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Greenberg responds to questions from June 15 meeting During a “Town Hall” meeting June 15, MUSC President Ray Greenberg, M.D., Ph.D., answered questions from faculty members on issues that concerned them. During the next few weeks, The Catalyst will publish those questions with Greenberg’s answers. The intent is to encourage further dialogue on issues of concern to the MUSC family. Questions, comments and concerns can be addressed by e-mail to president@musc.edu. Adrian Reuben, Gastroenterology  As chairman of the Faculty Senate, I want to bring up a situation I feel we represent and also say something rather strong that I think that I’m probably in the best position to do. You eluded to an erosion of morale and an erosion of trust and confidence between the administration and the faculty.  Now, as to whether that erosion is true or a perception seems to me to be immaterial because perceptions guide the way people act and the way people think. From my discussions with faculty from many colleges, I believe that there is that perception. There seem to be three base causes which I think must be addressed, otherwise the morale problem and the perception problem will continue.  The first is that the decision process often appears to be cryptic to the faculty even though I think the administration thinks it’s communicating well and tries to communicate in its own way, it does not succeed.  The second part of that lack of communication is that where a decision is made and there were alternatives, these have never been discussed, never been made apparent, nor has the reason for one alternative over another been made clear.  Most of the faculty are capable of analytic thought and would be able to dwell on the same points that the administration has wrestled with and maybe come to the same conclusion or have ideas of a different conclusion and could give their input.  And the third and probably the toughest thing I have to say is that there is a perception that the distribution of funds and sometimes the reallocation of resources is arbitrary sometimes and sometimes highly personalized. There isn’t the safe, secure server for faculty to communicate their concerns about those irregularities because it’s very difficult for them to do. So I think that those three things, the cryptic nature of the decision process - real or apparent, the lack of discussion of alternatives and why certain choices were made and certain concerns of allocation and reallocation of resources, to my mind, cause the faculty a great deal of concern. Dr. Ray Greenberg:  Let me try to deal with each of them. None of this is a surprise to me having been the provost here. I came onto this campus and felt a very strong historical alienation of faculty from the administration of the university. I’d like to think that at least for some points of time there has been some improvement and that clearly and you’d be able to speak to this for yourself as president of the Faculty Senate.  Clearly the relationship between the Faculty Senate and the central administration of the university, at any rate, has dramatically improved in the last few years. It is still not where it should be, in my opinion. I think that we should look at what we can do to improve the communication. I would absolutely agree with you that one of the greatest deficiencies as we, an institution, have is communication. We need to look at how to better communicate at all levels and bi-directionally.  One thing that I would propose to you right now is that we have a representative of the Faculty Senate sit on the President’s Council, every Wednesday morning for our discussion about university issues. I’d be perfectly happy to have a representative of Faculty Senate present at those meetings.  I think we need to have meetings of the general faculty, like this, on a regular and ongoing basis. It should not be a special event; it should be a regular event. People should be able to bring whatever concerns, thoughts, suggestions to a forum like that.  We should look at whatever communication vehicles would be helpful.  In terms of communication about resource allocation, I would like to hear more about the kinds of decisions you’re talking about now or at some other time. Because depending upon the kind of resource allocation it is, there are different ways of dealing with that.  It is very clear to me that the faculty don’t feel very well represented in decision-making. I hear that about lots of organizations related to the Medical University. I hear that about UMA, that a lot of the rank and file faculty don’t have a sufficient voice in the decisions that are made there. I hear it about departments in colleges. I hear it about the central university. So I think that it is a broad issue and the solutions really need to be targeted somewhat to the kinds of decisions that are being made that you think are most essential.  Certainly the core budget allocation process should be open to faculty from an information point of view spontaneously. We’re presenting it to the Board of Trustees tomorrow, it should be on the web. It’s public information and it should be available. It sounds like you’re talking about resources other than…. Reuben: It’s certainly true that in your tenure as provost and now with Dr. Crouch, communication is excellent. But I’m still hearing criticism from the faculty that their feeling is that decisions are being made where they would have had a different opinion, or even better opinion, and they somehow go willy-nilly. That’s really the issue. Greenberg:  Certainly one forum that I hope that faculty express their opinions on is the annual department chair evaluation process. To me that’s the perfect place for articulating that, so we can identify if this is a truly systemic phenomenon or are there particular places where the communication has been more limited than it has in other settings. I fully agree with your comment. You have put your finger on what universities in general are terrible at— communicating—but I think that we have more than the average challenge. Al Santos, Psychiatry  I wanted to share a thought I had that was stimulated by your comments. It is as though you were putting two of your principles almost in the same breath—that of access and our capacity to be able to render services under decent facilities.  