The University's efforts in health care have traditionally had a dual focus. Through the School of Medicine, the University enjoys national prominence in medical education and research. At the same time, the medical center, with its hospitals and clinics, is the first source of health care for the citizens of central Virginia and a last resort for people from around the world who require specialized care.
The University also recognizes its responsibility to address larger issues of access and cost-containment reflected in the national crisis in health care. In 1993-94, faculty researchers and clinicians made many contributions to improved health care for the citizens of Virginia and beyond.
Reviving a Crucial Link in Medical Care
Although the United States has more physicians per capita than any other country, doctors specializing in family practice, general medicine, general pediatrics, and general obstetrics and gynecology in rural areas and inner cities are in short supply. This shortage is particularly acute in Virginia, 60 percent of whose counties reported less than one family physician per 2,500 people.
"There is a need for more generalist physicians so we can continue to provide the public with quality health care," says Dr. Robert M. Carey, dean of the School of Medicine. "Preventive medicine and other treatment at the primary care level is not only highly effective at keeping people healthy, but it's the best way to keep health care costs down by treating or curing many problems before they become major."
This year, the University found new support for its generalist medicine initiatives. The state legislature granted the School of Medicine, in partnership with the Medical College of Virginia in Richmond and Eastern Virginia Medical School in Tidewater, almost $1.27 million over two years to establish generalist residencies for internal medicine and general pediatrics and to create incentives to increase the number of generalist graduates to equal 50 percent of the class by the year 2000. In addition, the medical school partnership received a three-year, $2.4 million grant from the Robert Wood Johnson Foundation for this effort. The University will coordinate this joint project through our Virginia Center for the Advancement of Generalist Medicine.
The Theresa A. Thomas Memorial Foundation of Richmond provided a five-year, $2 million grant to provide scholarships for students planning careers in primary care medicine or nursing. The grant also establishes a primary care nursing professorship.
Increasing the number of minority students in medicine is an important goal of the Health Sciences Center. This year, the School of Medicine offered the Summer High School Academic Reach Program for the tenth consecutive year. Minority high-school students take four weeks of free nonresident classes in scientific subjects and work with minority medical student mentors. Over the last decade, the program has produced eighty-three new doctors.
Reorganizing to Provide Cost-Competitive Care
This year, the University continued to streamline the delivery of medical care. A plan to give the University's medical center "codified autonomy" was approved by the Board of Visitors and enacted by the General Assembly. The legislation enables the University to enter into joint ventures and provider networks.
At the same time, the Health Sciences Center has received approval from the Board of Visitors to establish a health maintenance organization called QualChoice to serve the ten-county Blue Ridge region of central Virginia. The Health Services Foundation and medical center will invest in starting up the network, inviting regional community hospitals and physicians to participate as partners. "Our goal is to develop a plan that will meet the challenge of proposed health care reforms and provide coverage for people of this region," said Dr. Don E. Detmer, vice president and provost for health sciences.
One goal of any effort to address the health care crisis is to deliver services more efficiently. The medical center believes strongly that the first target for cost containment should be operations, not patient care. The more efficient delivery of medical services is shown in our figures for hospital admissions and outpatient visits. For the second year in a row, admissions have declined, while the average length of stay dropped from 7.5 days in 1992 to 6.6 days this year. At the same time, outpatient visits increased from 314,000 to 339,000.
Reaching Out to More People
In 1994, fifty-one University of Virginia physicians, in fields ranging from cardiovascular disease to neurological surgery, were included in The Best Doctors in America. This number is an indicator of the high level of care our patients receive and of the high regard in which peers around the country hold our faculty.
This year, we took a number of steps to make our physicians' skill and knowledge available to doctors and patients in other hospitals. Last fall, we began forming a telemedicine network with Rockingham Memorial Hospital in Harrisonburg. The network will provide two-way video communication between the hospitals, allowing doctors here to view Rockingham Memorial patients, their vital signs, X-rays, and medical records, via fiber-optic phone lines. This network will expand in the coming year to include physicians at Augusta Medical Center and to provide physicians at both hospitals interactive continuing medical education programs from the University.
The University has also emphasized its outreach to Charlottesville public housing to ensure that residents receive adequate health care. With a $1.2 million federal grant, the School of Nursing has expanded its clinic at Crescent Halls and opened a new clinic at the Westhaven complex.
Expanding Our Understanding of the Human Body
Advances in the delivery of health care have been accompanied by substantial advances in our knowledge of disease. Researchers are working to diminish the memory loss associated with advanced age. With a $436,000 grant from the National Institute of Mental Health, Carol Manning, assistant professor of neurology, is conducting a five-year study of the underlying cognitive and neurobiological structures of memory and the potential of doses of glucose to enhance memory. Former University professor of pharmacology Alfred Gilman won the Nobel Prize in medicine this year. Dr. Gilman did much of his work on the cellular mechanisms that are affected by such diseases as diabetes and cholera while at the University of Virginia.