BILL ANALYSIS                                                                                                                                                                                                    



                                                                     AB 174


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          Date of Hearing:  March 3, 2015


                       ASSEMBLY COMMITTEE ON HIGHER EDUCATION


                                    Medina, Chair


          AB  
                       174 (Gray) - As Amended  February 9, 2015


          SUBJECT:  University of California:  medical education
          
          SUMMARY:  Would appropriate funding to the University of  
          California (UC) to support the UC Merced Programs in Medical  
          Education Program (PRIME) and a study of the creation of a  
          permanent medical school at UC Merced.  Specifically, this bill:  
           

          1)Finds and declares that the federal Patient Protection and  
            Affordable Care Act provides millions of previously uninsured  
            Californians access to health services.  A result of this  
            increased demand is a projected physician shortfall of 17,000  
            by 2015; the San Joaquin Valley faces health care access 31%  
            lower than the rest of the state and many regions are  
            designated Medically Underserved Areas (MUAs); funding the UC  
            Merced Program in Medical Education (PRIME) is key to meeting  
            the region's needs.

          2)Appropriates $1,855,000 from the General Fund to UC each  
            fiscal year, commencing with the 2016-17 fiscal year, for  
            allocation to the UC San Joaquin Valley PRIME to admit up to  
            12 students per year and operate the program with up to 48  
            participants from across the four-year curriculum.

          3)Appropriates $1,000,000 from the General Fund to UC to support  
            a two-year planning effort geared toward the establishment of  
            a traditional medical school at UC Merced.  UC would be  
            required to submit a report to the Legislature by March 1,  
            2019 regarding planning efforts and recommendations for  








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            infrastructure, personnel, and funding necessary for creation.  
              

          FISCAL EFFECT:  Unknown.  However, at least $2,855,000 from the  
          General Fund in direct appropriations to support the programs  
          outlined in this bill.
          
          COMMENTS:  Background on PRIME.  Currently, UC operates the  
          largest health sciences instructional program in the nation,  
          enrolling more than 14,000 students across 17 schools at seven  
          campuses; six are medical schools (Davis, Irvine, Los Angeles,  
          Riverside, San Diego, and San Francisco). 

          In 2004, UC launched a systemwide medical education initiative,  
          Programs in Medical Education (PRIME), intended to help address  
          state needs and focus on the needs of medically underserved  
          communities.  UC Irvine launched the first UC PRIME focusing on  
          the growing needs of California's Latino communities.  Three  
          other UC schools (Davis, San Diego and San Francisco) admitted  
          their first classes in fall 2007 in programs focused on rural  
          health and telemedicine (Davis), health equity (San Diego), and  
          the urban underserved (San Francisco).  In 2008, UCLA launched  
          its PRIME program, training physicians to proactively address  
          the needs of diverse disadvantaged communities by delivering  
          culturally competent clinical care, providing leadership for  
          health delivery systems and conducting research on health  
          disparities.


          UC Merced currently offers degrees in fields that satisfy  
          medical school preparatory requirements and is developing plans  
          intended to lead to a School of Medicine.  In 2010, UC Merced  
          opened a PRIME program in partnership with the UC Davis School  
          of Medicine and UCSF focused the health needs of the San Joaquin  
          Valley.  Students admitted to UC Merced PRIME spend their first  
          two years at the UC Davis campus in Sacramento. The groups'  
          third and fourth years are spent conducting clinical rotations  
          at San Joaquin Valley clinics and hospitals. 

          According to UC, as of the 2014-15 academic year, UC will enroll  
          333 medical students in PRIME.  UC notes, however, that only 78  
          PRIME positions are currently funded by the state.  UC indicates  








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          that a permanent funding source must be identified to continue  
          this enrollment level for PRIME.  This bill would appropriate  
          $1,855,000 from the General Fund to UC each fiscal year,  
          commencing with the 2016-17 fiscal year, for allocation to the  
          UC San Joaquin Valley PRIME to admit up to 12 students per year  
          and operate the program with up to 48 participants from across  
          the four-year curriculum.

          Background on UC Merced.  UC Merced opened with 875 students and  
          60 faculty in 2005, as the tenth UC campus.  As of Fall 2014,  
          enrollment at the Merced campus reached 6,300 students.  The UC  
          Office of the President has been providing interim supplemental  
          support for the campus as the campus grows.  In order to meet  
          the goal of 10,000 students by 2020, UC Merced has embarked on a  
          major initiative to further expand and develop the campus.  The  
          "2020 Project" will require a significant investment of state  
          resources.  

          This bill appropriates $1,000,000 from the General Fund to UC to  
          support a two-year planning effort geared toward the  
          establishment of a traditional medical school at UC Merced.   
          Devoting limited state General Fund resources for the long-term  
          planning necessary for a medical school could divert energy and  
          resources from the development of the core infrastructure  
          necessary for the overall campus to grow.    


          Evaluation of new programs.  Prior to 2011, the California  
          Postsecondary Education Commission (CPEC) was charged with  
          reviewing and making recommendations regarding proposals for new  
          programs at California's public colleges and universities.   
          Specifically, CPEC's review was intended to determine whether  
          the costs of a program are justified by societal need and  
          student demand for that program.  Since the de-funding of CPEC  
          in 2011, no additional state program reviews have occurred.  The  
          Legislature is now placed in the position of examining and  
          reviewing the academic, programmatic, and fiscal implications of  
          new programs.


          Purpose of this bill.  According to the author, "despite its  
          numerous benefits for the region PRIME lacks an ongoing source  








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          of funding for its current enrollment as well as the financial  
          resources to expand capacity to meet the needs of the valley.   
          Additionally, state support is vital to the continued expansion  
          of the campus of UC Merced and to lay the foundation of a new UC  
          Medical School."    



          UC position.  UC has not taken a position on this bill.   
          However, on prior legislation regarding a medical school at UC  
          Merced, UC indicated that it is a higher priority to build the  
          general campus rather than develop a medical program.  UC noted  
          that accreditation by the Liaison Committee for Medical  
          Education (LCME) is required for all Doctor of Medicine programs  
          and that the resources required for accreditation standards are  
          considerable.  Based on the experience with the UC Riverside  
          medical school, UC did not believe that LCME would accredit UC  
          Merced for a medical program without a significant financial  
          contribution. 
           
           Related and prior legislation.  SB 131 (Canella) is virtually  
          identical to this bill and is currently pending in the Senate.   
          AB 2232 (Gray) and  SB 841 (Cannella), of 2014, as introduced,  
          were identical to this bill but subsequently amended to remove  
          the appropriation and accompanying language in support of  
          planning for a medical school.  Both bills were held in the  
          Senate Appropriations Committee. SB 21 (Roth), Chapter 203,  
          Statutes of 2014, requested the School of Medicine at UC  
          Riverside develop a program, consistent with its mission, in  
          conjunction with the health facilities of its medical residency  
          programs, to identify eligible medical residents and to assist  
          those medical residents to apply for physician retention  
          programs, as specified.  

          REGISTERED SUPPORT / OPPOSITION:
          
          Support
          American Federation of State, County and Municipal Employees  
          (AFSCME), AFL-CIO
          
          Opposition
          None on File








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          Analysis Prepared  
          by:              Laura Metune/HIGHER ED./(916) 319-3960