmanClinical ChairmanObstetrics and Gynecology, Las Vegas – Paul StumpfObstetrics and Gynecology, Las Vegas – Paul Stumpf

Internal Medicine, Las Vegas – Daniel M. GoodenbergerInternal Medicine, Las Vegas – Daniel M. GoodenbergerPediatrics, Reno – Nevin WilsonPediatrics, Reno – Nevin WilsonEmergency Medicine – Dale CarrisonEmergency Medicine – Dale CarrisonFamily Medicine, Las Vegas – Elissa PalmerFamily Medicine, Las Vegas – Elissa PalmerFamily Medicine, Reno – Daniel SpogenFamily Medicine, Reno – Daniel SpogenMojave Mental Health – Coni Kalinowski (Medical Director)Mojave Mental Health – Coni Kalinowski (Medical Director)

19

Growing clinical programsGrowing clinical programs

Pediatric Surgery, Las Vegas – Dr. John GoschePediatric Surgery, Las Vegas – Dr. John GoscheEndoscopic Bariatric Surgery, Las Vegas – Dr. Endoscopic Bariatric Surgery, Las Vegas – Dr.

James LauJames LauNevada Neurologic Consultants merger with Nevada Neurologic Consultants merger with

UNSoM, Las VegasUNSoM, Las VegasExpanded subspecialty programs in internal Expanded subspecialty programs in internal

medicine, Renomedicine, RenoSports medicine fellowship in family and Sports medicine fellowship in family and

community medicine in Reno and Las Vegascommunity medicine in Reno and Las Vegas

20

Despite significant resource Despite significant resource limitation, UNSoM has grown limitation, UNSoM has grown

significantly over the past 5 yearssignificantly over the past 5 years

21

UNSoM Budget 2001-2006Revenue $ by Category

$0

$20

$40

$60

$80

$100

$120

$140

$160

2001

2002

2003

2004

2005

2006

Mill

ion

s

Year

Tuition and Fees

Government Appropriations

Grants and Contracts

Practice Plan/Medical Service

Gifts and Endowments

Medical SchoolPrograms/Affiliations

Miscellaneous Revenue

Total Revenue

Total Expenses and Transfers

22

UNSoM Budget 2001-2006% of Revenue

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

2001

2002

2003

2004

2005

2006

Year

Tuition and Fees

Government Appropriation

Grants and Contracts

Practice Plan/Medical Service

Gifts and Endowments

Medical SchoolPrograms/Affiliations

Miscellaneous Revenue

Clinical practice revenue is an

increasingly important revenue source

23

UNSoM Employee Growth 2002-2007

0

50

100

150

200

250

300

Oct

-02

Oct

-03

Oct

-04

Oct

-05

Oct

-06

Oct

-07

Date

Number

AcademicAdministrativeClassifiedResidentsPostdoctoralPoly. (Postdoctoral)Poly. (Administrative)Poly. (Classified)Poly. (Academic)Poly. (Residents)

24

Ratio of Various UNSoM Employees Has Remained Constant 2002-2007

0.0

0.2

0.4

0.6

0.8

1.0

1.2

Oct-0

2

Oct-0

3

Oct-0

4

Oct-0

5

Oct-0

6

Oct-0

7

Date

Ratio

Residents/AcademicFaculty

Classified/AcademicFaculty

Administrative/Academic

Faculty

25

UHS Practice Plan Employee Growth

0

100

200

300

400

500

600

2003

2004

2005

2006

2007

Year

Number

MSAN

MSAS

NFPRP

Total

26

UNSoM/UHS Combined Employee Growth

0

200

400

600

800

1000

1200

1400

2003

2004

2005

2006

2007

Year

Number

PracticePlanUNSoM

Total

27

The Faculty Practice Plan is an The Faculty Practice Plan is an economic engine driving our growth economic engine driving our growth

and sustains education and and sustains education and scholarshipscholarship

28

Academic Medical Centers Face Difficult TimesAcademic Medical Centers Face Difficult Times

A two-part article in Tuesday's issue of The Oregonian reports that:A two-part article in Tuesday's issue of The Oregonian reports that:

““Oregon Health & Science University's losses on laboratory Oregon Health & Science University's losses on laboratory research and doctor education are growing far faster than research and doctor education are growing far faster than anticipated and are projected to reach $50 million this year.”anticipated and are projected to reach $50 million this year.”

Those losses mean tough choices for the university, which has Those losses mean tough choices for the university, which has ambitious plans to treat more patients, expand its scientific research ambitious plans to treat more patients, expand its scientific research and build a world-class medical school that will train new doctors and build a world-class medical school that will train new doctors for Oregon. The article further reports that OHSU President Joe for Oregon. The article further reports that OHSU President Joe Robertson told the paper "that the university has sufficient Robertson told the paper "that the university has sufficient resources for the next 20 months, but that its current financial resources for the next 20 months, but that its current financial course is 'not sustainable.' Robertson declined to speculate how the course is 'not sustainable.' Robertson declined to speculate how the university might address the growing losses or say whether cost-university might address the growing losses or say whether cost-cutting alone could close the gap."cutting alone could close the gap."

