December 20, 2012

Rounds: A message from the Vice Chancellor

At Vanderbilt, we are all — faculty and staff — invested with the profound intergenerational responsibility to pass on our knowledge. It is that responsibility — to train individuals across all areas of this Medical Center who will be tomorrow’s leaders — I wish to discuss with you this month.

As legislators negotiate how best to pull our nation back from the looming fiscal cliff, my concerns are many. In late November, I traveled to Washington, D.C., and met with a number of our elected officials. As the drama unfolds in Washington, it has become clear to me that our efforts to train the nation’s next generation are at risk.

We would all agree that reductions in health care spending are essential to rebuilding the nation’s fiscal health. Unfortunately, rather than fairly spreading federal spending reductions across the entire health care industry, the proposals under consideration would disproportionately cut funding to our nation’s academic medical centers — a lynchpin of our country’s training and innovation engine.

A major target in the federal dialogue is the advanced training of physicians. Graduate Medical Education (GME), the training our doctors receive after medical school (these are our interns, residents and fellows), ranges from three to nine years depending on the area of specialization. At Vanderbilt, we have more than 900 physicians in 78 different residency and fellowship training programs. For nearly 40 percent of these programs, Vanderbilt remains the only institution in Tennessee training physicians in critical areas where significant shortages already exist.

For example, we have the only accredited training programs in Geriatrics, Pain Management, Neuroradiology and Interventional Radiology. We also have the only Pediatric Sports Medicine fellowship in Tennessee, and one of only two Vascular Neurology programs for stroke.

It is a common misconception that Vanderbilt and other top-ranked medical centers in this country exclusively train specialists. In primary care, Vanderbilt trains 43 percent of all Tennessee pediatricians, 33 percent of all general surgeons and 20 percent of all obstetricians and internists.

What I learned in Washington confirmed my suspicions. Many of our elected officials share a public perception that resident physicians somehow offer teaching hospitals like ours reduced labor costs. The reality is that federal funding for graduate medical education supports less than half of the cost of training. Vanderbilt makes up the cost differential, at least $40 million per year, to make our residency programs not only the highest quality, but with trainee numbers meeting critical needs for the people of our region.

It is ironic that Washington is seriously questioning the merits of supporting these programs at a time when U.S. physician shortages are projected to reach 90,000 by 2020, due to the aging of our population. Yet, nearly all proposals for avoiding the fiscal cliff have placed GME on the table as one of the targets for reductions in funding.

All of us must fully understand the consequences. Tennessee already ranks 27th in the per capita number of physicians, with only one physician for every 241 citizens.

Through it all, Vanderbilt continues to train individuals who often play a dual role — serving the health care needs of the region while leading in broad areas from biomedical discovery to health care entrepreneurship, making Tennessee a national and worldwide destination for health care. Our Schools of Medicine and Nursing are both among our nation’s most highly respected and highly selective. We know from our own experience that health care professionals who train here have a far greater propensity to remain here to practice. Reductions to GME funding will put training positions at Vanderbilt and virtually all other academic medical centers at risk.

For example, our School of Nursing continues to experience record enrollment. More than 900 students are pursuing master’s and doctorate degrees in a wide range of disciplines such as Gerontology, Neonatology, Midwifery, Informatics, Women’s Health and Primary Care. Our nursing graduates frequently become leaders playing mission-critical roles in our state and throughout the nation. The School of Nursing’s blended distance learning program is serving as a model for expanding the nation’s finest educational programs throughout the region and worldwide.

The Medical Center is also home to nearly 650 graduate students pursuing master’s and doctorate degrees in all areas of biomedical science. These students will play a fundamental role in our future as caregivers and researchers. For example, our Department of Biomedical Informatics, the nation’s largest, is training future leaders in health care information technology, a discipline that is transforming patient safety and the quality of health. Our doctorate in Audiology is the No. 1 program in the nation according to U.S. News and World Report’s Best Graduate Schools rankings.

And this year, there were 5,647 applicants for the School of Medicine M.D. program. From this extraordinary pool, we admit only 105 women and men with average MCAT admission scores in the top 10 percent in the nation and an average GPA of 3.8 from the nation’s most prestigious universities. Our M.D. graduates, residents and fellows make profound contributions to health care. They do so through myriad lessons learned every day from all who work here, from nurses to respiratory therapists and social workers. At Vanderbilt, all members of the health care team participate in meaningful ways in training our future clinicians.

As we remain focused on saving lives and making discoveries, one of our finest and most enduring legacies remains the seeds we plant for the future by training tomorrow’s leaders.

I sincerely hope our elected officials will continue to support programs that are pivotal to the future of health care. Our trainees are the doctors and nurses who will someday care for our children, our loved ones, and for all of us — in Tennessee and across the nation.

— Jeff Balser, M.D., Ph.D., vice chancellor for Health Affairs and dean of Vanderbilt University School of Medicine