Can new dean heal U medical school?

Dr. Brooks Jackson
Dr. Brooks Jackson, University of Minnesota medical school dean, photographed Tuesday, Mar. 17, 2015, in Minneapolis.
Jennifer Simonson | MPR News

A year into his tenure as dean of the University of Minnesota Medical School, Dr. Brooks Jackson is working to revitalize a slipping institution.

With the governor expressing concern over the school's performance, Jackson is out to restore its days of research prominence, an era when the school was renowned for such breakthroughs as the first open-heart surgery and the vaccine for Lyme disease.

"We want to be really world-class," Jackson said. Having a world-class research and training program doesn't mean just prestige for the U, but also "new drugs, new vaccines and new medical devices that benefit all Minnesotans."

The new dean also wants to ensure the school can head off a looming shortage of physicians in various specialties and regions of the state. And he wants to nurture a sometimes difficult relationship with Fairview Health Services, which owns the university's hospital.

The slide in the school's reputation began arguably in the mid-1990s, around the time the National Institutes of Health sanctioned it following a series of financial scandals. Fiscal problems prompted the U to sell its teaching hospital to Fairview in 1997.

Explaining graphic
University of Minnesota Medical School professor John Osborn explains a projected graphic during a lab at the U of M in Minneapolis, Monday, March 9, 2015.
Jeffrey Thompson | MPR News

"Those same financial woes made it difficult to retain faculty," Jackson said. The NIH sanctions "required a lot of resources, and made it much more difficult for faculty to obtain grants, causing a number to leave — and again making it more difficult to recruit."

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The university slipped from the top 15 in the 1980s to 30th last year out of 144 schools in NIH grant funding, a ranking that many faculty and students consider a sign of excellence.

Meanwhile, the school suffered from a "malaise," according to a 2012 external review. Faculty, the report said, complained the U had "no consensus regarding [its] goals and aspirations."

The decline caught the attention of Gov. Mark Dayton, who last year established a committee, which includes Jackson, to find ways to improve the school.

The new dean says he aims to have the U in the top 20 of the NIH ranking within five years and the top 15 within a decade.

"At the end of five to 10 years," he said, "you will look back and say, 'This was transformational.'"

To get there, he's pushing three strategies — generate top research, improve the school's relationship with Fairview and produce doctors to meet the state's growing needs.

Generate top research

The number of faculty is still down about 20 percent from 540 in 1990. Getting back to that level would mean hiring 100 researchers at a cost of $375 million over eight years, the governor's panel concluded. Dayton has proposed funding just half of that, but Jackson says he thinks he can still hit his 5-year goal.

The university would take a new approach with those researchers. Rather than having them work solo on projects, people from different specialties would form medical discovery teams that would each tackle a selected problem.

But Jackson says he needs to change the culture they'll be entering — one in which productivity in scholarship and research for years hasn't been measured "in any systematic way."

He wants to establish rigorous performance goals for scholarship and research. The governor's committee says a 10 percent productivity boost could help the school generate more than $65 million in additional federal funding over the next decade.

Riding a bike
First-year University of Minnesota Medical School student Brooke Jensen rides a stationary bicycle during a lab at the U of M in Minneapolis, Monday, March 9, 2015.
Jeffrey Thompson | MPR News

Ultimately, Jackson says, the investment in researchers should pay off in the long run.

"For schools at the top of NIH funding, it does become easier to become more financially independent," he said. "There's more philanthropy, more clinical income, more patents and royalties."

Improve the school's relationship with Fairview

Fairview has long been a key to the medical school because it owns the teaching hospital and clinics where medical students train and researchers apply their discoveries to real patients.

"We cannot have a world-class medical school without a world-class health system," Jackson said.

The two have sometimes experienced tension, however, because the university's mission of teaching and research requires a lot of time and resources, and doesn't always mesh well with Fairview's need to treat a lot of patients in an efficient fashion.

Jackson's aim is to make sure a recent five-year management deal between Fairview and the U works well so that the university can expand its presence in Fairview's hospital and clinics. That would give the U access to a larger pool of patients, which would generate more revenue.

An expanded clinical presence would also give university researchers more potential subjects for its drug and device trials.

Jackson has warned regents that some medical-device companies won't test their devices through the school because it can't offer enough patients for testing.

"If you don't have a large health system, it's hard to expand your clinical research enterprise," he said.

But Jackson's push for closer integration has hit an early obstacle. Fairview's CEO, Rulon Stacey, caused a stir last month when he announced he was resigning after only 15 months on the job.

Jackson says Stacey's departure is no signal that the integration is foundering, just that Stacey disagreed with other leaders on the way to carry it out.

But Allan Baumgarten, an analyst on health care finance and policy, said Stacey's departure could be problematic because it comes during a legislative budget session.

"If there's uncertainty about whether or not Fairview is supportive of initiatives that the [U of M] wants to launch, that doesn't help anybody," he said.

Produce more of the most urgently needed doctors

Although there's little consensus on how many doctors the state will lack in the next decade — one estimate puts it at 2,000 — many health care experts agree the state will face shortages in rural and inner-city areas, as well as in disciplines such as primary care, geriatrics and psychiatry.

That means the med school needs to make more of the state's limited number of residency training slots available for specialties the state needs most, Jackson said. He wants to establish half a dozen primary-care teaching clinics in underserved regions as part of a proposed $26 million health initiative.

Jackson came to Minnesota from the Johns Hopkins University School of Medicine, where he'd been head of pathology for more than a decade. Under his tenure, the pathology department rose nationally from fifth to first in NIH funding, an achievement that campus officials have highlighted.

President Eric Kaler said when he appointed the new dean in November 2013 that he hoped Jackson "brings some of that magic" to the med school, energize it and improve morale.

First-year students
First-year University of Minnesota Medical School students applaud a class volunteer during a lab at the U of M in Minneapolis, Monday, March 9, 2015.
Jeffrey Thompson | MPR News

Part of the dean's strategy is to make the med school — which has the 18th-highest tuition among public medical schools in the country — more affordable. So he's pushing for a freeze on tuition, which currently stands about $38,000 a year. He also wants to expand financial-support programs for medical students who want to practice in rural and inner-city areas.

Jackson said he's also considering a proposal to cut the four-year undergraduate requirement for some students by a year, enabling them to finish medical school after seven years instead of eight.

Attracting enough of the best students "is part of becoming a world-class medical school," Jackson said. "If you look at world-class medical schools, a significant percentage of their faculty came from their medical school as students."

Dr. Jon Pryor, the Hennepin County Medical Center CEO who served on the governor's panel, says Jackson's attempt to raise the school's research prominence "is going to be tough."

"When you put a lot of focus in the area of research, does that hurt the other aspects of the mission? I hope not, and I'm sure he hopes not," Pryor said.

Jackson and the U also face at least two external reviews that could put a dent in the very research reputation they're trying to build.

In the first, released Feb. 27, the Association for the Accreditation of Human Research Protection Programs strongly criticized the med school for not adequately protecting the human subjects in its clinical research trials.

On Thursday, the state legislative auditor is expected to release the results of his investigation into the 2004 suicide of Dan Markingson, a mentally ill man who killed himself while participating in a clinical drug trial at the U.

State Sen. Terri Bonoff, DFL-Minnetonka, chair of the Senate higher education committee, says she found the first report "disturbing," and is waiting for the next before passing judgment.

So far says she's heartened by university leaders' statements that they'll fix the problems the first report has exposed, and said that with a new university president, head of research and medical school dean, "we have a rare opportunity to press 'reset.'"