Health education: Another budget dilemma

Proposed federal cuts could impact UND’s ability to prepare allied health professionals for service in North Dakota 

A domino effect. That’s how Gayle Roux describes the impact of proposed budget cuts by President Trump’s administration that could slash $5.8 billion from the National Institutes of Health (NIH) in 2018, a 16 percent budget decrease.

The NIH and other federal agencies, also facing cuts, support education, research and training at UND. The budget, which must be passed by Congress, has not yet been finalized.

If enacted, the cuts could impact research, education, enrollment and service to the state, and decrease the number of health providers in North Dakota, especially in rural and tribal communities.

Budget cuts at the state level are also impacting education, research and service.

“Our challenge is to maintain the highest quality outcomes with a balanced budget and affordable costs to students,” said Roux, dean of the College of Nursing and Professional Disciplines. “A federal budget cut could dramatically impact our ability to maintain nursing workforce numbers and to enhance diversity among nurses due to potential cuts to the RAIN (Recruitment and Retention of American Indians Into Nursing) Program.”

Negative impact

“A significant cut would impair our education, research and service functions,” said Joshua Wynne, dean of the School of Medicine and Health Sciences (SMHS).

The SMHS derives 25 percent of its budget from external sources, mainly federal funds, and mostly from the NIH to support research, said Wynne. In fiscal year 2016, the School received $12.3 million from NIH, $7.8 million from the Health Resources and Services Administration (HRSA), and $700,000 from the Indian Health Service (IHS).

The SMHS is known nationally for its work to find solutions for Alzheimer’s disease, Parkinson’s, and other conditions. Faculty researchers also teach students, bringing that knowledge into the classroom. And they also teach students to interpret research and use that information to help patients.

Research, said Wynne, is a requirement for accreditation and is critical in the health professions. “Evidence-based medicine,” he said, “helps physicians better care for patients. We need more effective — and more cost-effective — therapies, and you can only get that through research.”

“The NIH is so important to what we do,” said Wynne. “Research is an integral part of education. You don’t want doctors practicing 1900s medicine.”

Producing results

Highly successful programs that produce results — doctors who completed their degrees with help from the INMED (Indians Into Medicine) program, nurses who took part in RAIN, and those enrolled in INPSYDE (Indians In Psychology Doctoral Education) — could be impacted, along with programs that increase the numbers of healthcare providers in rural North Dakota.

INMED began in the 1970s and is funded by the Indian Health Services with in-kind support from the SMHS. It has been spectacularly successful: one of every five American Indian physicians in the U.S. trained at UND through the program. It’s important to know, said Wynne, that students enter the program and medical school with challenges that many other students don’t have.

“INMED students perform at the same level and pass the same exams,” he explained. “INMED provides financial and cultural support to help students succeed.” INMED also assists American Indian undergraduates in nursing, medical laboratory science, clinical psychology, counseling, dietetics and nutrition, social work, sociology and psychology.

“It’s critically important to maintain —if not augment — money for INMED and other programs that serve American Indians,” said Wynne. “It gives students the opportunity to pursue a career, and they are more likely to go back and address health disparities. These programs help students blossom and grow, and they go back to help their people, increase the health of the population, and serve as role models.”

The RAIN program is funded by HRSA, which focuses on medically underserved populations. The 26-year-old program has graduated 79 percent of American Indian registered nurses in the state who return to practice in rural tribal communities.

Other programs include the North Dakota IDeA (Institutional Development Award) Network of Biomedical Research Excellence at the SMHS, which helps young people, especially tribal members, to become scientists, and INPSYDE.

Rural service

Federal funding also helps both SMHS and Nursing to supply healthcare providers to rural North Dakota, which has experienced severe shortages of physicians, nurses, physical and occupational therapists, nurse anesthetists, dietitians, and other health professionals.

“North Dakota has a very high rate of aging population over 85; our ratio is second in the nation after Florida,” said Roux. “We work to educate and graduate nurses who can respond to North Dakota residents who want to age at home where they have an enhanced quality of life.”

“Cuts in educational training funds will increase student debt, decrease applications from students with social and racial diversity, and lower graduation rates,” she continued. “The No. 1 reason that students who are admitted with a high GPA don’t maintain their grades is that they’re working too much. That lowers our retention and graduation rates.”

“For every physician we educate, the economic impact on that community is $2.25 million,” Wynne said. “If we have 10 more doctors practice in rural North Dakota, the direct economic impact is $22.5 million. The multiplier effect, especially in rural areas, can be enormous.”

“Since its inception, the School has focused on service to the community,” said Wynne. “Federal funding is an essential component of our ability to deliver on our promise to North Dakota. Our purpose, according to the Century Code, is to educate physicians and other healthcare providers for service in North Dakota and to enhance the quality of life of its people. Other purposes include the discovery of knowledge that benefits the people of this state and enhances the quality of their lives. Federal support helps us fulfill that mission.”