For a state like South Carolina that is so poor and rural it is almost an odd thing that we would be so obsessed with the facilities in which we work as opposed to going out wherever the patients need us. It is remarkable that we are laying people off where so many parts of South Carolina are getting no care at all.  I do know that the Catalyst has done a great job featuring lots of isolated, outreach projects of all sorts in the different colleges and departments, but one thing we might do is coordinate that a little better so that we can serve the state. From the international perspective, Americans are completely obsessed with the quality of their health care facilities.  It is nonsense to think that we can’t provide quality care without the finest of everything, from furniture to lighting. As long as we have good sterile fields wherever we are, things will work out just fine. Greenberg:  Al, I agree with much of what you said. I didn’t want to seem like too much of the public health guy up here. Part of my message outside of the Medical University is to educate the public on how specific the health problems of this state are. The fact that we have the highest stroke death rates in the country—we’re the buckle on the stroke belt – and here’s the perfect example of a program mismatch: We don’t have a comprehensive stroke program. We have the highest stroke rates in the country and we have a neurology department. They’re recruiting, I interviewed a candidate this week, but there’s an imbalance there. Why would we be so slow to develop that on this campus?  Heart disease—we have the fifth highest heart disease rates in this country and we need to organize ourselves in the terms of the full range of cardiac services. And we have the seventh highest mortality rate from diabetes in the country. Among males, we have the seventh highest smoking rates in the country. We can judge our performance in lots of traditional parameters whether it’s dollars, or whatever, but if we’re not fundamentally dealing with those issues ultimately we’ve failed in some way.  I’m very proud of what’s happened with the Healthy South Carolina Initiative. There are 28 projects that were competitively funded that are now in their last year. Some have gone on to get federal and other sources of funding to perpetuate.  The Dental College now has a van that’s going out and putting sealants on children. After acute infections, the leading cause of absence from school is oral heath problems in this state. There is a lot that we can do if we’re committed to working in the community. I agree with you that not all the issues that we need to deal with are in the high-tech end that has been the traditional domain of academic health centers. Dawn Clancy, Department of Medicine I’ve been here pretty much my entire medical career except for about a year and a half in private practice. I’ve been over at McClennan-Banks and I was very excited to hear you talk about interdisciplinary teaching. I’m also very concerned, because as I understand it our interdisciplinary model which is certainly not perfect but it’s the model that we have now and that we continue to work on is going to erode.  Along with the erosion of that model, which has provided an excellent forum for teaching of students from all the different colleges involved. We have at this point in time at least 700 patient visits scheduled through December. Those patients are not going to in theory have a provider to see them for those scheduled visits. We will somehow try to absorb them. I’m very concerned that we’re going to have erosion of patient care, erosion of patient trust.  I realize the patients are uninsured and they don’t bring in a lot of money. But we’re going to be jeopardizing our teaching mission as well as our research mission because it’s going to be very difficult to get those patients back into the fold, and we need them to do research on strokes. We need them to do research on diabetes, and it’s going to be very difficult to bring them back for clinical care if and when we have relief from the federal government. It will probably, I imagine, be relief for all and why would these patients want to come back here?  Greenberg: The specific topic that you’re commenting on was a focus on what I think was some very animated discussion between the deans of the various colleges and the leadership of UMA this morning. UMA is the vehicle through which we handle the ambulatory care agreement, which is the vehicle which has provided funds to run the clinic. Whether that will change any of the decision-making regarding the clinic, I’m not certain at this moment.  I agree with you that it’s something that’s been built there that would be sad to see deteriorate because of the financial conditions. I wish I had great solutions in mind for McClennan-Banks.  One of the things that I’ve been given some optimism about, but it’s not going to happen on the time horizons of some decisions that have to be made, is that I’ve encouraged the Charleston County Medical Society to put together a committee to focus on the issue of the uninsured patient in Charleston and how we deal with it.  They’ve brought together an interesting proposal about basically creating an endowment, if you will, getting all the providers to pay into this endowment which we could then go to Blue Cross/Blue Shield and buy the low-cost insurance policy to help cover these costs.  I think that Mark Lyles has been involved and Dick Gross has been very involved in that, but I don’t think Dick is here.  There are examples: Hillsboro, Florida, and Buncombe County, North Carolina. They developed models like this that have been successful.  In the long term, we need to create a sustaining source of revenue to help fund that.  The problem is that we’ve been given the bag to carry financially on our own, and we just don’t have the money right now.  That’s the problem.  Clancy:  I understand that we don’t have the money, but I’m also thinking about a very large AHRQ grant that we may be getting.  They’ve funded two already, and we’re up right now with Dr. Tilley.  