School of Medicine 2005 State
of the School Address
 |
| Richard Krugman, MD |
On Nov. 29, 2005 UCD School of Medicine Dean, Richard Krugman, MD, gave the annual State of the School Address:
Today, I’d like to talk
about our School’s past, present and future. But first, I would like
to begin with a moment of silence for our faculty colleagues who
have passed away this past year. Let us all be thankful for the accomplishments
of those
who came before us.
Charles Brown, MD
Associate Clinical Professor of Orthopaedics
Margaret Hoehn, MD
Clinical Professor of Neurology
Peter Kohler, MD
Professor of Medicine
William Krupski, MD
Professor of Surgery
Theodore Puck, PhD
Professor Emeritus of Medicine
Michel Reynders, MD
Clinical Professor of Pathology
Conrad Riley, MD
Professor Emeritus of Preventive Medicine
Brandt Steele, MD
Professor Emeritus of Psychiatry
Karl Sussman, MD
Professor of Medicine
Yasuhiko Takeda, MD
Professor Emeritus of Pathology
It is with great pleasure that I offer the annual State of the School
Address to the faculty, staff, residents and students of the University
of Colorado School
of Medicine. I have been honored to serve as your dean for the past 15 years.
Together, we have grown and matured as colleagues and as an institution. We
should be proud of all that we have accomplished.
One of the unintended consequences of keeping all of you up to date with a
weekly e-mail is that you get down to the time for the annual State of the
School and
wonder, “What can I tell them that they don’t already know?” Throughout
the last year I have peppered you with more than 50 e-mails in the effort to
improve communication in our School. There’s not much that I haven’t
told you.
Therefore, I want to use this time to remind you of the remarkable journey
that we, and this School, have made over the past decade-and-a-half, and then
refocus
our collective attention on our future.
So where have we been that has led us to where we are now?
As I prepared for today and thought back over the past, it was apparent that
our faculty had a common modus operandi. Simply put, despite many challenges,
we have found our own solutions.
For every institutional challenge, we’ve become more resilient.
For every resource cut back, we’ve become more entrepreneurial.
For every regulatory hassle, we’ve become more effective.
For every attempt to constrain our creativity, we’ve become more adaptive……..and
believe it or not,
For every attempt to divide us, we’ve become more collaborative.
The bad news is that the days of challenges are not over. The good news is
that we have a 15-year track record of working through challenges together.
I’m
confident that with our institutional ability to translate every challenge into
an opportunity, no matter how difficult or painful, we will no doubt rise to
the occasion challenges face us in the future.
Let me remind you of some of the “challenges” that you’ve converted
into successes over the past 15 years……where we’ve found our
own solutions……together.
In the last century, our Flexnerian curriculum was stagnant and did not
treat
our students as adult learners and as partners in their education.
We revitalized our curriculum and completely transformed it to the point
that it is being held up as a national model. Thanks to the tremendous work
of our
outstanding faculty and staff, we will no doubt graduate better prepared physicians
to deal with various populations, medical challenges and scientific advances.
At the same time, our School increased its medical student class size for
the first time in 30 years to respond to the predicted physician shortage of
the
future and to increase access to Colorado residents.
We’ve raised nearly a million dollars to offset the one-time costs of
developing our new MD program.
The COPs will be sold December 22 and the education buildings will begin
construction in the New Year.
The faculty in our Physical Therapy degree program recognized the changes
in the industry and evolved the program into a premiere doctoral program.
The faculty of our Physician Assistant program – now more than 30 years
old – is still one of the best examples of pure medical education in the
country.
The faculty of our Masters of Science in Public Health degree have looked
to other collaborating partners and are poised to branch off into a School
of Public
Health.
Our rural outreach was virtually nonexistent.
We recognized that the school’s rural outreach was minimal and needed
work. It’s now difficult to look at a Colorado map and not see the School’s
reach.
Our clinical practice generated little revenue, grappled with compliance
issues with Medicaid, and our faculty were dissatisfied with our practice plan,
UPI.
Our practice plan is remarkably successful and stable and has successfully
adapted to one of the most competitive managed care markets in the United States.
We entered into the CHAMPUS/Tri-Care/Tri-West contract which laid the foundation
10 years ago for a successful joint venture with University of Colorado Hospital.
