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COM dean addresses students, faculty State of the College 2005 Jan. 31, 2006 Basic Science Building Auditorium by Jerry Reves, MD Dean, College of Medicine Good Afternoon Ladies and Gentleman. And welcome to the fifth annual address to our faculty, students and staff regarding the state of the College of Medicine. As ever I am honored to speak with you about our College, its accomplishments and our future. Being the oldest medical school in the south, and at one time, before the Civil War, arguably one of the best in the country, we have yet to reach our proper place among all American medical schools. In other words, as good as things are, and they are better than ever before, I know that we are all committed to reaching even greater heights in our own professional development and the development of our College of Medicine. When considering all that we could discuss this afternoon, I believe it important to focus on five categories. These are: 1) a report card on the year 2005 goals; 2) mentioning other accomplishments; 3) highlight a few of the many individual achievements; 4) review three concerns that I will spend some time; and, 5) discuss goals for the coming year (2006). I believe that the faculty should hold the dean and other leaders accountable for achieving publicly announced goals. I’m happy to report that our most immediate goal last year was to receive LCME accreditation of the Medical School. We were site visited in January by the LCME and in the summer received an eight year extension of our accreditation for the Medical School. This was a major accomplishment that many of you played large roles in and all of us can be pleased that we received the maximum accreditation possible.   Dr. Jeff Wong created an education strategic plan based on a retreat with college leaders interested in our undergraduate educational offerings. That strategic plan is in the process of being implemented as we speak. A university research space plan was developed under the leadership of the Provost and has been adopted but not yet fully implemented. This plan rewards scientific and academic productivity and provides incentives for growth in this area as well as penalties for less productive use of our limited research space. As you know we have created a single Neurosciences Department and I am pleased to report that this department is continuing to thrive, recruit well and enhance its educational, research and clinical status. This has proven to be a viable concept and continues to be an exciting creation that so many of the faculty of the united disciplines assisted in creating. Our interdisciplinary research and clinical programs are all doing well. Later I will focus on one, the Hollings Cancer Center as an example of the progress being made in all. We have failed to implement a MUHA Center Profit Sharing methodology, but I am pleased to report that I believe we will accomplish this in the coming year. This will be addressed later, as well. Finally, we have worked very hard with the VA to improve our relationship with this essential and important partner and there are still very exciting possibilities for us to share more intimately clinical facilities with the VA. As an example of interdisciplinary research and clinical care, The Hollings Cancer Center continues to thrive in all of its domains. National Cancer Institute sponsored research has nearly tripled in five years. This is remarkable growth and a tribute to the leadership of Andrew Kraft, Yussef Hannun and the many others whose work is in the Hollings Cancer Center. One of Dr. Kraft’s, along with Dr. Carolyn Reed’s, major initiatives has been the creation of the Statewide Cancer Clinical Trials Network. This too has been successful in achieving the overall vision that “every South Carolinian has immediate access to the latest cancer therapies.” I mentioned that we have achieved our goal of developing closer relationships with the VA, but when I addressed you last year, I had no idea just how intense this work would become. We created four work groups, many of you served on these work groups to analyze ways that the VA and MUSC might share equipment, space and other resources to provide high quality, efficient and effective care to our veteran patients. We reviewed a number of options to plan service improvements through increased efficiency and improved access and with continued excellent quality. During this year I expect us to determine exactly what we will do with the VA as it relates to new facilities including phase II of our adult hospital. Another achievement this year was to formalize the reporting relationship of Graduate Medical Education (GME) in the college. Working with Stuart Smith and Franklin Medio, the designated institutional officer, as well as our attorneys, we clarified the reporting relationship of the Designated Institutional Officer (DIO), Franklin Medio, up through the educational chain of command in the college to the provost and president, and ultimately the board of trustees. This clarification of reporting relationships makes it easier for Dr. Medio to function and assist the chairs of our clinical departments in the very important work of educating our residents and fellows. Another initiative that is always ongoing in our college and one that I like to report to you each year is our progress in diversifying our faculty and students. We have seen significant increases in the number of under-represented minorities in our faculty such that now 72 percent of our departments have under-represented faculty up from 56 percent in 2003. Likewise in our student body, we have sustained our increase in the recruitment of under-represented minorities to the College of Medicine and we are holding steady at approximately 16 percent of the student body, this is a vast improvement over where we