Thefourth meeting of the Subcommittee on Postsecondary Education of the Interim Joint Committee on Education was held on Monday, November 14, 2005, at 10:00 AM, in Room 149 of the Capitol Annex. Senator David L. Williams, Co-Chair, called the meeting to order, and the secretary called the roll.
Members:Senator David L. Williams, Co-Chair; Representative Mary Lou Marzian, Co-Chair; Senators Gerald A. Neal, R. J. Palmer II, Gary Tapp, Johnny Ray Turner, Jack Westwood, and Ken Winters; Representatives Jim DeCesare, C. B. Embry Jr., Bill Farmer, Mary Harper, Reginald K. Meeks, Charles L. Siler, Kathy W. Stein, and Addia Wuchner.
Guests: Mr. Tom Layzell, Dr. Cheryl King and Mr. Reecie Stagnolia, Council on Postsecondary Education (CPE); Mr. Ron Greenberg, Chair, CPE and Mr. John Turner, Vice Chair, CPE; Mr. Clyde Caudill, Jefferson County Public Schools and Kentucky Association of School Administrators; Dr. Lee Todd, President, Dr. Kenneth Roberts, Dean of the College of Pharmacy, Dr. Jay Perman, Dean, College of Medicine, and Dr. Sharon Turner, Dean, College of Dentistry, University of Kentucky; Dr. James Ramsey, President, Dr. Larry Cook, Executive Vice President for Health Affairs, Dr. Mark Pfeifer, Interim Dean for the School of Medicine, and Dr. Rowland Hutchinson, Acting Dean of the School of Dentistry, University of Louisville; and Ms. Kimberly Maffet, Associate Vice President for Workforce Development, Norton Healthcare.
LRC Staff: Jonathan Lowe, Sandy Deaton, and Lisa Moore.
Representative Farmer made a motion to approve the minutes, and Representative DeCesare seconded the motion. The motion was approved by voice vote.
Senator Williams introduced Mr. Ron Greenberg, Chair, CPE, who gave an overview of the process that has been undertaken to review and make changes to the postsecondary education institutional funding model. He described the meetings that have occurred between institutional staff and the CPE council staff under the supervision of the CPE board to see how to provide a better funding model. He believes the proposed model is much improved, but not yet perfect. Mr. Greenberg stated that as part of the review process, the CPE board has asked all university presidents as well as staff of the institutions if they were satisfied with the final assumptions, and have received no objections from any president or institution.
Mr. Greenberg said there would be a request for a 6.8 percent increase in base institutional funding to support operations for each of the two years for the biennium. This is an amount that is needed to keep the institutions on track to meet their goals and to meet most of their needs for the next two years.
Mr. Greenberg said accountability needs to be incorporated using better benchmarks in order to show the legislature how the institutions are making progress toward their goals. He also said there are some public policy issues that need further discussion, such as the importation and the funding of intellectual capital, tuition policies, and remediation issues.
Mr. John Turner, Vice Chair, CPE, said it is important to recognize that the world is not standing still. He said China and India will graduate almost ten times as many engineers as the United States will in a comparable period of time. He stressed that the decisions made today are an investment for the future.
Mr. Tom Layzell, President, CPE, explained the 2006-2008 postsecondary and adult education budget recommendation, as well as the process used to develop the recommendation and the underlying policy issues. He said the request for the base funding of the institutions was increased to $150,621,100, which is about a 13.6 percent increase. He said the overall request for general funds is about $193 million, or an increase of just under 18 percent over the biennium. He said there is another $63 million in capital requests. A complete detailed analysis of the budget request is located in the members' meeting folders. Meeting materials are filed in the Legislative Research Commission (LRC) library.
Mr. Layzell explained the process used to review and revise CPE funding policies. He said the council reviewed all major funding policies over the past year and a half in a process that involved over 100 meetings and two intensive multiple day retreats. This process included broad participation from council members, presidents of the institutions, chief budget officers, Governor's budget staff, and legislative staff.
Mr. Layzell said there were four major components of the request. They were: 1) the base funding, which uses a benchmark model. The request seeks funding for each institution above the benchmark average within the next four years to facilitate achievement of House Bill 1 goals. He said policy changes include a refined selection of benchmark institutions, changes to the distribution policy, an addition of a performance component to the funding model, changes in the treatment of tuition and fee revenue in the funding model, and a funding objective to get institutions at 105 percent of their benchmark average; 2) capital construction, for which the council developed a priority ranking model to evaluate projects based on CPE's statewide public agenda; 3) strategic trust funds and incentive funding programs that address key parts of the reform effort that are in addition to base and capital funding; and 4) institutional special initiatives, which is funding for specific institutional programs not covered in the base funding recommendation.
Mr. Layzell said one of the key elements of House Bill 1 was the creation of six strategic trust funds to address key parts of the postsecondary agenda. He said money has been requested for the research challenge trust fund, regional stewardship program, workforce development trust fund, and increased funding for adult education.
