There are several mis-assertions in Dr. Frank Opelka’s recent letter “Medical training changing for better.” A review of the recent U.S. Medical School Rankings ( reveals that of the top 15 medical schools in the country, 13 are state universities. Each university has its own hospital system that they oversee and govern. Some like Michigan even have their own insurance system, M-Care.

These institutions achieve a diverse payor mix because they are not micromanaged by their state capitols. This autonomy is essential to excellence in medical education.

The public hospital system in Louisiana has been essentially subsidizing the private sector for decades. The assertion made by Dr. Opelka that the proposed changes to the LSU System will improve medical education is just not evidenced based. In fact, the evidence points that the proposed model will lead to potential harm and many assurances would need to be put in place that medical residents receive the highest level of training possible. This includes having an autonomous classroom, i.e. a hospital.

What is most concerning is the fact that these transitions are not using evidenced-based principles and are driven by politics. Of most concern is the input of the Governor’s Office, which lacks any expertise in this area.

The current system is not sustainable; however, changes should be made based on best practices, evidence and not politics.

The governor’s refusal of expanded Medicaid coverage and the current haphazard implementation of this wrong decision will result in the premature death of Louisiana residents and the potential irreparable harm to the state’s medical education system.

Jay K. Kolls, MD

University of Pittsburgh School of Medicine