Maimonides Society

Friday, December 19, 2014

It’s an honor to be among such a distinguished group of health professionals.

And I know of all the great work members of the Maimonides Society have done through the years and generously given to the University. I thank you. I’m also delighted and encouraged by the holistic approach to the gathering. This group is truly interprofessional in nature, which, of course, is a cornerstone of medical education at the University these days, and should be of health care delivery as well.

I’m also very honored to be—I’m sure—among the first Presbyterians ever to give a sermon from the pulpit of Temple of Aaron. Being here has got me thinking about a controversy that’s raging among all faith communities, and certainly in the medical community. That is this fundamental question: When does life begin? Fascinating, argumentative, sometimes difficult to discuss among strangers, or even colleagues like you. But let me try.

In talking with some friends recently, I’ve gathered that—in the Jewish tradition—and, please, tell me if I’m wrong—the fetus is not considered a fully viable human being until after graduation from medical school. Furthermore, as a baseball fan, I’m thrilled that legend has it that Sandy Koufax attended services here at Temple of Aaron on Yom Kippur during Game One of the 1965 World Series, which was exactly 48 years ago this week.

I know that there’s been some doubt as to whether Koufax actually sat quietly in the back of the sanctuary here during morning services, or whether he simply observed the holiday in the Dodgers’ team hotel. In fact, Rabbi Fine here at Temple of Aaron recently investigated this piece of history, but inconclusively so.

But I say: Who cares? To be in the same place where Sandy Koufax might have been is good enough for me, and I’m guessing for you.

So, thank you for having me at such a wonderful Temple for this important event.

I want to talk tonight about the University’s role in the health sciences about the future of health care delivery, about our commitment and leadership in interprofessional education, and about my vision and goal to restore our Medical School to a national standing it once held.

We are very good

That’s not to say that our Med School these days is somehow failing, or that our Academic Health Center is not superb. Absolutely not. We are very good. Under the leadership of Dean Aaron Friedman we’ve continued to educate the physician talent force in this state and done a terrific job. Aaron is here - and I’ve been taking every opportunity to say thank you to Dr. Friedman for his leadership and his partnership during my first years as President. I will miss his counsel.

Also, our research enterprise remains strong, be it in cardiac care, children’s health at Amplatz Children’s Hospital, or in the laboratories where we are breaking ground in the areas of neuroscience and cancer, medical devices and stem cell research, among others. But it is to say that our complex partnership with Fairview Health Systems has been stymied over the past 15 years because of market forces, the changing landscape of health delivery in the United States, and because, frankly, our University of Minnesota physicians, nurses, other professionals, faculty members and students have found a certain lack of understanding among Fairview leaders about the role and importance of academic medicine. That, I guarantee you, will be changing as the University and Fairview implement a new integrated structure and as Fairview’s new CEO, Rulon Stacey, arrives from the University of Colorado Health System next month.

This is a very exciting time for our partnership with Fairview, and we are working very hard to develop a new branding face and a new spirit to our patients and customers.

We at the U are deeply committed to patient-centric care. Simply put, I see our role as three-pronged: To produce health care professionals whose highest priority is to provide the best possible care for their patients, sometimes given limited resources; To continue to produce world class research; And to assure the health of the people of Minnesota. It’s a huge role, but one that the state’s only public research university and only public medical school must embrace.

One significant approach to fulfilling our role is interprofessional education.

And, as we begin public interviews of the three finalists for the new Dean of our Medical School and Vice President of the Academic Health Center, the successful candidate will be one who embraces our interprofessional leadership and is prepared to be a champion for this work. Of course, we are not new to this effort.

Interprofessional education was a key priority for Dr. Frank Cerra when he led the AHC, and Frank is here tonight. In 2006 we launched the Center for Interprofessional Education, adjusting our University’s health sciences curriculum to better train our students for success within a changing health care landscape. In 2010 we launched an innovative program known as 1Health, a vision for interprofessional education that required students from across the health sciences to participate together in courses and experiences that would build their understanding of the complete health care environment. Last year, we became the nation’s first National Coordinating Center for Interprofessional Education and Collaborative Practice. Dr. Barbara Brandt is here tonight - thank you for your work and your leadership on this issue, Dr. Brandt.

The Center is moving forward quickly to impact education both here and nationwide. Only from new interprofessional education models can we properly train health care providers who leave our programs focused on teamwork, cooperation and new ways of thinking. Right now, for example, on a typical day, sitting in the same classrooms, are medical, nursing, veterinary, pharmacy, social work and occupational therapy students, all learning to work together. That’s remarkable.