We have made school finances transparent and decisions open.
In the early 1990s, our research enterprise was struggling. We faced
a flat NIH budget and our funding lines were below 10 percent. We faced a physical
plant
with limitations.
We created a research strategy where limited resources were pooled together
to support programs rather than individuals.
We reshaped the ICR formula, which has pumped an incremental $100 million
into the SOM.
We sustained the Academic Enrichment Fund that has supported the School’s
programmatic growth for a combined total of more than $132 million.
As a result, our research enterprise exploded with growth. The support from
the AEF supported the start-up costs of the Cancer Center, Neurosciences, Molecular
Biology and the Molecular Structure Program, among others.
Our rigorous research enterprise outgrew our physical plant and faculty developed
the new Fitzsimons campus. We stand here today in 600,000 square feet of research
space and next to a hole that will soon be another 500,000 square feet of research
space. That totals 1.1 million square feet of new research space that is the
envy of researchers across the country.
We have grown our NIH ranking from 30th into the top 20 in research funding.
Because of your creativity and drive, this School’s faculty, including
those at our affiliates, are ranked 4th out of all public medical schools.
In addition to these changes, we recognized that we must update the administrative
infrastructure of our School to create an environment that supports growth and
sustainability of our faculty in order to succeed in the future.
We separated Promotion & Tenure, putting all faculty on a level playing
field. We made explicit the requirements and emphasized the critical educational
role of each faculty member.
We put into place the BSI [Base/Supplement/Incentive] pay system to assure
that we could appropriately retain faculty and reward their productivity through
significant but scaleable increases in their salaries, and at the same time,
gave our units flexibility to decrease salaries should resources be scarce.
We moved faculty salaries from the 13th to at or around the 50th percentile
of AAMC salary benchmarks.
We’ve established formal affiliations with our teaching hospitals that
codified the equitable incorporation of our colleagues at these institutions
as full-time faculty of this school.
By addressing these challenges head on and using the entrepreneurial spirit
that permeates this institution, our institution has grown, evolved and emerged
a
stronger and more accomplished one.
As you can see, over the past 15 years, you, our faculty, have been moving
forward with tremendous momentum. We mustn’t stop evolving if we are to get where
we want and need to be. We lose ground if we stand still.
With faculty as talented as you, this School is in control of its own destiny.
As with the flattening NIH budgets and dwindling state funds, our challenges
may be great, but our talents are enormous. We must mobilize that talent to
go from good to great.
I need to add one special thank you here. There are lots of people in this
school who deserve our thanks, but in my view, no group has been on the bleeding
edge
of the sharp budget cuts more that our Administrators. As more and more work
gets pushed down from the President’s and Chancellor’s offices to
the School (as they had little reserves to buffer their severe budget cuts),
our Department Administrators, led by Lilly Marks and her staff in our office,
have done an extraordinary job in holding things together. We all owe them our
great thanks.
Leadership
This past year, we’ve faced changes in leadership at all levels of our
university. The most significant change has come with the appointment of President
Brown. We can all agree that his arrival has steadied the institution. I feel
quite confident that he understands academia and is supportive of research, of
access and of equality.
As for our Chancellor, I am confident that President Brown and the Regents
will work swiftly to identify a permanent Chancellor for the University of Colorado Denver who will be able to adeptly balance the
administrative, academic, research and clinical aspects that make up our consolidated
institution. We need the Chancellor to protect and nurture our academic mission
and excellence in the face of growing pressure as we continue to expand our
entrepreneurial and commercial endeavors.
We will be working with Greg Stiegmann, MD as the Interim Chancellor to assist
in any way we can to make his transition smooth. We look forward with great
anticipation to working with Bruce Schroeffel as our new President of the University
of Colorado
Hospital. We embrace his approach to leading – he believes that program
growth is a catalyst, that we cannot shrink our way to greatness.
Here at the School, we have a new chair of pathology, are close to naming a
new chair in pediatrics, are in process for ophthalmology and neurosurgery
and have
a new senior associate dean for education.