Mr. Layzell said the research challenge trust fund has goals for both the University of Kentucky (UK) and the University of Louisville (U of L) to become nationally recognized research institutions. These institutions will be expensive to develop, and another $34 million will be requested for "Bucks for Brains" to be used for research infrastructure, including the hiring of research faculty, renovations of lab space, and equipment purchases.
Senator Williams asked if the budget request reflects the intention of the council and the institutions to make additional requests for appropriations for "Bucks for Brains" in every budget from this point forward. Mr. Layzell said yes, the request includes $22 million for "Bucks for Brains." Senator Williams asked for a breakdown of the other components. Mr. Layzell said $18 million is non-recurring for research support, lab renovations, and equipment purchases. He said $4 million is recurring, which is for hiring research faculty in strategic areas to build up the research infrastructure.
Mr. Layzell said the regional stewardship is an initiative that was originally in the 2004 to 2006 budget request, and is a unique initiative in the country. He said Northern Kentucky University (NKU) is one of the leading institutions in the country in implementing a regional stewardship model. He said the notion behind the regional stewardship is that comprehensive institutions have a particular responsibility to the regions in which they are located. This across the board responsibility includes such activities as helping economic development agencies, K-12 institutions, not-for-profit businesses, local businesses, and local governments in ways that traditionally institutions have not addressed.
Mr. Layzell said the CPE is trying to work with the Kentucky Community and Technical College System (KCTCS) to develop programs and financial aid assistance through the workforce development fund to ramp up the transfers. He said more students have to come from KCTCS to the four-year institutions in order to meet the goals of degree production by 2014.
Mr. Layzell said more funding is needed for the adult education program, as funding on a per-student basis is well below the national average. The program has shown enormous success, but it needs more funding as Kentucky tries to face this great challenge within the Commonwealth.
Mr. Layzell said funding is also being requested for special initiatives not funded through base budgets, capital requests, or incentive trust funds. He said the selective special initiatives are: 1) the principal leadership institute; 2) retention and affordability; 3) the Kentucky Academy of Math and Science; 4) the 2+2 Middle School Math and Science Teacher Preparation Program; 5) Kentucky School of Craft; and 6) the University Center of the Mountains.
Mr. Layzell said the capital budget is broken into four major pieces. He said a $15 million pool is for capital renewal and maintenance. He said there are 15 education and general fund projects, which are essentially instructional, totaling $296,820,700, and four research and economic development projects for $170,322,000. He said there is also $25,000,000 targeted for information and technical equipment purchases.
Mr. Layzell explained the statewide capital projects evaluation model. The model evaluates projects based on the following five criteria: 1) the project directly supports House Bill 1 goals, the public agenda, and state economic development goals; 2) the project supports the institution's CPE approved mission and is a high priority; 3) provides for the completion of projects authorized in a prior biennium and which, if not funded, will compromise the viability of the phased facility; 4) the postsecondary system's Space Utilization Standards and Space Needs Model indicate a need for additional space or there is a specific need to remodel or replace existing space; and 5) the project significantly reduces the capital renewal and maintenance burden and the institution has demonstrated good stewardship through evidence of facility renewal and systems maintenance.
Mr. Layzell gave comparisons of the total public funds revenue for the Kentucky public postsecondary institutions for fiscal year 1999 and fiscal year 2006. He said Kentucky is at a point today where 46 percent of the public funds are represented by tuition revenue compared to 33 percent in 1999. He also discussed funding trends per full time equivalent for students, and for adult education.
Mr. Layzell said over the next 15 years, Kentucky will need to double the number of Kentuckians with at least a bachelor's degree from 400,000 to approximately 800,000. It is estimated that in 2020 Kentucky will have approximately 580,000 baccalaureate degree holders if historical trends continue. This would leave the state short of its goal by more than 200,000 degree holders. In order to plug this gap, the postsecondary system must: recruit and enroll more students; ensure more students persist to certificate and degree completion; and keep graduates living and working in the state.
Mr. Layzell said that in addition, over the next five years, Kentucky must more than double Kentucky adult education enrollment from 120,000 to 300,000 to significantly decrease the number of Kentuckians at the lowest literacy levels.
Mr. Layzell said according to a recent Kentucky Long-Term Policy Research Center analysis, the state could expect a cumulative increase of more than $5 billion in revenue and individuals could expect an increase of $71 billion in personal income if Kentucky reaches the national average in educational attainment by 2020. He also said higher levels of educational attainment means lower crime rates, increased quality of civic life, improved health and life expectancy and a more engaged citizenry.
