Medical School's New Dean

Mark Taubman Relishes Challenges, Appreciates Tradition and Opera

RM: What attracted you to the position of dean—the positives or the challenges?: This is a very challenging time, perhaps the most challenging time for the medical school. But this also is a time of great potential. In 2009, National Institutes of Health grants to School of Medicine and Dentistry faculty exceeded $168 million, and that is without counting stimulus funds. We had a growth rate in NIH grants from 2008 to 2009 of 13.5 percent, the second highest growth rate in the country. We are one of the 12 in the inaugural class of recipients of Clinical and Translational Science Awards from NIH. Next year, construction will be completed and we will open our Clinical and Translational Sciences Building, the first of its kind in the country. These are just a few of the reasons I see our great potential turning into growth, discovery and success.; We do have challenges, but I enjoy challenges and you can turn challenges into positive results. With any job, whether it is acting CEO, chairman of medicine or dean, it is dealing with challenges that really creates job satisfaction. You don't get satisfaction by sitting in your chair, making the coffee and watching things happen. Having spent the last nine months as acting CEO, I have a bigger and better picture of the institution than I had as chairman of medicine. I knew what the challenges of being dean would be. I felt that I was the best person to deal with these challenges. I decided I could meet these challenges and that I could bring people together to deal with them.
RM: Do you see the need for change in the School's curriculum or approach to education?: We've always been innovative. Around the country, people know and respect the University of Rochester's medical school and its educational innovations. I want our School to remain in the forefront of medical education. I admire the traditions of the School, but we have to look to the future. I am never a bull in a china closet and I don't see making any quick changes. But over time, we will have to look at our curriculum and the way we do things and make sure that it adapts to changes in health care delivery and remains in the forefront.; We have an excellent School. Look at the list from this year's Match Day and you can see our medical students are sought after. Our students matched at top-flight residencies across the country. We also have great residency programs that attract top medical students. We are making all of our institutional quality and safety initiatives an integral part of each training program. This will give a new skill set to the next generation of physicians. They will be savvy in health information technology. They will work well in teams. They will be aware of costs and practice evidence-based medicine. Many of the residents we train will stay in western and central New York to provide excellent care.; We have created new master's and doctoral programs in clinical and translational science. We recently established a partnership with two medical schools in China, adding to our many international collaborations that foster research. We already have more than 400 international scholars, including graduate students and post-doctoral associates, in the School. We look to the future but we will build on our strengths.; We are among the top medical research centers in the country. I don't want to change the character of this institution. I view myself as a guardian of what our medical school has been—a provider of excellent physicians, researchers and people who can play a major role in medical education. It is critically important that we remain committed to producing the next generation of academic physicians and researchers, who are quickly becoming an endangered species. However, we also have a responsibility to provide more primary care physicians, particularly for our region. There is an increasing need for primary care physicians and that will grow over the next 10 years. In this context, we still must provide an environment that ensures that students who come to us wanting to do primary care leave wanting to do primary care. We want to make sure that we can identify these people early and make sure that the curriculum provides a nurturing environment that will enhance their chances of remaining in primary care and practicing in the Rochester area.
RM: Do you see any specific areas in education that must be addressed?: One major change I do see is the use of simulation. Surgical specialties already have learned the value of simulation, and I see it growing more and more as an educational tool. Our School is at the forefront of medical education, so we have to have the people who can develop simulation as a tool for education and training. We might even see simulation replacing cadavers in anatomy. Imagine you are trying to show a problem to a class. With a cadaver, to some degree, it is catch as catch can. You might have to have everyone gather around one table to show something. But with simulation technology, you can show everyone what a lung looks like after a life of smoking. It can be a remarkable tool—and you won't get formaldehyde toxicity.; Electronic records will inform the way we teach future doctors to interact with patients and with other doctors. In working on our electronic records system, I learned patient satisfaction initially can be affected when electronic records are introduced. Working with records and other information on a computer changes the way a doctor interacts with a patient. And we know these records someday will be accessed on mobile hand-held devices. We all know how disconcerting it can be if someone is using a Blackberry during a meeting. Imagine how a patient might feel sitting on a table while you're working on your Blackberry. This might seem like a small thing, but one of our jobs as medical care changes is to make sure our curriculum addresses these changes. We've been very attentive to the patient with our biopsychosocial approach, but we must find ways to apply that approach to the patient in the context of today's technology.; This is what I mean when I say this is a time of great potential. In developing primary care physicians, utilizing simulation and shaping the doctor-patient relationship, we can demonstrate our innovative leadership in education.
