MU struggles to meet state need for more health providers

Monday, November 29, 2010 | 10:59 a.m. CST; updated 2:02 p.m. CST, Monday, November 29, 2010

COLUMBIA — MU’s teaching institutions are having difficulty producing enough graduates to soften the state's escalating need for more health care providers.

As health reform provisions kick in over the next few years, many of the more than 700,000 uninsured Missourians will gain access to coverage, increasing the need for MU and other institutions to produce more health care providers. Administrators at the School of Health Professions, School of Medicine and Sinclair School of Nursing said they’ve taken steps to increase enrollment and prepare students for modern health care challenges, but with space and funding in short supply, they can only do so much.

“Right now, there are literally hundreds of jobs in health care (in Missouri) that are unfilled,” said Richard Oliver, dean of the School of Health Professions.

“We’re woefully behind,” he said.

While enrollment in the School of Health Professions has increased from 584 to 1,748 students since 2002, the vast majority of that jump is outside of the school's professional programs. Professional student enrollment increased from 77 to 176 in that time. The school received a one-time, $1.6 million grant last year from a state initiative, Caring for Missourians, which it used to upgrade facilities and increase enrollment, but Oliver said professional programs are now maxed out.

He said the school has outgrown its space in Lewis Hall and can’t create more spots for professional students with current facilities.

“To some extent, we're just turning away more and more qualified students for our professional programs and that is not a good trend,” Oliver said.

“It’s a three-edged sword — students wanting in our programs, employers screaming for more graduates and this bottle neck of buildings and facilities," he said.

The School of Medicine is confronting a similar difficulty.

Last year, the School of Medicine received $5.8 million from Caring for Missourians and used some of the money to increase the size of the 2010 and 2011 classes from 96 to 104 students. But the school can’t further increase enrollment without additional space, said Linda Headrick, Senior Associate Dean for Education and Faculty Development.

To help meet the nationally anticipated shortage of doctors, the Association of American Medical Colleges recommends that medical schools increase enrollment by 30 percent by 2015. A major investment would be needed to meet that goal, Headrick said.

“In order to increase class size by eight we had to clean out a closet in the corner and turn it into a problem-based learning room,” she said.

Headrick said that if Caring for Missourians is not renewed, class size will return to 96 students. She said she worried the school was too lean to do much more with its current resources.

“I would rather stay small and have very high quality (graduates) coming out that we know are going to go out and do great work than stretch too far,” she said. “What I’d really like to do is have the funding and resources from the state to do more, because if anyone ought to be training more docs in Missouri, it ought to be us.”

At the Sinclair School of Nursing, Associate Dean Roxanne McDaniel reiterated the notion that the school can only expand as much as its resources allow.

Through a $1.7 million grant from Caring for Missourians, the school increased enrollment in its accelerated baccalaureate and doctoral programs by 10 students each. Because the online graduate courses available are less of a physical strain on the school, graduate enrollment has also gone up, McDaniel said.

“We are increasing, but without additional resources, we can’t do a whole lot more,” she said.

According to the Institute of Medicine, by 2020, the number of nurses with baccalaureate degrees needs to grow from 50 to 80 percent and the number of nurses with doctorates needs to double in order to meet the swelling need for health care.

“To increase our baccalaureate program, we really need bigger facilities because there are times when we really have trouble finding classrooms,” she said.

Although she stressed the importance of increasing undergraduate enrollment to produce new nurses, chief among McDaniel’s concerns is the lack of nursing educators.

“We have a horrible nursing faculty shortage and its probably going to get worse,” she said. To produce more educators, she added, more nurses need to be prepared at the doctorate level.

Although McDaniel, Headrick and Oliver all expressed concern over roadblocks to graduating more health providers, they said their students were being well prepared for modern health care challenges. In particular, curriculum changes in recent years have placed a greater emphasis on patient interaction, preventative care and collaboration between professions, they said.

For example, students from all three schools work together in simulated and clinical settings to learn how to assess and meet a patient’s needs while developing an understanding of the roles other health providers play in caring for patients.

Oliver said it was critical for MU graduates to understand the full continuum of care.

“You don’t have the luxury anymore of just saying let me do my job and I don’t need to know about all these other things,” he said. “You’ve got to have an understanding of how the health system works.”

He said he believed health reform “shines a light on our institution as the kind of institution that’s going to be required to respond to challenges.”

But despite the difficulty of preparing students for a tenuous, complex health care landscape, Oliver said the school’s ultimate challenge is getting a new building.

“We’re in a 1960s era dormitory,” he said.

“We think it’s very ironic that a school dealing with rehab and health care is in a building that is one of the least accessible by (Americans with Disabilities Act) standards on the MU campus.”

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