For the Record: All U of M Med School Faculty Should Read

[Added later:  Tidied up. If mistakes remain, let me know. Yellow highlighting is, of course, my own.]


Report from the Medical School Faculty Advisory Council to the Strategic Planning Committee

April 15, 2013

Preface: Strategic planning is a triangle whose cornerstones are 1) culture/climate; 2) leadership; and 3) infrastructure/programs. The comments from the FAC members have raised opportunities for improvement in all three domains. The comments are summarized in this report, with an attempt to group them into categories relevant to the strategic planning process.


Included in this report is an appendix which includes all the original, unedited comments made by faculty who are members of the Medical School Faculty Advisory Council to the Dean. They were gathered either via email or at the six individual meetings that were held over a period of three weeks. There was no attempt to cull or edit these concerns, and thus there are some redundancies. However, we believe it is important for the Strategic Planning Committee to see the depth and breadth of concerns raised by faculty members on the FAC, whose members represent every department in the Medical School.

SUMMARY

We have attempted to identify areas of strength and weakness within the current medical school structure with a focus on how we can get better. There are several basic questions we collectively believe need to be addressed. First, how can we restructure/reinvent the Medical School for what we believe are the future realities? Second, what can we do to affect areal and substantive sea change in our climate/environment? A subordinate but integral question that underlies this need to reinvent ourselves is just as important: What strategies can we use to “turn around” the scarcity of resources in the medical school?


Question 1: What are our top strengths or strategic assets of the Medical School for each of our three part mission: Clinical care, research and education?



The faculty identified a number of areas of strength within our medical school. Clinically we are a highly regarded clinical medical school, known to produce diverse and well- trained medical doctors with a focus on primary care. The UMN is among the few schools that graduates significant numbers of Native American physicians, and Duluth accomplishes its mission of producing rural physicians so well that UMN is ranked in the top 5 medical schools nationally. This is strengthened by UMNTC’s urban medical center, where the size and diversity of our patient population enables our clinical training to be very strong.

Collectively, faculty members in the medical school are excellent, with strong records of excellence in research, educational scholarship and teaching. Moreover, since we are a large research university, there are ample opportunities for collaboration within and amongst the research faculty.

These collaborations have been strengthened in a number of areas where there is a concentration on specific diseases and/or translational research. This includes such areas asTranslational Neuroscience, the Lillihei Heart Institute, the Center for Magnetic Resonance Imaging (CMRR), and the Muscular Dystrophy Center. These areas of focus have emerged and depended upon the efforts and vision of faculty members who have recognized the potential such centers can provide in terms of synergy, and have used as much influence as possible to affect faculty hiring to further support the missions of these centers.


Question 2: What do you believe are the top opportunities for the Medical School between 2013-2015?


In general, the comments we received in this domain focus on 3 areas: i) the benefit of modernization – updating our infrastructure; ii) changing the current leadership model school-wide; and iii) focusing on developing the capacity of current faculty members. The collective view is that by focusing on these areas, meaningful and substantive changes will result, improving the climate, leadership, and professional capacity of the faculty in general.


To summarize, the top opportunities can be addressed in four main ways. First, it is clear that the faculty see a need to develop a collective vision. We need to develop a 10 to 15 year plan for budgetary and sustainable excellence. This will help us build “pride of place”, which in turn will help improve public perception of the University of Minnesota Medical School as the place to go for cutting edge, quality, and accessible clinical care, biomedical education, and cutting edge research.


Second, there is a universal concern about leadership in the medical school at all levels, from division chiefs and chairs in clinical departments up to and including the dean’s office. In order to address these concerns, we believe significant change in leadership structure must occur. We need to provide for meaningful leadership review. A corollary to this would be to require that all medical school leadership positions have 5 year term limits. Only by overwhelming faculty vote could terms be increased by another 5 years.

This would ensure that everyone, leadership and the faculty doing day-to-day work, would have a similar vision and mission. In addition, it would help build leadership capacity within the faculty members in general.

Third, in order to facilitate the first two goals, we need to begin building our pipeline of future clinician/scholars starting with medical students, residents and fellows. We have a critical need to rebuild the ranks of tenured/tenure track faculty in the medical school. There is an increasing loss of mid-career faculty members, and this is a devastating loss to us in terms of investment in new faculty members who leave just as they are entering their most productive period.


