Accountability Report 2015

Chapter 11:


Under California’s “Master Plan for Higher Education,” the University of California is delegated the primary responsibility in public higher education for doctoral education. For the health professions, this means that UC is the only California public institution chartered to grant the following professional degrees: D.D.S. (Doctor of Dental Science), M.D. (Doctor of Medicine), O.D. (Doctor of Optometry), Pharm.D. (Doctor of Pharmacy) and D.V.M. (Doctor of Veterinary Medicine). Along with other private educational institutions, UC also provides doctoral education leading to Ph.D. degrees in Nursing and Public Health, as well as the Dr.P.H. (Doctor of Public Health) degree.

UC health sciences programs are national and international leaders in teaching, research and clinical care. In support of these programs, UC provides leadership and strategic direction to advance the missions of the University’s 17 health professional schools and 12 hospitals, referred to collectively as UC Health1

UC’s mission of instruction, research and public service is carried out across the entire system, but a great portion of the service activity, measured in terms of operating expenditures, occurs under the auspices of UC Health. In 2013–14, operating expenditures for UC Health rose to about $12 billion, almost 45 percent of the University’s total operating expenditures. Of this amount, $2.4 billion represented instructional activities, $1.8 billion was spent on research, and $7.3 billion was expended by the medical centers in the delivery of health care services.

In fall 2014, about 35 percent of all UC faculty worked in health science disciplines. These faculty made up about one-sixth of all ladder-rank faculty and more than one-half of all other faculty across the UC system. Ladder-rank faculty have duties primarily focused on teaching and research. Other faculty are primarily clinical faculty; other academics are primarily researchers.

In fall 2014, 43 percent of postdoctoral fellows were in health science disciplines.2

Educating health care professionals

The University of California operates the largest health sciences instructional program in the nation, enrolling more than 14,000 students annually. The systemwide instructional program includes six schools of medicine and three smaller medical education programs (located in Berkeley, in Fresno and at the Charles R. Drew University of Medicine and Science in Los Angeles); three schools of nursing (and one program in nursing science at Irvine); two schools each of dentistry, pharmacy and public health; and one school each of optometry and veterinary medicine. The long-standing medical education program that operated jointly between UC Riverside and UCLA for more than 30 years transitioned in 2013 to an independent UC medical school.

A focus on medical research

Health science research expenditures represent the single largest disciplinary focus of UC’s research enterprise. Half of UC’s total research expenditures were for medical research, including related fields such as public health and veterinary medicine. More than half of the funding for this medical research was provided by federal agency awards to UC.

Clinical trial research is an increasingly important component of UC’s medical research enterprise. During 2013–14, there were more than 2,800 clinical trials underway systemwide, and of the $2.3 billion UC received that year in medical research awards, about 17 percent of the total was targeted for clinical trials. More than 80 percent of these clinical trial projects were sponsored by businesses.

These clinical trials occupy a unique position in UC’s research enterprise. They represent the final stage in the journey from a scientific discovery or innovation to an effective therapy or treatment that could significantly enhance global health.

Keeping California healthy

The University of California’s five academic medical centers (Davis, Irvine, Los Angeles, San Diego and San Francisco) provide a vast resource for the clinical training programs of UC health professional schools. These centers prepare future generations of health professionals; they catalyze major advances in biomedical and clinical research; and they serve as California’s fourth-largest health care delivery system, with about 42,000 employees, including approximately 12,000 nurses. UC operates or staffs five major trauma centers, providing half of all transplants and one-fourth of extensive burn care in the state. UC hospitals are also designated as Ebola treatment centers for the state. UC medical centers manage more than 159,000 inpatient admissions, 334,000 emergency room visits and 4.2 million outpatient visits each year. Nearly 60 percent of UC patients are covered by Medicare or Medi-Cal, or lack health insurance. In support of its teaching, research and public service missions, UC health programs also maintain active relationships with more than 100 affiliated Veterans Affairs, county and community-based health facilities located throughout California.

In view of the size and contributions of health-related programs across the UC system, select performance indicators related to students, faculty and research are included both in this chapter and in the respective sections of this report that are devoted to those subject areas. For example, indicators related to students enrolled in UC professional degree programs are also included in Chapter 4 (Graduate Academic and Graduate Professional Degree Students). Chapter 5 (Faculty and Other Academic Employees) includes indicators related to UC faculty appointments, headcounts and conference of doctoral degrees. Information regarding diversity is found in Chapter 7. Research workforce indicators for medicine and health sciences, as well as indicators for general funding and expenditures, are included in Chapter 9 (Research — Increasing Public Knowledge).

In addition, this chapter includes information and performance indicators for various aspects of the University’s health sciences system, including information regarding health professional degree students, health sciences instruction and research expenditures, and the health sciences academic workforce. This section also includes a number of indicators and metrics related to the University’s health care delivery system.