State budgets
It was obviously a huge relief when Referendum C passed. Unfortunately, we
are not out of the woods, yet – the same set of circumstances we faced last
year are present again this year – very tight pay-lines at NIH, even more
pressure on clinical reimbursement and, in spite of the passage of Referendum
C, no clear signal that we will be able to recoup the staggering loss of state
money we have lived through the last four years. I worried some privately over
the last few months that if Referendum C passes it might have a paradoxical dampening
on our efforts to generate endowment for the school. I believed that it needed
to pass so things wouldn’t get worse – knowing that if it didn’t,
we would be in a real crisis. I applaud the Regents’ statement that higher
education needs to be a top priority and will ensure that the Governor and legislature
hear our need for critical fiscal support.
So where do we need to go from here?
There are many schools of medicine in the United States that have more resources
than we do but are less successful. In the coming five years, we must use the
successes over the past 15 years as the compelling reason for continuing to
grow. We can’t afford to wait for the state or the government to provide us with
the funding we need to continue to flourish.
Therefore, I’ve made raising a multi-million dollar endowment the School’s
top priority. Without this funding stream, the School will continue to be susceptible
to the fluctuations in public support. In past years you’ve heard about
the School of Medicine’s Council of Advisors, a group of business, community
and philanthropic leaders who are committed to the success of our School of Medicine.
Some are here today – we are grateful to all of them for their time and
effort.
This year, with their assistance, we’ve developed a case for support that
outlines our scientific breakthroughs, our educational positioning, and our clinical
track record. With their guidance and support, I’m leaving my comfort zone,
going on the road and pitching the School as a business person would pitch a
business opportunity……because as one of our advisors said, “if
the CU School of Medicine were a company, I’d buy it.”
When one looks at other schools of medicine, both those ranked above us and
below us, the majority of schools have larger endowments than we do here at
our School
of Medicine. I am taking responsibility for changing that situation and am
going to do everything in my power to share the remarkable contributions you
make every
day – in the lab, with patients, with students and in our community – with
prospective donors and corporate partners. We’ve already had some successes.
They say the first dollar is often the most difficult to get, and with the
hundreds of compelling ways our faculty impact lives around the world every
day, it makes
my job of finding individuals, corporations and foundations who are compelled
to support our vision all the more simple.
As you identify grateful patients, interested donors, corporate partners, know
that I will do anything in my power to assist you in your effort to bring in
outside financial support for your work. I commit myself to being available
24 hours a day, 7 days a week to grow our “safety net” in whatever way,
shape or form it may take to ensure that we can continue to thrive and grow as
a School of Medicine.
So what else does the next five years hold?
Education
Our challenge ahead is to complete the design and implement all four years
of our revitalized curriculum. Literally hundreds of faculty have worked hard
to
find better ways to make the connections between science and compassion, instill
a sense of life-long learning and collaborative health care decision making,
all the while equipping our students to move beyond cultural boundaries that
prevent uniform care. Not only should we strive to create the best prepared
physicians, but also support our innovative CHA/PA (Child Health Associate/Physicians
Assistant),
PT (Physical Therapy) and MSPH (Masters of Science in Public Health) programs
to round out our health care services education that we at the School of Medicine
provide our community.
As we move from a curriculum that resided in departments to one that’s
more centralized, we need to sort out the structural relationships between faculty
educators and departments.
As we move away from teaching one discipline singularly to integrating lessons
with basic science and clinical material, we cannot lose our connectedness
to our clinical and research missions located in departments.
Clinical
With the clinical enterprise, the next five years holds opportunities for joint
venturing, for ensuring high quality, adaptive care. Thanks to the leadership
of University Physicians, Inc., we are already ranked as the number one faculty
practice in the nation. But as with all things, to stay competitive we will
have to think more creatively. With the advances in new technologies, medical
care
will provided in new ways and in new locations. For example, our Department
of Family Medicine, Forest City and the University of Colorado Hospital are
collaborating
at Stapleton.
Many are pushing clinical care out to ambulatory settings, where
private physicians own the equipment and therefore reap the financial rewards.
This trend sets the stage for new opportunities to create different revenue
streams and to establish new joint venturing relationships with our affiliated
hospitals.
For example, we’ve created an investment pool and are now working with
The Children’s Hospital to develop an ambulatory surgical center. We welcome
the chance to develop a collegial and collaborative relationship with the new
CEO at University of Colorado Hospital, Bruce Schroeffel, to develop similar
joint ventures.
In addition, we must strive to develop clinical excellence as a group practice.