Mr. Layzell said working its way through the Education Cabinet is a joint budget request for the CPE, the Kentucky Department of Education (KDE), and the Education Professional Standards Board (EPSB), which is a first joint budget request for all three agencies to come together to deal with some common problems and cut across all the various jurisdictions. He also said the Kentucky Higher Education Assistance Authority (KHEAA) will be requesting financial aid somewhere in the range of $77 million for both need-based aid and the Kentucky Educational Excellence Scholarship (KEES) funds.
Senator Westwood asked whose responsibility it is to pay for remediation. Mr. Layzell said the CPE would be discussing this issue over the course of next year, but said about 40 percent of Kentucky students who enter the public postsecondary universities require at least one remedial course, and close to three quarters of the students entering KCTCS. He said this is a top priority of Chairman Greenberg for the council, and it will be discussing whether some charges should be levied against the school districts, but regardless, the remediation rates need to lower. He also said school districts will note that the postsecondary institutions sent them the teachers, and he said teacher preparation programs need to be strengthened.
Chairman Greenberg said the CPE council is in the process of looking to identify the areas where the greatest remediation is coming from. He said the purpose is to tie that back to the teacher preparation programs to see what systems need additional support, and to be able to hold the postsecondary institutions accountable for producing betters teachers, and link this to school districts for being accountable for producing better students.
Mr. Layzell said there is one item in the joint budget request that deals with data systems. He said this was the first year that the K-12 system assigned a unique student identifier for each student in the system. The first of those students will hit the postsecondary campuses next fall, and they are in various stages of readiness at the universities to get the maximum use of the student identifier, which is an attempt to be able to track back to the individual schools.
Senator Westwood said remediation is a concern that the Interim Joint Committee on Education has had for a long time, and it will a massive job to correct, as the levels are very high. He would like to get a sense of how much higher the rates are in Kentucky as opposed to other states. He said there are many issues to discuss before deciding how to address the issue with teacher preparation being an important one, and the principal leadership being another one. Mr. Layzell said the biggest need in remediation is in the area of mathematics.
Representative Farmer asked where Kentucky stands relative to other states on remediation rates. Mr. Layzell said there are a couple of comparative measures. A national comparison shows that for every 100 ninth graders, only 18 will graduate from college in a timely fashion. In Kentucky, that number is 15, which neither statistic is very good. He also said ACT data shows Kentucky to be very comparable to the national average, and every state has huge remediation needs largely in the area of mathematics.
Mr. Turner said benchmarking in the United States is wrong because this is a global problem. He said 50 percent of all the students in science technology, engineering, and math at postsecondary institutions in the United States are not United States citizens.
Representative Wuchner said she is concerned there are limited numbers of students from Kentucky and the United States enrolling in the engineering program at UK. She said it concerns her that Kentucky institutions are not graduating students that can compete in its centers of higher education, especially in the fields of engineering and mathematics. She has been surveying teachers and university professors who teach remediation in math, and she has discovered that shockingly, they report students come into higher education with a level of preparedness for mathematics at ninth grade at best.
Senator Winters expressed concern that UK should adequately fund the engineering education program, or abolish it. He said the Kentucky needs to think outside the box, or build a new box, for the areas of science and math. He said the performance of students needs to be examined beginning at the middle school level, and students should be nurtured at that time based upon their strengths. He commended the agencies for the joint budget request from the CPE, KDE, and the EPSB, and said it is a gigantic step forward in a collaborative effort to deal with the internal problems. He also said teacher preparation programs need assistance, and there may be too many elementary teachers, and not enough specialty teachers in middle and high school.
Senator Williams said Kentucky has a huge deficiency in the area of math, which leads to the deficiencies in science. He believes the General Assembly has already started to address the problem with early intervention programs for students struggling with math. He recently took a trip to China with other senators and said they look at the American education system as a model, so it is not all discouraging news. He would further say that the number of engineers in China is misleading, because the quality of the engineers in China is probably equivalent to engineering technology degrees in the United States. He said another point is that foreigners in the classroom today will be Americans in ten years.
Representative Marzian said education has been flat-funded or under-funded in the last couple of legislative sessions. Did this have an affect on the universities reaching their benchmarks and UK becoming a top 20 research university? Mr. Layzell said the universities had to increase tuition, and enrollment has continued to grow, but not as rapidly. He said UK has embarked upon a comprehensive study of what it will take to become a top 20 public research institution, and will share this information at their December meeting with specific benchmarks in order to reach the goal. He said this a crucial session for funding for education in order to meet benchmark goals.
Representative Marzian said women make up 56 percent of the population enrolled in higher education. She asked if there was funding provided in the budget request to provide childcare at the universities. Mr. Layzell said there is no funding targeted for childcare, but the benchmark funding could be used for this.
