Unions plan to strike May 21-22.

In response to a request filed by the California Public Employment Relations Board, the state’s labor board responsible for overseeing public sector collective bargaining, Sacramento Superior Court Judge David l. Brown today (May 20) issued an injunction limiting the number of union employees that may strike UC medical centers.

The American Federation of State, County and Municipal Employees, which represents UC patient care workers, has announced it is asking members to strike UC medical centers on May 21-22. AFSCME-represented UC service workers also are expected to strike “in sympathy” with patient care employees. The University Professional and Technical Employees union, which represents UC health care professionals, announced it also is asking its members to strike UC medical centers in sympathy with AFSCME for one day on May 21.

A copy of the injunction is available at www.universityofcalifornia.edu/news/documents/afscme-upte_strike_injunction_052013.pdf.

In bringing the matter to court, PERB issued a formal complaint against the unions asserting that encouraging employees who perform essential functions critical to patient health and safety to strike constitutes an unfair labor practice.

“We appreciate the injunction and PERB’s complaint, even though both are more limited than what we were seeking, as we believe it’s completely inappropriate to put patients in the middle of a labor dispute and jeopardize essential services to them as a negotiating tactic,” said Dwaine Duckett, vice president for systemwide human resources at UC. “Leaders of both unions claim their chief concern is patient care, but it’s very simple: if they strike, services to patients suffer.”

Even with the injunction, Duckett said the threat of an AFSCME strike alone already is impacting patients. For example, UC San Francisco has had to postpone five surgeries for children with complex heart conditions, 12 pediatric chemotherapy infusions and appointments for two women who need operations by fetal treatment center surgeons. At UC Davis Health System more than 45 surgeries, including cancer surgeries, and more than 500 radiological procedures have been postponed. At UC San Diego Medical Center, more than 120 surgeries in orthopedics, ophthalmology, gynecology, cardiac, urology and spine have been postponed, and 60 gastroenterology procedures have been postponed. UC medical centers in Los Angeles and Irvine are having to do likewise. If AFSCME goes through with its strike, it is also expected to affect UC students since AFSCME members work at student health centers.

UC patient care technical employees include technicians responsible for operating equipment for ultrasounds, X-rays, MRIs, CT scans, mammograms and other tests; radiation therapists who prepare and treat cancer patients; pharmacy technicians who deliver medications to patients; respiratory therapists who help patients with breathing and treatment plans; and technicians who sterilize equipment used in surgeries.

UC has been in negotiations with AFSCME since June 2012 over terms of a new labor contract for UC’s patient care employees. The key issue in the negotiations is the union’s ongoing resistance to UC’s pension reforms, which include:

• Increased contributions toward the cost of pension benefits from both UC and employees (currently 10 and 5 percent respectively, increasing to 12 and 6.5 percent respectively July 1, 2013)
• A new category (“tier”) of pension benefits for employees hired on or after July 1, 2013
• Revised eligibility rules for retiree health benefits

Eight UC unions representing 14 bargaining units have agreed to UC’s pension reforms, which also apply to faculty and non-union staff hired on or after July 1, 2013.

UC’s pension reforms are similar to what has been implemented for state employees, some of whom are represented by AFSCME.

Like many other employers, including the state of California, UC is enacting substantive pension reforms to help the university address a $24 billion unfunded pension plan liability, and enable it to continue offering employees financially sustainable pension benefits.

UC is offering AFSCME a four-year contract for UC patient care employees that includes:

• Up to 3.5 percent wage increase per year for four years. These increases are on top of at least 5 percent increases patient care employees received in each of the past two years, at a time when many other UC employees received less or no increases at all.
• Excellent health care benefits now and upon retirement. Retiree health care is a benefit that few public or private organizations nationwide still offer.
• Pension benefits that few public or private organizations nationwide offer
• Good working conditions and a satisfying work environment

The average salary of all AFSCME patient care employees is $55,000. Average salaries for specific patient care positions include:

$96,265 — Respiratory Therapist

$90,626 — Radiologist Technologist

$59,654 — Vocational Nurse

The average salary of all UPTE health care employees is $96,600. Average salaries for specific health care employee positions include:

$139,295 — Staff Pharmacist

$91,317 — Licensed Clinical Social Worker

$89,349 — Clinical Lab Scientist

$86,316 — Occupational Therapist

In addition to cash compensation, UC offers employees a very attractive benefits package that includes health benefits, pension benefits and retiree health insurance, which can represent an additional 25-40 percent of an employee’s annual pay.

