How do you make a medical school? Before you can explore that question, you need to know why you make a medical school.
In the case of Las Vegas, the answer is that, no matter the quality of doctors in Southern Nevada, the quantity of them is in a desperate state of want. That problem is undeniable to anyone who’s ever had to wait months to see their family doctor, a psychiatrist, an endocrinologist, or any other specialists on the long list of much-needed doctors.
Fixing the problem dovetails neatly with another perennially urgent issue facing Nevada — the lack of economic diversity in the state.
As the state was still reeling from the Great Recession, then-Gov. Brian Sandoval met with Mark Muro of the Brookings Institution and Robert Lang of Brookings Mountain West and The Lincy Institute in 2011 for a briefing on the report that would eventually be released as "Unify, Regionalize, Diversify: An Economic Development Agenda for Nevada." Sandoval wanted to create around 50,000 new jobs and asked Lang what Southern Nevada should be targeting.
Lang was unequivocal: health care.
“It’s $6 billion a year in missed output, and it’s a ton of jobs because the industry is very labor-intensive,” Lang said. “[Sandoval] asked what it would take to do that. I said, a med school at UNLV.”
Las Vegas was the only metroplex in America of more than 2 million people that didn’t have a four-year public allopathic medical school. Such schools raise the quality of care in a community through research and continuing education. They spur jobs and the economy. And Southern Nevada needed around 3,000 additional doctors just to come up to the national per capita average.
“When we interviewed within the medical community, (doctors) said, ‘There are patients that ask to see me in April and I can’t see them until November.’ They’ve got a lump in their groin, so they go to UCLA or Cedars-Sinai. They go to Los Angeles. Some of it was a flight to the quality you get at academic medical centers, but a lot of it was you just couldn’t get in here.”
Those patients were taking a third of their health care dollars and spending them in other states. He figured about half of that money going out of state could be recaptured in Nevada. Lang projected that the Legislature’s investment in the school would be paid back through taxes within 15 years. Another study in fall 2013 by the Tripp Umbach consulting firm estimated the school eventually would have $1.2 billion annual economic impact and could add 8,000 jobs to the Southern Nevada economy by 2030.
The dialogue intensified and the Nevada System of Education Board of Regents’ Health Sciences Committee met in summer 2013 to discuss the concept of a UNLV School of Medicine.
“We knew there was a pressing need to improve access to health care in the region,” said Dr. Mark Doubrava, chairman of the Board of Regents. Doubrava, who is a practicing ophthalmologist and a 1985 UNLV graduate added, “We saw a medical school at UNLV as an opportunity to affect meaningful change in the community by increasing the quantity and quality of care in a way that would have a positive impact in Nevada for future generations.”
There had been false starts before. Before the state had any medical school, debate in the late 1960s had revolved around whether to place it in Las Vegas or Reno, with the latter winning out. Former Mayor Oscar Goodman tried, unsuccessfully, to lure satellites of the Cleveland Clinic and the University of Pittsburgh Medical Center to Las Vegas.
This time was different. The plan was a win for Nevadans, for NSHE, and for the governor’s agenda at a time when state leaders were determined to reorder an economic environment that left Nevada vulnerable to catastrophe. The political will had been sparked. That was the easy part.
Back in action
In 2014, Dr. Barbara Atkinson had been retired for two years. The former dean and executive vice chancellor of the University of Kansas School of Medicine wasn’t planning on returning to work in less time than it takes a member of Congress to run for re-election.
Atkinson was initially approached to be a consultant, but then-President Don Snyder and Provost John Valery White were taken with her mix of academic and administrative experience. The more they worked with Atkinson, the more they pushed for her to take on the role of planning dean full time. The opportunity to build a new medical school from the ground up — infused with her own ideas about medical education and in a community that relishes continual reinvention — proved to be too appealing to pass up.
“It was a good time to be looking at, not the way medicine had always been taught, but what the future needed. It was a time for major changes in terms of everything from technology and computer sciences to interactions with people and the whole health care market,” Atkinson said.
Large lectures were not part of her vision; instead she wanted to see collaborative learning through small group discussion and research and with the faculty acting more as guides that continually prod students to analyze the situation.
“That’s what’s called problem-based learning,” she said. “The students essentially teach themselves and each other.” And the lifelong skills they gain will help them continually adapt as medical technologies and practices change.
Another key tenet of her vision was inculcating the faculty and student body with a commitment to serve Southern Nevada.
“I thought it was also really important, especially in this community that is so short of doctors, that we take people from within Nevada who would want to stay here,” she said.
Atkinson was officially named planning dean in May 2014. She spent the next six months on a listening tour of the community to sell her vision of a medical school and learn about what the most pressing needs were in the city.