Looking forward

California’s population is growing, aging and increasing in diversity. Already the most populous state in the nation, California’s population is projected by the Department of Finance to grow 39 percent from 2012 to 2060. Statewide shortages and maldistribution of health providers already exist in many health professions. These challenges will grow as health care reforms drive increasing demand for quality and accountability in the delivery of health services. At a time of unprecedented budgetary challenges, the financial success of UC medical centers has been an important resource for helping to back-fill diminishing state support for UC schools of medicine. However, the changing environment for health care signals changes that threaten this financial success and the ability of the medical centers to help support the academic mission of UC medical schools. Among these financial challenges are 1) reductions in federal and state spending for programs such as Medicare, Medi-Cal and the National Institutes of Health; and 2) challenges associated with the implementation of health care reform.

Notwithstanding these challenges and the uncertainties related to health reform, UC Health is working to support new initiatives and developments to help meet current and future health care needs. Within the health professions, these include the opening of the Betty Irene Moore School of Nursing at UC Davis; the creation of new programs, at each UC medical school, in medical education focusing specifically on the needs of medically underserved communities; and the opening of a new medical school at UC Riverside, concentrating on the needs of California’s Inland Empire, making UCR the first new allopathic (M.D.-granting) medical school to open in California in more than 40 years.

To recognize and accelerate implementation of innovative practices in clinical care, UC Health launched the UC Center for Health Quality and Innovation in 2010. The center promotes innovations in clinical care that improve patient outcomes and quality of care within the UC system and beyond. These and other activities are among the many initiatives now underway at UC to help improve quality, access and value in the delivery of health services.

Leveraging Scale for Value

The Leveraging Scale for Value initiative is the systemwide approach to cost reduction in the UC Health clinical enterprise. The activity focuses on four areas — supply chain, revenue cycle, clinical laboratories and information technology — with a goal of achieving a $150 million to $200 million reduction in expenses each year for five years. UC Health is on target for a $50 million decrease in supply chain expenses for fiscal year 2015. The revenue cycle activities are on target for a yearly recurring benefit of $108 million to $143 million.

1 Data in this chapter exclude UCSF Benioff Children’s Hospital Oakland except where noted.

2 Statistics are by headcount rather than FTE. Headcount numbers tend to be larger than FTE, especially in the health sciences, because non-ladder-rank health science faculty, such as clinical faculty, are more likely to have joint or partial appointments.



The UC Health website provides an in-depth description of UC Health facilities and activities.

Medicine is by far the largest UC health professional discipline. Medical students and residents together make up roughly two-thirds of all UC health professions students.

11.1.1 State-supported graduate health sciences students, by discipline, Universitywide, Fall 2014


Source: UC Information Center Data Warehouse

Health sciences students are in one of three program categories: professional degree programs, academic programs or residency programs. Professional degree programs lead to degrees such as M.D., D.D.S or D.V.M. Academic programs lead to a master’s or Ph.D. Residents are professional school graduates (i.e., dental, medical, optometry, pharmacy and veterinary medical schools) who participate in specialty training programs after completing their degree programs.

The other UC health science students shown above are in health-related life science disciplines, such as biomedical science, bioengineering, pharmacology, neuroscience and epidemiology.

Health science professional degree fees have leveled off after incurring sharp increases during years of declining state support.

11.1.2 Average total charges1 for UC health professional degree students Universitywide, 2004–05 to 2014–15


Source: UC Budget Office and UC campuses


Student charges include tuition and fees assessed systemwide to all graduate students, along with professional degree supplemental tuition, campus-based fees and health insurance assessed at the campus program level to professional degree students.

Professional degree fees (now referred to as professional degree supplemental tuition) vary across programs and across campuses; the figures shown above are the averages across all campuses with the associated programs.

State support for UC’s professional schools declined significantly during recurring state fiscal crises. This has resulted in a dramatic increase in professional fees. The figures above demonstrate the steady and substantial rise in total required charges over the past decade. Total charges now often exceed those of comparison public institutions and in some cases may be equal to or greater than the average for comparison private institutions.

Calculated as the mean of total California resident charges at each campus. Includes mandatory tuition and fees (educational and student services), professional degree supplemental tuition, health insurance, campus-based fees and other fees where applicable. Averages are simple averages based on campus amounts; the number of students in each program is not taken into account.

As fees for UC health professional degree students have increased, so has student debt.

11.1.3 UC health student debt at graduation, Universitywide, 1999–2000 to 2013–14


Source: UC Corporate Student System1

Increases in tuition over the past decade have increased the debt burden of UC health professional degree students. Rapid increases in the average student debt of graduates of UC schools of dentistry, medicine and veterinary medicine are illustrated in the figure shown above, and are representative of debt patterns for other health science professional programs. With rising tuition and fees comes a cumulative impact over the course of a student’s enrollment in a program. The figure above aligns with the increase in debt burden over this same period.

At least one-third of the revenue from professional school fees is used to provide financial aid to help maintain the affordability of a professional school education. Nonetheless, the cumulative impact of these rapid increases raises serious concerns regarding the educational debt burden for graduates of UC’s professional degree health science programs and the University’s ability to recruit the most highly qualified students. Anticipated debt levels are also identified as a major concern by students who have previously expressed interest in primary-care careers and/or practicing in a medically underserved community or health professional shortage area.

