Brad Berk's Comment

July 10, 2006 | Rochester, NY

Joel, thank you very much for those kind remarks.

It is my great honor to accept the position as Senior Vice President and CEO of the University of Rochester Medical Center (URMC). For me this opportunity is the culmination of my 30-year career in medicine. My experience as a physician is inextricably linked to URMC as I was a medical student here from 1975-1981 in the Medical Scientist Training Program. Over the past eight years as Chief of Cardiology, Director of the Cardiovascular Research Institute (CVRI) and Chairman of Medicine, I have come to appreciate the excellence of URMC, and I am committed to leading us to greater success.

During the process of interviewing for this position, I asked myself why I wanted to take this job, and what skills and ideas I could uniquely bring to bear. After much reflection, I think I have answers that I am pleased to discuss with you today. The "why" is the easy question to address and my answer should resonate with all URMC employees. We are all here because we want to make a difference to those people who need health care in our community. Each morning when I come to work I am inspired by Jackie Stevens, my administrative assistant in the CVRI. Jackie left her position at Kodak to seek a position at URMC because she felt a need to make a difference and to support an organization that had helped her family.

The "what" is the harder question to answer because the position as SVP/CEO requires so many different skills and abilities. However, I simplified the position to two major roles: leading a great health care delivery system and a major academic research enterprise. This duality is a role that I find comfortable having maintained my own duality of being a practicing MD, PhD, a physician- scientist. On one hand, I practice medicine to provide health care to my patients in Rochester and the surrounding communities. On the other hand, I study cardiovascular physiology to make fundamental contributions to medical research internationally. The University Rochester is an institution that encourages this duality and helps faculty succeed. As SVP/CEO, one of my duties is to ensure that both missions are performed at an excellent level. Specifically, my role is to make it possible for people to achieve their full potential to make a difference both clinically and scientifically.

These dual missions have always co-existed. My father-in-law, Earle Mahoney, was a 1932 UR Medical School graduate who returned to Rochester after his residency as a general surgeon. He initially worked with George Hoyt Whipple in the early 1940s on better ways to preserve plasma for transfusions, vital to treating the wounded in World War II. Building on this research experience, he pioneered the use of heart-lung machines required for cardiac surgery procedures, and performed the first such operations in Rochester. We must embrace this duality of clinical and research experiences, as the greatest advances in medicine occur at the intersection of these two activities.

My major goal as SVP/CEO is to continue to grow this superb institution that includes Schools of Medicine, Dentistry and Nursing, two excellent hospitals, two nursing homes, the University of Rochester Medical Faculty Group, a large primary care network and a Visiting Nurse Service among other components. Beginning in 1996 under Jay Stein's guidance, and more recently under Mac Evarts's leadership, we have pursued a strategic plan that has yielded significant advances in each of our four missions: clinical, community health, education, and research. Over the past year we have initiated a new strategic plan that will serve as the roadmap for the next ten years. I emphasize a timeline that encompasses 10 years, as both President Seligman and I recognize that it will require a decade for many of the programs we initiate to achieve maturity. In the next few minutes I will give you a brief overview of the process and highlight some potential programs.

The first step in my strategic planning process will be to develop further the concepts articulated over the past year during our initial planning. Specifically, we will define our core mission based on becoming the BEST in this mission. To do so we must choose several innovative programs to develop. A key process will be to identify those areas of medicine that will provide the most significant impact to research and health. Conceptually, we are looking for the right mixture of core medical specialties – and "hot" areas such as molecular biology in the 1980s and biotechnology in the 1990s – to choose these two or three programs where we can achieve excellence several criteria are important.

  • Return on investment – excitement and opportunity
  • Achieve national prominence
  • Make a difference to patient's health
  • Potential biotech and intellectual property
  • Builds on our strengths
  • Links clinical and basic research programs
  • Synergisms across River Campus and URMC
  • Consonant with becoming the BEST at our mission.

To create these programs will require substantial resources. Working closely with President Seligman, senior leadership, and the faculty I will devote substantial effort to obtain funding from government, donors, and foundations.