stood in 2001. I have said on many occasions, and believe it very fervently, that the recruitment and retention of under-represented minorities is good for our college and our state. It is the majority who benefit the most from learning from our under-represented colleagues what the issues are that we cannot know without their teaching us. The Office of Research Development (Peggy Schachte’s office) reports a remarkable increase in funding since 1997, most of which is in the College of Medicine. From that year, to the projected fiscal ’06 we have nearly tripled our NIH support and in the last five years, seen a 50 percent increase in NIH support. Obviously, ’05 and ’06 show the flattening in NIH dollars that reflects the NIH budget itself which is fundamentally flat. Nevertheless, this has been a remarkable achievement over the last several years, and even during the past year, and to maintain the funding in spite of the greater difficulty nationally is quite a good accomplishment and I congratulate our investigators and those who support them. In terms of our national and regional standing in NIH support--we are ninth of the 43 schools in the south, having moved up two positions during the past year. We are 49th, actually down one since last year nationally but still within striking distance of the upper third. Our goal remains the upper quartile. It is particularly evident that we have some outstanding departments, seven of whom are in the top 20 nationally, and all of these are in the top five in the south. If all of our departments matched these seven, we would make our goal of being in the upper quartile nationally comfortably. Of course I am aware that it is individuals who do all the work, and I thank you all. The problem in highlighting some of our faculty achievements as I will is that the majority of our faculty who are doing great things do not get listed because of the limitations of time. Nevertheless, I would like to point out some of our distinguished faculty who are doing wonderful things in many different areas. Going clockwise: from the bottom, Jim Norris is serving as President of the International Society of Cancer Gene Therapy, Yusuf Hannun was just awared the Governor’s Award for Excellence in Scientific Research, Pearon Lang is President of the American College of Mohs Micrographic Surgery and Cutaenous Oncology, and Peter Cotton has led the Digestive Disease Center DDC) for 12 distinguished years, establishing our DDC as one of the nations best. Drs. Key and Hollis have been elected into the American Pediatrics Society, the oldest Academic Society in America; Myra Haney, in our office, received the local Martin Luther King, Jr. Leadership Award for Education among all of the higher education schools in the low country; Carolyn Reed was elected President of the American Board of Thoracic Surgery and is the first woman to serve in this capacity. David Soper is President of the national OB/GYN Society of Infectious Disease; Joe Schoepf was distinguished as the number 7 Cardiac Imager in the world by Medical Imaging magazine. Phil Costello is shown at an autographing session with the media celebrity Larry King. John Oldham’s text book on personality disorders in a review in JAMA was heralded as “catapulting the field into the 21st century.” Darlene Shaw received the university’s Teaching Excellence Award in the educator/mentor category, but additionally, she and her husband George Kogar have pledged through a bequest, one of the largest gifts ever of any faculty to the College of Medicine for future scholarships. So she has contributed not only through her administration and teaching and mentoring, but materially to advance the College of Medicine. Overall, the College of Medicine is doing well and we have much to be proud of in the accomplishments of the past year and preceding decade. There are however three major immediate financial concerns, or as depicted on this slide, as well as a possible looming balanced budget II some storm clouds that are threatening in the longer term. I’ve already mentioned that the NIH is flat and therefore the light green, since we cannot depend on as much revenue coming from that sector of our activities in the near term. The clinical enterprise is still healthy and therefore a nice comforting dark green, but even there, there are uncertainties about whether this can be continued. The institutional infra-structure costs are rising faster than revenues to defray them. We are in fact running in the red particularly in utilities. To deal with the infrastructure problems, Dr. Greenberg asked our vice president for finance, Lisa Montgomery to develop a plan. She formed a University Funds Flow committee that has been studying the problem and their report is imminent. Many members of that committee are from the College of Medicine, and they are all excellent finance people. This brings us to the reality that only $1 comes in and only o$1 can be spent. We divide that $1 that comes in to the university, College of Medicine and other colleges, the departments and UMA, and this is the source of funding. This $1 is spent and we trust it is spent well by the various entities who have them. Since we only have $1, and we are one institution, our economic health is dependant on the health of all of our entities. It is generally held that in times of threat or stress that the best strategy is to select those things to focus on that are most important and that bring success and continued excellence. This is not a time to for too many uncertain ventures. So our strategy in these daunting times is to concentrate on the individual professional excellence of you, our faculty, to target certain inter-disciplinary research initiatives that are in keeping with the NIH’s roadmap, to carefully target clinical excellence and outreach initiatives that are likely to support our new hospital and to curb unnecessary expenses and eliminate deficit spending in areas in which it exists.   