She met with the heads of hospitals and health care groups, with community leaders, then-Clark County Commissioners Steve Sisolak and Lawrence Weekly, regents, legislators, Las Vegas Mayor Carolyn Goodman, with newspaper editorial boards, Gov. Sandoval, television outlets, and pretty much anyone else that would give her a chance to speak.
The consensus built in those meetings was realized when the regents and state approved a nearly $27 million budget to get the school rolling. But it was a journey to get there.
Maureen Schafer, who served as Atkinson’s chief of staff through much of the school’s development, said, “I think I was blessed by the naivete of what it was going to take to build a medical school. Dean Atkinson had the roadmap. Neither of us knew how vastly under-resourced UNLV was and how complex the politics were going to be to make this a reality.
“The broader community, the leadership at UNLV was committed, and the Legislature was committed — it was those three elements that made this a reality. But change is really hard, even when you know you need it.”
By March 2015, Atkinson had key staff in place, including Ellen Cosgrove, vice dean of academic affairs and education, and Samuel Parrish, senior associate dean of student affairs and admissions.
It meant that the leadership team could start taking some big bites out of the elephant: developing a curriculum and starting the accreditation process.
Before recruiting a charter class, a school has to receive preliminary accreditation from the Association of American Medical College’s Liaison Committee on Medical Education, the governing body for medical schools in the United States and Canada.
Atkinson and her team began documenting the school’s leadership, planning, finances, curriculum, faculty, facilities, and student support, among other things. The committee awarded the medical school preliminary accreditation in October 2016, opening the door to begin recruiting the first class — all of whom would receive full scholarships, driven in large part by a $10 million gift from the Engelstad Foundation that covered 25 of those scholarships.
The team had a blueprint for the steps the school would need to take toward full accreditation.
The curriculum focused on the kind of problem-based learning Atkinson favors, and also leaned heavily into high-tech solutions in medical education, like a virtual anatomy lab. It featured elements like requiring all students to train and work as EMTs; doing service around community health topics like homelessness and addiction; and a 12-week research project that could involve bench sciences or community health.
That focus on Southern Nevada in the curriculum was a reflection of the school’s broad commitment to community. The academic and research programs were to be complemented with more extensive clinical operations under the new UNLV Medicine practice plan, and an expansion of the residency programs that graduates complete before practicing in their specialities.
The UNR School of Medicine had long had a footprint in Las Vegas, offering clinical programs for its students in the city. With UNLV establishing its own School of Medicine, administration of the UNR practice plan was transferred south in July 2017.
Dr. Michael Gardner was serving as the vice president for ambulatory care at Harris Health System in Houston, where he supervised 2,000 employees and had a $200 million budget. The situation in Las Vegas would be much different, but the opportunity to make an impact in a start-up environment was attractive. He took the job as UNLV’s vice dean of clinical affairs and president/CEO of UNLV Medicine.
“There were a lot of people who had done a lot of good work from Reno and in the departments that were established,” Gardner said. But its main campus was some 438 miles away. “There wasn’t really a unified culture or a unified practice plan in Southern Nevada. My first job was to take us from UNLV medicines, with an ‘s’ to UNLV Medicine.”
Gardner helped bring in residencies and fellowships in orthopedic surgery, psychiatry, pediatrics, and obstetrics, which is crucial because residencies often predict where doctors will ultimately live and practice. It is imperative to expand residencies if the school is going to create Las Vegas doctors.
The next phase
As Gardner arrived in Las Vegas, though, Atkinson was faced with an illness of her own. She was hospitalized for a month, and she spent another month after that doing rehab. That was August 2017, and the charter class marked their formal entrance into medical school at their stethoscope ceremony without their dean present.
“That was sort of a warning sign that we needed to be thinking about what the future would look like,” Atkinson said.
With the class in place and enough bylaws written, however, governance had been established. The gears of the school were turning freely, so Atkinson began planning to hand over the reins.
In 2019, she announced she would be stepping down as dean and would become the school’s special advisor for community relations and accreditation. Dr. John Fildes took over as interim dean in September, and just a month later, the school received some of its best news to date: the Liaison Committee on Medical Education awarded provisional accreditation. It was the last stop on the way to becoming fully accredited.
Fildes kept the school on track through April 2020 and was succeeded by Dr. Marc J. Kahn, who came to UNLV from the Tulane University School of Medicine — just as an emerging pandemic was upending medicine, education, and everything else about daily life around the globe.
It was time to be nimble.
Connecting to the community
In the three months before his March start date, Kahn was frequently asked his priorities for the school; his answers were straightforward. “The top priority was accreditation because without accreditation, nothing really matters.”
