Before the House Healthcare Efficiencies Study Committee
Representative Stephen A. Huffman, Chair
Undergraduate & Graduate Medical Education in Northwest Ohio
Testimony of
Christopher Cooper, MD, Executive Vice President for Clinical Affairs and Dean, College of
Medicine & Life Sciences
The University of Toledo
September 3, 2015
Chairman Huffman, members of the House Healthcare Study Committee, welcome to Toledo
and thank you for providing us the opportunity to speak with you about medical education, the
foundation for healthcare. My name is Christopher Cooper and I am the Executive Vice
President for Clinical Affairs and Dean, College of Medicine & Life Sciences at the University
of Toledo.
The University of Toledo is a state-assisted higher education institution serving approximately
20,000 students with over 85% of these students coming from the State of Ohio. With over 300
academic programs across a broad range of disciplinary areas, UT is one of a select number of
universities in the nation to offer programs in arts and science disciplines, business, education,
social services, engineering, law, medicine, nursing, and pharmacy. In addition, UT owns and
operates its own full service hospital.
The combination of the entire health enterprise at UT including health professions education,
patient care, and research, is known as an Academic Medical Center, one of 100 or so in the
country. As an Academic Medical Center, UT provides education essential to Ohio’s higher
education system as we train future healthcare practitioners and scientists, provide patient care
from basic to the most advanced and cutting edge, and we conduct research, from discovery to
technological and bedside application.
I am here today to speak with you about training doctors, from medical school through residency
training. First, the phrase ‘undergraduate medical education”, typically refers to the four years of
medical school. Medical school curriculum includes two years of basic science instruction, such
as microbiology and anatomy in small group and lecture formats, followed by two years of
clinical experience, which is provided in hospitals and outpatient locations; at UT, in our clinics
and doctor’s offices, as well as in private practice offices in Toledo and across Northwest Ohio.
Graduate medical education refers to the medical specialty a student goes into for residency
training, e.g. family medicine, orthopaedic surgery or pediatrics. Residency training is typically 3
to 6 years. In addition some specialties require even more advanced training called ‘fellowships”,
typically 1 to 3 more years. All phases of medical education, both undergraduate and graduate,
now often take place in simulation centers, as we have at UT.
Without question Ohio needs more doctors now and certainly will continue to need more in the
future. Whether in primary care or in-demand specialties, like psychiatry and general surgery,
whether in rural areas or central cities, Ohio simply needs more doctors to care for our citizens.
At UT, we see our purpose as training doctors to practice in Northwest Ohio and we know that
the best way to accomplish that is to start with students who are from Ohio. I speak from
example as I grew up in Springfield, Clark County, and completed both undergraduate and
medical school in Ohio. I am happy to report that of our medical schools’ current first year class
of 177, 131 are from Ohio, and of that 1/3 are from Northwest Ohio. The class includes students
from Toledo, Fremont, Montpelier, Piqua, Wapakoneta, New Washington, and many other small
and urban communities.
Medical education is comprehensive by accreditation and expensive to provide. From basic
science labs and faculty ratios, student testing and assessment, curricular changes in how to best
teach students, new ways to deliver care, through clinical experience with faculty in hospitals,
medical education in an academic medical center is costly both to provide and costly to students.
As students finance their medical education on debt, often early intentions to go into primary
care specialties, such as family practice, pediatrics, and internal medicine evaporate, as mounting
debt drives them toward higher compensated specialties. Payment reform and initiatives to
address student debt are on many agendas, and we hold hope that movement will occur. In the
meantime, we have undertaken a very intentional path to long term sustainability and growth, so
we can continue to train the future doctors for many of the small communities in Northwest
Ohio.
All academic medical centers rely on support from their hospital for the medical school to
survive operationally. As hospital margins diminish, support to the medical school cannot be
sustained. Like many smaller academic medical centers, that is the case at UT. To continue our
mission and purpose, we needed to look for a new way of operating for the long term. Recently
we have announced an innovative public-private partnership between the UT’s College of
Medicine with ProMedica Health System. This affiliation is guided by the following principles:

Enhance the training and education of students, residents, and fellows;

Retain high-quality graduating students, residents, fellows, and allied health
professionals;

Elevate the stature of Toledo, Ohio, and its surrounding communities as a strong
academic medical community for patient care, training, and research;

Sustain and enhance the COM&LS in missions of education and research;

Expand volunteer and full-time faculty;

Ensure that the overall care delivery model in the communities served by the Parties is
high quality;

Develop Toledo Hospital and Toledo Children’s Hospital into a premier academic
medical center, including a preeminent quaternary center;

