Medical School, Center Need Attention, Wilkening Says : Education: New UCI chancellor says they must adapt to change to survive national health care reform. Top issues include how to pay for training, she says.

UC Irvine’s new chancellor said Tuesday that the university’s medical school and UCI Medical Center demand “immediate attention” if they are to survive the era of national health care reform.

“If we are going to survive and be viable in our hospital and medical school, we will have to adapt to change,” said Chancellor Laurel L. Wilkening, who took her new post July 1.

Because of changing state and federal requirements, Wilkening said issues such as the need to graduate more primary care physicians and how to pay for medical training under national health care reform must be given higher priority.

She noted that all medical schools within the California university system, including UCI College of Medicine, are taking steps to increase the number of students in their hospital residency programs for primary care physicians--including internists, family physicians, obstetrician-gynecologists and pediatricians--while cutting back more specialized residency programs.

The medical schools are responding to a mandate from the state university administration and efforts by employers and insurance companies to contain skyrocketing medical costs by having more procedures done by primary care physicians, who charge less than specialists.

Similarly, a push toward such “managed care” by using primary care physicians as “gatekeepers” who refer patients to more specialized treatment only when necessary is expected to be a major aspect of the Clinton Administration’s national health reform package.

In a recent interview, Wilkening said the hospital and medical school top her agenda as chancellor. However, she appeared to ease off that statement Tuesday, saying instead that the two facilities require “immediate attention” to cope with health care reform.

Mary Piccione, executive director of UCI Medical Center, the teaching hospital for the UCI College of Medicine, said Tuesday she is impressed by Wilkening’s interest and knowledge of health care.

“It was very exciting for me that she was interested enough in health care issues to meet with me at the hospital within the first week of her appointment,” said Piccione.

“She asks the right questions in a way that makes you realize she is not just a thinking person but she is someone who will help you implement major programs,” she said. On Tuesday, Wilkening skirted ongoing issues concerning the campus, noting that she is still gathering information and that people closer to the medical school and hospital have more detailed knowledge.

When asked about allegations of sexism in the hiring and promotion practices of the medical school, she said only that she has confidence that the dean of the school, Dr. Walter Henry, was handling the matter.

She showed support for Henry, who recently was under attack by faculty members upset with his leadership.

“From everything I have learned about, I think he is doing a good job,” Wilkening said. “It is hard to be a medical dean these days because there are so many changes that are not under your control but your faculty imagines you can control them.”

Concerned about adequate funding for the medical center, Wilkening said it is unknown whether the Clinton Administration’s national health care reform package will provide a way to reimburse teaching hospitals like UCI Medical Center for the high cost of training new doctors.

Wilkening also anticipates that under the national health care reform, hospitals no longer will be paid for each treatment they provide. Instead, they may be paid a flat monthly fee for each patient they are assigned as part of a managed care network.

Therefore, she predicted that “volume is going to be the name of the game” as hospitals seek more patients.

“That is why in California you see health insurance companies and health care providers joining together to position themselves” for high-volume business, she said.

Donald Hicks, senior associate director of planning and marketing at UCI Medical Center, said the hospital within the last year has begun “actively contracting with a whole bevy of managed care providers” to obtain more patients.

He said while many other hospitals have contracted for years, it is a relatively new marketing tactic for a teaching hospital.

He also said faculty members have formed an organization that is contracting with managed care companies to increase their private clinical practices.

Wilkening said she expects that future standards for evaluating medical schools may place less emphasis on publications and innovative research and more on working with patients.

“It is uncertain in the future what medical schools will look like or how they will be judged,” she said. “The emphasis in national health care reform is not on research but on patient care.”