Care in health care

That’s why I prefer to talk about the "care" in health care. I know that the business of the health sciences is extremely important and, frankly, lucrative, and I don’t want to minimize its importance to the University. In fact, our new arrangement with Fairview will drive $90 million over the next decade towards the Medical School to aid in research at a time when federal funds are drying up.

And such a reduction in research funds from the NIH and NSF, in particular, is affecting the U in all areas by at least $40 million this year alone.

I call that the innovation deficit, and it’s alarming that our federal government is cutting back as other nations are increasing research funding. I guess we’re not only cutting back, but shutting down. Just this week, New York Times columnist Thomas Friedman, who grew up in St. Louis Park, wrote that the NIH had plans in 2014 to stimulate research proposals in how to speed up the use of stem cells to cure Parkinson’s and other diseases, how to better manage pain in sickle-cell disease and how to improve early diagnosis of autism. These are some areas that some of our scientists are working on. But because of gridlock in Congress and the funding sequester, those proposals won’t be encouraged. They won’t be encouraged because they simply won’t be funded. That is outrageous.

This crisis of research funding, in my view, runs totally counter to the larger-than-life figure that your organization is named after—Moses Maimonides. As you know, Maimonides himself was an icon of interdisciplinary interests and scholarship. Of the many things he stood for, two were clearly scientific inquiry and, of course, for caring, as does the entire concept of Tikkun Olam, which I know is important to this Society.

As I understand it, Tikkun Olam means “repairing the world," or "healing the world," and it suggests humanity’s shared responsibility to heal, repair and transform the world. In a secular vein, that’s part of our mission as a University, too, particularly to transform the world through teaching, through research and through public engagement, using our expertise and resources to help solve some of the state’s and world’s most pressing problems. At the University we work to not only repair the world, but also to re-new, re-invent and re-build the world.

We are about the common good, the public good, and that must be driven by ethics, scholarship, compassion and the ambition to make this state and planet a better place to live and work. Whether it be helping to develop the medical device industry in this state and nation six decades ago, or blazing the trail for open heart surgery, or be on the verge of treatments for Alzheimer’s, or in working with others to close the unacceptable achievement gap among our young people of color…

What we do every day is, in some ways, Tikkun Olam. For, in the end, we are all measured not by what we have, but by what we give.

Crystal ball

Now, the University and its health science professional alumni—and the entire health sciences community in this state—have given much. But we are constantly expected to give more, and we must. As we move into an era of interdisciplinary and team-based health care delivery, health care professionals will need to become more sensitive leaders and better listeners. How do we teach our students to be technically competent as well as superb counselors and healers? I know we do it every day through our curriculum at all of the schools and colleges of our Academic Health Center.

I also know that our students of today are starting their careers amid what some have called “the biggest shakeup” in medical and health care delivery history.

Dr. Eric Topol of Scripps Health in California writes and Tweets—OF COURSE!—about this all the time. Some of his crystal ball work is a bit out there, but…

He writes that social networking is the new medical journal. He says that, before long, every patient will be taking her own blood pressure or sequencing her own genome with her smart phone, And that providers will be Skype-ing as they counsel her from afar on the prevention and treatment of various ailments.

Here’s what else I’ve been told might be in store for providers in the years to come. When our students begin practice, they will likely be responsible for more patients than physicians are today. The increased understanding of genetic influences will change the way patients want to be treated, even if we all know that environmental, social, and lifestyle factors will continue to account for most health challenges.

All of the technology will drive more patient self-care, so it will be the job of the doctor or nurse or pharmacist to interpret confusing data for them. With fewer face-to-face meetings, establishing doctor-patient trust will be difficult.

But establishing trust will be even more essential, and health care workers will have to work to do that. Health outcomes will take on increasing importance in assessing just how good of a physician or nurse or therapist or chiropractor you are. The outcomes are bound to be tied to certification and reimbursement.

And, as our population ages and that self-care expands, all providers will be more actively involved in end-of-life care. It will take previously unimagined collaborative skills—the kinds our students are learning right now—in which previously thought- to-be separate entities are partners, facilitating cross fertilization and better patient care.

In closing, I am enormously proud that the University is a leader in this interprofessional effort and many others. A part of our strength is our incredible community of partners in health care and beyond…that is, friends like you.

Your participation, your counsel, and your willingness to train and work with students contribute to a healthy, caring state. Your support of the University is deeply appreciated. We’re doing our part at the University of Minnesota, and, I believe we must do it in the spirit of Tikkun Olam,—with the goal of healing the world. Thank you.