Senator Neal asked how crucial funding is for this upcoming session. Will Kentucky be completely out of the game if adequate funding is not provided? Mr. Layzell said Kentucky took a bold step in 1997 to improve Kentucky's levels of educational attainment, to keep the economy growing, and to keep from getting too far behind other states. Kentucky has made great progress since 1997, but there is more work to do to meet the goals and attract jobs to the state that help the economy. Mr. Layzell said Kentucky will be right back where they were in 1997, and behind nationally and inter-nationally, if funding is not increased. Senator Neal said members should take note of the urgency for action.
Chairman Greenberg said he read a recent newspaper article that showed Kentucky students are well below the national average for computer utilization. He said many Kentucky families still do not have access to a computer or the internet. He said there have been small pockets of success in the area of health sciences, engineering, and pharmacy. He also said there is still a large part of the state that does not value education, and if some remedial progress is not made in the programming, Kentucky will be where it was in 1997.
Senator Williams asked what he meant by a large part of the state does not value education. He said a more appropriate statement would be to say a large part of the population, not the state. He said it is hard to generalize about different parts of the state.
Senator Williams introduced Dr. Lee Todd, President, UK, and Dr. Kenneth Roberts, Dean of the College of Pharmacy, UK to give a status report on the pharmacy, medical, and dental schools at UK. Dr. Todd also introduced Dr. Jay Perman, Dean of the UK College of Medicine, and Dr. Sharon Turner, Dean of the UK College of Dentistry.
Dr. Todd discussed the number of applications that the university had received for its dentistry, medicine, and pharmacy schools. He said 1,225 applied for the dentistry program, and 55 were admitted; 1,002 applied for the medicine program, and 103 were admitted, and 998 applied for the pharmacy program, with 131 admitted.
Senator Williams asked how many of the applicants were capable people that could have participated in the programs had space been available. Dr. Roberts said he interviewed approximately 240 students at the admissions committee in the pharmacy program that were deemed to have the academic credentials to be qualified to be admitted to the college.
Senator Williams asked if there was subjective criteria used to determine qualification or was there another group of people that could very well be successful in the programs. Dr. Roberts said all 240 applicants were interviewed, and he could have interviewed others beyond the 240 applicants, if the capacity was in place to interview all those people. He said it was a labor-intensive process that consumed the time of 50 faculty and students.
Senator Williams said he was surprised that 119 of the 131 applicants accepted into the pharmacy school were Kentuckians. Dr. Roberts said over 90 percent of the students who have been admitted into the program over the last ten to twelve years have been Kentuckians and this was intentional.
Dr. Todd said all the programs have a high percentage of first time pass rates. He said 100 percent of the students in the pharmacy program had first time pass rates, and 81 percent of the graduates stay and practice in Kentucky.
Dr. Todd discussed faculty and program quality. He said the College of Pharmacy was ranked 8th of 92 pharmacy schools in the United States, slipping from third in the nation, because of the quality of the facility. He said North Carolina was ranked 11th and moved up to the 3rd in the nation largely because their facility has four times the square footage in UK's College of Pharmacy. He said 134 of the full-time faculty in the College of Medicine have National Institute of Health (NIH) grants and produced over 2,543 publications in 2004-2005. He said the "Bucks for Brains" program had a tremendous impact with 119 endowed chairs and professorships. He also said five basic science and four clinical departments ranked among the top 20 nationally in NIH funding. He said there are nine endowed professorships in the College of Pharmacy.
Senator Williams asked about the ratio between students and faculty. He said based on the handouts, there are 640 full-time faculty for the College of Medicine with a total enrollment of around 1,300, and wondered what type of things some of the faculty were involved with outside of instruction. Dr. Perman said the faculty has a very diverse range of interests and activities, but virtually everybody teaches. He said the basic science teachers and clinicians are all involved in teaching. He also said faculty are heavily engaged in patient care both at the center and throughout central and eastern Kentucky. He said a good number of faculty spend a good deal of their time in research to advance healthcare. The NIH dollars are attractive to the Commonwealth, but they do demand intense time in the laboratory.
Dr. Todd discussed the productivity of the programs. He said one way to measure productivity is to look at the number of practitioners supplied to the state. He said 40 percent of all Kentucky dentists practice in Kentucky, 12 percent of graduates of the College of Medicine are Kentucky practitioners, and 80 percents of pharmacy graduates are Kentucky practitioners probably because UK has the only College of Pharmacy in the state.
Dr. Todd said outreach is extremely important for a flagship university. There are more than 100,000 patient visits per year in dentistry, 161 outreach sites and four Area Health Education Centers that provide health education to citizens located in Hazard, Morehead, Park Hills, and Rockcastle County, and 4,020 community service hours are required by pharmacy students. He also said there are pilot outreach programs throughout Kentucky in diabetes, pain management, and substance abuse. Dr. Todd said through administrative and health literacy initiatives over the last three years, the cost of the university's health benefits increased an average of 7.96 percent per year, and the national average was 11.27 percent. Without these initiatives, UK would have paid an estimated additional $6.4 million.