Second was to ensure the school’s clinical practice plan was financially sound, and then he would focus on fundraising and the graduate medical education program.
“When the pandemic really hit in earnest, the priority shifted,” he said. “All of a sudden the pandemic is priority one.”
As a hematologist, Kahn immediately wanted to institute a convalescent plasma program, where plasma from patients who had recovered from COVID-19 would be used to treat patients actively fighting the disease.
It took about three weeks to set up and by the end of his first month, the program was up and running as the first of its kind in the region.
The pandemic demonstrated the role UNLV had in shoring up community infrastructure. Along with UNLV’s schools of Nursing, Integrated Health Sciences, Public Health, and Dental Medicine, the medical school channeled its resources to address this health care crisis.
UNLV Medicine opened its drive-through coronavirus testing center on Shadow Lane in late March 2020, at a time when testing kits nationwide were difficult to come by, and as operations shifted to remote learning, the main campus was employed to expand operations.
As devastating as the virus has been, the crisis did create an opportunity for the young school to more tightly integrate itself within the community.
As vaccines become more widely available, UNLV Medicine has worked with sister programs at UNLV and across the Nevada System of Higher Education to distribute more than 100,000 vaccine doses through mid-April.
“The thing that COVID did was make it very easy to show why we need to be here,” Kahn said. “It was implicit and it was obvious why we’re here. This is what we’re doing. We’re not an ivory tower by any means. We are absolutely engaged in the community and committed to it.”
Cornerstone for the future
Now, as its charter class prepares to graduate and pandemic response operations are running smoothly, the school is ready to regroup and reassess those priorities Kahn outlined from before the world erupted.
Foremost is the construction of the medical education building, a $150 million, 135,000-square-foot building at the Shadow Lane campus set to open in 2022. The new home of tomorrow’s doctors is being developed by the Nevada Health and Bioscience Corp. Schafer, Atkinson’s former chief of staff, is now CEO of the nonprofit, which is managing the construction of the building in the heart of the Las Vegas Medical District.
At its core will be UNLV’s academic health center, which had been missing from the Southern Nevada health care landscape. It’s a major component in UNLV’s Top Tier strategic plan and in medical education around the country, where all of a university’s health sciences are united to enhance cross-disciplinary education and research. Earlier this year, Kahn was named UNLV’s vice president for health affairs, overseeing the schools of Medicine, Dental Medicine, Nursing, Public Health, and Integrated Health Sciences.
Medicine isn’t a “solo sport” anymore, Kahn said. Students have to learn to work in collaborative, interdisciplinary teams to provide the highest level of care for patients. Learning that kind of teamwork starts as a student.
More broadly, the academic health center, in integrating with University Medical Center, would be a major point of care for those most at need in the community. Academic health
centers typically provide about 60 percent of charity care in states that have them. They also deliver vital resources like burn centers, Level 1 trauma centers, and transplant programs. And as research and teaching facilities, they are sites for clinical trials, providing access to the newest health care breakthroughs to citizens.
“Academic health centers do things in the community that no one else either wants to do or can do,” Kahn said. “Bone marrow transplants, which is standard of care for many cancers in both adults and kids; liver transplants; high-level orthopedics care; high-level geriatrics care; cognitive science.
“The academic health center also becomes a major economic driver, not only for the university, but for the region. We need to diversify our economy. That’s made obvious by the current COVID crisis. We need to bring biotechnology, pharma, etc., to our citizens. UNLV’s academic health center is what will bring those industries here.”
Realizing the vision
Being part of the full development of UNLV’s academic health center is a cornerstone of the School of Medicine’s future. In the present, a trio of major milestones are marking the reality of the progress the school has made so far.
In February, Atkinson’s vision was rewarded with full accreditation from the Liaison Committee on Medical Education. There were six other medical schools that started the accreditation process around the time UNLV did. Only UNLV and the Dell Medical School at the University of Texas at Austin made it through without delay.
The school currently has 240 students, 150 faculty physicians, more than 300 community faculty, and more than 300 medical residents and fellows. On March 19, members of the charter class took part in the school’s first Match Day, where they found out where they’ll be doing their residencies. And in May, that first class will graduate.
After seven breakneck years to find footing in local soil, the School of Medicine will produce its first crop of doctors, many of whom will continue to serve a glaring need in Nevada.
“I still can’t believe it,” Atkinson said. “This was about one of the fastest startups I think you could have. But it’s just amazing to see this class and how well they’ve already done. It was exciting. It’s still exciting. Until we got (accreditation) to accept the first class of students it was unknown if we would even make it. It all happened right on schedule.”