Finally, to achieve any of these goals, we need a sustained and balanced investment in the career development of all faculty members. We need mentors to help new faculty develop their clinical and research programs. We need mentors to help established faculty maintain research and clinical excellence, and we need mentors to help develop leadership capacity in more senior members of the faculty. Organizations that use a mode of distributed leadership and whose “reporting structures” are shallow are more entrepreneurial and productive, as well as happier.


3. What critical future research, educational, and clinical trends do you believe we need to consider (as threats or opportunities) as we develop the strategic plan?

In general, the faculty felt there is a collective need for all of us to have the “courage of our convictions”. We need to plan our vision well and then BE BOLD AND TAKE RISKS!

This area focused more on potential solutions rather than threats to medical school excellence. In summary: several key areas stood out in our consensus discussion in the areas of leadership, climate, programs/infrastructure, and funding.

The biggest concern in the domain of leadership is that there has been no clear long- term plan for buildings (why do we need it and how will it be maintained), for faculty hiring (how many faculty do we need to accomplish our basic mission), for retention of mid-career faculty (which we are preferentially losing without any “exit interviews” to determine why these faculty members are leaving), and finally no plan for raising funds for an endowment and raising awareness/funding levels for the medical school at the legislature. This lack of a sustained vision for “what we want to be” has resulted in haphazard additions of new building(s) without any way to maintain their infrastructure, faculty hiring without clear reasons for increasing the number of faculty members in a particular area, and insufficient long term planning to sustain the growth that comes with the building of buildings and the hiring of faculty.

In the domain of culture/climate, it has become clear that we need to define the role of research at our medical school. We are a large research university with aging, inadequately funded and maintained infrastructure that makes it increasingly difficult for faculty to maintain cutting edge research programs. Without a means to facilitate, for example, the creation of genetically engineered mice or to perform the advanced genomic and proteomic studies needed as preliminary data for grants, the faculty becomes less and less competitive when applying for external funding. If we are a research university, then this research needs adequately supported (hardware and cost) infrastructure.

This brings us to the reason for declining infrastructure, and this is basically the scarcity of research funds outside the NIH or NSF dollars the faculty collectively bring in through grants. The Medical Schools needs to work hard to increase popular support from the state in general and the legislature specifically. We should have the “home team advantage” as the only state-supported research university in the state. Why don’t we?

We collectively need to decide to be “excellent”; excellent in research, excellent in education, and excellent in clinical care. We need to understand why people do not come to us for medical care. We should be the “go-to” place. This means that we have to invest in “cutting-edge” technologies in both clinical care and research that will set us apart from other medical providers in the state and the region and keep us competitive in the national research arena. This can only be done when we collectively and mutually define ourselves and develop a clear identity.


A third area that the faculty have found particularly problematic is in the area of infrastructure and programs. We have spread our faculty all over the place. How can we better connect our faculty to each other, to staff, to resources, to infrastructure? It is well known that collaborative interactions are increased when people meet each other at lunch or walking down the hallway. We have single departments that are spread out in 8 buildings. This is DEATH to collaborations.

The medical school needs to develop strategies for facilitating our research. There are increasing numbers of hurdles due to the decentralized “business” approach that has been foisted on the faculty in recent years. If our department structure is outmoded, we should redefine it. If it is still functional and important, we need to bring department members together under one roof, and not continue to rip apart faculty members from their departments and spread them all over the place.


One critical area that would enhance our research potential is to develop support structures that will fund early ideas and protect research time to increase the likelihood external funding can be obtained. The University of Minnesota-Mayo partnership grants prove that this works, but the funding is limited to only a few groups. Other states have specifically received funds for this type of thing from their legislatures. We need to put together a plan and create a climate for discovery.

The biggest threat to the Medical School is funding. We face declining patient revenues (which affects research and education), decreased funding for graduate medical and research education, and decreased NIH research funding. We have to clearly define the scope of the medical school of the future and come up with sustainable funding strategies. Currently the suggestion to simply ‘submit more NIH applications’ seems pointless at a time of decreasing NIH dollars.