Clinical Care

The clinical enterprise has witnessed enormous growth under Steve Goldstein's leadership and has been the economic engine driving URMC. We must continue to expand bed capacity at SMH to grow revenues further. However, because future trends favor ambulatory medicine, we also need to focus on shortening length-of-stay and developing special units to facilitate patient discharge. Patient quality of care requires constant improvement. We will need an electronic medical record to address the Pay-for-Performance initiative. Finally space needs (e.g., Imaging Sciences, Emergency Department) must be addressed in a timely manner. Reimbursement rates for both physicians and the hospital remain a key issue for our success. The ability of physicians to contract directly with Excellus should improve reimbursements. I look forward to interacting closely with leadership at our major insurers to develop mutually beneficial programs for patients, physicians and the hospital.

Community Health

An office for community outreach was created this year and Dr. Nancy Bennett was hired to lead the program. I anticipate significant efforts in this area working closely with her and local organizations and government.

Education

Among the most important contributions of URMC to our community and the country are the students, residents, fellows and scientists that we produce. In fact, UR has a disproportionate number of its trainees in academic leadership positions throughout the country (myself now included!). We must build on this tradition with new initiatives that take advantages of changes in job requirements and national standards such as the Med into Grad initiative sponsored by Howard Hughes Institute for PhD students, developing research-intensive tracks in the Schools of Medicine and Nursing, and changes in residency education for surgery.

Research

It is likely that the greatest challenge in academic medicine over the next 10 years will be to maintain the research enterprise that developed during the doubling of the NIH budget. Rochester has a unique insight into this issue since we fell from 14th in NIH rankings in 1988 to 29th in 1995 with NIH revenues flat at ~$60M. Over the past 10 years we have witnessed a remarkable 135% growth to $141M with a stabilization of our rank at 30th. My goal is for us to rise significantly in NIH rankings over the next 10 years. This will require an emphasis on faculty recruitment and retention. Many of you know that under Howard Federoff's direction we have been developing a program to provide significantly increased bridge funding for the next several years. One of my first tasks will be to quickly develop a set of criteria and implementation process. To grow, we will also need new buildings, and I anticipate that several buildings for clinical and basic research will be required over the next 5-10 years. I will discuss briefly five potential programs.

Aging and Geriatrics

Aging is a process that affects all tissues. The greatest disease burden in terms of societal cost in the next 50 years will be cognitive dysfunction. Because of our strengths in aging and development, geriatrics, and neurosciences it is logical that we elevate this area to the next level.

Computational Biology and Genetics

This field, sometimes called systems biology draws on strengths in modeling complex biological systems such as the pathways activated in cancer cells that enable dysregulated growth or the best approach to creating "herd immunity" for vaccinating a population to prevent avian flu. In addition, personalized medicine requires sophisticated software to analyze individual genotypes and biomarkers to improve diagnosis and therapy. This is ideal for collaboration across Elmwood Avenue.

Metabolic Disease and Obesity

The worldwide increase in obesity is the major developing health challenge. Programs that combine community outreach, behavior modification and drug therapy will be necessary to combat this epidemic.

Regenerative Medicine and Stem Cells

This program will focus on developing basic and clinical research that enables tissue and organ regeneration, likely using approaches that involve both stem cells and biotechnology. We have strengths in cardiovascular, gastroenterology, and neuroscience that would be logical disciplines to focus regenerative medicine.

Nanotechnology

Nanotechnology will enable both diagnosis and therapy to be individualized and to occur in real time. Devices such as microelectromechanical sensors that can monitor blood pressure, blood flow and heart rate in real time, as well as nanopumps that can deliver drugs locally will provide opportunities for new therapeutic approaches. Nanotechnology is another obvious opportunity for collaboration with the River Campus.

Finally, we must optimize the process for grant applications, accounting, and oversight. Working with Drs. Federoff and Pearson, we will carefully review current functions of the IRB, ORPA, and ORACS to ensure that they are providing optimum assistance and input to our investigators.

I have been given many opportunities by the University of Rochester and feel that this is my chance to contribute to its future. With the decline of local manufacturing businesses, the University will become a key source of economic growth for Rochester. As SVP/CEO I will encourage URMC to play a major role in reshaping and strengthening the local economy. The opportunity to carry out our strategic plan, working with President Seligman, is a rare opportunity that I look forward to with great anticipation.