The medical school would rise like a mirage from the cow pastures and almond groves of Merced County. It would be powered by one of the world's great research universities to serve one of the most doctor-poor regions in the state.
As envisioned by its planners, a University of California medical school at Merced would produce a cadre of physicians poised to settle and practice here in the San Joaquin Valley.
A large number of its students would come from rural communities. Many would look like the Latino and Asian-American patients awaiting them here in a region of more than 3 million people burdened by poverty and a scarcity of doctors.
The goal is not to duplicate the UC system's five other medical campuses, but to offer a new, less expensive model of education geared for rural medicine and research, say the UC Merced officials behind the plan.
"We're going to be different from the other UC medical schools," said biochemist Maria Pallavicini, founding dean of UC Merced's School of Natural Sciences and the point person in the proposed school's planning process. "Our structure's going to be different. We're not going to own a research hospital."
Despite new delays and mounting financial challenges, Pallavicini and others remain determined to craft a School of Medicine that eventually would enroll nearly 400 medical students to help ease physician shortages in the Valley and throughout California.
Those students would train in existing local medical centers and clinics instead of a pricey "Grey's Anatomy"-style teaching hospital. World-class specialists from other UC schools would rotate through the Merced campus or employ new technologies to teach students far from their classrooms.
Students would be encouraged to train as primary care physicians as well as specialists, and to remain in the San Joaquin Valley, wedged between the Sierra and the coastal range at California's core.
Health care would improve dramatically in this sprawling region of 27,280 square miles — larger than Massachusetts, Connecticut, Rhode Island and Vermont combined — where agriculture is both the economic mainstay and a leading source of medical ills.
It is an audacious vision with national ramifications for the treatment of poor and rural populations. It is a vision drawn up at an isolated campus of 2,700 students that's not even four years old. UC Merced won't hand out degrees to its first full undergraduate class until next spring.
Storm clouds dim the vision
It is also a plan that may be derailed by a host of financial and political problems: worsening state budget woes, deep-seated social ills in the Valley and a national economy and health-care system both strained to their limits.
"Nobody denies that we need a medical school. But where's the money going to come from? Without money we can't do it," said UC Merced Chancellor Steve Kang in an interview last week at the 104-acre campus seven miles from downtown Merced.
Already, officials have moved back the projected year of the medical school's first entering class from 2013 to an undetermined date. Kang acknowledged that he is "not as optimistic as before as (to) when we can make it happen."
Wall Street is helping drive that calendar. The fast-weakening economy is sapping money from stock portfolios of would-be donors and from UC's own endowment, which lost $1 billion, or 15% of its value, in the first nine months of 2008.
Ever-darkening projections of state revenue already are wreaking massive cuts on state campuses. Potential medical students will probably find dwindling loan and fellowship money. Early this week, Gov. Arnold Schwarzenegger declared a "fiscal emergency," saying that without legislative action the state would run out of cash by early spring.
"Everything's changing," Lt. Gov. John Garamendi, a UC Regent and a supporter of the medical school proposal, said this week. "Most every public plan, whether it's transportation, whatever, is changing because of the financial circumstances of the nation and the state." (Garamendi's son, John Garamendi Jr., works at UC Merced as a vice chancellor.)
The city of Merced's own 80,000 residents face uncertain times with the closing of such standbys as Mervyns, Circuit City and Linen ‘N Things. A record wave of home foreclosures has earned Merced the dubious distinction of "foreclosure capital of America." The New York Times, Wall Street Journal and the Financial Times all have covered the area's woes. Now, "60 Minutes" is making inquiries.
Concerns linger about the medical school's success. Some UC educators wonder whether planting a medical school at a new rural campus — even one with the UC label — can attract the best and the brightest faculty and students. Minutes of a UC Board of Regents committee in May quote some members urging school leaders to focus on bolstering an existing campus so new that it will not be fully accredited until June 2011.
Kang, Pallavicini and other project proponents remain undeterred.
"If you don't have a vision and a plan for the future, then it is never going to happen," Pallavicini said. She insists that the San Joaquin Valley deserves more than appendages of existing UC medical schools in San Francisco and Davis, which now sponsor a host of residency programs in the Valley for medical school graduates.
"Ultimately, what we want is an independently accredited medical school for the Valley," she said. "It is what the Valley wants and the Valley deserves."
Valley doctors in short supply
The nation is facing a physician shortage so severe that the Association of American Medical Colleges has called for a 30 percent increase in medical school enrollment by 2015.
In California, the eight-county San Joaquin Valley boasts fewer physicians per capita than any other region — only 173 physicians per 100,000 people, compared to 415 in the Greater Bay Area, 294 in Southern California and 302 statewide, according to a 2006 report from the Central Valley Health Policy Institute at California State University, Fresno. Its share of specialists is even smaller. Patients with major medical problems often must travel to Fresno, Palo Alto, San Francisco or even Los Angeles for surgery or long-term treatment.
"For years, it's been, ‘Don't get sick in Merced. If you have cancer or health stuff, get the heck out of here,'" said Diana Westmoreland Pedrozo, executive director of the Merced County Farm Bureau.
Diagnosed with Stage I breast cancer, Elaine Smith, the Merced City School District homeless services coordinator, sought an MRI-guided biopsy in Palo Alto, more than two hours away, and chemotherapy treatments in Fresno, an hour's drive away. "I have the financial means and the insurance to go to Egypt if I had to. It would have broken me, but we would have done it," Smith said. "For a lot of people in Merced, Fresno is like Egypt."
