Arizona Medical Schools Offer Free Tuition for Primary Care Commitment

The University of Arizona (UA) Colleges of Medicine in Tucson and Phoenix will offer free tuition starting in the spring semester for qualifying medical students agreeing to practice primary care (1). To be considered for free tuition, applicants must be an Arizona resident and current full-time medical student. A minimum commitment of 2 years practicing in an underserved Arizona community must be started within 6 years of graduation from medical school and completed within 10 years of graduation.

The money will come from part of the $8 million annual funding approved by the Arizona Legislature in May. According to the press release, nearly 100 students or about 10% of the student body could get free tuition at the two medical schools. Currently, tuition is $31,652/year in Tucson and $33,402 in Phoenix.

Arizona currently meets only 40% of its primary care physician (PCP) need, according to the Health Resources and Services Administration. Arizona ranks 42nd among states for total active PCPs at 77.9 per 100,000 (the US average is 91.7) according to the university's physician workforce report published in October.

In addition to enlarging the primary care workforce, the waived tuition is meant to reduce financial barriers to even applying to medical school with the looming promise of student debt. Nearly half of medical school graduates owe more than $200,000 in medical school loans, according to the latest Medscape Residents Salary and Debt Report.

UA joins a growing list of medical schools offering free tuition including New York University, the University of Houston, Kaiser Permanente, and Weill Cornell. None of the others require practicing primary care as a requirement for receiving the free tuition.

Reference

1. Marcia Frellick M. U of Arizona offers free med school tuition for primary care. Medscape. December 6, 2019. Available at: https://www.medscape.com/viewarticle/922275?nlid=132930_5461&src=wnl_dne_191209_mscpedit&uac=9273DT&impID=2196790&faf=1 (accessed 12/9/19).

Cite as: Robbins RA. Arizona medical schools offer free tuition for primary care commitment. Southwest J Pulm Crit Care. 2019;19(6):163. doi: https://doi.org/10.13175/swjpcc071-19 PDF 

University of Arizona-Phoenix Receives Full Accreditation

University of Arizona (UA) officials announced yesterday that the UA College of Medicine-Phoenix, which was originally a branch of the UA-Tucson medical school, was granted full accreditation by the Liaison Committee on Medical Education (LCME) (1). The College of Medicine-Phoenix was created 10 years ago. In 2012, the UA College of Medicine-Phoenix received “preliminary” accreditation with the LCME, then “provisional” accreditation in 2015 and now full accreditation.

To date, the UA College of Medicine-Phoenix has graduated 354 physicians, with classes of about 80 students per year. One year ago this month, the Arizona Medical Association asked for an investigation after a half-dozen of the Phoenix medical school’s top leaders left for positions out of state. Among those departures was the school’s dean, Dr. Stuart D. Flynn. Dr. Kenneth Ramos served as interim dean and helped lead the Phoenix medical school through the accreditation. Dr. Guy Reed from Tennessee was recently hired as the school’s new dean and assumes his duties in July.

There are now five medical schools in Arizona: the two UA medical schools; the Mayo Clinic School of Medicine, which is opening its Arizona campus in Scottsdale this summer; and Midwestern University and A.T. Still University, which both operate osteopathic medical schools in the Phoenix area. A sixth medical school, Omaha-based Creighton University School of Medicine, has medical students doing third- and fourth-year rotations in Arizona.

Richard A. Robbins, MD

Editor, SWJPCC

Reference

1. Innes S. University of Arizona's Phoenix medical school receives full accreditation. Arizona Star. June 14, 2017. Available at: http://tucson.com/news/local/education/college/university-of-arizona-s-phoenix-medical-school-receives-full-accreditation/article_64a1da80-1866-5a51-a062-7cc04ecd261d.html (accessed 6/15/17).

Cite as: Robbins RA. University of Arizona-Phoenix receives full accreditation. Southwest J Pulm Crit Care. 2017;14(6):311. doi: https://doi.org/10.13175/swjpcc077-17 PDF 

Knox Named Phoenix Associate Dean of Faculty Affairs

Dr. Kenneth S. Knox

The University of Arizona College of Medicine-Phoenix has announced the appointment of nationally recognized physician-scientist Kenneth S. Knox, MD, as the associate dean of faculty affairs. Dr. Knox who has been at the University of Arizona-Tucson since 2008, will oversee the Faculty Affairs Office whose charge is to promote an engaged, diverse community of faculty and scholars that sustain a culture of engagement, professionalism and inclusion. He also will serve as director of research at the Banner Lung Institute.

