EDINBURG, RGV – In various interviews with the Guardian over the years about the possibility of a four-year medical school being established in the Rio Grande Valley, Dr. Kenneth Shine would always offer a word of caution.

He would say that a top quality medical school could not be created without also having first class residency programs in local hospitals for its graduating students. It was as though he doubted the Valley’s capacity to invest in such programs.

Those cautionary remarks perhaps provide context to an extraordinary statement Shine made at a news conference held Friday to announce a major graduate medical education program at Doctors Hospital at Renaissance (DHR). The number of residency slots in the Valley is going to jump from 33 to 148, with a majority – 78 – based at DHR.

“I graduated from medical school 53 years ago and there has not been a more amazing day in my career than today,” said Shine, a former executive vice chancellor for health affairs at the UT System.

Asked to explain that remark after his speech, Shine said: “I said that because I think this program at Doctors Hospital is truly transformational in terms of being a major step forward for this region of the country and the state. This region is going to be helped immensely by this event. So, in terms of overall impact it is amazing.”

Dr. Kenneth Shine, special advisor to the chancellor, UT System, talks with Dr. Carlos Cardenas, chairman of the board of managers at Doctors Hospital at Renaissance.
Dr. Kenneth Shine, special advisor to the chancellor, UT System, talks with Dr. Carlos Cardenas, chairman of the board of managers at Doctors Hospital at Renaissance.

The importance of developing residency programs, to go alongside a four-year medical school is explained by these statistics: the national average for hands-on physicians is 240 per 100,000 residents; in Texas it is 180 per 100,000, and in South Texas it is 110 hands per 100,000. The South Texas border region has a substantial overall shortage of physicians.

Shine reiterated a point made earlier in the news conference by Dr. Carlos Cardenas, chairman of the DHR board of managers. Namely, that 80 percent of medical students who graduate in Texas make their careers in the Lone Star State and that between 65 and 70 percent of graduating medical students stay in the region they were educated. “You can see why establishing a medical school without an adequate number of residencies did not make any kind of sense,” Shine said.

Shine graduated from Harvard Medical School in 1961 and became a cardiologist and physiologist. He trained at Harvard’s acclaimed teaching hospital, Massachusetts General, where he became Chief Resident in Medicine in 1968. In 1969, he joined the faculty at the University of California at Los Angeles, ultimately becoming dean of the UCLA’s School of Medicine in 1986. In 1992, Shine was named president of the Institute of Medicine, a non-profit, non-partisan organization that helps influence national health care policy.

Shine joined the UT System in November 2003, spearheading a project called Code Red, a statewide call to action to improve access to care, streamline medical education and lay the groundwork for future medical schools in Austin and the Valley.  Following his retirement from UT in early 2013, Shine was named special advisor to UT System Chancellor Francisco Cigarroa.

In his interview with the Guardian on Friday, Shine paid tribute to other hospitals in the Valley for agreeing to expand their residency programs.

“Once we articulated the need for more residency programs, the hospitals in the region responded dramatically. Doctors Hospital at Renaissance was among the leaders in that kind of dramatic response in identifying what needs to be done and doing it very quickly. But, residency programs are also being introduced at other hospitals. In Harlingen, we have just introduced new program directors in adult psychiatry and child psychiatry. It is happening across the region.”

Four new residency programs and their directors were announced at the DHR news conference on Friday, which was held at the Edinburg Conference Center at Renaissance. Dr. Eron Manusov will direct the family practice residency program. Dr. Charles Richart will direct the general surgery residency program. Dr. Amer Malas will direct the internal medicine residency program. And, Dr. John Michael Breen will direct the obstetrics and gynecology residency program.

In his speech, Shine praised state Sens. Eddie Lucio and Juan Hinojosa for the vision they showed in bringing the Regional Academic Health Center to the Valley 14 years ago. He said 1,000 students have passed through the RAHC and they have done just as well as medical students educated in other parts of Texas. The RAHC is the forerunner to the four-year medical school now being established by UT.

Shine also praised the UT System regents for their commitment to South Texas. He said the regents are pumping $10 million each year for ten years into the region in order to develop the medical school. He said this in addition to $30 million for the STARs initiative, which includes a new diabetes and obesity program. He said a director for this program should be announced in the next month or so. He also pointed out that the UT System has approved $234 million for construction projects in readiness for the creation of UT-Rio Grande Valley, including $54 million for an academic center for the medical school in Edinburg. “The regents have been extremely supportive,” Shine said.