This is not the first time UC has had to pursue legal action against a strike threat from AFSCME.  In July 2008, the union called on UC patient care employees to strike at all five UC medical centers. UC petitioned PERB to request a restraining order against the strike on UC’s behalf. PERB issued a complaint against AFSCME for bad-faith bargaining and for encouraging employees who perform essential patient care functions to strike even though their absence from work would clearly endanger the public’s safety. The Superior Court of San Francisco issued a restraining order prohibiting the union’s strike.

For more information about UC’s negotiations with the AFSCME, visit http://ucal.us/PatientCareTechs.

Related links:

• UC Davis
• UC Irvine
• UCLA
• UC San Diego
• UC San Francisco

UC senior VP for health comments on impact of walkout on patient care.

Dr. John Stobo, UC senior vice president for health sciences and services, made the following statement today (May 17) about the human impact of a strike scheduled for next week at University of California medical centers:

“We will do everything possible to ensure the safety of patients at UC hospitals, and that will cost up to $20 million across the five UC medical centers. But the real cost is the human one. If employees represented by AFSCME and UPTE strike, it will mean cancer patients may have their chemotherapy curtailed. It will mean a burn victim may have to be diverted from the UC Davis burn treatment center. It will mean someone suffering from chest pains may have to travel an additional 15 minutes for treatment because a UC emergency room is backed up for lack of staff.

“At the regents meeting this week, AFSCME representatives shouted, ‘Shame on you.’ I say, Shame on them. Shame on them for jeopardizing health services that people need and deserve. It is completely inappropriate to threaten services to patients as a negotiating tactic — the health of our patients must not be held hostage. If union members are as concerned with patient safety as they claim, why strike? How does that help anyone? What will happen to people who need care?

“To resolve pension and other outstanding labor issues, the union leadership should return to the bargaining table rather than force UC medical centers to curtail services. There are no ‘ifs,’ ‘ands’ or ‘buts’ about it. If union-represented employees strike, people will suffer.”

Find out more
Additional information, including facts about the impacts of a strike, are available at http://atyourservice.ucop.edu/employees/policies_employee_labor_relations/collective_bargaining_units/patientcaretechnical_pct.

Unions representing workers at UC’s five medical centers plan May 21-22 walkout.

The California Public Employment Relations Board (PERB) will seek a temporary restraining order to curtail the number of striking employees by two University of California unions at UC’s five medical centers, the university learned late Thursday (May 16).

On May 10, the American Federation of State, County and Municipal Employees union, which represents more than 12,500 UC patient care employees, announced it is asking members to strike UC medical centers on May 21-22. AFSCME-represented UC service workers also are expected to strike “in sympathy” with patient care employees.

The University Professional and Technical Employees (UPTE) union, which represents about 3,300 UC health care professionals, announced recently it also is asking its members to strike UC medical centers in sympathy with AFSCME for one day on May 21.

PERB is the state agency that oversees collective bargaining activities for public employers. PERB’s notification of its intent to seek a temporary restraining order limiting the number of striking employees in the two unions came after UC representatives successfully argued that walkouts by certain essential employees pose an imminent threat to public health and safety.

PERB officials told UC they intend to seek the injunction in Sacramento Superior Court on Monday (May 20). In its notification to UC, PERB indicated its injunction request will focus on those UC employees that, in PERB’s view, work in critical health and safety positions.

UC patient care technical employees include technicians responsible for operating equipment for ultrasounds, X-rays, MRIs, CT scans, mammograms and other tests; radiation therapists who prepare and treat cancer patients; pharmacy technicians who deliver medications to patients; respiratory therapists who help patients with breathing and treatment plans; and technicians who sterilize equipment used in surgeries.

