From the Dean: Hellos and goodbyes

This has been a busy week at your UND School of Medicine & Health Sciences, largely related to the arrival last week of the 78 freshman medical students in the Class of 2026. This past Wednesday, Susan and I hosted a reception for the new students, as has been our custom over the years. We held the event outside in the newly renovated garden at the North Dakota Museum of Art across from Twamley Hall on the main campus. It was a really enjoyable event, and we were fortunate to have nice weather. Susan and I made the rounds, separately, so we could each chat with all of the students. The discussions included many topics, including career choices, how to balance work and family, and health care policy. During one discussion about career options, one student asked me about the apparent “bottleneck” (his word) in the transition from medical school to residency (post-MD training required for state licensure) across the country. He was referring to the relative decrease in the number of residency slots compared with the number graduating medical students over the past decade or so. This has occurred because of a significantly greater increase in the number of graduating medical students relative to the growth in the number of available residency slots. Hence, a bottleneck in career pathways.

So why hasn’t the number of residency slots across the country grown appropriately? It turns out – not surprisingly – that the main answer is “money.” Most residency slots are financed through the federal Medicare program, and there hasn’t been sufficient growth in Medicare residency funding to meet the increased demand. Fortunately, we in North Dakota haven’t waited for a federal solution to this dilemma, but have instead fashioned our own North Dakotan solution. Thanks to generous funding from the state legislature for our Healthcare Workforce Initiative, we have been able to add residency slots within the state to significantly augment the federally funded slots. We are now up to a total of 36 residency slots each year since we initiated the program in 2011, and will be able to ramp up to 48 slots total each year over the next three years. This effort has been buttressed by the willingness of Sanford Health to independently fund a variety of UND-sponsored residency slots. The net result is that much of the bottleneck has been eliminated for medical student graduates who match with an in-state residency.

Later today, we will sponsor a variety of Family Day events for the families and friends of the new medical students so they can gain a greater appreciation of what the students can expect over their next four years here. In my presentation, I’ll talk a little about the history of the School, our mission today, and where we hope to go in the future. You can review the slides I’ll use in the presentation here. One of the issues that is sure to be on the minds of many of the Family Day attendees will be the cost of medical education and the resultant debt load of many students. As you probably know, the School has focused in particular on the issue of student debt over the past decade or so. Back then, the average debt that our students had at graduation was significantly greater than that for students at most medical schools; our students were around the 75^th percentile level, meaning that only about one-quarter of medical students nationwide had higher debt. Through focused action, we were able to substantially reduce our students’ average debt so that about five years ago we were down to about the 30^th percentile, meaning that more than two-thirds of the medical students across the country had greater debt. But over the past five years we’ve slipped a bit, and we are now up to about the 40^th percentile, meaning that our students’ debt relative to that of other medical students has increased somewhat. Accordingly, we’ve been talking with Jeff Dodson, Director of Development for the School, in conjunction with the UND Alumni Association and Foundation and its leadership, about an even stronger push for enhanced philanthropy so that we can offer even more scholarships for our students. Thanks to the incredible generosity of our benefactors, friends, and supporters in the past, I suspect that we will see the curve of the cumulative debt of our students starting to bend in a positive direction soon. This year, for example, the SMHS had its most successful year ever in terms of total philanthropic donations. Thank you all for your generosity and commitment to UND and the SMHS!

Finally, yesterday Susan and I attended a somewhat bittersweet event. It was the farewell party for Jed Shivers, UND’s vice president for finance and operations and chief operating officer. Today is Jed’s last day at UND, as he will be transitioning to a similar position at Stony Brook University in New York. Over the past four years Jed has been an incredible colleague and collaborator as we worked together to make the SMHS and UND even better places. I am especially pleased at how successful Jed has been here since I chaired the search committee that named him as one of the three finalists before being selected by then UND President Kennedy. I’m sure Jed will do as terrific a job in New York as he has done here. And fortunately, the operation that he oversaw will be in good hands starting on Monday under the next Vice President for Finance and Operations and Chief Operating Officer, Karla Mongeon-Stewart. Karla currently is the associate vice president for finance, and I’ve worked quite productively with her over the past seven years that she has been at UND. Thus, I am confident that she will do a great job going forward! Congratulations Karla, and best wishes, Jed!

(Correction: Thanks to Mary Coleman, assistant professor of medical laboratory science, who pointed out that the manufacturer of the BinaxNOW home testing kit for SARS-CoV-2 is Abbott, not Pfizer, as I misstated in last week’s column.)

Joshua Wynne, MD, MBA, MPH
Vice President for Health Affairs, UND
Dean, UND School of Medicine & Health Sciences