Shine then spoke about how the expansion of residency programs in South Texas came about.

“About three years we had a discussion on how to make the transition from the Regional Academic Health Center to a fully-fledged medical school. We agreed it had to be a comprehensive school of medicine, one of first rank. We did not want a community based school. We wanted a top medical school. To have a top medical school you have to have top-flight education, top-flight research. That is why we are working on this Diabetes Institute and other kinds of research activities. If we were going to have a first class medical school we needed to have an adequate number of residency positions. At that time there were 33 residency positions in the Valley associated with the university.”

Shine said that even with the beginnings of a medical school, if such an institution graduated 50 students a year, ten or 11 residency positions would not cut it.  So, the UT System talked to the various local hospitals about expanding residency programs.

“I remember very vividly a conversation I had with Mr. Alonzo Cantu (one of the founders of DHR). I would have to say he is one of the architects of this activity. He indicated that Doctors Hospital at Renaissance would be very interested. Doctors Hospital stepped up to the plate in a big way. I would emphasize Israel Rocha (CEO of DHR), in terms of his energy and creativity he has been central to the success of this endeavor, as has Susan Turley, Dr. Carlos Cardenas and Dr. Ricardo Martinez, and Sofia Hernandez. A number of people here at Doctors Hospital stepped up and said we are going to do it and we need to find out ways to do it.”

Turley is president of DHR. Cardenas and Martinez are on the board of managers and Hernandez is vice president of graduate medical education and public affairs.

Shine also praised DHR for its commitment to excellence. “These residency programs need to be unique and outstanding. Doctors Hospital will become a major teaching hospital in any way you want to articulate that.”

Shine then focused his speech on the new medical school, which will be part of UTRGV. He said the founding dean of the medical school, Dr. Francisco Fernandez, will be coming to the Valley on April 28 to assume his responsibilities. “He and I have discussed these residency programs and he is excited and amazed that it has happened as rapidly as it has happened, and with the quality reflected in these program directors.”

Dr. Lois Bready, vice dean of graduate medical education at UT-Health Science Center San Antonio (UTHSCSA), also spoke about the rapid pace at which the residency programs are being developed. UTHSCA is working with DHR in developing the residency programs.

“Things are happening incredibly quickly. As I talk to my colleagues around the country who do what I do, they cannot believe how quickly things are moving,” Bready said, in her speech at the news conference.

Shine also spoke about the curriculum being designed for the new medical school.

“The school will have a curriculum that is integrated. Science and patient care will be part of the curriculum from the very beginning. Students will be introduced to patients on day one of the medical school and will continue to operate in an education environment which not only takes advantage of modern technology, distance and online learning, for example, but also focuses on team care and the role of interdisciplinary teams that care for patients, with physicians, nurses, pharmacists, other health professionals, working closely with each other,” Shine said.

“That is the model Doctors Hospital uses very effectively. It will form a logical continuum between medical school education and what will happen when these folks take their residencies.”

Shine also said the new medical school will provide students with exposure to the Valley community very early. “They will understand the issues related to community care, public health, and prevention. These are entirely consistent with the mission and vision of Doctors Hospital at Renaissance,” Shine said. He also spoke about DHR’s collaborations with the world renowned Joslin Cancer Center. “We anticipate having research activities which can seamlessly blend with those at Doctors Hospital at Renaissance. This is an important part of what we want to achieve.”

Accreditation applications have been made for the four new residency programs at DHR. Shine said residency review committees have already made two visits to the Edinburg-based hospital. “It is almost a breathless achievement, to move as quickly as we move to see this kind of thing happen. At the same time, there has been no sacrifice in quality. We have been very impressed with the quality of the individuals who have applied for these leadership positions and the quality of those who have been appointed. So, in terms of our vision, of a first class, comprehensive, medical school, we are well on the way to accomplishing that particular outcome,” Shine said.

Shine concluded his speech by saying the UT System is “extremely proud” of its relationship with DHR. “We are extremely proud of the recruitments they have undertaken, and the quality of the individuals they have appointed in collaboration with the Health Science Center; with the fact that they have been so forward looking in terms of the vision of not only Doctors Hospital but also their vision for the new medical school. We look forward to continuing strong relationships as we try new and innovative approaches to improve health.”

<I>Editor’s Note: This is the first in a three-part feature on the new graduate medical education program being developed at Doctors Hospital at Renaissance. Parts two and three will be posted in the coming days.</I>