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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. They will be published with replies as they become available. Bill Boggan, Psychiatry: I was pleased recently when I received an e-mail on the subject of teaching teachers to teach and improving the quality of teaching. It seems that over the number of years that I’ve been here there has been an increasing emphasis on raising dollars in the quality of teaching. The quality of teaching, the quality of research is measured in terms of dollars. It feels like if you don’t bring in dollars then you’re not a productive person and 2) if the dollars are not flexible, dollars in terms of indirect costs then those two are not as valuable as (teaching). Dr. Ray Greenberg: I certainly hope that we are not communicating a message that excellence in teaching is not highly valued within the institution.  Across this campus, I think the faculty is very committed to its teaching role and I hope that the administrators within the individual units are part of a reinforcement process for that.  I’m very pleased that we’ve put in place the Teaching Awards a few years ago, and I can tell you again having been the Provost and having seen who comes forward for tenure consideration, we’ve had several individuals who had what some of us would call fairly nominal publication records who were outstanding teachers who were promoted on the basis of that. And in fact having the Teaching Awards in place has provided a kind of documentation to support that decision-making.  It is certainly true that we are in an environment where entrepreneurial spirit on the part of the faculty is encouraged. No question about it. When you look at our budget and you realize that we’re a state institution but less than 15 percent of our operating budget comes from appropriated monies, it’s a financial reality of running the institution and the places where there’s the greatest opportunity for entrepreneurial spirit are in research and in clinical service.  So there’s no question that the institution has placed a lot of emphasis on that and maybe too much emphasis. I would be willing to hear that as a potential comment or criticism that we’ve emphasized that too much.  Within research, you talk, about the indirect cost piece and that some sources are valued more than others. There is probably a reality to that as well. As you know, the federal funding probably comes with the highest indirect cost rates that we can receive and that funding is necessary to support the infrastructure.  There’s a perception that that’s kind of free money to be used for all sorts of icing on the cake, but it really runs the research enterprise, and so it’s therefore necessary for us to bring it in. There are certain funding sources like foundations, American Heart Association, American Cancer Society, that come with very nominal funding and effectively becomes cost-underwriting by the university to accept those kinds of awards.  There’s no question that there has been a conscious effort to try to direct people towards those sources of funding that help pay the full weight of that.  I am not aware that someone could not submit a grant to a particular funding source because of the indirect costs associated with it, but it might of happened.  Boggan:  There is no case that I know of either. It does put the investigator in an awkward position if you want to seek funds at 8 percent indirect and that competes with time and energy to seek funds for 45-50 indirect. You don’t feel like you can juggle both and that’s the bind you find yourself in. Greenberg:  I understand, and it’s an excellent point. We should look for a mixed portfolio. I don’t think that we want to put ourselves in the precarious position to depend on any one funding source for operation. Jeanne Hill, Radiology:  I was very pleased to hear you speak to the perception that the faculty does not feel supported particularly with the number of people that are leaving. I’m speaking from experience from the university for a number of decades. My father was a faculty member here for more than 30 years, I did my residency and fellowship here, and I’ve been on the faculty for almost a decade and I think that there is a bigger problem and it’s not just the faculty. There is a perception among people here in the institution that they are not supported. Our support staff in radiology…we are losing a tremendous number of technologists and I don’t know how to change that but there seems to be a general lack of respect for the individuals and there are tremendous individuals here and I think our greatest resource as an institution is its people. We have spent a lot of time talking about the facilities, but the people are the bottom line and we are losing some of the best of them. Not just the faculty members but the people in the trenches and that concerns me greatly. Dr. Ray Greenberg:   I couldn’t agree more with what you just said. I think you’re absolutely right. My emphasis in this setting has been on the faculty equation rather than the staff part. I fully intend to meet with the staff separately and talk with them in a similar sort of format and I think it’s part of the culture of the institution for whatever set of reasons. I don’t know how it originated; I don’t know why it originated.  Hill:  It has got to change. If it doesn’t change people are going to die; people are running away because of it. I am very serious. I have a younger brother who is now in radiologic technology school. He has been doing his clinical rotations. He just finished the Medical University; he’s been at Trident; he’s been at the county. His statement is he would never, ever work here because of the way he’s been treated and I think that is a terrible indictment of our institution and we can’t go anywhere unless we fix it. Greenberg: You have no argument from me. I’m in complete agreement with you on it, and hope it’s widely felt by the faculty because unless there’s a consensus around an issue like that…It’s not something that a few people in the administration can change alone. I think that it’s a cultural phenomenon and I think that we need to work very, very hard on it.  