Dr. Knox is a pulmonologist known for his research in sarcoidosis, fungal diagnostics and immunologic lung disease. His work includes developing treatments for HIV, AIDS and valley fever. The division chief of Pulmonary, Allergy, Critical Care and Sleep Medicine in Tucson, Knox was responsible for dramatic growth. His accomplishments include increasing the number of clinical and basic science faculty from five to 30 and fellowship trainings from six to 20, rekindling the sleep program, establishing a section of allergy and revamping the teaching model in the intensive care unit. He also served as vice chair for education in the Department of Medicine.

Dr. Knox is co-principal investigator on the Arizona portion of a $9.7 million National Institutes of Health-funded clinical trial to test the use of fluconazole as an early treatment for valley fever. Additional grants for more than $6 million have been submitted for efforts to develop a valley fever vaccine. He has received continuous funding since 2001 for his research on the use of bronchoalveolar lavage for immunodiagnostics and lung immunity. He is NIH-funded to perform longitudinal translational studies correlating immunological findings and the lung microbiome with clinical disease in HIV as his lab seeks to understand the role of pulmonary inflammation in the development of HIV-related lung diseases.

A native of Youngstown, Ohio, Dr. Knox graduated cum laude with a bachelor’s degree in microbiology from Miami University in Oxford, Ohio. He completed his medical degree and residency training in Internal Medicine at Ohio State University and a fellowship in Pulmonary/Critical Care/Sleep Medicine at Indiana University where he remained on faculty for eight years, serving as educational director and director of the immunologic lung disease program before coming to Tucson. Dr. Knox is an associate editor of the SWJPCC and has edited the highly successful “Medical Image of the Week” section since its inception.

Richard A. Robbins, MD
Editor, SWJPCC

Cite as: Robbins RA. Knox named Phoenix associate dean of faculty affairs. Southwest J Pulm Crit Care. 2016;13(6):311-2. doi: https://doi.org/10.13175/swjpcc141-16 PDF

Garcia Resigns as Arizona University VP

Dr. Joe G.N. "Skip" Garcia resigned his administrative duties as senior vice president for health sciences at the University of Arizona. Garcia said he would devote his full attention as a professor at the UA College of Medicine-Tucson according to the Arizona Republic (1). "After much thought and reflection, I have decided that the time is right for me to take a step back and focus on my continually growing research commitments," Garcia said. "Please know that this decision was an exceptionally difficult one and not reached lightly, and that I am humbled by all of your support during my time as senior vice president."

Garcia was hired in 2013 to oversee the university's medical schools in Phoenix and Tucson, as well as the schools of nursing, pharmacy and public health. Shortly after Garcia was hired, he reorganized UA health sciences, recruited a roster of academics and tightened oversight of the Phoenix medical school. However, after Dr. Stuart Flynn, the Phoenix medical school's longtime dean, and most of his leadership team resigned to join the staff of a newly created medical school in Fort Worth, Texas, Garcia faced increasing scrutiny and criticism. The departures prompted the Arizona Medical Association, a physicians' organization with 4,000 members, to ask the Arizona Board of Regents to interview the departed leaders as part of an investigation of the school's management.

In August, the regents' health affairs committee held public hearings in Tucson and Phoenix to gather input from medical-school stakeholders. The regents also hired an independent consultant to evaluate concerns about the two medical schools. The consultant delivered a report to the regents, who concluded in October following a closed-door meeting that no further action was needed. Even though the Board of Regents spent $179,653 in public funds on the report, the regents have refused to provide a copy of the report to the public, citing attorney-client privilege and work-product protections.

UA President Ann Weaver Hart who previously announced she would leave the president’s post in 2018 praised Garcia's track record. "The work accomplished by Dr. Skip Garcia in just three short years as the senior vice president for health sciences has had a profound impact on the future of the College of Medicine-Tucson, the College of Medicine-Phoenix, and the Colleges of Pharmacy, Nursing and Public Health at the University of Arizona," Hart said in a statement released by the university.

