Regroup. Revisit. Then return.
That's the formula the UND School of Medicine should adopt now that Gov. Jack Dalrymple has decided not to include the school's expansion in his proposed budget.
** Regroup. Because of Dalrymple's decision, the project's odds of winning approval by the 2011 Legislature are not zero -- but they're close.
At the same time, the decision was not the project's death knell. Passage in the 2013 session remains quite possible, Dalrymple said Thursday in an interview with the Herald's editorial board.
Especially if the project ranks higher on that year's Board of Higher Education priority list.
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The project ranked fifth on this year's list but would have cost more than the first four priorities combined, Dalrymple pointed out. That's big money, and in order for the spending to be justified by the state, it's got to be listed at or near the top of the board's list.
So, UND and UND medical school officials need to take this information and regroup. Here's their first decision: Do we try to win passage in this year's session, or do we wait?
Given the now-long odds against passage in 2011 -- it seems unlikely that lawmakers will rally to support an expensive, Grand Forks-centered project that the governor downplays -- officials probably could better use their time by talking to lawmakers about the project and getting feedback.
Then that feedback could be incorporated into a revised project for 2013.
** Revisit. The revision could be important. After all, if the logic and data behind this year's project weren't compelling enough, why will conditions be different in two years?
True, North Dakota at that point probably will have two more years of experience with America's strongest budget, building lawmakers' confidence in the state's long-term health. That boosts the odds of the Legislature approving an expansion plan.
Even so, whatever doubts lawmakers and Board of Higher Education members had about this year's plan should be identified -- and the plan revised.
For example, some lawmakers fretted that too few of the new doctors produced by the expanded medical school would stay in the state. But in a fascinating op-ed in November, hospital administrator Richard Failing offered a possible solution: Recruit students from among health care professionals who already call rural areas home.
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"Without degrading its criteria, the UND medical school should look at developing modified admission requirements for the nontraditional students who'd be admitted into these 16 new slots," wrote Failing, chief executive officer of Kittson Memorial Healthcare Center in Hallock, Minn.
"The modified requirements would recognize these applicants may have been out of college for 10 to 12 years."
A five-year versus a four-year curriculum could bring these students fully up to speed. And "the residency then should be highly tailored: For example, the program should bring the physician back to his or her local community as often as possible in order to reinforce the new doctor's previous ties," he wrote.
Another of Failing's ideas: Start an accelerated, first-in-the-nation program to take rural physician assistants and nurse practitioners and train them to be M.D.s.
Speaking of PAs and NPs, that's another issue med school planners could tackle. Does the looming shortage of primary-care practitioners in North Dakota demand physicians and only physicians? Or, could the medical school make physician assistant and nurse practitioner training a bigger part of its expansion plan, thus easing the shortage at significantly lower cost?
That's the kind of creative problem-solving lawmakers and the Board of Higher Education likely would reward. If school officials learn from this year's experience and revise their plans accordingly, they'll boost the odds of their plan winning passage next time around.
** Return. As the governor said, his decision this year on the med school expansion is not the last word. School officials should learn all they can about the state's needs and the Board of Higher Education's priorities -- then come back in 2012 with an even-better vetted and even-more-carefully targeted plan.
-- Tom Dennis for the Herald