29

Role of the Practice PlanRole of the Practice Plan

• Ensures access to diverse patient population Ensures access to diverse patient population for students, residents, fellows and other health for students, residents, fellows and other health care providers in an educational environment care providers in an educational environment with supervised increases in responsibility of with supervised increases in responsibility of learnerslearners

• Generates 42% of total annual revenue to the Generates 42% of total annual revenue to the school of medicine, supports other missions, school of medicine, supports other missions, and provides the majority of clinical faculty and provides the majority of clinical faculty salarysalary

30

University of Nevada School of Medicine Revenue 2005-06

Miscellaneous Revenue

3%Medical School Activities at Hospitals

16%

Gifts and Endowment Income

1%

Clinical Practice42%

Grants and Contracts

17%

State Appropriation19%

Tuition and Fees2%

Data from 2006 LCME Report

31

Practice Plan OrganizationPractice Plan Organization

Integrated Clinical Services Board

NFPRP (Campus Pharmacy and

Mojave Mental Health)

Medical School Associates

South

Medical School Associates

North

University of Nevada, Reno

Leadership

Board of Regents

UNSoMLeadership

UNSoM Programs

32

Practice Plan AssetsPractice Plan Assets

Current AssetsCurrent AssetsCash and cash equivalentsCash and cash equivalents 12,920,77512,920,775

InvestmentsInvestments 1,327,5901,327,590

Patient Accounts Receivable, net of Patient Accounts Receivable, net of estimated uncollectibleestimated uncollectible

7,509,0897,509,089

Other ReceivablesOther Receivables 1,123,3761,123,376

Prepaid Expenses and Other AssetsPrepaid Expenses and Other Assets 859,465859,465

Total Current AssetsTotal Current Assets 23,740,29523,740,295

Capital Assets, NetCapital Assets, Net 2,884,1342,884,134

Total AssetsTotal Assets 26,624,42926,624,429

33

Practice Plan LiabilitiesPractice Plan Liabilities

Current LiabilitiesCurrent Liabilities Current Portion of Long-Term Notes Payable and Current Portion of Long-Term Notes Payable and

Capital Lease ObligationsCapital Lease Obligations 213,452213,452

Accounts PayableAccounts Payable 1,911,9381,911,938

Accrued Payroll and Employee Related ExpensesAccrued Payroll and Employee Related Expenses 1,650,0151,650,015

Other Accrued ExpensesOther Accrued Expenses 476,152476,152

Due To (from) Affiliates, NetDue To (from) Affiliates, Net 332,694332,694

Total Current LiabilitiesTotal Current Liabilities 4,584,2514,584,251

Notes Payable and Capital Lease Obligations, Net Notes Payable and Capital Lease Obligations, Net of Current Portionof Current Portion

405,989405,989

Total LiabilitiesTotal Liabilities 4,990,2404,990,240

34

Practice Plan SummaryPractice Plan Summary

Fund BalanceFund Balance

UnrestrictedUnrestricted 19,369,49619,369,496

Invested in Capital Assets, Net of Related DebtInvested in Capital Assets, Net of Related Debt 2,264,6932,264,693

Total Fund Balance Total Fund Balance 21,634,18921,634,189

35

UNSoM Clinical Revenues

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

2001

-200

2

2002

-200

3

2003

-200

4

2004

-200

5

2005

-200

6

2006

-200

7

Year

Revenue

MSAN

NFPRP

MSAS

TOTAL

36

What do we aspire to be?What do we aspire to be?

• A more complete medical school with the ability A more complete medical school with the ability to educate the physician workforce for Nevada to educate the physician workforce for Nevada in Nevadain Nevada

• A vibrant center of research, service and A vibrant center of research, service and learning that attracts a diverse group of the best learning that attracts a diverse group of the best and brightest faculty, staff and traineesand brightest faculty, staff and trainees

• A valued partner for patients and other health A valued partner for patients and other health care providerscare providers

37

What must we do to succeed?What must we do to succeed?

• Measure our performance against external Measure our performance against external benchmarks from peersbenchmarks from peers

• Streamline our procedures and administrative Streamline our procedures and administrative structure – “structure – “Faster, Better, Cheaper”Faster, Better, Cheaper”

• Identify and maximize revenueIdentify and maximize revenue

• Be focused and tenacious in pursuing our Be focused and tenacious in pursuing our goalsgoals

• Never sacrifice quality for speed or quantityNever sacrifice quality for speed or quantity