There are several of us on there who are going to rely on the patients from McClennan-Banks that may now not be there and that’s significant funds that will be coming in. There are other grants that are in right now or at least in the process of being done. We’re going to be shooting ourselves in the foot. I understand about needing to cost-share. Trust me, I’ve spoken with the people from the access program in Buncombe County, and I agree that long-term is what we need. But as I’ve said before, how will we get those patients back? Greenberg:  I agree with you that it’s a key issue.   Michael Wallace, Gastroenterology I have question about recruiting particularly young faculty.  Having interviewed a number of young faculty recruits and being a recent young faculty recruit myself, I’ve noticed two issues that have come up in essentially every person who I’ve interviewed who have subsequently decided not to come:  The perception of ongoing racial prejudice in the state of South Carolina and not so much in the u3niversity itself but certainly in the state and the national headlines that we’ve received.  The other is the state of education in our state and in our region. And although our region is better than many parts of the state, it is at best claims to be average.   Although these aren’t particularly university issues, they are issues that affect the university very much and if we have to turn more than 8 percent of our faculty every year, what can we do as a University to try and provide an example to these people that we are making an effort to provide a more diverse group of employees and faculty and to promote an opportunity where young faculty members can provide education for their children? Greenberg:  It’s an excellent question and one that you’re right is not focused on the University per se, but greatly effects us and our ability to attract the best and brightest young faculty and seasoned faculty.  It’s not just an issue for junior faculty.  Let me comment on, again, on the turnover of faculty.  When you look at the number like 8 percent you need to remember that 2 percent or 3 percent of that is retirement and so forth.  There are departures for pure career advancement and family reasons so it’s like the unemployment rate, there’s going to be a natural rate of 4 percent or 5 percent of regular turn-over. We need to keep it, in my opinion, as low as we can.  So in respect to the issues … the diversity issue and the culture of South Carolina and how people come from other parts of the country view how we deal with race issues.  I believe this has been a particularly difficult year for that obviously with the flag issue and the time’s really unfortunate to debate around the Martin Luther King holiday and other various quotes that got widely made. I hope that on that particular issue we’ve made some progress this year.  I know there was a time when I thought the General Assembly wasn’t going to act this year and that problem would just drag into the future.  I think that that’s certainly one start, but in some ways there’s almost been more stirred up in people’s feelings of the function of that discussion than it’s actually resolved and I think we have a long way to go.  As an educational institution, we have a moral responsibility to be part of the solution here and I think it goes back to Dawn’s question in some respects. Are we serving the whole community?  Are we serving selected parts of the community for whatever particular reasons might be chosen?  We’ve got to work on it and diversity issues, while we’ve made tremendous progress in diversifying our student body, and it’s been somewhat uneven across the university, but we’ve made significant progress. We still have a long way to go on our faculty and staff.  I was really reminded of this when I was back at Emory a month ago while I was giving a commencement address and I walked around and saw my old faculty and staff. It was a much more diverse faculty and staff that we have here. Part of that is Atlanta is an easier place to recruit people to, because there is much more of a middle-class African-American population and it’s an attractive place. But I was reminded of the fact of how far we have to go being back on campus there.  The school issue, there are points of light here.  George Tempel has devoted a substantial amount of his time in working to produce and improve math and science education here.  Mayor Riley asked me to serve on a special task force that he’s put together to network to try and work with and around the system here to improve the quality of education, and the Presidents are on that sort of ex-officio. Dr. Sanders is on that and General Grinalds is on that.  I’m hoping that that group will help bring to light some of the things that we can do.  When I was up at Norfolk looking at things they do on campus, they have a health sciences magnet school on the campus of their institution.  I’ve suggested to Joe Riley that that’s something that we ought to think about.  This is a tough time, when we’re cutting things to start looking at something like that but the truth of the matter is that we have a responsibility. If we view our educational mission so narrowly that all we focus on is the education of health care professionals and we’re not concerned about educating the public, we’re not concerned about starting early in children’s careers in getting them interested in pursuing health careers, I think we’re failing in some fundamental way.  But I feel it’s going to be a tough time to make progress in both of those areas, because I believe we’re going to be very distracted with internal issues. But we need to get there.  I’m right with you on it.  Wallace:  I would just emphasize that you can take a narrower view, but if you can’t recruit a bright young faculty because there isn’t a good public school for them to send their children then we’ve really failed, even in our internal mission. Greenberg:  Absolutely, there’s no question about it.  I’ve never kept any statistics, but I would be very interested to see what percentage of our incoming faculty enroll their children in private school vs. public school. It would be very disturbing and we are part of the intellectual resource to advocate for education in this community and we need to be visible in that regard.