Senator Williams asked about the interaction between the Colleges of Dentistry, Medicine, and Pharmacy. Dr. Roberts said his faculty have over 15 collaborations in terms of research both in the pharmaceutical sciences and pharmacy practice departments, as well as pharmacists that are associated with the clinical departments in the College of Medicine throughout the hospital and in the Kentucky Clinic.
Senator Williams asked the panel if they thought it was crucial to have that sort of collaboration between the medical and dental colleges. Dr. Perman said that in today's environment, interdisciplinary care has to be the norm, and it is becoming increasingly clear to the deanships that venues need to be created to teach these students together so they know how to practice together out in the community.
Senator Williams asked Dr. Roberts what type of relationship that UK's College of Pharmacy has with the U of L's College of Medicine and Dentistry. Dr. Roberts said he does not have any relationship with the medical school, but has a wonderful relationship with the U of L hospital's Department of Pharmacy. Senator Williams said he would like to see partnerships formed between the three colleges.
Dr. Todd mentioned the upcoming initiative involving satellite operations, which would allow fourth year students to do the practicums in the locations where they will work. Senator Williams said it was anticipated in the higher education reform for doctors, nurses, and pharmacists to be educated together and have cooperation and interaction between them.
Dr. Turner described the partnerships being formed to fight the meth problem in the state. She said the College of Dentistry is working with people in the health sciences schools, the College of Education, Agriculture, and Journalism to study the meth problem. She said everyone is working together to educate the public, health providers, public school teachers, and first responders.
Dr. Todd said UK's dentistry department had $8.3 million in funded research in 2004 to 2005, which was an increase from $2,316,000 in 1997; medicine had $122 million in funded research, which was an increase from $46.7 million in 1997, including $39.5 million in cancer related research; and there was more than $18 million in grants and contracts in 2004-2005, which was up from $5.5 million in 2000. The NIH funding has increased 400 percent in the past five years.
Senator Williams asked what sort of pharmaceutical research is conducted at an institution without a College of Pharmacy. Dr. Roberts said there is some pharmacy research conducted in the College of Medicine, the College of Dentistry, and other departments. Dr. Perman said the cancer initiatives would suffer if not for the collegiality and collaboration with the College of Pharmacy. Senator Williams asked what institutions do that do not have Colleges of Pharmacy. Dr. Perman said they may collaborate beyond the institution, or they do not do the kind of cancer related research that involves drug development. Dr. Roberts said that for example, Vanderbilt University and Washington University have come to UK's faculty of the College of Pharmacy for a $8.6 million collaborative grant just last year because they did not have the pharmaceutical expertise.
Dr. Todd said he believes Senator Williams is making the point that Kentucky needs research centers that collaborate with other institutions who do not have those centers, and he said UK and U of L have over 100 collaborative projects together right now. Senator Williams said UK should share its resource of the nationally recognized College of Pharmacy with other institutions.
Dr. Todd discussed the economic impact of the three colleges. He said the College of Dentistry has produced three patents and two start-up companies. He said there is a nine to one leveraging of state money in medicine for other income sources, and have conducted $689 million in research funding since 1997. There have been 17 start-up companies in the College of Pharmacy, and one just raised $51 million of venture capital. He said 27 of the 156 patents that have been issued to UK in the past six years have come out of pharmacy. He said there is also a Center for Pharmaceutical Science and Technology that will provide new manufacturing jobs and is projected to have $15 million in revenue by 2010.
Dr. Todd said UK has two capital construction projects that are priorities. One is the completion of the pharmacy biology complex, and the other is to have the bonding authority and the ability to spend agency funds to finish the medical complex.
Dr. Todd discussed the accomplishment of the UK HealthCare. They were: 1) completed a comprehensive strategic, facilities, and financial plan to move towards top 20 status as an academic medical center; 2) revenue growth of nearly $100 million; 3) a 13 percent increase in patients served in the last year; and 4) over 700 new jobs created in the last two years.
Dr. Todd said UK HealthCare will handle an increase from 22,269 patient discharges in fiscal year 2005 to an estimated 25,014 in fiscal year 2010, and 28,224 in fiscal year 2016. It will increase medical research substantially beyond the current $100 million annually, and will create 1,600 construction jobs and 1,300 permanent jobs. It will also generate $159 million in economic activity during construction and $92 million annually when the project is completed.
Dr. Todd said Kentucky has an aging population, with one-quarter of the population being between 41 and 59 years old. These Kentuckians are among the largest users of medications in the United States and will be for the coming decades. In 2003, the average number of prescriptions per capita in the United States was 10.7, and 15.5 in Kentucky.
Dr. Todd said the United States over-65 population will double by 2030 and use three times the number of medications, and the United States needs 150,000 more pharmacists to handle current demand. Kentucky currently imports 50 to 60 pharmacists per year. He said with the construction of the Biological/Pharmaceutical Complex and through the establishment of Clinical Education Centers across Kentucky, UK will have the capacity to double its enrollments in the College of Pharmacy.
