A Vision for the Future: Advance to Top Quartile

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Steve J. Schwab, MDVision has been defined as “the art of seeing what others can’t.” In his more than three years as executive dean of the UT College of Medicine, Steve J. Schwab, MD, has consistently practiced that art. During his tenure as executive dean, he has actively sought and enthusiastically seized new opportunities to advance the college and its myriad departments on three major campus sites across the state. Undoubtedly those abilities contributed to his appointment as chancellor for UTHSC, a role he assumed in June 2010.

Although he has shifted into the leading administrative role at UTHSC and will transition from the position as executive dean, Dr. Schwab is committed to tenaciously pursuing a long-term, strategic vision for the College of Medicine (COM). That vision is to advance the UT COM into the top quartile of academic medical institutions in the country.

Dr. Schwab recently spoke with Medicine magazine about his vision.

Editor: The Association of American Medical Colleges (AAMC) represents all 135 accredited U.S. and 17 Canadian medical schools. Where does the UTHSC College of Medicine (COM) currently rank?
Dr. Schwab: At the moment, the Health Science Center is slightly better than mid-pack in terms of total all-source funding — clinical, state, tuition and research. In terms of education, we’re top quartile already in most areas. We’re rapidly moving forward in our clinical practices and are on track to top quartile. The research enterprise needs investment in order to step up. Recovery dollars will help us jump start that enterprise. This will be a key area of focus. [Editor’s note: The “recovery dollars” reference alludes to the American Recovery and Reinvestment Act, often referred to as stimulus funds.]

Steve J. Schwab, MDEditor: What elements must be present to qualify an institution as top quartile? Since AAMC doesn’t maintain a list that ranks its members that way, can you comment on what is needed?
Dr. Schwab: To be in that group clinically, you need at least eight major areas of clinical excellence. Right now we only have five. Clinically it also requires a volume of care performed as compared to other members. The growth in all of our faculty practices but especially UTMG has been very encouraging and has us near the volume goal. In research we also need to double our NIH and all-source research funding to get into the top quartile. We have to go from $50 or $60 million in NIH funds — $100 million all research source — each year to double those numbers, and we have to sustain those gains for two to three years.

In education, the key measures are the depth and breadth of your medical and residency programs, and your accreditation and board pass performance.

Educationally and clinically we are in striking range. Our College of Medicine is fully accredited. We have a medical school class of 165 and our students perform well on national board exams. In advanced training we have more than 1,100 residents and fellows in 84 fully accredited programs with strong specialty board passage rates.

In research we need a financial commitment to growth. I have to extend kudos to Dr. Ken Brown and his vision for the new Translational Science Research Building and the potential new Clinical Building. Suddenly with a new building there, we can make an investment that irretrievably commits us to the science. We will build it, and they have to come.

Steve J. Schwab, MDEditor: Would you please identify the areas of excellence that you think will drive UTHSC into the top quartile and sustain our presence there?
Dr. Schwab: Those nine areas of focus are the Hamilton Eye Institute, trauma, transplant, maternal-fetal medicine and obstetrics, musculoskeletal, neuroscience, children’s cardiac services, adult cancer and adult cardiovascular.

Right now, I think we perform very well in five of these key areas. In two of them we are doing well, and I think we can get close to top quartile. And the others are aspirational targets where we have some work to do.

Adult-CancerThe five areas that I believe are already top quartile are the Hamilton Eye Institute, which combines clinical care with vision science; our Trauma Institute at The MED [Regional Medical Center at Memphis], which is one of the best in the nation; our top-10-rated Transplant Institute that we run in cooperation with Methodist University Hospital [MUH]; our Neuroscience operation at MUH, Le Bonheur and The MED, in cooperation with Semmes-Murphey neurosurgery, which combines powerful basic science — neurobiology and pharmacology — and clinical science with outstanding clinical care; and our Musculoskeletal area, which includes both a long-standing affiliation with Campbell Clinic for orthopedics and our well-recognized expertise in rheumatology, plus now we have committed to musculoskeletal science based in orthopedics and medicine. These areas can all be classified as having attained and sustained national stature.

Adult-Cardio-CareMaternal-fetal medicine and obstetrics are areas where we think we can move forward to top quartile. Dr. Mari and Dr. Dhanireddy are helping us get there.

Plus we think we can get close in children’s cardiac services. We’ve paired Dr. Knott-Craig and Dr. Chin together to create a Children’s Cardiac Institute, and they are making significant progress.

Our aspirational targets are adult cancer and adult cardiovascular care. I think we have a lot to do in cancer research, and we’ll work in novel ways with Dr. Reed, Dr. Pfeffer and Dr. Yunus at UTCI to move ahead.

Our Department of Physiology, which is doing world-class science under Dr. Tigyi’s direction, is committed to advancing toward our goals. Their work lays the foundation for a number of specialties like cardiovascular care. Our recently opened Regional Biocontainment Lab opens up new research opportunities, and our affiliations in genetics with the Oak Ridge National Lab through our joint Center for Integrative and Translational Genomics are emerging.

When we talk about the path to the top quartile, I think we need to focus on our scientists and their research portfolios. There’s also the national stature of the clinical enterprises and, there’s the educational portfolio.

Editor: Why top quartile? How did you arrive at that goal?
Dr. Schwab: You have to set a goal that you can achieve. Unattainable goals are just pie in the sky. We’re going to say since we’re an AAMC medical school — like Harvard, Duke, Johns Hopkins — we are going to compare ourselves to all AAMC Medical Schools. We are not going to juggle the rankings and only compare ourselves with state-funded institutions of a certain size in an attempt to create a higher ranking.

The organizations with the huge endowments and that own hospital systems to feed their research funding are the ones that stay high in these rankings. They include Johns Hopkins, Duke, and now Vanderbilt to name a few. Public schools like the universities of Michigan, North Carolina and Virginia are big contenders even though their state budgets were decimated too because they have private-school-level endowments and/or own their own hospital systems. The state funds them like we’re funded now but they have a well-managed university-owned hospital system. That’s a powerful advantage.

Editor: What are UTHSC’s main obstacles in getting to the top quartile and staying there?
Dr. Schwab: It’s all about funding. Can we raise the revenues to get where we have to go through discretionary funding, clinical practices and alignment with hospitals? Can we successfully partner with our affiliated hospitals to the extent that we can realize financial gains? Can we create joint ventures that create revenue streams?

We need our alumni to recognize the importance of their role in moving us forward. We need them to make an ongoing commitment to fund excellence in education. We’re there as far as students are concerned. We have very good pass rates, totally in sync with the top schools. In fact, with a 95 or 96 percent pass rate for medical students, we are above the national average for medical schools. It’s hard to get 1 or 2 percentage points above the mean of 95 percent but we consistently do.