Garcia is a pulmonary physician whose research focused on the genetic basis of lung disease and the prevention and treatment of inflammatory lung injury (2). He had previously served in academic positions at the University of Texas Health Center at Tyler, Indiana University School of Medicine, Johns Hopkins University School of Medicine, the University of Chicago, and the University of Illinois at Chicago before coming to Arizona. He has been continuously funded by the NIH since 1988 and has authored or co-authored more than 400 peer-reviewed publications and over 35 book chapters. In 2016, Dr. Garcia received the Trudeau Medal from the American Thoracic Society in recognition of his lifelong major contributions to the prevention, diagnosis and treatment of lung disease through leadership in research, education and clinical care.

Richard A. Robbins, MD

Editor, SWJPCC

References

1. Alltucker K. Joe 'Skip' Garcia, the embattled University of Arizona med-school chief, quits his VP post. Arizona Republic. December 8, 2016. Available at: http://www.azcentral.com/story/news/local/arizona/2016/12/08/embattled-ua-med-school-chief-quits-vp-post-to-return-to-teaching-and-research/95156932/ (accessed 12/9/16).
2. The University of Arizona Health Sciences. Joe G. N. “Skip” Garcia, MD biography. Available at: http://uahs.arizona.edu/senior-vice-president-health-sciences/joe-garcia-bio (accessed 12/9/16).

Cite as: Robbins RA. Garcia resigns as Arizona university VP. Southwest J Pulm Crit Care. 2016;13(6):305-6. doi: https://doi.org/10.13175/swjpcc137-16 PDF

2014's Top Southwest Medical Stories

The end of the year has traditionally been a time to reflect on the top stories of the year. Here's our list of the top local medical stories.

1. VA scandal

Phoenix was the epicenter of the VA scandal but Albuquerque and the Greeley, Colorado clinic also figured prominently in the falsification of patient wait lists. Investigations revealed that at least 70% of the VA hospitals falsified records leading to the resignation of VA secretary, Eric Shinseki, and his under secretary for health, Dr. Robert Petzel. Eventually the director of the Phoenix VA, Sharon Helman, was fired-not for the falsification of medical records but for taking inappropriate gifts. However, most of the directors of the VA hospitals that falsified data remain untouched, still receiving their bonuses. Similarly, the politicians, the inspector general and those in the VA central office whose job was to provide oversight remain unscathed. On the bright side, the scandal did result in a modest influx of monies which hopefully will be spent on patient care rather than administrative bonuses.

2. Ebola outbreak

This seems a bit odd for a local news story but the Ebola epidemic in Africa did impact locally. The outbreak was largely ignored by the American public until a patient and several healthcare workers became infected in the US. Politicians and healthcare administrators seized the opportunity to hype the hysteria and insist on training of healthcare workers. One Arizona Thoracic Society meeting was cancelled because a nursing service needed the room to do "Ebola training". As Peter Sagal said on "Wait, Wait, Don't Tell Me" there have been more Americans married to Larry King that infected with Ebola illustrating the hysteria and resultant overreaction. This year's true medical heroes are the thousands of physicians and nurses who worked on the frontlines of the Ebola crisis in Africa at tremendous personal risk and despite chaotic conditions, underequipped facilities, and overwhelmed local health systems. In contrast to the politicians and healthcare administrators, Anthony Fauci has consistently offered reasonable recommendations and insight based on science.

3. Banner Health, University of Arizona Health Network merger

In June, the Banner Health and University of Arizona Health Network (UAHN) began negotiations to merge with Banner absorbing UAHN's $146 million debt. Banner promised to spend at least $500 million toward capital projects in the next five years and pay $300 million to establish an academic endowment. The deal is to be completed about the end of January, 2015. Mergers between the private and public health sectors have been a mixed bag and this one warrants close watching.

4. Meaningful use

Many physicians suspected that the Centers for Medicare and Medicaid Services' (CMS) meaningful use was little more than a scheme to have physicians perform useless clerical tasks. When they were not done, payment would be denied. At the end of 2014 this appears to be true. There remains no data that the meaningful use is "using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities" as intended. About 257,000 physicians will receive a 1% reduction in reimbursement in 2015.

5. Reduction in CMS hospital payments

Despite the lack of data that CMS' value-based healthcare program is doing much to benefit patients and some data that performance of the measures has been associated with adverse outcomes, CMS continues to reduce hospital payments because of hospital-acquired conditions and high readmission rates. We initially reported on this in June, 2013. We are not advocating for hospital-acquired infections or readmissions, but are advocating for measures that improve patient outcomes. Despite a phone call assuring us that CMS would look into it, nothing has seemed to change. Furthermore, much of the data is self-reported by the hospitals. As the VA scandal illustrates, self-reported data is not always reliable especially when money is involved.