I have already mentioned that infrastructure (primarily because of increased utility costs and reduced State support) is running a deficit because these expenses are paid centrally. It might be appealing to say this is the problem of the vice president for finance and not the College of Medicine. This is not a prudent or responsible position to take since most of the infrastructure is used by the College of Medicine. An example of why the infrastructure budget is not balanced is shown in this slide. F & A or indirect research dollars from our extra-mural funding come in to the university and are distributed as you see on this slide. About half of the indirect dollars stay centrally, but in our cost report, that we use to justify our indirect cost rate, we say that infrastructure represents 41 percent of our cost. If 41 percent of our costs are infrastructure and we only allocate 20 percent of indirects to this, it is obvious that the budget will never be balanced unless there are other sources for infrastructure. Thus, we are going to have to take a look at this distribution as a part or partial remedy to some of the infra-structure costs. This is the responsible thing for us, the users of this infrastructure, to do. We will be doing that this year. In focusing on interdisciplinary research, I call your attention to the NIH roadmap and in particular the interdisciplinary research category that is about the only area in the NIH budget projected to get meaningful increases and funding in the future. As the old adage goes, we better follow the money and we plan to do so. There is an NIH initiative designed to help lower artificial organizational barriers and advance science. There will be a series of awards to make it easier for scientists to conduct inter-disciplinary research and there will be funding for training of scientists in inter-disciplinary areas, creation of specialized centers to help scientists forge new and advanced disciplines from existing ones and ones to supplement existing awards which encourage interdisciplinary planning through the creation of Clinical and Translational Science Awards. Clinical and Translational Science Awards, or CTSA, are being created to assist institutions to transform themselves into better translational research enterprises. These CTSA awards will encourage novel methodology, biomedical informatics, design biostatistics, research training and career development, translational technology resources and community engagement. The NIH has pointed out what we all know that clinical scientist’s infra-structure is not well coordinated throughout the county or here at MUSC. We have a GCRCs, abutting and sometimes connecting disease centers, such as cancer or aging centers, and we have training programs in various settings and a K-30 curriculum. These are not well integrated into the institutional effort for translational research. The brown circles indicate the strategy that NIH believes is required to integrate all of this and we are fortunate to have Kathleen Brady leading our home for clinical and translational sciences as the GCRC which she leads transitions into the center for translational sciences. In preparing us to take this next exciting step, Dr. Brady and her collegues have analyzed our strengths, which are rapid research growth, our endowed chairs program that we spoke about last year, our center funding, the many community ties we have and the diverse research training portfolio that exists on our campus. We also have weaknesses and these relate to insufficient dedicated time for research or low expectations that research be done in some clinical departments, few incentives for collaboration across colleges, departments and divisions, no incentives and limited protected time for research mentoring, lack of agreement over the structure and support for centers and departments, problems with grants accounting that often seem the faculties’ adversary and our computational biology is not what it needs to be, and there has yet to be a clear vision or plan for information technology across the campus. Recognizing our strengths and weaknesses in mind, we plan to apply for the CTSA grant. The RFA issued in October and the first award applications are due in March of which there will be four to seven full awards. There will be more awards later and we will be applying for our award early 2007. We will be applying for one of the 50 planning grants in March and believe we ultimately will be one of the 60 planned CTSA’s. One of our steps is to get the GCRC renewed and we are submitting that application this year. The CTSA will go in the following year. The CTSA requires building blocks; one is the training grant (T 32) that Dr. Tilley was recently awarded. We are confident we will have a funded GCRC and those are two of the essential building blocks required in the CTSA application. Dr. Brady will want to work with any of you who wish to be a part of this major translational research initiative.  In addition to our focus on interdisciplinary research initiatives, you are probably all aware that we have many statewide clinical outreach initiatives as depicted on this figure. 