COM dean addresses faculty for 2008
Editor’s
note: On Feb. 26, College of Medicine Dean Jerry Reves, M.D., presented
his State of the College speech to COM faculty and staff. Following is
a portion of his speech.
Welcome to the 2007 State of the
College address. It is my
great privilege to report to you on our fiscal year 2007 and discuss
our future
directions together. As your dean, I feel strongly that I should be
held accountable
for accomplishing the goals of the college as outlined for you during
last year’s
address, so I will first present these focus areas and update you on
our
progress to date, followed by a review of key MUSC Excellence goals and
activities within the College of Medicine, concluding with a look to
the year
ahead.
Reviewing our progress on last
year’s goals, we have recruited
the chairs of surgery and psychiatry, as well as a number of the
service line
leadership positions. We implemented several service lines in July with
more to
follow, but we have not been successful in working out an agreement
with the VA
regarding phase 2 of the Hospital. We have implemented a medical
information system
that is fully integrated within the clinics and will become
synchronized with
our inpatient records. We have established greater clinical outreach in
our
North Area, recruiting approximately 20 new clinicians, in keeping with
the UMA
recruitment plan.
We assisted Dr. Kathleen
Brady with the Clinical and
Translational Science Award (CTSA) application in October, and we have
emphasized with our Chairs the critical importance of faculty
development and
research growth. We have built the endowment of the College
of Medicine as you will see
later,
and we have worked hard with Health Sciences South Carolina (HSSC) to
honor
MUSC’s commitments throughout the State, striving to make HSSC a
national model
for collaboration. We have been successful with the recruitment of
underrepresented
minority (URM) students, residents, and faculty, and we have worked
collaboratively
with the other colleges to put together a robust inter-professional
educational
curriculum. So, all in all, 2007 has seen many accomplishments, and I
hope that
you will consider that our work in progress is reasonably well
fulfilled.
You are all familiar
with the College of Medicine’s
Pillar Goals,
established through MUSC Excellence, which is our method to move the
college,
and now the entire University, to a significantly higher level of
performance.
Our first pillar goal is People, because we believe that people are the
most
critical factor within the college. We have set goals for employee
satisfaction
and are monitoring turnover in our staff and faculty as a measure of
that
satisfaction.
In terms of non-faculty
staff satisfaction, we surveyed
everyone in 2007 and our baseline score was 66, which placed us in the
52
percentile in the Press Ganey database. We will establish a higher goal
for
this year, and all of our leaders are hopefully hard at work already on
plans
to achieve better internal satisfaction. In terms of preventable
turnover for
the staff of the College, it was at just below 8 percent this year,
which I believe is
a very good number, and we would hope to maintain this or lower it.
For faculty attrition,
we set a goal of 10 percent, and during
the last four years we have been significantly below our goal, which
again is a
good thing. We are pleased that both our staff and faculty are staying
on
board, reflecting our shared commitment to excellence. Not only are our
existing
faculty staying, but we are actually growing, with increases in both
the Basic
and Clinical Departments, and over 1000 faculty members currently
appointed to
the College of Medicine.
This has been an
important year in recruiting new academic
leaders. In addition to the appointment of Drs. Cole and Uhde as Chairs
of
Surgery and Psychiatry, Dr. Robert Adams was appointed our Center
of Economic Excellence
(CoEE) Endowed
Chair in Stroke, and Dr. Harry Drabkin is now the Department of
Medicine’s
Chief of Hematology-Oncology. Dr. Jay Moskowitz has joined us from Penn
State as President of
HSSC and our
CoEE Endowed Chair in Healthcare Quality, and Dr. Iain Sanderson has
been
recruited from Duke as our CoEE Endowed Chair in Medical Informatics.
We are also quite
pleased that a number of individuals are
now occupying prestigious Endowed Chairs with the College: Drs. Craig
Crosson,
Harry Drabkin, Robert Gemmill, Bob Hawes, Gene Howard, Inderjit Singh,
Kerry
Solomon, and Marc Chimowitz. It is quite an honor to hold these
distinctive positions
within our College, and we are proud of the accomplishments of these
faculty
members.
I will now continue the tradition
of mentioning just a few
of the many successes of our faculty. Bruce Thiers is editor of the Journal of the American Academy of
Dermatology, and Lou Luttrell was awarded imminent scholar status.
Maria
Buse has now served 50 years on our faculty--an unimaginable milestone
of
achievement of which we are exceedingly proud. David Soper serves on
the
University Health System Consortium (UHC) Obstetrical Steering
Committee. Elizabeth
Slate has been elected an American Statistical Association Fellow, and
is now
an Associate Editor of Biometrics. Yusuf
Hannun received the Governor’s Award for Excellence in Scientific
Research. Lisa
Cunningham has been named the Burt Evans Young Investigator of the
Year.
