Road Map to the Future: Shaping a Common Agenda Donna Katen-Bahensky and Jean E. Robillard

UIHC Overriding Purpose To improve the health of patients, populations and communities in Iowa, nationally and internationally.

Specific Missions  Excel in Education  Lead in Research  Facilitate Technology Transfer  Provide quality care and services to our patients  Improve Iowa communities

Pressures Affecting Our Mission External Market Forces Decreased State Support Decreased Reimbursement New Demands and Standards of Accountability Changes in Health Care Needs

Pressures Affecting Our Mission Health Care Spending as Percentage of GDP Health-care spending in the U.S. soared to $1.42 trillion in % of the GDP in $2.0T (40% increase from 1999) % GDP. Hospital spending, due largely to greater use of services and higher prices, was responsible for 30% of the increase in overall spending. Prescription-drug spending continues to increase at a very rapid rate -15 to 16% per year.

Annual Percentage Change in Per Capita Healthcare Spending and Gross Domestic Product,

Pressures on Academic Medical Centers Academic medicine is under tremendous pressure to recruit, hire, and maintain its leaders. 15% of Medical School are searching for a new dean 16% are searching for a new chair of Internal Medicine (compared to 7% 10 years ago) 30% are searching for a new chair of surgery 40% of internal medicine’s residency training program directors turned over last year

Nothing new: “Every generation believes that it is living in a period of unprecedented changes.”

Are We Going To Survive?

YES We Are Going To Survive But “Business as Usual” Will Not Suffice

How Can We Prepare For The Future? How Can We Continue to Focus On Our Missions and Maintain Our Responsibilities?

Road Map To the Future Medical Education

What are our educational challenges? The scientific basis of medical practice expands exponentially. The nature and demands of medical practice are changing. Methods of instruction in medical education evolve at a rapid pace. Innovations can be costly to implement and to sustain over time. The clinical environment is often perceived as unreceptive to medical education. Pressures on the clinical enterprise undermine financial support for medical education.

What Do We Need To Do To Overcome The Road Blocks In Medical Education? Continue to include improvement of medical education among our highest priorities. Develop new ways to measure the costs and quality of our medical education missions. Establish mechanisms that encourage faculty to engage in educational activities and to expand and improve their teaching skills. Increase our efforts to recruit underrepresented minorities and to prepare young physicians to care for an increasingly diverse population.

Cultural Diversity and Medical School Education “Adequate representation among students and faculty of the diversity in our society is indispensable for quality medical education.” (Jordan J. Cohen)

US Population Forecast Source: US Bureau of the Census

Underrepresented Minorities (URMs) in the US Population and Among Medical School Matriculants, 1960 to 2001 (JAMA. 2003;289: )

Cultural Diversity and Medical School Education “Increasing the diversity of the physician workforce will improve access to health care for underserved populations.”

Cultural Diversity and Medical School Education “Increasing the diversity of the research workforce will accelerate advances in medical and public health research.”

Road Map To the Future Research

Road Map To the Future Research How Do We Perform?

Road Map To the Future Research How Should We Perform?

Road Map To the Future Research We Should Be #1 In Number Of Grants Per Faculty

Road Map To the Future Research What Do We Need To Do To Be #1?

Road Map To the Future Research To Climb to #1 85more grants 4 new grants per department 1 new grant / department / year over 4 years

Road Map To the Future Research How Do We Do This?

Research Enterprise Opportunities Create Biological and Clinical Scholar Programs to attract the best. Foster interdisciplinary research:  Cancer Center  Center for Aging  Cardiovascular Center  Neuroscience Center  Center for Organogenesis  Center for Proteomic Research Involve other schools and colleges in participatory programs:  Genetics  Bioinformatics  Bioengineering … Re-engineer our clinical research enterprise Invest in Health Services Research.

Research Traditional laboratory is to become a virtual “collaboratory”  PI’s laboratory will become “hub” interfacing with series of multiple collaborators across the country and the world.  Investigators will be academically independent but constructively partnered.

Road Map To the Future Clinical Research

Translating Biomedical Research Funding Time Societal Impact NIH Support Non Federal Support Outcome Research Clinical Guidelines Clinical Trials Basic Research Clinical Research Translation Tech Transfer Conflict of Interest Clinical Studies Database – IT IRB Participants Investigators Improved Health

Road Map To the Future Clinical Research Create new ways to increase research study participants. Streamline the regulatory process and compensate faculty for IRB activities. Develop biomedical informatics programs and invest in IT systems that specifically address clinical research needs. Develop an adequate clinical research workforce: interdisciplinary arrays of clinical investigators. Develop incentives to attract faculty in clinical research. Develop Health Service Research agenda.

Road Map To the Future Business and Innovation Research

UI Research Foundation Patents Filed & Issued, FY87 to FY02 (Total No. of Patents Issued, FY87-02 =316) (Total Patent U.S. Applications Filed, FY87-02=601)

UI Research Foundation Total Income*, FY87 to FY02 (Total Income from FY87 to FY02 = $27.4 million) *This chart reflects UIRF earnings, patent cost reimbursements are not included. $ Millions

2000 AUTM Survey Results Big Ten Conference Comparison CollegeGross Licensure Revenue (Millions) AUTM National License Revenue Ranking Big 10 License Revenue Ranking Illinois (Chicago & Urbana) Indiana Iowa Michigan4386 Michigan State26111 Minnesota23132 Northwestern Ohio State Penn State Purdue Wisconsin23143 Iowa State1.269N/A

Road Map To the Future Faculty Development

Road Map To the Future Faculty Development Enhance recruitment, retention and multi-stage career development of outstanding faculty. Create a supportive environment Develop and recruit leaders to address accelerating institutional and societal needs

Faculty Satisfaction Productive Academic Organization Great Faculty Outstanding Environment Superb Leadership Productive Organization

The University of Iowa Presidential Biomedical Scholar Program The objective of this new program is to recruit and support new investigators of outstanding promise in the basic biological and clinical sciences. Three tenure-track assistant professors either in basic sciences and/or in clinical sciences will be appointed annually to the program. Each scholar appointed to the program will be provided with seed funds of $300,000 for the first year and annual funding of $100,000 for three years thereafter for a total of $600,000. The scholars may apply themselves or be nominated by department heads and directors of basic and clinical academic departments and research centers.

Road Map To the Future Philanthropy

Big 10 Total Gifts Received InstitutionTotal Private Gifts Rec’d Indiana$126,112,957 Ohio38,331,008 Michigan37,100,812 Minnesota31,818,967 Iowa22,563,315 Illinois12,307,380 Michigan State1,750,000

Big 10 Ratio of $ per Development Officer InstitutionRatio Gifts to DOsTotal Private Gifts Rec’d Indiana$18,016,137$126,112,957 Ohio State4,791,37638,331,008 Penn State3,356,00816,780,042 Iowa3,223,33122,563,315 Michigan2,650,05837,100,812 Michigan St.1,750,000 Illinois1,367,48712,307,380 Minnesota1,325,79031,818,967

We Will Continue to Exist? Which other institutions should teach the nation’s health professionals? Which other institutions will train the next generation of clinical and clinically oriented biomedical researchers? Which other institutions will provide their clinicians the protected time necessary to conduct clinical research and to experiment with new forms of clinical care? Which other institutions will serve as providers of last resort in their communities? Which other institutions will test and implement nascent clinical practices when they are still relatively unproven?

“We must adjust to changing times and hold to unchanging principles.” -- Jimmy Carter Nobel Peace Prize Lecture