Clinical excellence will be defined by access, service, and quality. We’ll
be looking at pay for performance and documentation of quality for our patients.
This will require a cultural change in our clinical enterprise – one that
I suspect may be harder than the others we have done.
Research
As anybody who’s doing research today knows, we are vulnerable. We face
another period of flattening NIH budgets. We must use our lessons learned from
1990 and tackle this problem head on.
I plead with you to look critically and creatively at ways to become more interdependent,
to collaborate……Look at everyone around you as collaborators. Look
to the researchers on the floors above and below you, look across the hall. Look
around the city, the state, the country and the world. Clinical researchers need
to reach out and collaborate with basic researchers. Basic researchers need to
reach out and collaborate with clinical researchers. We must look to identify
new ways to collaborate to not only make our dollars go farther, but also to
make our research and our science better.
The NIH has unveiled the Clinical and Translational Science Awards that emphasizes
a new type of collaboration between clinical and basic researchers. I have
organized a group to tackle this effort and use this new structure to strategize
ways of
our effectively competing for limited research opportunities.
With Fitzsimons, we finally have state-of-the-art space to advance science.
At the same time, we need to be sure that we deal with the potential casualties
of the tight NIH budget by working together to support bridge-funding opportunities
for certain units. I have committed $1 million through the Strategic Initiatives
Research Committee to bridge funds for researchers who may need such support.
Core Mission of the Dean’s Office
I have said before that we are about people here – the School of Medicine
is only as good as its faculty. Faculty development is absolutely critical to
sustain and improve upon our collective success.
We face a challenge in attracting graduates into academic medicine. In the
1960s and 1970s, we flourished with the work of dozens of young graduates and
trainees
from this school. As we look ahead to the next generation of faculty, we need
to strike a healthy balance among those we “homegrow” and those we
recruit from around the world.
We need to help faculty engage in scholarship, to provide another dimension
to their experience here. We are not a collection of clinicians, educators
and scientists – it
is scholarship that weaves through all our efforts and makes us unique and valuable.
We are not a collection of departments and centers – it is scholarship
that reaches across imaginary boundaries and ensures our own life-long learning
by instilling those values in others we train, treat and study.
I believe the School of Medicine must strengthen the collegial, diverse landscape
of faculty and students to encourage new thought. With the inclusion of new
thoughts, ideas, experiences, cultures, we’ll strengthen our institution. Yet let
me be clear. All of our efforts will be in vain if we forget the human element
in what we do.
Given the day to day challenges we face, it’s easy to become mired in the
crisis du jour. I am occasionally guilty of this just as I suspect from time
to time some of you may be as well.
But in the coming years I am going to work to protect the humanity of this
institution. I challenge each and every one of you to do the same.
As a grandfather, I see the impact my words and actions have on my grandsons.
It reminds me that as educators, we have tremendous responsibility to demonstrate
our behavior in a way that students model the good and not the bad. I am reminded
that we must remember that our students are our next generation of care providers.
When they see us demean a colleague when we’re having a bad day, when they
see us focusing on the day to day malfunctions, they think this is a bad place
and worse, a bad profession.
It has been said that people remember not what you say or what you do, but
rather how you made them feel.
As faculty we are the protectors of our profession, the stewards of our collective
soul. We are the ones who model the behavior, set the tone, and inspire our
students and trainees to go bring soul to this profession. We work in an environment
of
great power imbalances – and we must be cognizant of those real or perceived
imbalances in our work with other faculty, trainees, students and staff. Through
our behavior with trainees and staff we garner loyalty and energize their efforts
and talent. We instill the belief systems that will advance science and improve
care for the next generation of physicians and their patients. I hope each of
you will join me in making this a personal responsibility and goal.
Your talent and drive can get us where we need to be.
Every day is not going to be a great day.
Ray Helfer was one of my mentors. When he heard that I had become Acting Dean
in July of 1990, he told me something that has been enormously useful in my
work. “Don’t
ever think that people create problems for you in that job,” he said. “The
job is problems, and your job is to solve them!” That is what we all face
in our work every day – one problem after another – one road block
after another – you have done a terrific job of hurdling them all.
You’ve proven that you can turn any challenge into the chance for great
opportunity. With the cumulative talents of those around us, we can accomplish
what we need to, and I look forward to leading you in this effort.
Thank you.