The Valley's contradictions
For health care professionals, the San Joaquin Valley presents a bundle of contradictions. Farm workers harvest bountiful fruits, nuts and vegetables in the nation's food basket. But they also suffer diabetes and heart problems aggravated by a starchy diet of tortillas and sugar-laced energy drinks. They suffer depression driven by poverty.
The air is so thick with pollutants from diesel-burning trucks and farm equipment, dusty farmland, wood-burning stoves and oil production fields that some patients suffering from chronic disease must be confined in hyperbaric chambers to heal. In Merced County, with a population of 246,000, An estimated 36,000 residents have asthma — a third of them children under 14.
The new medical school, slated to become a preeminent top-tier UC-quality university, would lie on the outskirts of a city where only 11 percent of adults have bachelor's degrees.
Med school could also draw new jobs
With such problems, it's no wonder, then, that the planned medical school is generating interest in almost all quarters of the valley. The medical establishment, local politicians, advocacy groups for the poor and the area business community all give the plan their enthusiastic support.
The boards of supervisors of all eight counties in the San Joaquin Valley have passed resolutions supporting the school. Local leaders have sent scores of letters of to the UC Board of Regents and state and congressional lawmakers. Twelve state legislators from the Valley signed a bipartisan letter in February to the UC Regents, urging support for the plan.
One champion, U.S. Rep. Dennis Cardoza, D-18th, who represents much of the Valley, says he's working to win support from Capitol Hill colleagues. He's also meeting with representatives of several prominent foundations who are potential donors. He and others see the school not just as a boon to the Valley's health care crisis, but as a potential economic catalyst that would attract new jobs and research money in the same fashion as the relatively new medical schools at UC Irvine and UC San Diego.
"Nearly $1 billion goes out of the Valley for specialty care. Those are jobs and dollars that need to stay in the Valley," Cardoza said.
One reason specialists are in short supply is the complexity of the state's program that provides health care to the poor, known as Medi-Cal. Some physicians don't treat Medi-Cal patients because of payment and other bureaucratic problems, Cardoza and others say. They blame a flawed reimbursement formula that fails to account for the relatively high cost of living in rural areas of California.
That leaves a smaller pool of physicians treating the poor, forcing many patients to get their care in emergency rooms or to forego medical care altogether.
Merced County has the second-largest percentage of Medi-Cal patients in the state, behind Tulare County, said county public health director John Volanti.
"Because of our poverty, because we lack such a real economic base, it makes it much more difficult to improve care," Volanti said.
Now the worsening local economy is leaving more residents without a safety net, said Alicia Bohlke, a Mercy Medical Center administrator who until recently headed the family care clinic at the 176-bed Catholic facility, Merced's only hospital. "More and more people have lost their jobs and their insurance," she said, "and they don't know what to do."
Many who live in the region closely monitor news reports of the planned medical school, voicing guarded optimism that it will serve as a cure for shortcomings in local health care.
Whether the school can live up to such expectations won't be known until when — and if — it begins producing doctors who decide to settle here.
A rural med school model
Traditionally, most medical schools are built in metropolitan areas, even those tied to rural universities. The University of Kansas is in Lawrence, but its medical school is in Kansas City, Kan. Indiana University is in Bloomington; its medical school is in Indianapolis. Cornell University is in Ithaca, N.Y., but its medical school is in New York City. The five existing UC medical schools are in the state's major population areas: San Francisco, Los Angeles, Sacramento, Orange County and San Diego.
Now, the university is considering two new medical schools with a rural emphasis, in Merced and at UC Riverside. California is not the first state to launch programs aimed at shoring up the ranks of rural physicians.
For decades, states such as Minnesota, Illinois, Washington and Kansas have been doing exactly that.
But even the most established schools in rural areas still find that their graduates will migrate to the city, and experts elsewhere warn that UC Merced faces the same scenario.
"That's a problem. If you look at the national statistics, you probably have to train 10 or 15 to get one or two to go back to a small community," said Dr. Paul M. Paulman, assistant dean for clinical skills and quality at the University of Nebraska College of Medicine in Omaha.
Recruitment and admission of students from rural areas could be paramount to the school's success, Paulman said. "If they recruit people from Los Angeles to go into rural medicine, guess what? They'll go back to Los Angeles."
So UC Merced officials have designed into their plans an intensive effort to seek potential students from the Valley who are more likely to stay after earning their medical degrees. They plan to work with local school districts to improve science education and track young people who might be candidates for the new medical school.
UC Merced must not only educate those students but also instill a commitment to rural practice, say some Valley doctors willing to join in that effort.
Dr. Silvia Diego wants to see third- and fourth-year students working at Merced-based Golden Valley Health Centers, a network of 26 clinics where she is chief medical officer.
"We are hopeful," she said, "that the medical students will develop a passion for what we do here, and stay with us. We don't expect all of them. But if we get 50 percent or 75 percent to stay, that would be wonderful.
"Or if they go out to rural America and do the same thing that we do here, that would be great. Then UC Merced will have served its mission."
Reporters Deborah Schoch and Danielle Gaines can be reached at firstname.lastname@example.org.
UC Merced long-range development plans
Download: PowerPoint presentation of UC Merced plan
WWAMI Web site