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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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