Potential solutions that the faculty envisioned would be to increase philanthropy, both medical school-wide and in each department. We cannot depend on MMF/University Foundation to do this. We all must participate in this. It is also imperative that we increase state funding for our only state-supported medical school. The state reaps great benefits from the health care professionals we produce, but they do not pay for it. We need to do a better job of telling our state representatives the “return on their investment” they receive, and why it is critical to support the research engine of the medical school to support our educational excellence.


Another way to increase funds for the medical school is to increase our clinical areas of strength. We need to develop new clinical programs that will draw patients based on future health trends, such as geriatric centers, centers for Neurodegenerative Disease and/or autism, and the like. Every year the CDC publishes the 15 most common causes of morbidity and mortality. These may differ a bit for Minnesota, but they are well known. We should be preparing ourselves to become centers of excellence in the major causes of disease in our state and nation.



Question 4: The AHC Review noted a general “malaise” of the Medical School and its faculty in their report. What do you feel are the top three reasons for this “malaise”?

Many of the issues raised echo what has been stated in previous sections and relate specifically to the current climate/culture in the medical school. Climate and culture set a world-class institution apart from a mediocre one. In general, many feel they have minimal voice in decision-making with little discussion, especially if one disagrees. In fact, many faculty members have stated that they have been harassed if they disagree with a decision made by clinical chiefs, department heads, or various assistant and associate deans.The consensus is that climate/culture needs to be an area of focus of the strategic plan. Meaningful leadership reviews with turnover as the rule would help.


Governance: Specifically faculty are frustrated due to 1) lack of their input in decision making, 2) lack of transparency in finances and decision making at the top, and 3) token solicitation of and lack of responsiveness to their input in all matters. Many also feel that there is little room for discussion if they disagree with decisions that are made at departmental or medical school administrative levels.


Leadership: Faculty members are frustrated by the fact that the UMP mission, and particularly the Fairview mission under its current administration, is not concordant with the academic mission of a medical school. In addition, we seem to have “leaders for life”. Many faculty members are quite unhappy at the division or department level, but have no recourse. This could easily be fixed by creating term limits for the dean, all assistant, associate, and senior associate deans, department chairs, division chiefs, etc. which additionally would include 360 reviews of those holding these positions. Moreover, all administrators should undergo the annual review that is expected of the faculty.


Support: Lack of support for the faculty is exemplified by 1) lack of protected time making it hard to maintain scholarly productivity, 2) lack of sufficient bridge funds especially Duluth, 3) an aging faculty with very few middle-level faculty, and 4) hiring largely or only on teaching or clinical scholar tracks. This represents misuse and abuse of these types of faculty, when tenured or tenure-track faculty should be hired.

Summary: It is clear that the faculty love their research, love teaching and training the next generation of clinicians and research scientists, but are more and more hampered in their efforts by aging infrastructure, weak leadership, and lack of a collective vision for the medical school. We are all particularly excited at the potential offered by the Faculty Led Strategic Planning Committee initiative. We hope these collected thoughts are helpful to you as you develop a strategic plan that will become the cornerstone of all we do in the next 20 years.


APPENDICES

Appendix I

All faculty comments are included with no editing.




Question 1: What are our top strengths or strategic assets of the medical School for each of our three part mission: Clinical, research,education?

Top strengths:

One strength that encompasses all three domains is the strong cross-school (Medical School – SPH; Medical School-Engineering etc.) and cross-departmental (centers – Neuroscience, translational neuroscience, muscular dystrophy center, etc.) collaborations that are possible.


Clinical

in Duluth, Center for Rural Mental Health Studies Family Medicine physicians teaching in years 1 and 2 Historical reputation of excellence in the community Talented clinical scholar faculty


Physician-scientists: physicians that bring cutting edge medical developments to their patients They are developing new treatments


Teaching keeps every current

Size and diversity of the patient population makes our clinical training of medical students/residents/fellows very strong


Patient-focused specialty clinics: e.g. Cystic Fibrosis, Muscular Dystrophy, Bone Marrow Transplantation and Transplantation in general…Known to be the place to go for specific diseases


We have an excellent variety of clinical cases, many of whom are receiving innovative treatments unique to this institution (Bone marrow transplantation for epidermolysis bullosa comes to mind).


We need to regain our national prominence in the transplant field




Research


NIH funded research in basic science in Duluth (who teaches medical students in Duluth).


