The first class of the new four-year medical school at East Carolina University enrolled in 1977, and the mission of the school had been clearly stated by lawmakers who approved it: Boost the number of family physicians in the state, improve the health of people in the Eastern North Carolina and provide access to a medical education for minorities and other students who might have found that prohibitive.
It is fair to say this fine school, now called the Brody School of Medicine, has done its part and then some. It has stayed true to its mission and has done what its leaders were promising since ECU officials started campaigning for the school years before it was approved and opened.
Dr. Paul Cunningham, the dean, is a person of compassion and commitment to that mission, a great leader. But now the school is in need of an infusion of state money, $8 million this year and an additional $30 million a year in the future. Those figures come from ECU Chancellor Steve Ballard.
It is a fair request.
Value beyond dollars
Cunningham, who travels the rural areas of Eastern North Carolina that are served by the Brody School, is one who tries to impress on public officials that the value of the medical school isn’t something that can be measured in numbers, in revenues from clinics associated with the school or its associated hospital, Vidant Medical Center, for example.
One of the school’s missions, after all, is to care for poor people, and many of those people, who haven’t had access to preventive medical care, also happen to be very sick. They can’t pay, but their care is expensive.
It’s a formula that doesn’t do much for the bottom line but does quite a bit in terms of helping people in an area of the state with much need.
Something else that doesn’t do much for the bottom line is the state’s failure to expand Medicaid, the federal/state insurance program for the poor and disabled. Though Medicaid fees have been reduced, another problem for Brody and the doctors who are in its clinics, the money at least offsets some costs as opposed to treating people who can pay nothing.
Under the Affordable Care Act, states were allowed to expand Medicaid, with the federal government picking up all the expense for three years, and 90 percent of it thereafter. But North Carolina’s Republican leaders in control of the General Assembly have declined to allow perhaps 500,000 more North Carolinians to be covered with Medicaid. Their excuse seems to be that the state can’t afford the extra expense and the federal government may renege on its promise to pay at least 90 percent of the cost.
Without more help from the state, the Brody School will face an uncertain future.
Broader funding needed
The president of Vidant, the university’s partner, says the hospital bolsters the medical school, but adds that, “only so much of that can go on.” Brian Floyd added, “You can’t run a whole (public) medical school on clinical dollars. You have to have education dollars from the state.”
The News & Observer reported that the school has critics who claim it hasn’t been efficient in terms of operational expenses and has bought private practices it should not have.
But certainly it appears a lot of the troubles are due to inadequate state appropriations and the loss of potential Medicaid funding.
In addition, lawmakers limited the way medical schools could pursue patients who didn’t pay. Taking those limits away presumably could bring in more revenue, but Adam Linker, a health care expert with the N.C. Justice Center, said that would be at the expense of poor people.
Given revenue shortfalls, it’s not a good year for additional appropriations. But the Brody School should not be punished, in effect, for doing everything it can to keep the promises it made upon its creation.