We are purchasing a da
Vinci robot, which Drs. Hebra, Savage, Carter, Kohler, and others
will jointly
use. Rob Stuart was selected “Health Care Hero of the Year,” and one of
our
spinoff companies led by Inderjit Singh and Lyndon Key received
$500,000 for research
on statin use in juvenile diabetes. Dick Gross is the American
Academy of Pediatrics’
Orthopaedic
Distinguished Service Award winner. Ken Tew has been elected a Fellow
of the American
Association for the Advancement of Sciences and President of the
American
Medical School Pharmacology Chairs.
Our research stays in the news. For
example, Michael
Schmidt’s work regarding copper’s anti-microbial potential has garnered
recent national
attention, and Mike Zile’s efforts in predicting congestive heart
failure risk through
a simple blood test have also achieved significant recognition for the
College
and HSSC.
We’ve had many collective successes
as well. The Emergency
Medicine residency program has been established. We have 281 physicians
named
in the nation’s Best Doctors list. The Neurosciences Department in
particular
has had a banner year in terms of funding, with multimillion dollar NIH
awards
to Drs. Kalivas, Granholm, See, and their newest faculty member, Marc
Chimowitz.
One remarkable success
has been awarded by the University
Health System Consortium: the Quality and Accountability Performance
Award for
Significant Improvement, reflecting our movement in rank from group 4
to group
1 of academic medical centers. This is a big deal and represents the
collective
work of everyone to make our Hospital a better place to be as a patient
and to
work as a physician.
In terms of our graduate
education, we continue to get
major recognition by US News and World Report for our drug and alcohol
abuse
work, and we also have several clinical specialties that are signaled
out each
year as some of the country’s best.
Our students are active
in many things in addition to
doing school work. Clarice Seifert is the Southern Region Chair in the
Organization of Student Representatives to the Association of American
Medical
Colleges (AAMC); Kristie Appelgren is the Chair of the National
Committee on
International Health and Policy in the AMA-Medical Student Section;
Karen
Hammond is the recipient of the 2008 Sanofi-Aventis Minority Scholars
Award,
only 1 of 8 awarded nationally this year; and Vandy Gaffney is the
co-organizer
and leader of the remarkable “A Gentleman and a Scholar” Program, which
develops underrepresented minority medical student candidates through
outreach
programs.
Our students are very
active in many community service
activities. Their work at the Crisis Ministries Homeless Shelter won
the
Service Learning Award from the South Carolina Commission on Higher
Education
last year. Our students and their faculty supervisor, Dr. Wanda
Gonsalves, also
received a grant from the AAMC’s Caring for the Community Program for
the
Community Aid, Relief, Education, and Support (CARES) Clinic.
Our second Pillar Goal
is Service, where we examine how we
are doing with those whom we serve—our patients, students, and faculty.
In terms of outpatient
satisfaction, the overall
percentile ranking has increased, surpassing our 2007 goal of the 62nd
percentile, with a current rank at the 79th percentile. This has been an immense improvement,
representing the hard work of the MUSC Excellence program, and I
believe that
we should single out Dave Neff for his leadership in our clinics.
I am also encouraged by
our overall improvement over time
in patient satisfaction on the inpatient side. Compared to all
hospitals, we
are at the 70th percentile, and when we compare ourselves to the
academic
hospitals, we are at almost the 90th percentile. This is an
extraordinary
performance and I again commend all of our doctors and nurses and
others who
make this possible.
We inaugurated four
service lines in 2007 and appointed
their medical directors. Eric Powers leads the Heart and Vascular
Center, Mark DeLegge
directs the Digestive Disease
Center,
Phil Saul leads Children’s Hospital, and Prabhakar Baliga leads the Transplant
Center. Some have been
on the job
for awhile, like Phil Saul, and those that are new to their posts are
also doing
well.
We have selected medical
leaders for four additional service
lines for July 1:
Jill
Mauldin for Perinatal, Sue Hardesty for Psychiatry, Marcy Bolster for
Musculoskeletal, and Alice Boylan for Critical Care and Acute Care.
These
splendid leaders will be joined by the “to be recruited” appointees for
Neurosciences and the Hollings
Cancer Center.
We have set a goal for
overall student satisfaction with
their medical education to be above the national average, and although
we are
high, with a score of 88 compared to the national average of 90, we
have not
yet obtained our goal. This is disappointing. In trying to understand
why we
have not been successful, we have looked at what our students say on
the AAMC
graduation survey, and we are above average in terms of access to
administrators, awareness of their problems, responsiveness to their
problems, and
assistance with career planning. As we perform these component
activities well,
it is unclear why we don’t get a better “overall quality of education”
score.
We will continue to strive toward this important goal.
