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Cuts to university system budget could hurt UND med school, leaders say

David Molmen, former CEO of Altru Health System and head of the School of Medicine and Health Sciences Advisory Council at the University of North Dakota, speaks to legislators about the medical school's priorities for the biennium. Sydney Mook / Forum News Service

BISMARCK — The University of North Dakota School of Medicine and Health Sciences leaders say any cuts to the higher education system could hurt the school, especially its residency programs.

The school is asking the Legislature to provide the requisite funding to continue its work by accepting the North Dakota University System’s needs-based budget without any cuts, said David Molmen, former CEO of Altru Health System and head of the medical school’s advisory council, said

“We are not asking for more to do less. We are asking to continue the plan that was initiated several years ago,” Molmen told legislators on the House Appropriations Education and Environment Division Committee this week.

The medical school’s advisory council is made up of legislators, State Board of Higher Education members, health care providers and campus leaders from across the state.

Rather than allocating some of the Healthcare Workforce Initiative money to “one-time” funding, Molmen said all of the funds for the initiative should remain in the school’s base funding because of the long-term commitment the school makes to its students, residents and faculty that extend beyond the biennial budget cycle.

To “ensure the recruitment and retention of high-performing faculty and staff, it is important to endorse the salary merit increases proposed by NDUS,” Molmen said.

Any cut to the university system’s funding would have an effect on the medical school, Dean Joshua Wynne said, especially as operational costs, including the increased charges to access medical journals, continue to rise.

“If there were a major cut in our funding, we quite frankly would have limited options for adjusting to them,” he said.

Wynne said the school has four options to adjust its budget: admit more students, accept more enrollments from out of state, raise tuition or eliminate programs.

However, each of those options come at a price, he said.

The school has maximized the clinical sites in North Dakota for medical students, and admitting more out-of-students would be “contrary” to what the school is trying to do. Raising tuition also could impact the number of people coming to the program, especially from rural areas, as high debt can be a “barrier” for some students, Wynne said.

The medical school only has eight programs, so eliminating programs is not an option, Wynne said.

“All of these programs are interconnected, so which of your children do you love more? We think all of these programs are important, and I’m not sure that I could pick one to eliminate,” Wynne told the committee.

Residency slots

The medical school has a total of 193 residents who are training in various specialities throughout the state.

Residencies can take up to five years to complete and cost around $150,000 per resident student each year, Wynne said.

Residency slots are funded through the Medicare program and are based on a cost report submitted by participating hospitals.

North Dakota also pays for additional residency slots in the state because funding those positions is directly related to increasing the distribution of physicians in North Dakota, especially in rural areas, according to an appropriations fact sheet from the school.

“If a doctor completes both medical school and residency (in North Dakota), there is a 2-3 likelihood that the doctor will practice (in North Dakota),” the document reads.

Since the 2011-13 biennium, the medical school has had an increase of 35 resident spots. The medical school had a goal of increasing that by 51 spots, Wynne said.

However, Wynne noted he is not asking to fill those additional 16 spots.

Wynne said the medical school is not asking for more money to fill those additional spots, but the number of resident slots at the school garnered lengthy discussion.

The “biggest target” for cuts would be the school’s residency spots, which cost the school around $10.7 million a year, Wynne said. The deadline for slots over the next five years will expire by the end of April, he noted.

Legislators likely will continue to work out the budget through that month.

“The school has to make a commitment at that time, and quite frankly, we just hope that the funding works out down the line,” he said.

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