Slow Medicine

On a cold Friday morning as he drove from one meeting to another, Dr. Jose Manuel De La Rosa took a moment to reflect on the 10 years it took to establish a medical school in El Paso.

Medical students are now dissecting cadavers and assessing community medical needs on a sprawling, shiny new campus that sits in the shadow of the Franklin Mountains.

“Persistence pays off,” said De La Rosa, founding dean of the Texas Tech University Paul L. Foster School of Medicine. “You’ve got to be tenacious and persistent and consistent and constant.”

As El Paso begins to wear the new off its hard-won medical school, a second Texas border community is starting on the long road to establishing one of its own. University of Texas System officials are evaluating how long it will take and how much it might cost to start a medical school in the Rio Grande Valley.

Last year, lawmakers approved a bill that gives UT permission to establish a medical school in Harlingen. But that's just the beginning. The measure sets the region on a quest to secure the hefty political and financial support required to complete the massive undertaking. In El Paso, it took more than a decade to get the job done, a decade that was fraught with political fights both local and statewide. Legislators from the Valley said they learned useful lessons from observing the El Paso experience and hope that their path is shorter and smoother. “I think they needed a medical school in that part of the border and that part of the state,” said state Sen. Eddie Lucio Jr., D-Brownsville. “But, quite frankly and quite sincerely, I think the need in the Valley is even greater.”

El Paso Example

El Paso political and business leaders got together in 1998 at an economic conference and decided it was high time the border city had its own medical school. The growing region had few family physicians and even fewer specialists to treat the needy population. Diabetes, obesity, cancer were all rising, but the medical professionals who treat and research those diseases were in short supply.

Initially, even some in El Paso poo-pooed the idea that the long-ignored border city could garner the political and financial capital it would take to establish a first-rate medical school. There were disagreements about where the campus should go, where the money would come from and how, if at all, the two university systems with facilities in El Paso — UT and Texas Tech University — should collaborate. And, of course, there were squabbles about which politicians should take credit for progress on the project and suffer blame for delays.

But advocates of the school, including state Sen. Eliot Shapleigh, D-El Paso, were not easily discouraged. “Never ever give up,” was the message the outgoing senator had for his border colleagues in the Rio Grande Valley.

El Paso started its medical school project with Texas Tech’s two-year medical program already in place. The campus had been educating third- and fourth-year medical students since the early 1970s.

After community leaders made the four-year medical school their main priority, Texas Tech’s board of regents in 1999 voted to make the project their top job, too. Major progress came again in 2001 when J.O. Stewart, a retired wealthy businessman, donated 10 acres for the campus and legislators approved $40 million for the first research building on the campus.

The medical school started rising from the ground when construction of the first research building started in 2003. And with it rose El Pasoans' hopes that what once seemed impossible would become reality. But anticipation that the school would come to life quickly — and bring with it the promised doctors and economic boost — also became one of the hardest things to manage, De La Rosa said. “Our biggest obstacle really was the community and legislators’ expectations that it was sort of a one-shot or one-session project,” he said.

They soon found out it would take more than one shot to get the job done.

With construction underway for the medical school, El Paso lawmakers in 2005 went to the Legislature with designs on getting about $60 million to hire doctors, scientists and researchers to populate the campus. They were disappointed, and so was the community. The funding failure was chalked up to politics. El Paso legislators bickered too much about who would get credit, some said, causing legislative leaders to ignore their requests. Others said the request was rebuffed because the Democratic delegation refused to go along with the pet issues of Republican leaders, primarily then-House Speaker Tom Craddick, of Midland. Whatever the cause, the legislative session ended with no new money to operate the medical school but millions for a new clinic in Midland.

El Paso lawmakers tried again in special legislative sessions in 2005 and 2006. Even though business leaders in the community — campaign donors to Republican leaders like Craddick, Gov. Rick Perry and Lt. Gov. David Dewhurst — beseeched legislators for the funds, the answer was still no.

Finally, in 2007, Craddick agreed to put the El Paso medical school funds in the budget. With much jubilation, lawmakers and Texas Tech officials announced that the campus would accept its inaugural class of four-year medical students in 2009, a year later than initially planned.

De La Rosa said the years of working together to cajole and convince lawmakers from the entire state that El Paso needed a medical school brought the typically fractious legislative delegation a level of unity rarely seen before. “It was the medical school that taught El Paso that a unified voice could get some things done,” he said.

The Valley Vision

There’s no doubt that it’s high time for a medical school in the Rio Grande Valley, too. It’s among the most medically underserved regions of the nation. The area has just 57 doctors for every 100,000 residents. Statewide, there are about 157 doctors per 100,000 residents, and nationally, the average is about 220 doctors per 100,000 people, according the Texas Higher Education Coordinating Board. “The population growth down here and the high level of need in the Valley dictate that a medical school is needed and needed soon,” Sen. Lucio said.

The University of Texas Health Sciences Center in San Antonio already operates the Regional Academic Health Center, or RAHC, a four-campus medical education and research facility Brownsville, Edinburg, McAllen and Harlingen. Each year, 48 third- and fourth-year students finish up medical school in Harlingen.

Ken Shine, vice chancellor of health affairs at the UT System, said staff there is figuring out how much time and money it will take to transform the RAHC into a full-fledged four-year medical school. Even without the completed report, which is expected by the fall, Shine said UT officials have some idea about the difficulty of the task ahead.  “If we’re going to have a medical school in South Texas it has to be a high-quality activity … and that is an expensive proposition,” Shine said. “And finding ways to do that in a situation in which the economy is under pressure and we’re looking to a difficult legislative session in January because of the economy is going to be very challenging.”

Among the first challenges ahead will be establishing enough residency programs for budding doctors. Currently, there are only about a dozen residencies in the area, Shine said. The region needs to have about 50 residency positions available, according to the Higher Education Coordinating Board. Doctors tend to stay in the communities where they complete their residency programs. If the medical school is to improve health care access for South Texas, there must be opportunities for the doctors to stay after graduating.

UT also needs to increase the size of its facilities in Harlingen and the number of students who attend programs there, Shine said. Getting the school off the ground will take at least $12 million from the Legislature, according to the Higher Education Coordinating Board. And once it's up and running, the school will need about $99 million each year in state funds.

Last session's medical school bill, co-authored by Lucio and state Rep. Aaron Peña, D-Edinburg, was a big step forward for the region but didn’t come with any funding to help make the school a reality. Despite projections that lawmakers could be facing a $10 billion to $15 billion budget hole in the 2011 legislative session, Peña said he is hopeful the money for the South Texas medical school will come through next year. “Every session I expect that we will move the ball forward, every session,” he said.

Political problems that plagued the El Paso lawmakers, Peña said, won’t be so problematic for Valley legislators. He said the local legislators have vowed to work together as a region, putting aside provincial mindsets, to secure the medical school. And state leaders, inlcuding House Speaker Joe Straus, R-San Antonio, who was elected in 2009, understand the needs of South Texas and that the area has long been neglected, Peña said. “I think we have the legislative muscle now to where we could have strong influence on the future of things,” he said. “It’s now just a matter of money.”