We sent
a questionnaire to the research faculty in July. There
were 210 respondents, and there was no baseline data for comparison, so
this
data becomes our baseline. The score responses were on a 1 – 5 scale,
with 5
being the highest, and our goal is to reach a score of 4 for the
reviewed
areas. Our research faculty generally are satisfied with Departmental
and
University support, although when looking at University functions only,
the
areas of Intellectual Property, Purchasing, and Human Resources were
found to
be at the 3 or lower level.
In the annual faculty survey in
which all of you
participate, you will see that the Chairs are generally rated well at
the goal
range of 4. Though the Dean is ranked slightly below that by the
faculty, I am pleased
to say that the Chairs’ ranking of the Dean’s performance is higher
than the
faculty’s. Certainly we want our faculty to be pleased with their
Chairs and
their Dean, and we will continue to seek out your input as we advance
our MUSC
Excellence efforts.
Our third
Pillar Goal, Quality, is arguably the most
important thing besides people that we concentrate on. We have goals in
patient
mortality; student national examinations; NIH support; honorary
societies;
diversifying our faculty, residents, students, and staff; and fostering
interdisciplinary programs.
In terms of the
mortality index, we continue to decline
and this is certainly a good thing. Though the definitions have changed
and we
will be setting a new goal, we obviously need to keep doing everything
we can
to reduce the mortality index for our patients.
I am extraordinarily pleased to
report that the kidney and
pancreas transplant program has been ranked number 1 in terms of
mortality and
length of stay. This is just an extraordinary achievement. We are also
one of the
leading renal and liver transplant programs in the country.
Our students are at or above the
national average on the
United States Medical Licensing Examination (USMLE) for first time pass
rates,
and the same is true for step 2 for the last two years.
Despite the flat NIH
budget, we have had a 9 percent increase in
NIH funding, and overall our research funding has continued to grow
despite the
funding climate. I am particularly proud of the NIH performance, as
that is the
national benchmark by which we are judged.
In October, we submitted
our CTSA grant application, led
by Kathleen Brady in collaboration with the University
of South Carolina, the
Medical
College of Georgia, and Health Sciences South Carolina. We have
recently
learned that we will have the opportunity to resubmit this grant, which
means
another Herculean effort, but one that we hope to be successful on the
next
submission. We await the pink sheets at this time.
Iain Sanderson, one of
the top recruits to MUSC and HSSC,
is our CoEE Chair of Medical Informatics. We are moving away from
paper-based
data storage on this campus and will be linking informatics systems
around the
State via the HSSC consortium, possibly also working with Vanderbilt on
similar
database methods.
There is nothing more
important on this campus and in our college than developing careers.
The Provost is developing and consolidating a
number of initiatives to this end. We have the BIRCWH (Building
Interdisciplinary
Research Careers in Women’s Health) Award, which prepares outstanding
junior
faculty to become independent investigators. We have several COBRE
(Centers of
Biomedical Research Excellence) Awards designed to foster strength by
developing and mentoring promising early career scientists.
I am extraordinarily
pleased to say that the Neurosciences
Department has recruited Marc Chimowitz, leader of a 25 million dollar
clinical
trials network. One of the conditions under which he wanted to come
here was that
he be given responsibility to help all faculty in the College
of Medicine develop
clinical
investigative careers. So Marc will be the college’s associate dean for
faculty development and that will be his charge.
We understand that
people need places to work, and Dr.
Raymond has done tremendous work to make the Drug
Discovery Building
a reality, soon to be followed by the Bioengineering
Building.
These two buildings will bring over 200,000
new square feet of research space, and incidentally they will include
lecture
halls that are large enough to accommodate even greater audiences
within the College of Medicine.
The fourth Pillar Goal
is Growth, reflecting the old
adage: “Either grow or die.” We are
monitoring the number of graduates, our NIH ranking relative to others,
our
market share, and patient volumes.
In the last two years we
have seen an increase by 10% in
our accepted students, so we are responding to the AAMC goal for
increasing
medical education. In terms of our relative research NIH standing, we
are in
the upper quartile of free standing academic health centers, and we are
quite
proud being in the upper echelon of our peers.
In terms of patients, we
have seen over the last several
years a steady increase in market share. One of the innovative ways we
are
doing this is by using the internet. It is the largest way that we get
new
callers through MUSC, far out-stripping other media in this particular
category. Chris Murray and Dave Bennett both are on the frontier of
this new technology
in steering patients to MUSC. For example, online advertising is such
that if you
google “weight loss surgery,” you will find MUSC right at the top. This
is one
way to get new patients to our Hospital.
We have been very
successful in increasing the admissions
to our Hospital, despite the fact that we haven’t had new beds. We had
a 3 percnt
increase between 2005 and 2006 and a 6.8 percent increase between 2006
and 2007. We
are up to 34,000 admissions. This has
been a Herculean effort on everyone’s part.