Although each UC medical center has a contingency plan to ensure its doors stay open and patients receive quality care, a strike at UC medical centers can have significant impacts on patients and their families depending on which employees participate in the strike. Adult and child patients’ diagnoses and treatments may be delayed because laboratory tests, imaging and other work normally performed by patient care employees may not be completed in a timely manner. Some elective surgeries, including pediatric surgery and neurosurgery, may be postponed. Additionally, critical trauma patients may need to be diverted to other non-UC facilities that provide a lower level of care.

“It is highly inappropriate to threaten services to patients as a tactic in contract negotiations,” said Dwaine Duckett, vice president for systemwide human resources at UC. “We believe our current offer to AFSCME, which includes wage increases and good benefits, is very fair, and our pension reforms are similar to what has been implemented for state employees, some of whom are represented by AFSCME.”

UC has been in negotiations with AFSCME since June 2012 over terms of a new labor contract for UC’s patient care employees. The key issue in the negotiations is the union’s ongoing resistance to UC’s pension reforms, which include:

• Increased contributions toward the cost of pension benefits from both UC and employees (currently 10 and 5 percent respectively, increasing to 12 and 6.5 percent respectively July 1, 2013)
• A new category (“tier”) of pension benefits for employees hired on or after July 1, 2013
• Revised eligibility rules for retiree health benefits

Eight UC unions representing 14 bargaining units have agreed to UC’s pension reforms, which also apply to faculty and non-union staff hired on or after July 1, 2013.

Like many other employers, including the state of California, UC is enacting substantive pension reforms to help the university address a $24 billion unfunded pension plan liability, and enable it to continue offering employees financially sustainable pension benefits.

UC is offering AFSCME a competitive four-year contract for UC patient care employees that includes:

• Up to 3.5 percent wage increase per year for four years. These increases are on top of at least 5 percent increases patient care employees received in each of the past two years, at a time when many other UC employees received less or no increases at all.
• Excellent health care benefits now and upon retirement. Retiree health care is a benefit that few public or private organizations nationwide still offer.
• Pension benefits that few public or private organizations nationwide offer
• Good working conditions and a satisfying work environment

Duckett said UC’s top priority is taking care of patients, and that UC will take whatever steps are necessary to keep its medical centers open and ensure quality patient care during a strike.

He also said UC remains open to compromise, but that leaders from both AFSCME and UPTE must engage substantively.

This is not the first time UC has had to pursue legal action against a strike threat from AFSCME. In July 2008, the union called on UC patient care employees to strike at all five UC medical centers. UC petitioned the Public Employment Relations Board, the state agency responsible for overseeing collective bargaining for public sector employers, to request a restraining order against the strike on UC’s behalf. PERB issued a complaint against AFSCME for bad-faith bargaining and for encouraging employees to strike even though their absence from work would clearly endanger the public’s safety. The Superior Court of San Francisco issued a restraining order prohibiting the union’s strike.

More about these negotiations at http://ucal.us/PatientCareTechs

Union plans to strike May 21-22.

The University of California today (May 10) announced it will seek a restraining order against the American Federation of State, County and Municipal Employees union, in response to an announcement from the union that it is asking UC patient care and service employees to strike at UC medical centers May 21–22.

Strikes that pose a substantial and imminent threat to public health or safety are illegal under state law. UC believes a strike targeting UC medical centers would pose an imminent threat to public health and safety and would improperly withhold health care from members of the public.

State law also requires that strikes be considered only as a last resort after all other options have been exhausted. UC believes AFSCME has not explored all options in good faith through the bargaining process.

“It is highly inappropriate for AFSCME to threaten services to patients as a tactic in negotiations about pension benefit reforms,” said Dwaine Duckett, vice president for systemwide human resources at UC. “Other UC unions representing 14 bargaining units have agreed to our pension reforms, which also apply to faculty and non-union staff. AFSCME wants special treatment, which is unfair to the rest of the UC workforce.”

