The University of Texas Medical School at Houston The University of Texas Medical School at Houston
April 11, 2008 | from the Office of Dean Giuseppe Colasurdo

Distributed on Fridays via e-mail to all Medical School employees, students, residents, and postdoctoral fellows, UT 2 Me is Dean Giuseppe Colasurdo's weekly update of news and items of interest. He also welcomes feedback through this two-way communication.

As promised last week, I want to give you an update from the meeting I attended in Austin, which was organized by the Governor’s Health Care Policy Council and the Texas Medical Association (TMA). The TMA shared their concerns about the crisis of the physician workforce in Texas. The numbers of physicians per 100,000, presently and projected, are alarming. The areas of psychiatry, pediatric specialties, and geriatrics stand out as hot spots. There is no specific measure in place to resolve this issue, as it takes 10 years to train a specialist and the numbers of residency programs and positions are regulated. To help solve this problem, I believe we must capture the interests of medical students early – provide them good experiences with residents and fellows, and ensure there are enough faculty in given specialties so that they will have a mentor in their subspecialty pursuit.

Locally, the opening of our Medical School Expansion is a good start to address this issue. We also have new residency programs, including a new program in geriatrics. Four new fellowships in psychiatry will soon be added; however, as an institution we remain challenged by resources to adequately solve this problem.

Today we are celebrating a special grand opening of the Center for Clinical and Translational Sciences’ (CCTS) new facility in the UT Professional Building. The CCTS is a testament of the investment of the UT Health Science Center in collaborative and successful research programs – collaboration is a key element for efficiency and knowledge transfer.

On the presidential search, the search committee’s job has been completed, with four candidates’ names submitted to the UT System Board of Regents. Dr. Ken Shine has requested feedback from those who have interviewed the now three candidates locally. The Board of Regents will next interview the candidates and then will announce their decision publicly. While I would like to share the names of the candidates with you, I must follow the rules of such a search, which are established by the UT System. I am confident that the Board of Regents will name the right successor to Dr. Jim Willerson who will take the UT Health Science Center to the next level. We have the foundation and the infrastructure, as established by Dr. Willerson, and we owe it to him and ourselves to see his vision through.

With our chair searches, we are expecting the first candidates for Physical Medicine and Rehabilitation and Psychiatry and Behavioral Sciences coming soon. There is an upcoming meeting to report on the status of the search for the Internal Medicine chair, and the Ophthalmology search is just getting under way.

The conflict of interest policy draft regarding pharmaceuticals is being reviewed by students and Faculty Senate representatives. Dr. Shine and Dr. Willerson feel strongly about soliciting feedback from everyone, including staff and the community. I assure you that the policy will have value yet be flexible, reflecting the dynamic relation between academic centers and private industry.

I want to make you aware of the Medical School’s Office of Communications. This group promotes the Medical School through professional communications and creative services, furthering education, research, and patient care. As large as the Medical School is, we must have an office focused on us to help create and support our identity – and I am looking to this group to be innovators in communications. The office works closely with the Office of Institutional Advancement and UT Physicians. The Office of Communications is responsible for the Medical School’s Web site redesign, which will completed by July 1. Look for the departments of Internal Medicine, Ophthalmology, and Cardiothoracic and Vascular Surgery to have their new Web looks unveiled next. These sites will have a link to UT Physicians, and we are planning a marketing campaign to follow the Web redesign.

We are having very positive discussions with Juanita Romans, chief executive officer of Memorial Hermann – Texas Medical Center, on the annual operating agreement. I am impressed by Juanita’s approach to the financial challenges of our group practice, which are the result of the reality of any academic center in the nation. When we can show that faculty are productive, that we have a defined process of billing, and that we are aligned with hospital needs, Juanita has been very supportive of including funding to allow for growth. By the end of day, we will have reviewed all of the clinical departments, and we will present the results to the chairs and schedule a second round of budget negotiations. Our ability to grow is dependent upon our current performance of service and of faculty – if production is questionable, we will not recruit until productivity has reached an acceptable level.

