Top-ranked UCSF School of Pharmacy challenged to retain accreditation under outdated state funding model

Historical underfunding of the UCSF School of Pharmacy, which has been exacerbated by successive California state budget cuts, threatens the School's ability to retain accreditation status of its doctor of pharmacy program, explains the School's dean, Mary Anne Koda-Kimble, PharmD. The School is the nation's top-ranked pharmacy school as measured by research funding from the National Institutes of Health and U.S. News and World Report rankings. "We're between a rock and a hard place," she said, calling the dilemma "a financial infrastructure issue about how programs are funded at the University of California level."

The full interview with the San Francisco Business Times appears below (reprinted with permission).


UCSF pharmacy chokes on bitter budget pills

by Chris Rauber, from San Francisco Business Times, Friday, July 25, 2008

University of California, San Francisco's nationally ranked School of Pharmacy lacks the money to make all the changes it has been told are required to keep its accreditation, according to Dean Mary Anne Koda-Kimble.

The pharmacy school's accreditation, which is under the purview of the American Council on Pharmacy Education, has been renewed for six years. But it's being monitored, and by mid-October Koda-Kimble must report on how the school will handle troublesome budgetary and staffing issues she says she has no way of resolving by then. In the meantime, the council's web site lists 2008/2009 accreditation for UCSF's school of pharmacy as "continuing," which means it's fully accredited, despite the budget problems. "What's happened is we're down to the core, and we've been asked for a 7 percent cut," said Koda-Kimble, referring to likely state-mandated budget cuts at UCSF and the rest of the UC system.

Koda-Kimble and other UCSF officials blame the situation on a "death by a thousand cuts" trend in recent decades, which has seen state funding dip year after year for the School of Pharmacy and similar programs.

"We're between a rock and a hard place," she said, calling the dilemma "a financial infrastructure issue about how programs are funded at the University of California level."

It's a strange place to be for a pharmacy program ranked No. 1 in the nation in National Institutes of Health funding, based on $19.6 million in research and training grants. But the state's funding assumes an 11-to-1 student to faculty ratio, based on decades-old standards, even though pharmacy is now considered a hands-on clinical specialty, and the actual student-faculty ratio is similar to UCSF Medical School's 3.5-to-1 ratio.

UCSF officials say state budget cuts, which are being reviewed by the UC Board of Regents and the University of California Office of the President, will be painful because this will be the 15th year in the last 19 in which the San Francisco medical research and teaching campus has been hit by reductions in state funding. In fact, funding from the state in fiscal 2006-07 only represented 9 percent of UCSF's $2.5 billion operating budget, or about $220 million—less than it received from government grants and contracts (21 percent) and private philanthropy (11 percent).

And smaller UCSF programs, like pharmacy, dentistry, nursing, and graduate education are most affected by the seemingly endless rounds of cuts, which could total $15 million this year, because they tend not to get as much outside funding. The final damage won't be known until the state budget is finalized in September.

The nursing school, for example, gets about 40 percent of its $27.6 million operating budget from the state, while the pharmacy school has seen its percentage of state-provided funding dip from 24 percent in 2001-02 to 16 percent in 2006-07. It now gets about $10 million from the state, out of a $65 million budget, and after shifting most of that to pay for salaries, it has just $250,000 left to pay for operational expenses—despite raising student fees a burdensome 14.8 percent for the coming school year.

Exacerbating the funding problems, said Associate Vice Chancellor Eric Vermillion, is the impact of increasing energy costs, guaranteed salary increases, and increased employee health-care costs. As a result, UCSF is "using discretionary funds to pay for operations," shifting resources from strategic, long-term objectives to short-term goals, like "just to keep the lights on."

Because UCSF's roughly $2.8 billion budget is incredibly balkanized, with funding specified for certain departments and purposes, even relatively small cuts to particular programs that have been hit hard in the past can be critical, officials say. Vermillion notes that as recently as 1990, when the budget reductions began to take hold, the state funded about twice as much of UCSF's budget as it does now, 18 percent vs. 9 percent.

The difference could be enough to put its vaunted pharmacy school in hot water on accreditation issues, or cause further demoralizing cuts in staffing, infrastructure, financial aid and other support for graduate students, on top of higher student fees that are sending some top candidates to rival colleges.

"We try to make sure our three smaller schools are taken care of," by bolstering them with discretionary funds obtained by "indirect cost" portions of large research contracts, Vermillion said. But a "perfect storm" of state and federal budget cuts is making that tougher. In the pharmacy school, "the faculty will have to work harder, and they're already overworked," Koda-Kimble said. This is a key factor in the accreditation agency's concerns about the program, and a broader concern in a state facing a shortage of nurses, pharmacists and other specialized clinical workers.

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School of Pharmacy, Department of Pharmaceutical Chemistry, Department of Bioengineering and Therapeutic Sciences, Department of Clinical Pharmacy, PharmD Degree Program, Dean's Office

About the School: The UCSF School of Pharmacy aims to solve the most pressing health care problems and strives to ensure that each patient receives the safest, most effective treatments. Our discoveries seed the development of novel therapies, and our researchers consistently lead the nation in NIH funding. The School’s doctor of pharmacy (PharmD) degree program, with its unique emphasis on scientific thinking, prepares students to be critical thinkers and leaders in their field.