UC has been in negotiations with AFSCME since June 2012 over terms of a new labor contract for UC’s 12,500 patient care employees. The key issue in the negotiations is the union’s ongoing resistance to UC’s pension reforms, which include:

• Increased contributions toward the cost of pension benefits from both UC and employees (currently 10 and 5 percent respectively, increasing to 12 and 6.5 percent respectively July 1, 2013);
• A new category (“tier”) of pension benefits for employees hired on or after July 1, 2013;
• Revised eligibility rules for retiree health benefits.

Like many other employers, including the state of California, UC is enacting substantive pension reforms to help the university address a $24 billion pension fund liability, and enable it to continue offering employees financially sustainable pension benefits.

“We think our current proposal that includes wage increases and good benefits is very fair, and our pension reforms are similar to what has been implemented for state employees, some of whom are represented by AFSCME,” said Duckett. “AFSCME is demanding its members pay less than other UC faculty and staff for the same benefits, which is unfair to other employees.”

UC is offering a competitive four-year contract for UC patient care employees that includes:

• Up to 3.5 percent wage increase per year for four years. These increases are on top of at least 5 percent increases patient care employees received in each of the past two years, at a time when many other UC employees received less or no increases at all.
• Excellent health care benefits now and upon retirement. Retiree health care is a benefit that few public or private organizations nationwide still offer.
• Pension benefits that few public or private organizations nationwide offer
• Good working conditions and a satisfying work environment

Duckett said UC remains open to compromise, but that AFSCME leaders must engage in a substantive way and focus on resolving differences at the bargaining table.

This is not the first time UC has had to consider legal action against a strike threat from AFSCME. In July 2008, the union called on UC patient care employees to strike at all five UC medical centers. UC petitioned the Public Employment Relations Board, the state agency responsible for overseeing collective bargaining for public sector employers, to request a restraining order against the strike on UC’s behalf. PERB issued a complaint against AFSCME for bad-faith bargaining and for encouraging employees to strike even though their absence from work would clearly endanger the public’s safety. The Superior Court of San Francisco issued a restraining order prohibiting the union’s strike.

More about these negotiations: http://ucal.us/PatientCareTechs

Union represents patient care employees at the university’s medical centers.

Dwaine Duckett, University of California vice president for systemwide human resources, issued the following statement April 19 regarding an announced strike vote by the American Federation of State, County and Municipal Employees’ (AFSCME) union, which represents UC patient care employees:

AFSCME’s announced strike vote is another attempt to divert attention away from the key issue in our contract negotiations with union leaders: their refusal to agree to UC’s pension reforms. These pension reforms apply to UC faculty and staff hired on or after July 1, 2013. Eight other UC unions representing 14 bargaining units have already agreed to them. UC’s pension reforms also are similar to what has been implemented for state employees, some of whom are represented by AFSCME.

In addition to the strike vote announcement, AFSCME recently launched a campaign to spread negative information about the quality of patient care at our medical centers in an attempt to gain leverage at the bargaining table. Our medical centers are renowned for providing world-class patient care and consistently are ranked among the best medical centers in the country for quality care, innovation, groundbreaking research and education.

By encouraging a possible strike among our patient care employees, AFSCME is attempting to use patient care as a tool in contract negotiations, and potentially endangering public health, which is completely inappropriate. Patients are not bargaining chips.

As a public institution, UC has an obligation to manage its employee benefits in a financially prudent way, which is exactly what UC’s pension reforms are aimed at accomplishing. Like many other employers, including the state of California, UC is enacting substantive pension reforms in order to provide retirement benefits that adequately recognize our employees’ service to the university and the people of California, and that are also financially sustainable over the long term.

UC has bargained in good faith with AFSCME since last June, and we have presented AFSCME leaders with an attractive total economic package that includes:

• Annual wage increases of up to 3.5 percent for the next four years (which include skill- and experience-based steps) — increases that are on top of the 5 percent pay increases patient care employees have received in each of the last two years
• Quality pension benefits that many public and private organizations no longer offer
• Good employee health benefits
• Health benefits for retirees, which very few public or private employers offer

Thus far, AFSCME has rejected all of UC’s proposals and is demanding higher wage increases and lower payments for benefits as compared to other UC employees, which we don’t believe is fair.