12 of our clinical departments cover most of the state in some capacity. Many of these outreach initiatives have clinical research as part of their work. In striving to reach our full potential as regional and national leaders, I spoke about this lst year to demonstrate our potential to work with partners around the state in Columbia, Spartanburg and Greenville through the Health Sciences South Carolina (HSSC) consortium that Dr. Greenberg put together. As the major academic medical center in our state, we can partner and bring our translational work with the other excellent academic physicians and clinicians that are spread around the state in the Greenville/Spartanburg area and at USC and in Columbia. We have traditionally, and must continue in the future to, play the lead role in these important statewide initiatives sponsored by the HSSC. USC's Harris Pastides presents an exciting and potentially important initiative in which we are involved. We are currently recruiting a director of this program which is funded by one of the CoEE grants on clinical effectiveness and patient safety that has already been awarded through the State’s Lottery Centers of Economic Excellence (COEE) program. This individual will lead the collaborative efforts of all of the partners in the Health Sciences South Carolina with a mission to improve health care quality and effectiveness. Programmatic areas are in neuroscience, cancer, vascular disease, health care quality and health care finance. Current focus is recruiting a director who can integrate the health services research, create and integrate a health services research unit designed to improve health quality around the state. Our big idea, and one that I believe is absolutely achievable, is that MUSC and its HSSC partners can be the national, and therefore a global leader in clinical effectiveness and patient safety. This is an achievable goal and one that will involve many of our faculty as well as our newly created director of simulation education research, Dr. John Shaefer. I mentioned earlier that the one goal we did not achieve this year was the establishment of service line management of our major clinical practices. This year we have engaged The Bard Group that specializes in transforming clinical practices into comprehensive service lines. They have taught us that there is an increasing level of sophistication along a spectrum of clinical care that begins with the identification of a clinical practice area, moves to providing that clinical service in a quality way, finally the development of a more coordinated clinical program, then the establishment of service line management of that clinical program, and ultimately a comprehensive therapeutic service line can be developed involving translational research. The reason to develop service lines or the value proposition for the establishment of these lines is that they have the broad impact on an organization and are a source of great pride. They are a method to have a competitive clinical strategy to improve business performance to recruit and staff the organization, to develop and cultivate leadership to make the most of facilities and technologies, to enhance clinical performance and of course a method for branding. In a recent Cleveland, Ohio, health survey the question was asked “which health care program was the most trusted name in obstetrics in this city?” and the answer was the Cleveland Clinic. This was not surprising because of the power of branding that has been established by the Cleveland Clinic. What was surprising was the fact that the Cleveland Clinic has no OB. At MUSC we strive to create comprehensive, innovative, integrative programs which invent the future of care and are clearly the superior providers of that care in our market and our state. We believe we can and are already doing this in Cancer, Children’s, Digestive, Neurosciences and Heart & Vascular. These comprehensive programs are found only in large academic medical centers. They provide an external reach to the program that is broad and wide, they insure that we have substantial staff and resources that foster collaboration within cross clinical disciplines, the personnel understand and support centralized planning and accountability to a leader of the service line and research is an essential part of inventing the future of patient care. The last clinical initiative to address this afternoon is a UMA consider a multi-specialty clinic in the north area. This planning will be done in two phases, the first is to refine a plan and utilize projections about the feasibility, explore the financial impact and create a business plan that shows whether or not such a project is viable. If the business plan is not viable we will not do it, of course. There are a number of possible sites that such a project, if it is deemed viable, would go and they are shown in this map, and all are above Ashley Phosphate Road and in and around the Summerville or Trident Hospital areas. The possible specialty mix at these sites would be internal medicine and several of the sub-specialties of, ENT, Dermatology and Radiology. We expect this year to conclude phase one of our planning of this possible clinical initiative. As I have already mentioned, the goals for next year are to implement a plan to assist the university in solving its financial issues, to assist scientists and Dr. Brady with a formation of a CTSA proposal, recruit a new director of the DDC to replace Peter Cotton, who has led this wonderful center for 12 years. We will be working hard to plan for the opening of the new hospital and the best use of backfill space in the old hospital. We will assist Drs.Wong and Hannun, respectively, with implementation of the College of Medicine’s strategic plans in education and research. We will push for an implementation of the VA/MUSC joint facilities plan, determine which model to use in the VA/MUSC joint facilities plan. We will continue to explore ways to find new revenue to support our critical missions and to stay focused on our major issues that affect all of you our faculty, students, and staff. In concluding these remarks, it is my hope that you join me and Dr. Feussner who, as president of UMA, is helping chart our future in making these plans reality. I suspect when you look at us you believe that we either are contemplating a very bright future or fearing that this is the blind leading the blind.     Friday, Feb. 3, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778, ext. 201.