RM: What are the major challenges you and the School face?: Over the next few years, our medical school will experience a significant financial challenge. This challenge really is a child of the success of our research expansion. Under the best circumstances, research costs most institutions an additional 30 cents on the dollar above the indirect cost recovery from funding agencies like the National Institutes of Health. When I go to meetings of deans and department chairs, everyone is asking the same question: How do you handle that 30 percent? Over the last dozen years, we have expanded our research portfolio by $100 million. That means we could expect a $30 million shortfall.; This is a serious challenge but we should not forget how well our research programs are doing. We now have a total of 251 active R01 grants from NIH, including seven at the School of Nursing. In 2009, our faculty won 38 new R01 grants from NIH worth $15.9 million. That is impressive.; So how do you deal with a looming fiscal challenge? One of my top priorities is to move forward with the Medical Center's strategic plan, but emphasizing quality rather than quantity. In the past, we focused our attention on recruiting many young investigators without funding, but who showed the greatest potential. Although that is still the model I would most like to follow, the economic realities will dictate that we focus more on selectively recruiting investigators who already are well funded and whose programs dovetail best with our areas of excellence. We also need to do whatever we can to make sure our investigators maximize their funding and get multiple grants. One way is to promote more collaborations among investigators, centers and departments. The Clinical and Translation Science Institute should help this. The CTSI and the infrastructure it is creating make it easier for investigators to integrate translational research and attract more funding. It also will be the centerpiece for the research initiatives that are being developed by the new director of NIH, Francis Collins.; We also have to be more efficient. We saw how well the hospital did this year in generating efficiencies. We have 36 departments and centers. There are undoubtedly efficiencies that can be achieved by sharing services and eliminating duplication of services. We have to look closely at where we can save more by centralizing and by sharing.; Another area that generates revenue is intellectual property. We have done better than most institutions in dealing with intellectual property and royalties. We're usually in the top ten in the country. But our royalty stream has been relatively flat and it certainly is not growing at the same rate as our research programs. We have to make sure we take advantage of our research and that our investigators are thinking about how to commercialize their work. We must develop intellectual property, establish more start-up companies and help bring things to the market.; Finally, we need more philanthropy. Although this is a difficult economic time, the University is making its most ambitious efforts to enhance philanthropy. This will be crucial to our ability to maintain and grow our research programs.
RM: What are the other challenges?: There will be changes in health care delivery. Whether it comes as comprehensive reform or more piecemeal, it will have several major effects. The way we have set up our faculty practice probably will not make sense in a different reimbursement environment. Whether it is an accountable care organization, payment bundling or some other approach, over time reimbursement will be less directed to fee-for-service or specialty care and more towards capitation to support comprehensive care. If you wait until you know 100 percent, it will be difficult to adjust in time to the changes. We will have to anticipate what we think medical care will look like and then adjust the way we provide care to our patients and the way we run our faculty practice.; More and more, quality outcome metrics will drive health care reimbursement. For example, we will get penalized if we have too high of a readmission rate. We have tended to incentivize our faculty for doing research, for education, for reaching certain clinical volumes. We have to figure out how the quality piece fits in the academic model. There are institutions where the quality initiatives are published, places where appointments and promotions committees are finding it easier to advance people who are doing research in quality rather than in more traditional academic fields. One of challenges is taking quality improvement and giving it an academic structure.; We have an excellent leadership group and a committed faculty working with these challenges. It is always easier to make decisions by talking things out with others.
RM: What do you look for from alumni?: I want alumni to be engaged. People who have graduated from our medical school have very positive feelings about their experiences here. On the other hand, they don't necessarily feel engaged. That's why we have a national council to reach out to alumni so they can know and understand what is happening and provide input. They are doctors and scientists and their input is important. I hope our alumni will support the institution so we can continue to be vibrant. We do need their help.
RM: You're a serious fan of opera. How did that develop?: My mother still teaches piano. She is an internationally renowned teacher. As a child, I always was exposed to music. When I was four years old, there was a television broadcast of a performance of Rigoletto. I was totally riveted. I listened to so much music growing up. I had my first record player when I was just a year and a half. My parents took me to concerts all the time. As I grew up, I started to go to operas. In high school, I commuted to New York City and went to operas. I decided I loved opera and then I became obsessed with opera. The Metropolitan Opera presents about 25 operas a year.; My wife and I usually go to about 13. I am a Met patron so I usually can get tickets for the performances I want. I am working on the 2010-2011 opera season now. I took my daughter to her first ballet when she was just three. It was a full-scale opera, Cinderella with Mikhail Baryshnikov. So I have continued the family tradition.