The way to resolve differences about employee pay and benefits is through substantive and collaborative discussion at the bargaining table — not by threatening strikes that endanger patient care. As we have for nearly the past year, we will continue to be open to compromise and do what we can on our side of the negotiating table to reach a fair and financially responsible contract for our employees. But we cannot do it all ourselves. AFSCME leaders must engage in a substantive way.

House Democratic leader, others say federal budget cuts would hurt health of Americans.

Nancy Pelosi, Democratic leader of the U.S. House of Representatives, said Friday that the federal government’s budget cuts through sequestration hurt the health and well-being of Americans.

Pelosi, a longtime champion of public education, scientific research and UC San Francisco, joined scientists and city public health officials to call attention to the severe impact that across-the-board spending cuts would have on the nation at a news conference at UCSF’s Mission Bay campus.

Democratic Leader Nancy Pelosi talks about the impact of federal budget cuts on public health and science at a news conference at UCSF Mission Bay while UCSF Provost Jeffrey Bluestone and others look on.

Pelosi said the solution is not difficult. It’s a matter of setting priorities. For her, it’s a simple choice to fund Meals on Wheels, which delivers food to homebound seniors, over giving tax breaks to tycoons for corporate jets. It’s a choice between ending subsidies for big oil companies versus funding Head Start, an early educational program for young children.

When people ask Pelosi what is her preferred agenda to stimulate the economy, create jobs and foster innovation in the U.S., she replies, “science, science, science and science.”

“Our purpose here today is to demonstrate how important investments in science are to us,” Pelosi told UCSF’s graduate students, postdoctoral scholars, faculty, staff and others gathered in the atrium in Genentech Hall.

Jeffrey Bluestone, Ph.D., executive vice chancellor at UCSF, said now is not the time to cut the nation’s investment in life sciences research.

“This is an exciting time at UCSF and in the health sciences, overall,” he said. “Over the past decade, the Human Genome Project has contributed to a flood of research into the root causes of disease, as well as new understanding of the genetics of health and longevity. Nascent efforts in precision medicine – our ability to understand the building blocks of human health and disease in each individual – are transforming the way we will prevent, diagnose and treat disease.

“We are truly in the middle of a revolution in health sciences, a time we will look back on as the equivalent of the Industrial Revolution in the magnitude and pace of the advances we are seeing,” Bluestone said. “This revolution is being primarily funded by the federal government.”

Read more

Related links:

• UC Berkeley
• UC Irvine
• UC San Diego

New public-private partnership launched between university and health insurer.

John Stobo

Anthem Blue Cross and University of California Health — UC’s medical centers and health professional schools — announced today the launch of a groundbreaking alliance aimed at addressing some of the most critical issues facing the state’s health care delivery system.

Under this new agreement, Anthem and UC Health will focus on care innovation and California health policy development with the purpose of improving access to affordable, quality health care for California residents. The parties have named this joint venture the California Health Alliance. Both expect an enduring and productive association that will benefit the people of California.

With all five of the world-class UC academic health centers in Anthem’s network, both organizations have a long-standing history of serving residents throughout the state and are uniquely positioned to understand the health care needs of Californians. And, as the state prepares to expand health care through the Affordable Care Act (ACA), both organizations believe that today, more than ever, a collaboration of this type can effectively address the impact expected on the state’s health delivery system as more residents prepare to access medical services.

Among some of the initial areas of focus of this alliance will be the development of accountable care models to better manage costly chronic conditions and the expansion of alternate delivery systems, such as telemedicine to encourage wellness and prevention and to provide access to health care for residents in rural areas. In addition, this new alliance is expected to provide opportunities for research, analysis, literature development and policy recommendations.

“We know that residents of the state look to a future that includes access to quality health care that is affordable,” said Pam Kehaly, president of Anthem Blue Cross. “By teaming with the University of California Health, we are bringing together some of the most innovative minds to help us achieve a common goal: to improve the health and wellness of California residents.”