1 Average debt is for those with debt.

Medical and dental practice income supported over half of the instructional expenditures in the health sciences in 2013–14 (primarily for their respective educational programs).

11.1.4 Health sciences instructional expenditures, Universitywide, 2013–14


Source: UC 2015–16 Budget for Current Operations and UC Budget Office

Academic and staff salaries and benefits constitute nearly three-quarters of all health sciences instructional expenditures.

UC general funds provided about one-fourth of expenditures in health sciences instruction. Student fees, primarily professional school fees (i.e., professional degree supplemental tuition) also contributed to funding health sciences instruction.

Research in medicine constitutes the bulk of health science research and involves by far the largest number of faculty, staff and students.

11.2.1 Health science research workforce FTE [Note Scales], Universitywide, 2013–14


Source: UC Corporate Personnel System. Categories are based on UAS discipline assignment.

The approximately 12,000 FTE shown above represent about 27,000 headcount personnel. Students and staff assistants often have part-time appointments. Faculty and academics, in addition to their research duties, have joint appointments as instructors, administrators and clinical service providers.

Other academics are primarily project scientists, professional researchers, specialists, and medical interns and residents. Other staff includes research associates, technicians, laboratory services, computer programmers/analysts, social services and administrative support.

The general decline in federal research funding over the past few years has also affected health science research.

11.2.2 Research expenditures, by health science discipline [Note Scales], Universitywide, 1997–98 to 2013–14


Source: UC Corporate Financial System. All amounts are adjusted for inflation.

UC’s five medical centers represent an enterprise of nearly $8 billion.

11.3.1 Medical center operating expenses, Universitywide, 2013–14


Source: UC Medical Centers Audited Financial Statements. Due to new accounting standards implemented in 2014, prior-year data are not comparable. Children’s Hospital and Research Center Oakland (CHRCO), which became a discrete unit of the University of California on January 1, 2014, is not shown.

The majority of medical center staff members are in UC’s Professional and Support Staff (PSS) personnel program; the majority of these are unionized.

11.3.2 Medical center staff, by personnel program, Universitywide, Fall 2004 to fall 2014


Source: UC Corporate Personnel System

Three unions — AFSCME Patient Care Technical Union, the California Nurses Association and the UPTE Health Care Professionals — represent more than 90 percent of the unionized medical center employees.

UC hospitals provide almost 900,000 inpatient days a year and serve a significant number of patients statewide.

11.3.3 Hospital inpatient days, UC medical centers, 2003–04 to 2013–14


Source: UC Medical Centers’ Audited Financial Statements1

The University’s academic medical centers operate in highly dense areas located throughout the state, including Orange, Sacramento, San Diego and Los Angeles counties, as well as the San Francisco Bay Area. Three of the five centers are former county hospitals. Each medical center has several primary care and specialty clinics distributed across the communities they serve.

In addition to providing primary and specialty care, UC medical centers treat critically ill newborns, care for cancer patients, and treat half of all transplant patients and one-quarter of extensive burn cases in California. As tertiary and quaternary care centers, they also treat patients from other hospitals that have exhausted all other efforts.

“Inpatient days” represents the total number of days that all patients spend in a hospital bed. The graph presented here displays the total number of inpatient days at the five UC medical centers.

1 UCLA Medical Center = UCLA Medical Center, Ronald Reagan, Santa Monica and Resnick Neuropsychiatric
UCSD Medical Center = UCSD Medical Center, Hillcrest and Thornton
UCSF Medical Center = UCSF Medical Center, Parnassus and Mount Zion

UC medical centers handle almost 4.2 million outpatient visits per year.

11.3.4 Outpatient visits, UC medical centers, 2003–04 to 2013–14


Source: UC Medical Centers Audited Financial Statements. Note that methodology changes at Los Angeles make year-over-year comparison problematic.

Outpatient visits are defined as visits during which patients see either a physician or a nurse practitioner in a clinic. Visits to other units, such as radiology, laboratory and physical therapy, are not counted as outpatient visits.

The medical centers provide a full range of health care services and are sites for testing the application of new knowledge and the development of new diagnostic and therapeutic techniques.

The cases treated by UC medical centers tend to be more complicated than is typical for medical centers and hospitals in California.

11.3.5 Patient complexity, UC medical centers and California median,
2003–04 to 2013–14


Source: UC Medical Centers’ Audited Financial Statements and the CA Office of Statewide Health Planning and Development

The “Case Mix” Index is a standard hospital metric for addressing the question: “How sick are our patients?” Hospitals with patients who tend to be more seriously ill score higher on the index, which translates into more resources used per patient by the hospital and into higher costs. A patient of average complexity scores 1.0 on the index. The index has been rising at each of the medical centers, reflecting growth in highly complex care, including complex surgical cases and transplants.

The patient mix at the UC medical centers reflects the role of these centers as tertiary referral hospitals that often serve sicker patients and those with the most complex cases. As noted earlier, they treat critically ill newborns, care for cancer patients, and treat half of all transplant patients and one-quarter of extensive burn cases in California.