Develop a unique academic/clinical medical partnership focused on safety, quality,
efficiency, and patient-centered, cost-effective medical care and identify and develop
unique areas of clinical and research excellence.
The transition of our programs, in this innovative partnership requires significant capital
investments to renovate and create space for our learners within ProMedica Health System, along
with renovating existing space on the UT Health Science Campus. We will be requesting your
assistance through capital support to further this innovative partnership that will train the next
generation of students and residents that will care for Ohioans in Ohio communities.
As exciting as the future of our medical school is, we need your help more than ever and the help
of your legislative body, to continue the educational legacy your support has made possible over
many decades.
Through the Department of Higher Education, state support of medical education includes a
percentage of the State Share of Instruction (SSI), and five other budget lines for specific uses:
Clinical Teaching, Geriatrics Education, Primary Care, Family Medicine and the Area Health
Education Centers, totaling $ 24 M to UT. The amount of state support is down 27 % from what
it was in 2001.
You can see the impact of doctors in your own communities. The Robert Graham Center for
Policy Studies (Feb. 2009) estimated that one full time family physician creates on average five
full time staff positions, which results in an average of $904,000 of economic impact.
The funding for those lines are vital to the future of medical education in Ohio and should
remain within the Department of Higher Education, going to Ohio’s medical schools. Thank you
for your past support which has allowed us to train doctors caring for you and your families. We
respectfully ask for your support going forward and to work with us toward updating and
stabilizing funding mechanisms for medical education, to regain some of the 27% loss.
Regarding graduate medical education, the UT College of Medicine & Life Sciences sponsors 26
accredited medical residency and fellowship programs. These programs range from
the key primary care areas of family practice, internal medicine, and pediatrics to highly
specialized fellowships such as interventional cardiology and pulmonary/critical care as
examples. The UT also sponsors residency programs in General Dentistry, Pediatric Dentistry,
General Pharmacy, Critical Care Pharmacy and Community Pharmacy.
In total, there are nearly 340 residents and fellows helping to deliver high quality, patient
centered care at the University of Toledo Medical Center and its affiliated educational partners
which include ProMedica Toledo Hospital, ProMedica Toledo Children’s Hospital, ProMedica
St. Luke’s Hospital, Mercy St. Vincent’s Medical Center, and the Toledo Veterans Affairs. Of
note, for our 2015 graduating class of residents and fellows that entered into practice, 40 % did
so in Lucas County or other areas of Northwest Ohio.
As recently as March 2015, the Association of American Medical Colleges (AAMC) Center for
Workforce Studies published a study “The Complexities of Physician Supply and Demand:
Projections from 2013 to 2025”. The study confirmed prior reports and concluded that demand
for physicians continues to grow faster than supply, even taking into account the growth in
advanced practice nurses and other health care providers. Projections suggest a shortfall of
46,100 to 90,400 physicians by 2025, including a shortfall in the range of 12,500 to 31,100
primary care physicians and a shortfall in the range of 28,200 to 63,700 non-primary care
physicians. 1 These estimates are based on an increasing and aging population, physicians
reaching retirement age, and expanded health insurance coverage under the Affordable Care act,
potentially introducing nearly 30 million more patients into the health care system.
Anticipating these projections, leaders of the AAMC in recent years called for a substantial
increase in medical school enrollment. This growth has been accomplished by both increasing
enrollment at current medical schools and the creation of new medical schools throughout the
country. However, because training to become a physician requires the completion of both a
medical doctor degree and a residency training program, without a complementary growth in
funded residency slots for GME, few additional physicians will be added to our health care
system.
Due to the cap placed on Medicare funding to hospitals with existing GME residency positions
as a result of the 1997 Balanced Budget Act, expansion of residency positions has, in many
cases, fallen on the local academic medical center or health system to provide the financial
support. UTMC has 160 Medicare funded residency cap slots. At present, we are 25 residents
FTEs over this cap each year on average. The cost to the College of Medicine and Life Sciences
to cover the over cap expenses is in excess of $ 2 million each year.
As you and your colleagues are presented with approaches for re-structuring of GME funding,
we support targeting funding to not only primary care but also other in-demand specialties
which are necessary for primary care doctors to have available for their patients. Further, we ask
that you consider the innovative and long term public- private partnership of The University of
Toledo College of Medicine and Life Sciences with ProMedica Health System and support
additional funding to the current state GME program, as well as capital project funding for
transition to small group learning space that will endure with the partnership.
1
Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections From 2013 to 2025.
Washington, DC: Association of American Medical Colleges, March 2015.