“As two of the state’s leading organizations, this new affiliation has the ability to revolutionize California’s health care delivery system,” said Dr. John Stobo, senior vice president for UC Health. “By coming together, we know we can develop meaningful research, policy and best practices that can be leveraged on a broader scale to help improve the state’s health care system and the health of the population at large.”

Media contacts:
Leslie Porras, Anthem Blue Cross
(818) 234-3368
leslie.porras@wellpoint.com

University of California Media Office
(510) 987-9200

About Anthem Blue Cross:
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Additional information about Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin.

About UC Health:
University of California Health includes five academic health centers — UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco — with 10 hospitals and 18 health professional schools and programs on seven UC campuses. For more information, visit http://health.universityofcalifornia.edu.

Brown bag discussion for UCOP employees covers health reform.

Garen Corbett, director of the California Health Benefits Review Program, discusses health care reform at a brown bag event in Oakland.

By Alec Rosenberg

Health care reform is putting pressure on providers to decrease costs, increase quality and redesign the delivery of care, University of California Health Senior Vice President John Stobo said Wednesday.

President Barack Obama’s Affordable Care Act (ACA) is having a big impact on UC Health, California’s fourth-largest health care delivery system and the nation’s largest health sciences educational system. The November election will be an important milestone, but reform efforts will continue regardless of the outcome, Stobo told UC Office of the President employees at a brown bag discussion in Oakland.

UC Health has recognized the need for reform. Four years ago, UC Health’s rates of central line-associated bloodstream infections were above the national average. Through a concerted effort, those rates are now below the national average.

“Seventy patient lives were saved by preventing these infections,” Stobo said. “This is one example of what we can do when we put our minds together as a system.”

To continue UC Health’s focus on improving quality, access and value, it established the Center for Health Quality and Innovation two years ago. The center, which has hosted a colloquium and awarded a round of grants and fellowships, just issued a request for proposals for a second round of fellows.

The Affordable Care Act is a historic opportunity to improve the health status of the American people, UC Health Associate Vice President Cathryn Nation said. The law includes a number of provisions to help foster health professions training and workforce planning, though most have no funding appropriated. Meanwhile, some provisions also will heighten the nation’s existing health workforce challenges, which are particularly acute in California, where the population is increasing in size, age and diversity, she said.

“California has huge challenges because we are a large and complex state,” Nation said.

UC Health has worked to close those workforce gaps, she said. Systemwide initiatives include:

• Increasing medical student enrollment through UC PRIME (approximately 300 more students training to serve medically underserved populations);
• Planning for a new school of medicine at UC Riverside (with a goal of admitting a first class in fall 2013); and
• Establishing new nursing programs at UC Davis and UC Irvine.

The goals for health care reform – from expanding coverage to controlling costs – remain similar to those of Republican plans dating back to President Richard Nixon, said Garen Corbett, director of the California Health Benefits Review Program. But now upwards of 50 million Americans have no health insurance, including 6.9 million Californians.

The Affordable Care Act aims to extend insurance to more than 30 million people, primarily through expanding Medicaid. Those with private health insurance already are benefiting from the law’s provisions for dependent coverage to age 26, no lifetime caps and no cost sharing for preventive services, Corbett said. For the uninsured, many key provisions are scheduled to take effect in 2014, such as Medicaid expansion, health insurance exchanges, premium subsidies and the individual mandate, which requires that most Americans obtain health insurance or face a tax penalty.

While the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act’s individual mandate in June, the law’s fate could turn on the November election, said UC Health and Clinical Affairs Director David Brown. If former Massachusetts Gov. Mitt Romney is elected president and Republicans gain control of the Senate, repeal of the ACA in its entirety or, at the very least, the individual mandate would be a real possibility, Brown said. If President Obama is re-elected, implementation of the law likely would stay the course.

Either way, the push to increase quality and decrease costs will persist, as will UC Health’s efforts to address those issues, Stobo said.

UC medical centers provide vital support to health professional schools. (View chart).

John Stobo, UC Health

By John D. Stobo

At University of California Health, patient care, health professional education and biomedical research go hand in hand. The connection has become only more important during these difficult budget times.