Senator Williams asked what the cost was of starting a College of Pharmacy compared to the start-up costs of the medicine or dental schools. Dr. Roberts said typically is it less expensive than the other schools if it is only going to be for the professional degree; if it a comprehensive program, there will be more equipment needed and expensive faculty.
Senator Williams introduced Dr. James Ramsey, President, Dr. Larry N. Cook, Executive Vice President for Health Affairs, Dr. Mark Pfeifer, Interim Dean for the School of Medicine, and Dr. Rowland Hutchinson, Acting Dean for the School of Dentistry, U of L, to discuss the U of L healthcare professional schools. Dr. Ramsey said the research programs at U of L are not as big as the research programs at UK. He said the goal for U of L's program is to increase economic opportunity and the quality of life for the community and the state. He discussed the loss of manufacturing jobs over the last decade, and said U of L and the community want to build the life science, healthcare, and medical industry in the community to supplement new jobs for economic development and also for healthcare reasons facing the state.
Dr. Ramsey said U of L has four major research priorities within the strategic plan. They are: 1) Life Sciences and Healthcare; 2) Logistics Distribution; 3) Early Childhood; and 4) Entrepreneurship. He said the most emphasis will be placed in the life sciences and healthcare and the research focus will include: cancer; cardiology; pediatrics; organ transplantation; Center for Birth Defects; spinal cord research; genetics of aging; proteomics; Institute for Deterrence of Bioterrism/Biowarfare; and bioengineering.
Senator Williams asked Dr. Ramsey if U of L has faced any impediments as a result of not having a College of Pharmacy on campus. Dr. Ramsey said U of L researchers are doing drug development, with 15 drugs currently being developed in the cancer research center. He said the biggest impediment would be that there is not enough local funding available to move drugs through the clinical trials.
Dr. Ramsey emphasized that 70 percent of federal and non-federal research grants to UK and U of L were for Life Sciences research compared to the average 55 percent for public universities overall. He said U of L is going to focus on the School of Medicine and have placed huge amounts of internal resources and have asked the state for funding for "Bucks for Brains" monies, startup costs, and space for this area.
Dr. Cook discussed the goals of the U of L School of Medicine. They are: 1) to be a vital component in the U of L's quest to be a premier, nationally-recognized, metropolitan research university; 2) to excel in the education of physicians and scientists for careers in teaching, research, patient care, and community service; 3) to bring the fundamental discoveries of our basic and clinical scientists to the bedside; and 4) to provide leading-edge patient care in our community and region.
Dr. Cook said the school had just finished its Liaison Committee on Medical Education (LCME) seven-year accreditation process. The LCME recognized U of L's progress and magnitude of increased funding; increases in research facilities and faculty; the empowerment of students; the five teaching hospitals available; the Patient Simulation Center and Standardized Patient Center, which is one of the largest programs in the nation and provides students with clinical exposure in all four years of the program; and the LCME recognized the exemplary appointment, tenure, promotion, and faculty review process.
Dr. Cook discussed sources of funds for U of L's School of Medicine. He said 40 percent of funding comes from professional fee income, 18 percent comes from affiliated hospital support, and 8 percent of funding comes from the Commonwealth itself.
Dr. Cook said there are 150 students per medical class with almost 600 medical students and 242 graduate students. He said there is a new M.D. and Ph.D. program that is growing rapidly, and 48 accredited residency programs.
Dr. Cook discussed student demographics and said both UK and U of L have experienced a modest downturn in female medical students. He said 81 percent of the students are from Kentucky, and 19 percent are from out-of-state. He also said that half of the graduates of the school are practicing in Kentucky and Southern Indiana after 10 years post-graduation, with about 40 percent of graduates locating in rural locations, and 60 percent are locating in the urban areas of Kentucky.
Dr. Cook said there are eight Kentucky Area Health Education Centers (AHEC) sites in Western Kentucky run by U of L, and all medical students must complete rural AHEC rotations in their third and fourth years and select other AHEC rotations as electives. There is a wonderful family medicine residency program in the Glasgow that trains physicians for practice in rural-based communities that spans several counties and supports nearly 200,000 people. He also said there is a very unique program at the Trover Clinic where five to ten percent of the classes are rotated in their third and fourth years.
Dr. Cook discussed workforce trends in Kentucky. They are that: 1) Kentucky ranks 35th in the nation in physicians per capita; 2) Kentucky has 60 active primary care physicians per 100,000 population, lower than the national rate of 69; 3) Kentucky ranks 26th in medical school graduates per capita; 4) Kentucky is well below the national average in the number of mental health professionals per capita, the shortage of psychiatrists is particularly acute; 5) The Commonwealth's physician workforce is aging; and 6) Other challenges include encouraging diversity and rural practice as well as professional liability insurance.