Tariq Javed, Dental Medicine:  I am extremely impressed and I want to thank you for your attention to the physical plant at this university. I think as you have said many buildings have been here 30, 40, 50 years with very little attention to updating and modernizing, and I want to thank you for addressing these issues. This lecture hall looks better. The 02 rooms look better, and we have a long way to go. Our yards and all that look very good from the outside, but we have a lot more work to do to make these buildings more functional. But again, as I said earlier, I want to thank you for addressing a critical need of this university to improve our physical plant.  Thank you for that. Paul Gold, Psychiatry:  The department just had a meeting and we learned the degree of deficit that we face. Our department accounts for greater than 50 percent of the deficit in the College of Medicine and already a number of people have been notified that they will be dismissed by June 30. I don’t know who ultimately will go, but the three I know of are all outstanding clinicians. I’m now a researcher and supported completely on federal dollars so I’m making a comment on their defense and not to protect myself. I would like to ask who and what kind of process is best able to deal with a crisis situation in finances as we have without it resulting in the loss of the best and brightest clinical faculty, individuals who have spent years here in loyal service? They are gone and I don’t know what else is to happen but I ask this difficult question in their defense. Greenberg:  Psychiatry is facing one of the biggest financial problems that any single department is facing. It represents a substantial portion of the total problem that the College of Medicine is facing. It is an extremely important department in the university because when you compare it to its peers nationally in certain parameters it is one of our shining stars. I think it’s very important in dealing with the problem that we don’t choose solutions that are going to undermine the strength that that department has had for many, many years. We need to be very careful in how we go about that. Again, this is a question that Dr. McCurdy or Dr. Ballenger may want to address.  I think there have been two levels thus far in trying to deal with the problem. One is at the college level and there is a finance committee who’s looked at the issue, helped characterize the magnitude of the problem, brought in an external consultant to help characterize the problem, and there has been a college-level review and set of expectations put in place. There also has been a department-level review and set of proposals, and I’ve been a step removed from that. I know that there is a group of four or five individuals that have been working on the development of the plan.  I think that the real issue, given the magnitude of the issue in psychiatry, is to think through how quickly one can recover.  Is it possible to correct the magnitude of the problem in one or two years or should we think about a longer plan? The problem is that we don’t have a lot of reserves to back it up in the meantime. The real problem, in my opinion, is that this was not identified and dealt with two years ago. The disturbing thing about the numbers that Dr. Heffner shared with me is that the two departments that are experiencing trouble are departments that grew above the average rate of growth in the last two years. One has to wonder why there were additional faculty being added when there was a deficit situation being created. My sense is that there were not very good management structures in place to recognize the problem and deal with them.  Psychiatry has a peculiar situation because of historical financing of the department through revenue streams coming from clinical operations that have since disappeared. The dean's office has been trying to replace those over time but it’s been a struggle to do that. I’m sure that’s been discussed with faculty.  Jim Ballenger, Psychiatry: It’s been a very tough time for us and it’s a mixture of part of what you mentioned, not knowing, not being able to know as things change. During this last several years’ period, we doubled our research intake from $12 million to $23 million. Not having the accounting mechanisms to keep up with it, we’ve ended up with a deficit that is very difficult for us to currently deal with. But we are dealing with it.  For me, the issue is, as Dr. Gold said, and Dr. Greenberg said, is making sure that we hold fast to what we really value the most, to why we’re here and why we’ve devoted our careers to this, and to try to preserve the best of that even though the funding levels are changing radically. In psychiatry, the clinical revenues are radically changing. What we value the most needs to be defined and protected, and I’m pleased to hear that Dr. Greenberg doesn’t think that we have to do this overnight. Greenberg:  I know that from the number of e-mails that have come to me and the magnitude of the problem to be dealt with, I know that it’s a particularly challenging situation and we need to work through it together as best we can.  Yvonne Michel, College of Nursing:  As provost you charged a gender issues committee to look into the recruitment, promotion, and tenure of men and women disparities at the Medical University. In the last six months, since you’ve become president that committee has not met and no work has been done. I want to know if you remain committed to that investigation? Greenberg: Absolutely, and I hope that is not lack of something on my part that that investigation has not moved forward and there may be someone on that committee who can address….Deb, do you want to address this?  Debbie Carson: Yvonne, we’re just waiting for the stuff from Columbia to come to us. We’re still in business, but we had to contract with the department that keeps all the records to go through their databases to get us a 10-year history. So I’ve got it on my list of things to do to find out where it is. Provost Crouch has allotted some money for us to pay for it because there is going to be a cost. They called me back and said that they expected it would be a little more than $200, and it shouldn’t be too much more. So we’re still in business. Greenberg:  It’s hard for me to believe that Provost Crouch would not be entirely committed to that issue.