UC’s medical centers provide vital aid to UC’s medical and other health professional schools: $522 million this year in professional services and support of research and educational programs. UC medical centers have nearly doubled their contribution over five years, helping fill in the gap from shrinking state support. Indeed, UC medical center support for UC’s health professional schools now exceeds state general fund support.

The growing support from UC medical centers has been a lifeline for UC’s aspiring doctors, dentists, nurses, optometrists, pharmacists, public health professionals and veterinarians, bolstering the nation’s largest health sciences education system. But this lifeline is under threat.

UC’s self-supporting medical centers, which receive no state general funds, operate in extremely competitive environments. Their ability to sustain support for medical education – and provide a significant amount of care to low-income people – faces key fiscal challenges:

Capital requirements: UC medical centers’ capital needs are approximately $5 billion over the next five years. To best serve patients and meet government requirements, UC medical centers have major capital commitments from electronic medical records to state-mandated seismic-safety upgrades. UC San Diego and UC San Francisco have new hospital projects under construction. UCLA’s Santa Monica medical center completed a major rebuilding project this year. UC Davis opened a new surgery and emergency services pavilion in 2010. UC Irvine opened a new hospital in 2009.

Pension costs: UC medical centers face a growing obligation to pay pension costs. Those employer costs are projected to total nearly $3 billion over the next seven years. UC medical centers receive no state support to offset these costs.

Labor costs: UC medical centers have significant labor costs. They offer competitive compensation, which is necessary to attract and retain the nurses, doctors and other health care professionals who make UC medical centers such renowned institutions.

Health care reform: Under health care reform, reimbursement for clinical services by government and private insurers could be reduced substantially, including reimbursement rates for service and payments for graduate medical education.

The combined impact of these challenges could erase medical center margins. UC Health is working hard to address these issues. As UC Health moves into the throes of health care reform, the mutually beneficial relationship that exists between our medical centers and health professional schools must be preserved.

John D. Stobo, M.D., is senior vice president for UC Health.

New law OK’s UCLA pre-residency training pilot for international medical graduates.

UCLA International Medical Graudate program participants Carmen Morales (right), Joaquin Velarde (left), Edna Biddy (second from left) and UCLA faculty member Ravi Dave

Gov. Jerry Brown has signed into law a measure that broadens UCLA’s International Medical Graduate (IMG) program by allowing graduates of approved foreign medical schools to engage in “hands-on” training while being instructed in patient care by licensed California physicians.

The measure — AB 1533, which was authored by Assemblymember Holly Mitchell (D-Culver City) and takes effect in 2013 — was sponsored by the University of California and the Medical Board of California and passed with unanimous, bipartisan support. It allows medical school graduates of schools in Latin American countries whose curricula meet the Medical Board of California’s requirements and who legally reside in the U.S. to acquire the same supervised, interactive experience with patients as current UCLA medical students. Hands-on clinical experience is required to become a licensed physician in California, but these medical school graduates have been restricted to “observer” instruction until later in their medical training than graduates of U.S. medical schools.

UCLA’s IMG program, founded in 2006, is a pre-residency program that recruits talented bilingual and bicultural trainees from Latin America. As a condition of the program, the trainees make a two- to three-year commitment to practice in a medically underserved California community. The new law will mean more physicians in the areas of greatest need in California.

Dr. Patrick Dowling, chair of the Department of Family Medicine at the David Geffen School of Medicine at UCLA and co-founder of the IMG program with Dr. Michelle Bholat, the department’s co-chair, cited the example of one graduate of IMG who practices in Tulare County, which is 61 percent Hispanic yet has only 42 Hispanic physicians out of a total of 486.

“In doing so she not only addresses the immense shortage of primary care in the area but bridges the linguistic and cultural barriers that interfere with effective care for so many,” Dowling said. “With the newly expanded IMG program, we will have many more trained physicians who can do what she is doing.”

Mitchell, whose district includes UCLA, noted that the federal Affordable Care Act mandates health care for millions who are now uninsured, “so we need more physicians coming through California’s pipeline who are competent and committed to treat patients whose home language isn’t English.”