Great faculty

Areas of strength (centers) in the biomedical domain: e.g. Graduate Program in Neuroscience; Muscular Dystrophy Center

Access to centralized core facilities that are world class - CMRR, Biomedical Engineering, etc. We have the potential for strong collaboration with other departments throughout themedical

school and university that allows particularly clinicians to pursue research in spite of having a

limited availability of time.


Education


We turn out great primary care physicians (70 %?) to serve Minnesota.

We have a good physical facility for education and, at least at the department level, a strong commitment to education.


Question 2: What do you believe are the top opportunities for the Medical School between 2013-2015?

Leadership

Provide for meaningful division chief, department chair, assistant, associate, senior associate deans, and medical school dean 360 reviews. Limit all terms to 5 years, with the potentialto be voted back into the position for another 5 years.

Increase the collective faculty voice in medical school decision-making. Stop top-down dictates and develop a sense of collective vision and purpose. (e.g. higher level medical schoolleadership shows distain for faculty; make decisions without understanding what faculty need; focus on a few “superstars” and ignore everyone else; don’t know what the averagefaculty member is doing; goals of the faculty and the higher level medical school administration are not aligned; goals of Fairview are not aligned to the needs of academic medicine,etc. Run the medical school governance like a democracy not like an autocracy.

Increase transparency of how the medical school works.


Climate/Culture

Increase the openness to change. Striving to be better is not “subversive”.

Physical distances are an increasing problem. The closer colleagues are to each other the more they collaborate. The further they are from each other, the less likely they are to collaborate.

Develop a sense of pride in our medical school. ? Create a culture that defines WHO WE ARE and WHAT WE DO.

We have the opportunity to become the top institution for developmental clinical medicine in the upper Midwest.

Program/Infrastructure

Significantly raise funds for the endowment of the medical school – overseen by a faculty committee

Facilitate research in cutting edge areas of medicine and research: nanomedicine, stem cells, RNA-Seq or Chip-Seq genomics technologies, bioinformatics, and tissue procurement.We are falling behind on keeping our facilities up-dated and adequately staffed to ensure rapid turnaround. The lack of faculty access to these technologies makes us less competitive forR01 and other grants.

Focus on doing a few things really well – continue to develop centers of excellence. These could focus on main, current causes of death/disability (causes of death according to theCDC): Psychosocial, Heart, Cancer, Trauma, Neurodegenerative Diseases, and Chronic Respiratory Diseases.


Faculty Development/Research Environment

Recruit and retain the best faculty.

Increase support for current faculty: reinstate hard salary lines for faculty; support shared facilities to enhance our research capacity; etc. We can only recruit great faculty if wehelp make our entire faculty great.

Develop improved pathways for collaborations and facilitate information sharing and collaborative connections between schools (Med. School and Biomedical Engineering, SPH, CLA,etc.) and between departments.

Increase the opportunity for and develop pathways for Public-Private Partnerships for Entrepreneurial activity of faculty.

Facilitate research in cutting edge areas of medicine and research: nanomedicine, stem cells, RNA Seq or Chip-Seq genomics technologies, bioinformatics, and tissue procurement.We are falling behind on keeping our facilities up-dated and adequately staffed to ensure rapid turnaround. The lack of faculty access to these technologies makes us less competitive forR01 and other grants.

Increase and facilitate collaborations between MD and PhDs.

Develop an “ambassador” program: identify faculty who know a lot about the people and the resources of the medical school/university. Assign all new faculty members anambassador to help them get integrated into the medical school research and clinical communities. Ambassadors could also help with recruiting new faculty – get visiting jobapplicants connected with people who will help recruit them here.

We could and should pursue becoming outstanding in medical device development and biomedical engineering.

Education

Re-engineer are medical education so students understand the “checklist manifesto” – quality, safety, use of metrics. Improve the sense of medicine as “teamwork” between MDs andother health care practitioners.

We have the potential to become one of the top medical schools in providing outstanding education.

Public Relations


Increase public awareness of the medical school gems. We need to “toot our own horn” much more so the public understands what we do. (CMRR, etc.) Identify areas of strength andbrag. Make sure it includes all departments.

Improve the relationship of the U of M medical school to the state: both legislatively and with the public. We are not seen as “the place to go” for medical treatment. Spread the word! (e.g.why don’t our doctors refer patients in-house? –time to make appointments is too long; understaffed due to budget concerns, etc.

