By Mark Couch
(Jan. 10, 2018) - In his third annual State of the School address, Dean John Reilly, Jr., MD, said the University of Colorado School of Medicine continues on a growth trajectory that offers time and resources to build an even stronger medical school.
By depending on its existing clinical enterprise, the School has been able to provide funding for robust research and education programs.
“We’re in an amazing time here at the School of Medicine,” Reilly said. “Our clinical practice is growing gangbusters, we’re successful in competing for scientific and clinical talent, we are getting great medical students, we are getting strong residents, our hospital partners are financially healthy. This is, in many senses, as good as it gets in medicine.”
Then, referring to a photo from his presentation of a surfer riding a huge wave, he said: “Surf’s up. We’re riding the wave and now we have to look at how we’re going to get to the beach.”
Managing abundant growth is the kind of problem that many other medical school leaders would like to have, Reilly conceded. He noted that clinical revenues have grown at double-digit rates and the number of faculty have increased by about 500 since he became Dean in 2015. The School attracts more than 7,000 applicants each year for 184 seats in the MD class.
For the CU School of Medicine, such growth raises concerns about building programs that are sustainable and consistent in quality, particularly when the clinical revenues that fuel growth are certainly going to come under pressure in the future.
“The dilemma is if we have to subsidize research and education, which we do, and we don’t get it from the state and we don’t have a big endowment, that subsidy is largely coming from our clinical practice and we’re going to start to get pressure in our clinical practice, the big question here is when, how big to we want to be?
“How big do we want to grow our research and education enterprise, particularly our research enterprise, given the ongoing investment it takes?” Reilly said. “I would argue that we want to prioritize quality over quantity here and prioritize strength over size, so that’s going to be the subject of a lot of internal dialogue over the next year and ongoing about how to do that.
It has a couple of implications. It means we have to be better at judging quality than we have been and taking appropriate action if we’re not having the kind of quality results that we want.”
That means a rigorous approach to performance evaluations and recognizing that not all are should be getting ratings of exceeding expectations or outstanding.
“I would say if everyone exceeds expectations, maybe it’s time to adjust our expectations. We’d all like to be in Lake Wobegon, where everybody’s above average, and we are, but I think we need to set the bar a little higher.”
He also called on the School leaders to improve their efforts at recruiting diverse students, residents, faculty and staff.
“I would say this needs to become a priority for us, not in the sense of obligation, but because we want to be great,” Reilly said. “It’s pretty clear from the literature that a diverse workforce and a diverse community working on solving complicated problems performs better than a homogenous community.”
He said about one-third of the medical school class are from backgrounds underrepresented in medicine and “that is a tribute to the admissions office, to holistic review, to the financial support that President Benson of the University of Colorado provided to increase student scholarships to help us compete for highly qualified, underrepresented candidates, all of which I think have been successful.”
In recruiting residents, the School is better than it was five years ago, but still needs to improve.
“This needs to be a continued area of focus because this is the pipeline for our faculty,” he said. “We draw a large proportion of our faculty from our trainees both in research and in our clinical residency and fellowship programs.”
He credited the second-look day, which was pioneered by Jeffrey Druck, MD, associate professor of emergency medicine and an assistant dean for student affairs, as one factor in improving diversity among residents.
With regard to diversity among the faculty, Reilly said the School still has a long way to go. He reminded department chairs that the Dean’s Office provides funding for salary support for recruiting faculty who are underrepresented in medicine.
“But we’re going to have to have a serious discussion this year about developing a more comprehensive strategy to move the needle in this regard.”
Pointing to a photo of three trees with tangled trunks, Reilly discussed the complex and rapidly evolving relationship with the School’s clinical partners on the Anschutz Medical Campus.
“We’re now not a sole destination,” he said. “We are now the hub of a couple of complicated clinical care delivery systems and this has implications for us as we partner with UCHealth, we’re going to have a presence at the new hospital in Highlands Ranch, we’re going to have a presence at the new office building in Cherry Creek, the new sports performance center down in Inverness, up in the hospital in Broomfield, etc., etc. With Children’s, we’re going to have a presence in Colorado Springs in their new hospital, an expanded presence up in Broomfield, we will continue to have the multispecialty clinic located down in Colorado Springs.
“Long story short: My predecessor Dick Krugman had to convince everybody to move east to come to this campus and now I have to convince everybody to move west and south to get off this campus.”
With those priorities in mind, Reilly outlined an expansive plan for the School in the upcoming year and near future, calling for
- Expanding of clinical activities off campus in new locations with hospital system partners.
- Providing access to care for underserved populations in new clinical locations. “We need to engage with our local community, provide a new learning venue for our residents and medical students, and actually try to get the population engaged in clinical research so that we can provide more value to the Aurora community than we do already and that we can advance medical knowledge and care in our community.”
- Working with the University Chancellor’s office on plans to construct a new building on campus that will provide additional office space for new recruits.
- Developing a coherent message to the community that the Anschutz Medical Campus is best place in the Rocky Mountain West to get clinical care. “We still operate as three unrelated entities, at times, on this campus,” Reilly said. “We need to develop a coherent message about the Anschutz Medical Campus and translate that coherent message to a proposal for investment from the philanthropic community in Colorado and nationally.”
- Improving participation from patients across the entire Front Range in clinical research. “Nobody else in Colorado is going to do that,” he said. “That is our opportunity and, I would argue, our responsibility.”
- Integrating the Cancer Center and its National Cancer Institute designation into the delivery of clinical cancer care across the state of Colorado.
- Generating a visual resource that connects research efforts across this campus.
- Creating a working group to propose what Medicaid should look like in 2025. “We can sit by the sidelines and wait until Medicare and Medicaid do something to us or we can try to take the lead and imagine what a health care system should look like, understanding that we can’t continue on the same expenditure curve.”
Reilly ended by thanking all who contribute to the School’s success.
“This remains a remarkable place to work, it remains a remarkable place to get care, it remains a remarkable place to get educated. We are really, truly on an amazing trajectory and I think we need to take advantage of this moment in time to build a foundation that will weather us through times when resources aren’t flowing in the way they are now.
“That means becoming more efficient in the way we provide clinical care, it means becoming more efficient in the way we do our research, it means becoming more efficient in how we use our research space – hint, hint – but we should not lose sight of what has made this place great. It is not the buildings. It’s not the research space. It’s the people. That continues to be our distinguishing resource and it’s the culture that we have to nurture and maintain even while we’re going through all of these changes.”