Ambulatory visits have
also gone up by 21 percent since 2005 and
although the majority of the patients are seen on campus, the greatest
increase
has been in our off campus offices. We
are seeing nearly 550,000 visitors a year in our clinics.
When we talked about
moving into Ashley River
Tower,
we said that we had to develop innovative care strategies as new as the
Hospital. One such effort is the Vascular Services’ Strategic Alliance
of surgery
with interventional radiology, where the revenues, regardless of whom
performs
the procedures, are split 50/50 based on a pre-defined CPT case set.
Faculty
have joint academic appointments and they are sharing access to the
interventional radiology suites and operating rooms. Of course, this is
what
the patients expect--a single service line of providers with different
types of
expertise, so that they get the right procedure at the right time by
the right
person.
We have developed a
hub-and-spoke outreach strategy in
response to projected areas of population growth, where we have large,
multi-specialty buildings with our physicians in East Cooper, West
Ashley and the
North Area. UMA has plans to expand all of these areas with the goal to
keep
our Hospital full and profitable, as our entire enterprise benefits
from the
clinical revenues that are used to support academics. Hilton Head, the
Bluffton
area, and the Beaufort area are growing and they are areas where we
must
outreach. Last Friday, Bruce Elliott and Andrew Kraft announced the Hollings
Cancer Center
affiliation with Hilton Head
Hospital. It is
activities like
these that bolster our scientific and clinical missions.
We are also anticipating
building what is called the Sabin
Street Children’s ED and OR. This will
include 10 new operating rooms and the Children’s Emergency Department. This will give us much needed relief in the
operating room congestion and allow us to expand the adult Emergency
Department,
consistent with the educational and clinical needs of MUSC.
Finance is the final
Pillar Goal. The College of Medicine
knows that it must
assist the Hospital in improving its operating margin. We must assist
the university
in reducing energy cost. All of our units must maintain a balanced
budget, and
we have to see our research flourish and understand that that takes an
investment.
The Hospital’s fiscal
margin goal of 2007 was 5.8 percent, and the
actual margin was 4.7 percent, so they did not quite make goal. The College
of Medicine’s goal was to
have a
margin of 2 percent and we actually had one of 4.6 percent. The
university is still deciding
how best to measure utility use, but we are confident that will be
measured
this year.
The College
of Medicine
computes a return on investment rate for dollars invested in
Departments for
research expenditures, and we have seen a reduction from 4 to 3.5 in
this
number. This is going the wrong direction and probably represents the
flattening
of the NIH budget. We have a number of initiatives to try and improve
in this
area.
The college is doing
well in philanthropy, and several departments
have been quite successful in raising funds for endowment and other
uses. There
is no question that the state’s Centers of Economic Excellence matches
with
endowment dollars have been a useful tool for raising money, and we are
about
to announce in May a $350 million capital campaign which will give us
all an
opportunity to be more successful in obtaining funds from philanthropic
sources
to support our academic missions.
This brings us to the
point in the talk where we review what
we will be doing next year. The first thing we will be doing, of
course, is
using MUSC Excellence as a tool for improving the College and
University. We
are committed to assisting faculty and Departments with research
growth, and we
will continue to support the CoEEs and large centers and grants as a
method of
doing this. We are excited about the career development opportunities
that we
will support in the College
of Medicine
with Dr. Chimowitz and the Chairs.
We are working with Dr.
Deborah Deas and many others,
including all of the chairs, to recruit underrepresented minority
students,
residents and faculty. The Hollings Cancer Center NCI application goes
in this
May, which is a critical process for this Institution; we must all do
everything that we can to assist Andrew Kraft and others to make this a
successful application.
We will continue to work
with Dr. Wong and others in
curriculum change and work collaboratively with the other colleges in
the
inter-professional curriculum, which we believe will be an important
national
model. We will be assisting Dr.
Sanderson and HSSC with the implementation of medical informatics,
creating
opportunities to do things never before dreamed of in this country and
certainly on this campus.
We will continue to
implement service lines, and we will
recruit and assist their leaders while building the endowment of the College
of Medicine through support
of the
capital campaign. We will work with Dr. Moskowitz to make HSSC a
national model,
and finally, but not last, we will see what is possible working with
the VA and
MUHA to get to phase 2 of the new hospital as soon as possible.
As in previous years, I
will conclude by reminding us all
that the College of Medicine
is the oldest medical school in the South, but that it has yet to reach
its
proper place among American medical schools. Our destiny for excellence
in all
that we do has yet to be achieved, though we are building on our many
successes,
and it is my genuine privilege to work with you in doing this together.
Friday, March 7, 2008
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