Clinical

Help facilitate studies on lower cost approaches to treatment.


3. What critical future research, educational, and clinical trends do you believe we need to consider (as threats or opportunities) as wedevelop the strategic plan?

Leadership

Leadership that does not authentically involve faculty in decisions about the medical school that affects them.

Processes for choosing leaders that consult only those currently in those positions, and thus those chosen are all the same.

No process for review of those in leadership positions by those they work for – faculty, staff, etc.


Climate/Culture

Under-appreciation for the diversity of medical environments for training of medical students and residents offered by affiliated hospitals.

Overuse and misuse of the clinical scholar track instead of tenure-track faculty. Reduces faculty voice and increases individuals’ sense of vulnerability to the “whims” of leadership at alllevels.

Program/Infrastructure

Decreasing NIH dollars – how do we change our dependence on this money?

Decreased medical reimbursements – need a plan for how resources are used and distributed. Increase our cutting edge translational efforts – nanomedicine/medical devices/new drugs.Research trend is “large group science”. How can this be facilitated?

There is a major need for IT support and infrastructure that is stable, reliable, and has growth potential. It will be impossible for us to match or exceed success of similar institutions if ourIT is outdated.

Do something about the Tech Transfer Office. They do not help most investigators to protect their intellectual property, or to help towards commercialization. They are too narrow intheir thinking, and should help all faculty who believe they have a patentable idea for treatment


The potential discussion of a merger between Fairview and Sanford has the potential to adversely affect the clinical practice of medicine at the university.

The well-publicized billing scandal involving the leadership at Fairview has also harmed the reputation of the institution and may harm the clinical practice of medicine at the universityas well.


Faculty Development/Research Capacity


Aging faculty – no clear plan for replacement or growth

Decreasing NIH dollars – how do we change our dependence on this money?

Increase our cutting edge translational efforts – nanomedicine/medical devices/new drugs. How we increase faculty diversity? (an issue in Duluth)

Increase disease-based collaborations (e.g. angiogenesis; stem cells…)


Reduce administrative work load (IRB, IBC, IACUC, etc. with multiple inspections and non- functional web submission site)

Research is dependent to a large and in my opinion too great extent on government grants. This makes research at this institution dependent on the good-will of governmentbureaucrats.

Education


There is overuse and misuse of “teaching scholar track” instead of tenure-track research oriented faculty. This has resulted in significant decreases in educational richness and faculty expertise.

Educational trend is “small group/active learning”. What does this do to our teaching? Loss of numbers of fellowship slots; loss of fellows working at affiliated hospitals


Looming potential decrease in ACGME funding for resident training may have significant impact on all 3 aspects of the strategic plan


Increasing our teaching load is not the way out of our financial problems.

Public Relations

Increase public education and outreach to change decreasing support for the medical school


Clinical

We need to invigorate the clinical practice: increase our patient population, expand the clinical care in the area of primary care/family medicine

We need to focus on developing areas of expertise that are different than those available in the community.

Aging of the population – are we planning ahead? Geriatrics Center

More rural primary care physicians are needed – how can we affect doctor distribution in MN

Decreased medical reimbursements – need a plan for how resources are used and distributed.

We need to build our clinical research infrastructure. Set up clinics to do research to include development of patient data bases and a management system and set up patient tissue repositories

Facilitate cooperation between the U of M Hospital and all the affiliated hospitals to better access patients for clinical research.

Question 4: The AHC Review noted a general “malaise” of the Medical School and its faculty in their report. What do you feel are the topthree reasons for this “malaise”?


1. Incongruent objectives of entities controlling clinical practice and the academic clinicians actually doing patient care (difficult to be teach or be productive in research whenclinical practice does not run efficiently and is difficult to change, or when costs for patient-oriented research are prohibitive)


2. Lack of transparency and accountability in governance (with respect to decision-making, finances, etc.).


3. Culture of “it can’t be done” or “that’s how things are done here”


4. Lack of faculty voice in decision making. There is a token addition of faculty input to decision-making.


5. Top-down decisions without having developed a collective vision and purpose with the faculty


6. When problems arise, there is minimal assistance in addressing the issue(s) faced by the faculty member


7. Misuse and overuse of the clinical scholar track. Those in the track are not given any protected time for research yet scholarly product is expected.