Linda K. Whitney, executive director of the Medical Board of California, said that access to quality care is a primary concern of the Medical Board. “This bill will help increase the placement of bilingual primary care physicians in California training programs,” Whitney said. “The Medical Board of California would like to thank Assemblymember Mitchell for carrying this important legislation and the University of California for their support as fellow co-sponsors.”

Dr. Cathryn Nation, UC associate vice president for health sciences and services, said the law will benefit underserved communities throughout the state by strengthening the preparation and path to licensure for bilingual physicians who are committed to working in areas of need.

Fifty-four UCLA IMGs currently are serving family medicine residencies in underserved communities in California. (See chart for areas where UCLA IMGs are now serving.) Current and past graduates say the program has been instrumental in helping them achieve their dream of practicing medicine in the United States and helping medically underserved communities. Marcos Uribe, who comes from Mexico and will complete the program in 2013, noted that currently he can only observe and not participate in patients’ care, even when the patient speaks only Spanish.

“I’m thrilled that AB 1533 passed, not just for the ways in which it will enhance my own education and training but as one more sign that I am welcome here, and that my contributions both in training and in my eventual career as a doctor are appreciated and needed,” Uribe said.

Dr. Blanca Campos completed the IMG program in 2008 and now practices medicine in Wilmington, which could use more doctors who have the training, cultural and language skills to meet the community’s needs.

“AB 1533 is so important for people like me, who were educated in medicine in other countries, but would like to practice here in the United States,” the Belize native said. “Training as part of a medical team, where one can learn how to interact directly with patients, is really important in developing our skills, particularly for IMGs. It’s a vital component of becoming a competent physician as well as a trusted member of the medical team.” She said she looks forward to being a positive role model for the families and patients she works with and inspiring some of them to follow in her footsteps.

UCLA is California’s largest university, with an enrollment of nearly 38,000 undergraduate and graduate students. The UCLA College of Letters and Science and the university’s 11 professional schools feature renowned faculty and offer 337 degree programs and majors. UCLA is a national and international leader in the breadth and quality of its academic, research, health care, cultural, continuing education and athletic programs. Six alumni and five faculty have been awarded the Nobel Prize.

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UCLA Medicine Magazine IMG feature

Legal, policy, economic experts discuss Supreme Court ruling on the ACA.

UC Berkeley panel discussion

On the first Monday after the Supreme Court’s decision on the Patient Protection and Affordable Care Act, a half-dozen UC Berkeley experts in constitutional law, public policy, economics, and health law and policy rendered their judgments on the ruling during a panel discussion at Berkeley Law. Health care economics, the challenges of implementing a complex law about which the public is deeply divided and the powerful role of politics were all put under the X-ray.

Calling Republican outrage over the ruling “all about politics,” moderator John Ellwood, a professor of public policy, noted that challenges to the ACA were raised “within a nanosecond” of its signing by President Obama in March 2010. For starters, numerous states challenged provisions on expanding healthcare coverage under Medicaid, the program that covers vulnerable individuals of limited means and is funded jointly by the federal government and the states. (The high-court justices, by a 7-2 vote, nullified the federal government’s ability to withhold all Medicaid funding for states that fail to expand Medicaid coverage under the reform.)

Now, in the wake of the decision upholding the law’s so-called individual mandate, “The Republicans are committed to repealing the Affordable Care Act,” Ellwood said. The path to do that would be clear were they both to regain the presidency and take control of the House and Senate in the fall election, he added. Short of that development, it’s still “going to be very messy,” he predicted. The reform’s determined opponents will wage a long campaign to “strangle ACA — and in the process, they’ll make it very inefficient.”

Constitutional-law expert Jesse Choper said that one of the most significant implications of the high-court ruling is in limiting Congress’s power to “make all laws which shall be necessary and proper” for executing its enumerated powers. “It’s the first time in 100 years that the court has put an important limitation on the ‘necessary and proper’ clause,” he said.

Several panelists gave a nod to the law’s potential to significantly expand access to health care. But “whether or not the expanded coverage is going to be affordable in the long run, that is the central question now,” said Stephen Shortell, dean of public health.

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