Within a few years of graduating from Southern Utah University with a degree in construction management, Sam Murray had an epiphany. He would rather heal people than build things, so he returned to the Cedar City campus to study biology, organic chemistry, anatomy and other prerequisites for medical school.
Now he has a dozen applications out, including one to the University of Utah, home to the only medical school within 500 miles of the state capital. But Murray's chances of admission to the U. dimmed earlier this month when lawmakers declined the school's request for funding to restore its medical class size to 102 seats.
"They should do what they can to maximize the available seats so those from Utah can go, especially if they want people to stay and practice here," said Murray, who grew up in St. George and is married with a first baby on the way.
The news also disappointed U. trustees, even though they were grateful many other funding requests infrastructure upgrades, a modest pay hike, and bonding authority to build parking structures, an athletics training center and a law school building were granted. Given the size of the U.'s service region and student interest, the class size should be 125 to 150, far larger than the 82 enrolled each of the last two years, trustees Chairman Clark Ivory told his colleagues.
"It was difficult to get one more thing [funded] that was a big priority for us," Ivory said. "That's still the drum we are going to beat. We want to get to 122."
Increasing the class size is a priority because of a projected shortage of physicians, particularly in primary care and in rural parts of the state, officials say.
"It's about a public health care crisis," said Kim Wirthlin, an associate vice president with the U.'s health sciences wing. "To be forward looking, we need to be restoring and expanding. We have the capacity to expand in terms of labs and clinical rotations."
Raise tuition? • In the wake of a $10 million cut in federal Medicaid reimbursements, state budget cutting and declines in cigarette tax revenue, the U. trimmed its class size from 102 to 82 in 2010. But officials say the shortfall cannot be made up through tuition, already at $30,000 a year.
Vivian Lee, the U.'s new senior vice president for health sciences, has argued that boosting tuition would force students to borrow more and encourage them to pursue careers in more lucrative subspecialties, rather than stick with primary care, where they are needed most. She also pointed out that the $26.5 million the state gives the medical school accounts for just 4 percent of its budget, far below the national mean of 14 percent for public medical schools.
Lee proposed a cost-sharing arrangement to build up the class size to 122 over two years. That would eventually raise the state's contribution by $9.6 million, while the rest of the $12 million needed would come from the U.'s clinical departments.
Graduating U. senior Brett McGettigan of Farmington, who has been admitted to the University of Colorado's medical school but has yet to hear from the U., said it is "irresponsible of the Legislature to not fund increasing the class. Eighty-two is not sustainable for the state of Utah." McGettigan, who hopes to go into internal medicine, wouldn't mind going to Boulder, but annual tuition is $20,000 higher.
"I want to come here, but the decreased class size might force me out," said McGettigan, who will learn his fate on Friday.
Sen. Ross Romero, a senior Democrat on the Higher Education Appropriations Subcommittee, proposed moving the med school class up the priority ladder, but the committee voted it down.
"Against the other pressing needs, it didn't get support," said Romero, whose Salt Lake City district covers the U. "We haven't felt the impact in our communities for a lack of doctors. Obviously we don't want to get to the point where that occurs."
Beyond numbers • Meanwhile, some question whether more medical students, by itself, will affect the number of primary care physicians practicing in Utah. Other factors, such as resident programs and pay inequities between specialties, are just as important, said Marc Babitz, director of the state Health Department's division of family health and preparedness. Many residents in primary care later go into subspecialties, often lured by higher pay.
Utah taps a national pool of medical talent, even though salaries in the state are only two-thirds the national average in primary fields and about half for specialists, according to David Squire, executive director for the Utah Medical Education Council.
On average, 330 doctors start practicing in Utah each year. Of those, about 120 had no prior ties to Utah, about 95 were retained from residency programs, and the rest studied or grew up in the Beehive State, Squire said. Utah's landscape and outdoor recreation help attract and keep physicians here, but that could change given the lower pay scale.
"What happens if the national [physician] shortage becomes more acute? Will Utah be able to compete?" Squire said. "With low incomes [for primary practitioners] and high debt loads, they'll go to the highest bidder, and Utah is not the highest bidder."
Regardless of workforce needs, many Utah students want to be physicians but cannot get into medical school. Only 108 of the 269 U. graduates who applied to any medical school last year were accepted, according to the U.'s Preprofessional Advising Office. The U. medical school took 44 of them. Lee's proposal to increase the class size by 40 seats would directly benefit Utah graduates because 70 percent of the school's slots are reserved for state residents.
SUU, a small public liberal arts school, sends about a dozen graduates to the U. each year to learn medicine. This year, 18 SUU students applied, but only 13 have so far won admission.
Sam Murray is among five waiting to hear. He has been admitted to Creighton University, a private medical college in Omaha, but prefers to stay in Utah.
"If I wind up at Creighton, that's where I'll make my connections. When you look for a residency a lot of that comes from connections you have," Murray said. "You put roots down. Maybe my kids will be in school. That will make it harder to come back to Utah."
U. School of Medicine
The university is facing its third year with a reduced medical class, downsized from 102 to 82 because of past state budget cuts and loss of federal revenue. The Legislature funded many higher education projects this session, but declined the medical school's initial request in a multi-year effort to enlarge the class size by 40 seats. Increasing the number of slots would eventually cost taxpayers $9.6 million a year.