When Dr. Brooks Jackson arrives Monday as the new dean of the University of Minnesota Medical School, the Johns Hopkins pathologist will tap a reservoir of optimism that he’s the right person to lead the U back into the top echelon of American academic health and research institutions.
The optimism is born in part from frustrated hopes. The U’s well-regarded medical school, which trains most of Minnesota’s physicians, has spent two decades battling tight budgets, ethics scandals and a strained relationship with its hospital partner, Fairview Health Services. Two years ago, a team of consultants hired by university President Eric Kaler said a “malaise” had fallen over one of the state’s most important medical and scientific institutions.
A dozen years ago another pathologist, Dr. Deborah Powell, took over as dean amid similar acclaim and high hopes, only to see the school continue its downward slide in the national competition for research grants. She lost her dean’s chair seven years later.
Today, however, observers across the Twin Cities say Jackson is arriving at an opportune time. The med school is climbing again in national research rankings, has socked away money to recruit new faculty heavy hitters, and, educators say, is well positioned to be a leader in the new landscape created by federal health reform.
“They got a little off track, and I think now they’re back on track,” said Hubbard Broadcasting CEO Stanley Hubbard, who served on a special board of outside advisers to the school. “I think it’s terrific, what they’re doing.”
Kaler says the school has landed the leader it needs.
“He comes from arguably the best medical school in the country. He has a great reputation as a researcher. He has a lot of experience with excellence and knowledge of what it takes to move an organization to the highest levels.”
History of firsts
It’s hard to overstate the school’s importance to Minnesota and its medical science community. It brought international acclaim to the state in the 1950s, when Drs. C. Walton Lillehei and John Lewis performed the world’s first open-heart surgery and, with Earl Bakken, invented the portable cardiac pacemaker. A decade later, the world’s first bone-marrow transplant was performed there by Dr. Robert Good, considered the father of modern immunology, spawning transplant and stem cell innovations that continue today.
The school is also a vital training ground. Seventy percent of Minnesota’s doctors either graduated from it or had their residency training there. It anchors the broader Academic Health Center, a $1.6 billion behemoth that operates three hospitals, trains hundreds of nurses, pharmacists, dentists and other health workers, and brings some $400 million in research funding to Minnesota every year.
At the same time, serious challenges remain. In the mid-1990s, the school was ranked 15th nationally in the competition for critically important grants from the National Institutes of Health (NIH); today, after sinking to 32nd place, it has rebounded, but only to No. 25.
Kaler said competition for NIH funding is likely to intensify, and federal funding for graduate medical education remains uncertain, leaving medical residency slots in short supply.
Former Gov. Arne Carlson, another member of the outside advisers board, says the school also must address the spiraling tuition costs that are plaguing all of higher education. Carlson, a longtime booster of the U, said higher education as a whole is in a crisis because it’s built on an unsustainable economic model that relies on students taking on crushing debt. Tuition at the medical school — third highest among public medical schools in 2011 — should be cut by 80 percent, Carlson said.
Still, Kaler is hopeful.
“I don’t mean to paint a completely rosy picture,” Kaler said. “But I think there are reasons to be optimistic.”
Others echoed Kaler’s view.
“I think this is a very encouraging time,” said Dr. Bobbi Daniels, CEO of the University of Minnesota Physicians, an independent group practice with more than 50 clinics that spin off about $40 million a year for the U’s academic mission.
Daniels said a new agreement hammered out between the physicians, Fairview and the U has everyone sharing the same vision for the first time in their 17-year relationship. A new, $160 million clinic and research building near Interstate 94 and Huron Boulevard will allow the UM Physicians and Fairview to blend research with patient care and promote crucial collaboration among doctors, nurses, public health workers and scientists.
Jackson arrives at a time of great ferment in American health care, with the federal health law expected to increase the demand for doctors, extract new efficiencies and push medical care in the direction of preventive medicine and primary care.
The U — with its strong reputation in primary care and collaboration among health disciplines — could be well positioned to help chart the new course.
The U received an important NIH grant to establish the National Center for Interprofessional Practice and Education, which could set new standards for training medical professionals to work as a team, according to Dr. Aaron Friedman, who served as the school’s dean for the past three years.
Friedman said America’s fee-for-service health care model has relied too much on rewarding volume of services and physician specialists. Those trends are unsustainable, he said, and the Affordable Care Act will oblige medical schools to adapt.
“It’s really a question of how to … provide more and better care with a whole array of health professionals, whether they’re nurses, pharmacists, occupational therapists, respiratory therapists [or] doctors,” Friedman said. “That challenge is big. There aren’t that many places that actually practice in an interprofessional level.”
Four years ago, the U overhauled its curriculum to emphasize interprofessional education among the schools of nursing, pharmacy, social work, dentistry, public health, mortuary science and medicine, according to Dr. Kathleen Watson, senior associate dean for undergraduate medical education. “We’ve got a long way to go, but we’re continually evolving,” Watson said.
Mallory Yelenich-Huss, president of the medical school’s class of 2014, disputes the “malaise” characterization and said the school is nationally competitive for students and new faculty.
“Our classes are consistently scoring above national average on our board exams. We match into amazing residency positions nationwide,” said Yelenich-Huss, who’s vying for a residency in ear, nose and throat surgery.
In a widely watched scorecard by U.S. News & World Report, the medical school ranks fifth nationally for rural medicine, seventh for primary care and 10th for family medicine — but 38th for research. In related subjects, the U ranks second for health care management, third for pharmacy, sixth for clinical psychology and eighth for both public health and nursing-midwifery.
Nearly a decade ago, the medical school formed a panel of prestigious advisers called the Board of Visitors and asked them to help restore the school’s luster. Even in the worst of times, the school had its strengths, several members said in recent interviews. Now, with the selection of Jackson as dean, they said the school appears to be getting back on track to become a national leader.
One member, Dr. Richard Carlson, past-president of the Medical Alumni Society, said he’s encouraged that the schism between the U and Fairview has been resolved and that the medical school will see great improvements as a result.
“We’ll have to wait and see, though,” he cautioned.
Jackson, a prolific scholar with an international reputation in HIV-AIDS research, said in an interview that he agrees high tuition and student debt are serious concerns. He said he worries that costs will drive some students away from medical school, or away from academic medicine, which typically pays less than private practice.
Even so, Jackson said, “I’m very optimistic for the medical school as well as the health sciences.”
In addition to his reputation as a pathologist and researcher, Jackson has proved himself an accomplished fundraiser, and he thinks he knows why. People want to give to programs they believe will result in a cure or prevent a particular disease, Jackson said. You achieve that by being the best in the field, then getting the word out by publishing.
“And so there will be a big focus on scholarship, and applying for funding, and on taking on projects that are truly meaningful and will ultimately change the practice of medicine,” Jackson said.