Sunday, May 17, 2015

For the Record: Former U of Minnesota Doc: What Did They Do To My U?

Former Minnesota Medical School cardiologist: What did they do to my U?

Under poor management, the school has turned into the equivalent of a junior-varsity team. Unfortunately, it produces the bulk of the state’s doctors.

From the Star-Tribune:

(Emphasis added.)

When I joined the faculty of the University of Minnesota Medical School as a junior cardiologist in 1986, it was vibrant and highly ranked nationally. Now it is ranked in the second tier of schools for research. Its main hospital, the University of Minnesota Medical Center, was then among the top in the country. Now it is ranked by U.S. News and World Report as third in the metro area, behind Abbott Northwestern in Minneapolis and Mercy Hospital in Coon Rapids.

How could this happen? And why hasn’t it been a subject of alarm for our Board of Regents or for university administration?

Over the last two decades, the Medical School has been rocked by successive ethical scandals. Poor financial management led the Board of Regents in 1996 to sell the university hospital to Fairview, a community hospital chain with an average reputation in health care. Since then, review after review has found a lackluster record of achievement; a loss of important faculty members, and inept, bloated administrative functions.

All of this prompted the dean of the University of Michigan Medical School (who is a University of Minnesota graduate) to tell the Michigan Daily about his once-great alma mater: “They have disassembled the whole enterprise … and they’ll never recover from it.”

When I recently talked to a few regents about how this could happen, I got a similar story. They did not feel capable of managing a health care enterprise, so they relied on the university administration to keep them informed and take care of business. That apparently did not happen. Few of them were informed about the fall in rankings. Most claimed to be surprised by each scandal.

In the Navy, they say, “When there is trouble on the deck, look to the bridge.” In this case, the bridge was asleep.

Why should this matter to Minnesota? After all, we have the Mayo Clinic. It could be Minnesota’s varsity health care organization, and the U could be a nice JV team.

The problem is that the U produces the vast majority of the doctors for this state. If you want a JV doctor in 10 years, then that is a good approach. If you want the best for our state, the U matters.

In addition, JV teams do not generate economic activity. The U Medical School is responsible for a great deal of the medical-device industry in Minnesota. We would not likely have a medical-device industry without the medical school that we created in the 1950s and ’60s. Imagine Minnesota without Medtronic and St. Jude Medical (not to mention more than 100 other businesses that sprang from the Medical School).

Gov. Mark Dayton recently got the message and created a blue-ribbon commission to study the problem. The commission’s decision was to throw money at the school. That is a good start, but it does not address the root cause of the problem. Compared with other public medical schools, the U med school has been relatively well-funded (not great, but in line).
The U med school, however, has lacked vision and leadership. Its goal is to be top decile in clinical care. What is that? Top 10 percent of all hospitals — one of the top 500? Wow.

As discussed by former Gov. Arne Carlson (“U can’t regain trust under its current leadership,” April 12), the administration is plagued by cronyism and conflicts of interest. There are legitimate questions about the transparency and truthfulness of its leaders. Poor leadership is how we got to where we are, not lack of money.
In addition to the leadership issues, there is an elephant in the room: Fairview. To its credit, Fairview restored the financial performance of the university hospital; the U accounts for half of the net margin of the entire Fairview chain. But Fairview has taken its toll. The hospital it manages, and the one where most of Minnesota’s doctors are trained and where research is done, has become a B-level facility. Fairview’s contribution of profits to the Medical School is meager compared with other university hospitals in the country.

There is no way to have a great medical school without a great hospital. Unless the Fairview problem is solved, we are destined to have a B-level medical school and a JV team.

After 27 years, I left my position at the U at the end of 2013 because, like the dean of the Michigan Medical School, I just did not see any hope that the U med school would turn around. I’m seeing a glimmer of hope with former Gov. Carlson’s commentary several weeks ago. The light shown on the lackluster administrative culture by the Dan Markingson case external review and legislative auditor’s report validate the problems. Gov. Dayton seems engaged. The regents may be waking up. Sunshine may be the best antiseptic.

Let’s hope that the Medical School responds with new, clean growth instead of withering in the light.

Robert F. Wilson is former chief of clinical cardiology at the University of Minnesota.

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