Dr. Cook discussed the goals of the U of L School of Dentistry. They are: 1) to educate and develop competent general dentists and allied dental professionals; 2) to provide quality dental care; 3) to provide life-long learning opportunities for dental professionals; 4) to advance knowledge through research; and 5) to serve the profession, the university, the community and Commonwealth, and the national and international community.
Dr. Cook said the dental program was accredited by the Commission on Dental Accreditation of the American Dental Association in July, 2001. The accredited programs include: dental education; dental hygiene; endodontics; orthodontics and dentofacial orthopedics; periodontics; prosthodontics; and advanced education in general dentistry and dental practice residency.
Dr. Cook said there is a class of 80 dental students with 320 students in cycle. He said there are 60 dental hygiene students, 35 Ph.D. students, and five accredited dental residency programs with 42 residents in them.
Dr. Cook said about two-thirds of the dental graduates engage in primary versus specialty dentistry with about half of the graduates practicing in Kentucky or Southern Indiana ten years post-graduation. The majority of the graduates locate their practices in rural areas.
Dr. Cook said all senior D.M.D students complete required clinical rotations in eight rural AHEC centers in Western Kentucky, and all dental hygiene students also complete AHEC rotations. He said there are about 2,000 patient contacts, most with individuals who are medically underserved.
Dr. Cook discussed the workforce trends. They are: 1) the dental profession as a whole is aging; 2) Kentucky has 54.4 dentists per 100,000 citizens, below the national rate of 63.6; 3) a significant shortage in dental specialties; and 4) a lack of allied dental health professionals.
Dr. Cook said since 1986 more than $12.7 million was allocated to minority recruitment, and there is more than twice the rate of African-American and Hispanic enrollment over the past two decades. In early November, U of L was informed that the Robert Wood Johnson Foundation awarded a $1.18 million grant for a summer medical and dental education program to encourage minority recruits, and there is a very active minority program in the nursing program as well.
Dr. Cook said Kentucky's nursing workforce faces a shortage of baccalaureate nursing graduates and lags the nation in advanced practice nursing graduates by more than six percentage points per 100,000 population. Kentucky joins the nation in facing an overwhelming shortage of public health professional in an era of increasing demand.
Dr. Cook said the U of L hospital serves 14,000 patients annually and 2,000 babies delivered annually. They have the region's only Level 1 trauma center with 41,000 visits last year. It also has the region's first Joint Commission Certified Level 1 stroke center, which treated 250 patients last year.
Dr. Cook said the university hospital provides more than $104 million in charity medical care annually: $30 million is reimbursed by the Quality Care Charity Trust (QCCT) fund, a unique funding arrangement between U of L, Louisville Metro, and the Commonwealth of Kentucky supporting hospital-based medical care for the uninsured in the Louisville region; $39 million is reimbursed by a combination of federal programs; and $35 million is unreimbursed.
Dr. Cook discussed the community clinics and said U of L faculty serve 15,000 children under the Passport Medicaid Managed Care Plan. He said U of L engages in over 1,100 community partnerships.
Dr. Cook said the James Graham Brown Cancer Center has 11,500 outpatient cases each year, and 2,400 inpatient cases. There are outreach programs located in Taylor County, Madisonville, and Owensboro. The melanoma clinic is ranked in top three in the nation, and a one-half cent cigarette tax has been designated for research. He also said the extramural research support will top $45 million in 2005, and there are 14 drugs being developed for cancer drug therapy.
Dr. Cook said space is currently the key limiting factor in research expansion. He said U of L will be asking for funding for another research building in the next legislative cycle.
Representative Marzian asked if any research had been done to study the drop in the number of women in medical school. Dr. Cook said there are no explanations for it at this time, but hopes it is cyclical. Dr. Pfeifer said this problem is more focused in Kentucky than nationally, but UK and U of L have been talking to the medical school counselors who have noticed the drop in the applicant pool.
Representative Marzian noted that Kentucky is six percent lower than others states in the advanced nurse practitioner program and said Kentucky is one of four states where nurse practitioners cannot use their abilities to the fullest because they can not write prescriptions for scheduled drugs. Dr. Cook said U of L values advanced nurse practitioners in academic medical centers and with the resident work hour restrictions, more advanced nurse practitioners are coming on board to help with education and patient care.
Representative Stein said Kentucky seems to discount the importance of dental health and poor oral care has been linked to other health problems such as diabetes, stroke, and heart disease. She has proposed a bill draft for years that would require children entering kindergarten have an oral exam just as they have an eye exam, but it seems that there are not enough dentists across the state that will accept Medicaid. She believes if children can learn about oral care at this critical time then Kentucky would have a healthier population base. Dr. Cook agreed, and said education for children to see their dentist is very important.