6. Congress again fails to pass SGR fix

Congress passed a budget but failed to fix the widely hated sustainable growth rate (SGR) formula for physician reimbursement under Medicare. Also missing was an extension of the current pay bump for primary care. SGR has been present since 1997 and the one of the few things the politicians seem to come together on is not paying physicians, especially primary care physicians, a decent living wage.

Richard A. Robbins, MD

Editor

Southwest Journal of Pulmonary and Critical Care

Reference as: Robbins RA. 2014's top southwest medical stories. Southwest J Pulm Crit Care. 2014;9(6):350-1. doi: http://dx.doi.org/10.13175/swjpcc167-14 PDF

Banner Health, University of Arizona Health Network to Merge

On Thursday, June 26, the Arizona Board of Regents and the University of Arizona Health Network (UAHN) Board unanimously gave the go ahead to formal negotiations with Banner Health. Under the proposed agreement Banner will acquire the University of Arizona Medical Center and its south campus, which have 624 beds between them, UAHN's faculty practice, University Physicians Healthcare and the system's three health plans. Initial terms of the agreement stipulate that Banner will spend at least $500 million toward capital projects in the next five years, and it will pay $300 million to establish an academic endowment (1). UAHN’s long-term debt, totaling about $146 million, will be absorbed by Banner. UAHN and Banner said plan on reaching a definitive agreement by September.

UA President Ann Weaver Hart was quoted by Tucson News Now as saying, "These 30 years which this agreement anticipates are going to be among the most transformational in health care in America experienced in the last century. And we're absolutely committed to be the leaders in that environment. This is extremely exciting. And I hope you can feel our commitment. We are going to make the future. We are not going to be recipients of the future made by others" (2). We have a solution to expand our capabilities to move care to a higher level, to advance research for our community and our state and to educate the future health care professionals for the state of Arizona," said UAHN President and CEO Dr. Michael Waldrum.

Under the agreement Banner will commit to the "employment of the employees of UAHN and its subsidiaries for at least six months after closing at their current base salaries and retention of their seniority for employee benefits purposes. " (1). The proposal also includes a severance package for any employees who are laid off after that six-month period.

Banner owns 25 hospitals in seven states. In total, the proposed transaction is expected to generate about $1 billion in new capital, academic investments and other consideration and value beneficial to UA and the community, a news release said. The resulting organization will employ more than 37,000 people, after adding 6,300 employees at UAHN's two hospitals, the health plan and the medical group.

The Arizona Cancer Center is excluded under the proposed agreement and will remain part of the University of Arizona. The proposal does not affect Banner's existing agreement with the Banner MD Anderson Cancer Center at Gateway Medical Center in Gilbert nor does it affect UAHN's agreement with St Joseph Medical Center in Phoenix.

This would be Banner's first acquisition on an academic medical center which reflects the growing relationship between academia and corporate America (3). Balancing the teaching and research goals of academia and the profit goals of corporations whether profit or not-for profit can be difficult. Some physicians have been troubled by Banner's non-compete clauses on physician contracts as well as Banner's aggressiveness in employing physicians that directly compete with private practice physicians at their hospitals. It is unclear how this agreement might conflict with the academic goals of UAHN as well as affecting the relationship with physicians currently practicing at Banner.

Richard A. Robbins, MD

Editor

References

1. Arizona Board of Regents agenda. Available at: http://azregents.asu.edu/boardbook/Board%20Agenda%20Books/2014-06-26%20Board%20book.pdf (accessed 6/27/14).
2. Ames J, Grijalva B. UA Health Network, UA move forward in negotiations with Banner. Tucson News Now. June 26, 2014. Available at: http://www.tucsonnewsnow.com/story/25880624/ua-health-network-ua-to-move-forward-in-negotiations-with-banner (accessed 6/27/14).
3. Reece EA, Chrencik RA, Miller ED. Fully aligned academic health centers: a model for 21st-century job creation and sustainable economic growth. Acad Med. 2012;87(7):982-7. [CrossRef] [PubMed] 

Reference as: Robbins RA. Banner health, University of Arizona health network to merge. Southwest J Pulm Crit Care. 2014;8(6):358-9. doi: http://dx.doi.org/10.13175/swjpcc085-14 PDF