Etc.: Last Word

The Ranch Comes of Age

By Steven Brown, M.D.

Teaching hospitals develop their academic patina over time, and the Lyndon B. Johnson General Hospital (LBJGH) is no exception. Originally planned as an obstetrics and pediatric hospital, LBJGH became a general community hospital in a single day in July 1990 when the UT Medical School provided the faculty, residents, and students to serve the growing community of underinsured patients in partnership with the Harris County Hospital District (HCHD).

Ascribed to Mark Edwards, M.D., '88, LBJGH was nicknamed "The Ranch" early in UT Medical School's involvement. Originally given for LBJGH's location, the moniker persists with trainees and now carries the affection and pride of those who experienced the broad range of clinical problems and learned to resourcefully problem solve in the face of large patient volumes. In the intervening 17 years, LBJGH has become a critical component of the hospital system of Harris County as a Level III trauma center and a key site for teaching, clinical service, and research for the UT Medical School.

Adjacent warehouse space, now known as the East Wing, was converted to classrooms and offices for researchers and faculty in 1995 in collaboration with the HCHD to support the growing importance of LBJGH to the Medical School's mission. Now, state-of-the-art video conferencing supports bilateral transmission of conferences with the Medical School, and the 17,500-square-foot space encourages the growth of an on-site contingent of consistent faculty, a key step in the maturation of an academic hospital. The East Wing continues to grow and evolve as LBJGH becomes more integral to the UT Medical School's future.

LBJGH and its seven associated community health centers are impressively busy with 78,000 emergency center visits, 300,000 clinic visits, 17,000 admissions, 5,200 deliveries, and nearly 6,000 surgeries in 2006. Approximately 70 percent of the patient contacts with LBJGH and its associated community health centers are not covered by health insurance. Annually, the UT Dental Branch provides two faculty and UT Medical School provides more than 350 faculty and staff, almost 200 residents and fellows, and much of the approximately 200 member medical student class to support this system of health care in collaboration with the HCHD staff. To support the growing need of the community, design of a new, larger LBJGH emergency center is under way, and nearby land is being purchased to support the hospital's expansion.

LBJGH is a crucial part of the UT Medical School's future. The challenges of limited resources and a growing uninsured population, that all public hospitals face, encourage the development and use of evidence-based care systems. These care systems require cooperation between the UT Medical School, the HCHD leadership, and the Baylor College of Medicine. The ensuing healthy debate among these entities helps craft efficient care policies. Now the debate teaches critical thinking and collaboration to UT's trainees and faculty, while in the future the experience can help shape efficient, quality health care systems across the nation. Combining this policy development process with the larger national debate about the health care of the uninsured, UT Medical School and LBJGH are in position to contribute to these decisions.

The multicultural faculty, medical school class, and postgraduate trainees of the UT Medical School serve an equally diverse population at LBJ General Hospital. The diverse patient population brings an extraordinarily broad spectrum of clinical experience that includes tropical infectious diseases and illnesses thought to be of bygone days, such as a case of tuberculosis that mimicked esophageal carcinoma and a recent case of syphilitic aortitis, in addition to more common processes that UT trainees will treat throughout their careers. Treatment of these unusual and common diseases requires consideration of cultural beliefs and practices, and this broadens the trainees' perspective while engendering respect for other cultures. As Texas' cultural diversity expands, LBJGH will continue to have a unique role in the UT Medical School's portfolio of clinical education well into the future.

The next phase in The Ranch's maturation as an academic hospital is the development of a more robust and independent research program. This year, 101 active research protocols are in place at LBJGH and associated clinics and include numerous federally funded grants. The diverse spectrum of disease and large multicultural population at LBJGH and related clinics offer huge opportunity for research including translational research, ethics, public health, epidemiology, disease management, and pharmaceutical trials. Although this potential is just being tapped, further growth of the research environment requires the continued development of a committed LBJGH-based faculty and a larger collaboration with all the UT Health Science Center components. Another important component of clinical research development at LBJGH includes the data base potential of the Epic clinical information system now being implemented throughout the HCHD with the physician leadership of John Riggs, M.D., '86, an associate professor in the LBJGH Department of Obstetrics and Gynecology.

The leadership of the health science center and the UT Medical School recognizes the growing importance of LBJGH to its teaching, clinical, and research portfolios. No more is "The Ranch" a remote appendage as it has become a prime site for the university's activities. With the enlargement of the UT Medical School class, LBJGH provides the required expansion capacity and an important diversification of clinical experience for all trainees. In partnership with the HCHD, the hospital and its associated clinics are emerging as major teaching and research facilities that provide care to all, including those who can least afford care. The vision that recognized LBJ General Hospital's potential and led to its affiliation with UT Medical School in 1990 continues to gain momentum.

Steven Brown, M.D., is the associate dean for Harris County Programs and chief of staff of LBJ General Hospital.