Senator Neal asked what is happening in dental schools to recruit minority students. Dr. Rowland said ten percent of entering freshman are African-American in the School of Dentistry, and this exceeds the national level. He said there are active programs in the high school and said the Robert Wood Johnson Foundation is important as well for recruitment for a summer dental education program. Senator Neal asked if they were primarily recruiting students from Kentucky, and they said yes.
Representative Meeks said it is heard that Kentucky is losing the best and brightest students and he said the numbers of 80 and 90 percent staying in Kentucky graduate schools does not appear to back up that notion. Dr. Ramsey said research shows that students who feel like they have to leave Kentucky in order to get a quality education, the likelihood of them returning is greatly diminished. He said both UK and U of L are very focused on recruiting the best students at the undergraduate level. He said the reform has put a renewed emphasis on the state's professional programs and the quality. He said Kentucky is competing, and students do not feel like they have to leave the state in order to get a quality medical education.
Senator Neal asked about minority matriculation in the U of L School of Medicine. Dr. Cook said there was about seven percent in the 2005 class and the Robert Wood Johnson Foundation grant will bring 20 minority pre-dental and 20 minority pre-medical students onto the campus this coming summer.
Senator Williams asked Dr. Cook to look at the research and find out what kind of contractual relationships there are with any other schools of pharmacy, and to see if there is a way to collaborate with UK. He also requested UK to see what sort of outside research is going on.
Senator Williams introduced Ms. Kimberly Maffet, Associate Vice President, Workforce Development, Norton Healthcare, to discuss Kentucky's healthcare workforce challenges and issues. Ms. Maffet said Norton Healthcare has invested many millions of dollars to fund different initiatives addressing the workforce shortages in Kentucky. She said Norton Healthcare is the third largest employer in the state of Kentucky with almost 9,500 employees, and is non-profit. Norton Healthcare also has one of the lowest vacancy rates in the country. There are shortages in nursing, pharmacy, and allied health physical therapy professions.
Ms. Maffet said one initiative to address workforce needs that started in 2000 was a scholarship program called "Norton Healthcare Scholars". It has graduated more than 630 graduate scholars. She said these students are at all universities and colleges in the state of Kentucky and 99 percent of the recipients are from Kentucky.
Ms. Maffet said that in the coming years a large percentage of registered nurses will need to be trained to make up the total workforce demand. She said there is a projected deficit in 2020 of over 800,000 nurses alone.
Ms. Maffet discussed the partnership between Norton Healthcare and the UK School of Pharmacy. She said Norton Healthcare will invest $230,000 to support faculty in the next two years primarily at a satellite facility on U of L's campus. The program will start in the Fall of 2006, and 25 pharmacy students will relocate to the Louisville area in their final year of school. She said the students will have clinical rotations within the five hospitals and adjunct faculty to provide instruction. She also said Norton Healthcare will provide scholarship support to secure pharmacists for Norton's workforce over the next five to ten years.
Ms. Maffet said Norton Healthcare competes with other hospitals, but also with retail pharmacies for the services of pharmacists. She said there are 400 retail pharmacies open in Kentucky, which post an estimated 320 positions annually, in comparison to healthcare facilities, which provide 80 to 90 new and replacement positions annually. She said the projected statewide need is 400 annual vacancies, and 70 pharmacists were imported from out-of-state in 2004. She said retail pharmacies offer higher salaries with bonuses and scholarship payoffs. They also provide better hours with limited weekends, few nights, and pharmacists are not on-call.
Ms. Maffet said demand has pushed pharmacy salaries up. Pharmacy starting salaries have increased 27 percent over the last three years. She said if the salaries continue to rise at this rate, major problems will develop in the future.
Ms. Maffet said Norton Healthcare has invested money to support workforce development initiatives and it carries over throughout the entire state. She said it is important to engage more private industries in collaborations with the universities to increase the workforce and to provide quality care to the citizens of the Commonwealth.
Ms. Maffet said other solutions include the funding of educational initiatives to meet economic development demand, private employers forming partnerships with public and private higher education providers, and concentrated workforce development strategies for the Commonwealth that meets current needs and attracts new business, which ultimately creates new jobs.
Senator Williams commented that there were 400 pharmacy positions available in the state, but only 70 pharmacists are imported out-of-state, and wondered if these people are moving around. Ms. Maffet said they do move around, and healthcare has tried to stay clear of providing bonuses. She said retention is a big issue, and retail pharmacies continue to grow. Senator Williams said the argument could be made that the number of pharmacists being graduated is sufficient to meet the needs. Ms. Maffet said over half of the students that graduate from the College of Pharmacy program are female, and many work part-time.
Senator Neal asked what specifically is driving up the pharmacist salaries. Ms. Maffet said it is the competition, and there is a shortage of graduates to fill these positions.
With no further business before the committee, the meeting adjourned at 12:35 p.m.