8. Trying to maintain productivity in the face of fewer and fewer resources


9. One comment was as follows: leadership takes credit for anything good that happens and blames faculty for anything bad that happens”

10. Very poor leadership at UMP, the hospital and the medical school.


11. There are also no means for faculty to have input into replacing these people in leadership positions despite of our providing most of their financial support. For example, if a faculty member is nominated to run for a spot on the UMP board they first must pass through a nominating committee. The nominating committees only chose people who will not “rock the boat.” The result is that poor leaders are never eliminated. The leadership issue is so important that it dwarfs any other concern.


Appendix II




Members of the Medical School Faculty Advisory Council Chair


Dr. Linda McLoon, Professor, Department of Ophthalmology and Visual Neurosciences


Vice-Chair


Dr. Ameeta Kelekar, Associate Professor, Department of Laboratory Medicine and Pathology




Elected Regular Members

Dr. Aviva Abosch, Associate Professor, Department of Neurosurgery

Dr. David Beebe, Professor, Department of Anesthesiology


Dr. Sue Berry, Professor, Department of Pediatrics

Dr. Peter Bitterman, Professor, Department of Medicine

Dr. Paul Bohjanen, Professor, Department of Microbiology

Dr. Elizabeth Braunlin, Professor, Department of Pediatrics

Dr. Colin Campbell, Associate Professor, Department of Pharmacology

Dr. Dana Davis, Associate Professor, Department of Microbiology

Dr. Barbara Elliott, Professor, UMD – Family Medicine and Community Health

Dr. Sean Elliott, Associate Professor, Department of Urologic Surgery


Dr. John Foker, Professor, Department of Surgery


Dr. Dan Garry, Professor, Department of Medicine


Dr. Kalpna Gupta, Associate Professor, Department of Medicine


Dr. Kristin Hogquist, Professor, Department of Laboratory Medicine and Pathology

Dr. David Ingbar, Professor, Department of Medicine


Dr. Lazaros Kochilas, Associate Professor, Department of Pediatrics


Dr. Walter Low, Professor, Department of Neurosurgery


Dr. Matthew Mescher, Professor, Department of Laboratory Medicine and Pathology

Dr. Harry Orr, Professor, Department of Laboratory Medicine and Pathology


Dr. James Pacala, Associate Professor, Department of Family Medicine and Community Health


Dr. Mary Porter, Professor, Department of Genetics, Cell Biology and Development

Dr. Marc Pritzker, Professor, Department of Medicine


Dr. Lee Pyles, Associate Professor, Department of Pediatrics


Dr. Jean Regal, Professor, Department of Biomedical Sciences, Duluth

Dr. Kiki Sarafoglou, Assistant Professor, Department of Pediatrics


Dr. Bradley Segura, Assistant Professor, Department of Surgery


Dr. Yoji Shimizu, Professor, Department of Laboratory Medicine and Pathology

Dr. Joseph Schuster, Assistant Professor, Department of Orthopedic Surgery

Dr. Brian Sick, Assistant Professor, Department of Medicine


Dr. Julia Steinberger, Professor, Department of Pediatrics


Dr. Robert Sweet, Associate Professor, Department of Urologic Surgery


Dr. Michelle van Ryn, Professor, Department of Family Medicine and Community Health


Dr. Carol Wells, Professor, Department of Laboratory Medicine and Pathology



Dean’s Appointed Departmental Representatives


Dr. Jim Boulger, Professor, Department of Behavioral Sciences, Dulut


Dr. Rahel Ghebre, Assistant Professor, Department of Obstetrics and Gynecology


Dr. Kristen Hook, Assistant Professor, Department of Dermatology


Dr. Susanta Hui, Associate Professor, Department of Radiation Oncology

Dr. Carol Lange, Professor, Department of Medicine


Dr. Michael Lee, Professor, Department of Neuroscience


Dr. Stephanie Misono, Assistant Professor, Department of Otolaryngology


Dr. Becky Olson-Kellogg, Assistant Professor, Department of Physical Medicine and Rehabilitation


Dr. David Walk, Associate Professor, Department of Neurology



Affiliate Members



Dr. Gerhard Johnson, Department of Medicine, VAMC


Dr. Jose Pardo, Professor, Department of Psychiatry, VAMC


Dr. Chip Truwit, Chief of Radiology, Department of Radiology, HCMC