The Health Science Center leadership also presented our budget and strategic initiatives to the UT System via a videoconference this week. Dr. Shine was highly complimentary of the Health Science Center, Dr. Willerson, and Kevin Dillon. He also asked about challenges to the group practice and our projected growth and finances. Our clinic collection rate has moved up, and we made progress on our revenue cycle, completing clinic and billing integrity department reviews and further integrating with IDX. We cannot be reactive in our approach to strategically planning our budget – we must plan and invent our future. We discussed initiatives with Memorial Hermann, including joint ventures, and the expansion of UT Physicians, including growing women’s services, neurosurgery, and pediatrics citywide. We were asked about the faculty’s perception of our outsourced billing group, McKesson, and if we plan to retain them in the future. While our contract is not finalized, our intention is to retain McKesson and work with them, continuing to monitor their performance. We expect high standards. We are doing our best to improve communication to chairs and share information about the clinical program at Faculty Senate, and want to ensure that faculty know that they are not held accountable for the billing – they are responsible for charges, relative value units (RVUs), and other benchmarks.  While not perfect, our billing efforts have been improved. In this respect, Andrew Casas, vice president and chief operating officer of UTP, grilled 180 hamburgers for our friends at McKesson today in recognition of their strong performance in February and March. I would like to personally thank Andrew and Elisabeth Duhon, regional vice president of McKesson, for their leadership in this area.

I want to thank Dr. Willerson, Kevin Dillon, Andrew Casas, Julie Page, Angela Hintzel, Jorge Zambra, Dr. Brent King, and others for their attention and leadership regarding our finances, and also the compliance effort to limit our liability exposure. While our financial outlook remains positive, it will not be easy as we face a future that will stress health care.

Trust is vital to our success  – and to any relationship or team. Someone gave me the book, Trust Matters New Directions in Health Care Leadership, which was co-written by Dan Wilford. This is a very provocative book, which outlines some simple strategies and ideas we usually take for granted. The seven elements of trust: commitment, familiarity, personal responsibility, integrity, consistency, and forgiveness make up this value, which is integral to group success. The absence of trust is detrimental, in fact lethal, to group dynamics. Let’s take some time to think about our relationships (work and personal) and how trust is the underlying foundation.

We must be in a position of growth and sustainability as the future of health care will be driven by academic health centers. The key is to develop integrated programs to deliver a high quality of care while remaining economically efficient. Academic Medicine, the journal of the Association of American Medical Colleges, recently published a viewpoint on this topic. The authors say there are seven lessons for creating a clinically integrated program:

  1. Start with centers that are most likely to succeed.
  2. Work closely with all department chairs whose faculty or department will participate or be affected by the formation of a new center.
  3. Understand and manage faculty needs.
  4. Fashion and experiment with governance models that bring chairmen, faculty, and other leadership together to provide direction and oversight for the new centers. Be very clear about the authority and reporting relationships of the center director.
  5. Information transparency is vitally important.
  6. Develop an internal investment strategy.
  7. Departments organized as stand-alone profit centers may not be the best model for the academic health center going forward.

I encourage you to read this paper and think about how the success of such an integrated program would promote our clinical program and result in better patient care.

The Medical School leadership cares about our global culture for teaching programs – our overall academic environment, which includes staff, researchers, students, residents, and faculty. We will invest resources in this area but must consider reassessing the foundation of this environment – one in which mentoring is a core value. It is very important to recognize and lift up these qualities, which are explained in an “Anatomy of Mentoring” article published in Notes from the Association of Medical School Pediatric Department Chairs, Inc. The mentor must be credible, inspirational, empathetic, role model, listener, humble and available. The mentee will be receptive, creative, motivational, persistent, and honest.

Consider these traits and take a moment to think about mentoring. This is a topic not specific to faculty – everyone, staff, students, residents, postdocs, and fellows all need someone who can help navigate career paths and share knowledge and values.

Have a great weekend,


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