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COM dean addresses students, faculty Editor’s note: On Jan. 31, College of Medicine Dean Jerry Reves, M.D., presented his State of the College speech to COM students and faculty. Following is an edited version of his speech. For the unedited version, visit http://www.musc.edu/catalyst/archive/2006/address.html. by Jerry Reves, M.D. Dean, College of Medicine Welcome to the fifth annual address to our faculty, students and staff regarding the state of the College of Medicine.   I am honored to speak with you about our college, its accomplish-ments, 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, I know that we are committed to reaching greater heights in our own professional development and the development of our college.   It's important to focus on five categories: 1) a report card on the 2005 goals; 2) mentioning other accomplishments; 3) highlight a few of the individual achievements; 4) review three concerns and, 5) discuss goals for 2006. Dean's Report Card I believe the faculty should hold the dean and other leaders accountable for achieving 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.   Dr. Jeff Wong created an education strategic plan based on a retreat with college leaders interested in our undergraduate educational offerings. That plan is in the process of being implemented.   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  research space.   As you know we have created a single Neurosciences Department and this department is continuing to thrive, recruit well and enhance its educational, research and clinical status.   Our interdisciplinary research and clinical programs are all doing well. Veterans Administration Medical Center Finally, we have worked hard with the VA to improve our relationship with this essential and important partner and there are still  exciting possibilities 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. The increase of National Cancer Institute-sponsored research has nearly tripled in five years.   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. I expect us to determine what we will do with the VA as it relates to new facilities including phase II of our adult hospital. Graduate Medical Education Update Another achievement this year was to formalize the reporting relationship of Graduate Medical Education (GME). We clarified the reporting relationship of the designated institutional officer up through the educational chain of command—COM to the provost and president and to the Board of Trustees—making it easier to function and assist the chairs of our clinical departments as they work in educating our residents and fellows.   We have seen significant increases in the number of under-represented minorities in our faculty. Likewise in our student body, we have sustained our increase in the recruitment of under-represented minorities to the college and we are holding steady.   The Office of Research Development has reported a remarkable increase in funding since 1997, mostly in this college. The college has nearly tripled our NIH support in the last five years.   In terms of our national and regional standing in NIH support, we are ninth of 43 schools in the South. We have some outstanding departments, with seven ranked in the top 20 nationally, and all of these are in the top five in the South. Individual Achievements I am aware that it is individuals who do all the work and I thank you all. I would like to recognize some of our distinguished faculty who are doing wonderful things in many different areas. They include: Dr. Jim Norris, president of the International Society of Cancer Gene Therapy; Dr. Yusuf Hannun, award recipient, Governor’s Award for Excellence in Scientific Research; Dr. Pearson Lang, president, American College of Mohs Micrographic Surgery and Cutaneous Oncology; Dr. Peter Cotton, MUSC Digestive Disease Center for 12 years; Dr. Lyndon Key and Dr. Bruce Hollis, recently elected, American Pediatrics Society; Myra Haney, Lowcountry Martin Luther King Jr. Leadership Award for Education; Dr. Carolyn Reed, president-elect, American Board of Thoracic Surgery; Dr. David Soper, president, National OB/GYN Society of Infectious Disease; Dr. Joe Schoepf, considered seventh best world cardiac imager, Medical Imaging magazine; Dr. John Oldham, fourth edition text, Diagnostic and Statistical Manual of Mental Disorders; Dr. Darlene Shaw, recipient MUSC/HSF 2005 Teaching Excellence Award, Educator-Mentor. Financial Issues There are three major financial concerns I would like to address. I’ve already mentioned that the NIH is fundamentally flat and we cannot depend on as much revenue coming from that sector of our activities in the near term. The clinical enterprise is still healthy, but there are uncertainties. The institutional infrastructure 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, a university funds flow committee is studying the problem.   This brings us to the reality that only $1 comes into the university and  only $1 can be spent. We divide the $1 that comes into the university with the College of Medicine, other colleges, departments and UMA. This is the source of funding.   So our strategy is to concentrate on the individual professional excellence of our faculty to target certain interdisciplinary research initiatives that are in line with the NIH’s roadmap.   The infrastructure problem (based on increased utility costs and reduce state support) is running a deficit because these expenses are paid centrally. About half of the university's indirect $1 stay central. It is obvious that the budget will never be balanced unless other sources support the infrastructure. Thus, we are going to have to take a look at this distribution as part of the infrastructure costs.  Interdisciplinary Research Focusing on interdisciplinary research,  the college focused on the NIH roadmap, particularly the  interdisciplinary research, which is the only area in the NIH budget projected to receive meaningful funding increases  in the future.   An NIH initiative was designed to help lower artificial organizational barriers and advance science. Additionally, there will be a series of awards to make it easier for scientists to conduct interdisciplinary research, funding for training of scientists in interdisciplinary areas, creation of specialized centers to help scientists forge new and advanced disciplines from existing ones and others to encourage interdisciplinary planning through the creation of the NIH's Clinical and Translational Science Awards (CSTA).   The CTSA assist  institutions to transform themselves into better translational research enterprises.   The NIH has pointed out weaknesses in the clinical scientist's infrastructure both nationally and at MUSC. Although MUSC has general clinical research centers, training partnerships and programs in various settings, plus  a K-30 curriculum, they are not well integrated into the institutional effort for translational research.      In preparing us to take this next step, our strengths have been analyzed—rapid research growth, the  endowed chairs program, center funding, and   community ties.    We also have many weaknesses. Examples of this include  insufficient time dedicated to research, low expectations that research be done in some clinical departments, few incentives for collaboration across colleges, no incentives and limited protected time for research mentoring.   Recognizing our strengths and weaknesses, we plan to apply for the CTSA grant. The RFA issued in October and the first award applications are due in March. There will be more awards later and we will be applying for our award in 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. Statewide Initiatives In addition to our focus on interdisciplinary research initiatives, the college has many statewide clinical outreach initiatives. Many of these initiatives have clinical research as part of its work.   In striving to reach our full potential as regional and national leaders, our potential to work with partners around the state continues to grow through the Health Sciences South Carolina (HSSC) consortium that Dr. Ray Greenberg put together. As the major academic medical center in South Carolina, we can partner and bring our translational work with  other academic physicians and clinicians that are spread around the state in the Greenville/Spartanburg area and at USC 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.   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. Service Line Management 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.    The reason to develop service lines or the value proposition for the establish-ment of these lines is they have the broad impact on an organization and are a source of 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, and of course a method for branding. Comprehensive Care Programs At MUSC we strive to create comprehensive, innovative, integrative programs which invent the future of care and are 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 and vascular. These 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. UMA The last clinical initiative is for UMA to 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.   There are a number of possible sites that such a project, if it is deemed viable, would go, 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 ear nose and throat, dermatology and radiology. We expect this year to conclude phase one of our planning of this possible clinical initiative. Moving Forward in 2006 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 with a formation of a CTSA proposal, recruit a new director of the DDC.   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  with imple-mentation 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.     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 Island papers at 849-1778, ext. 201.