Letters from Leadership

Mark Taubman, M.D.
Dean of the University of Rochester
School of Medicine and Dentistry
Vice President for Health Sciences

This issue of Rochester Medicine, my first as dean, provides many examples of the quality of a University of Rochester School of Medicine and Dentistry education and of the superb performance of graduates of the School.

Take a look at this year's Match Day list. The Class of 2010 scored very well, matching with superior programs. We will have graduates from this class in residency programs in 30 states. To our benefit, 19 Class of 2010 graduates became residents at our Medical Center. The matches by members of this class demonstrate the high level of their achievement.

In this issue, graduates Rebecca Ryan and Jason Kurland eloquently explain why they chose family medicine and their plans for the future. More graduates are going into family medicine or are considering primary care than in recent years, but we have a long way to go to meet a growing problem. The need for more primary care physicians is increasing and I expect it to grow through the next decade. Our School has a responsibility to educate more primary care physicians. We must provide a curriculum and an environment that nurtures students who come to us wanting to do primary care so that they graduate still wanting to do primary care.

Please also read the three articles on the response to the earthquake in Haiti. Two graduates of the School of Medicine and Dentistry, Toni Eyssallenne of the Class of 2006 and Alexi Matousek of the Class of 2009, write about their experiences in Haiti and quietly display the values that are a part of a Rochester medical education. The third article describes the University of Rochester Medical Center's strong response to the earthquake. Several of those who went to Haiti are alumni.

A trio of Rochester alumni lead new medical schools and campuses. Deborah German, M.D. (R '79), dean of the University of Central Florida College of Medicine, launched her school's first class last August. Lawrence G. Smith, M.D. (R '79), dean of the Hofstra University School of Medicine, will admit his school's first class in 2011.

In this issue, Barbara L. Schuster, M.D. (M '77, R '80), also a former Rochester faculty member, discusses the development of a new medical school campus, the Medical College of George/University of Georgia Medical Partnership in Athens, Ga. She says the Rochester medical school system had a significant effect on her and will influence the school in Georgia. "Many physicians—George Engel, Lawrence Young, Rudolph Napodano, Elizabeth McAnarney and others—were mentors and role models," she says. "You will see Rochester in what we do. We will spend a lot of time on the core skills that were emphasized at Rochester."

This issue's report on the success of the Fields Center for FSHD and Neuromuscular Research and the work by the center's director, Rabi Tawil, M.D. (R '91, FLW '93), illustrates another hallmark of the School of Medicine and Dentistry—the power of collaboration, which is an essential element of Rochester research.

I look forward to more achievements by our faculty and our alumni. And as dean, I look forward to hearing from all those who take pride in our School of Medicine and Dentistry.

Taubman Signature

Bradford C. Berk, M.D., Ph.D.
CEO, University of Rochester Medical
Center, Senior Vice President for
Health Sciences

Watching the national health care reform unfold from the vantage point of a CEO, a physician, and a patient, I am intrigued by unprecedented opportunities to expand coverage, improve quality and care coordination, reward effective and efficient care, promote innovation and decrease costs. I'm also impressed by the enormity of the task—especially in an environment in which so many factors remain uncertain.

One thing, however, is certain. Meeting the objectives of health care reform requires systemic change in how health care is delivered in the U.S., which in turn, requires fundamental restructuring of the incentives created by current payment systems. It will require more integration, more shared risk among providers, and more accountability for fiscal and quality outcomes. Physicians, hospitals, and academic medical centers will have to continue, if not accelerate our progress in these areas.

I do want to share with you general approaches that we're taking here in Rochester—and hope that you will tell us about your challenges and how you and your organizations are meeting those challenges.

To meet the increased demand for primary care, we're working with other local hospitals and insurers on community-wide strategies to recruit and retain doctors, including loan forgiveness, advanced medical home projects, and the use of physician extenders. We are considering new ways to organize ourselves so that we can be prepared for delivery and payment systems premised on shared accountability among providers across many settings. This may mean restructuring our Medical Faculty Group so that it is less departmentally driven and better able to accept risk for populations or disease-specific components. We are looking across our continuum of inpatient, outpatient, nursing home and home care services to facilitate care and move each patient to the most medically appropriate and cost-effective setting.

Like most health care organizations, the University of Rochester Medical Center is making a substantial investment in an electronic medical record that will allow us to move information across the organization and between other providers, a prerequisite for lowering costs and streamlining care. As integration and management of financial risk become more prevalent, we must decide if we can address these challenges institutionally, or if it makes sense to forge new alliances with other providers or insurers.

Fortunately, Rochester and the Medical Center have many advantages when it comes to advancing health care. Throughout the 1980s and early 1990s, Rochester earned national praise for hospital collaboration across the community, focused around an experimental payment system credited for holding costs below the national average. Today, it still has financially stable health care institutions, locally owned insurers, and a robust physician supply seeded by a respected medical school. Among 87 Council of Teaching Hospitals institutions, Strong Memorial Hospital ranks as the sixth most efficient hospital in terms of cost-per-discharge. We believe that these attributes will once again make Rochester a preferred community to develop new health care delivery and payment systems.