| The development of a set of basic assumptions is fundamental to any planning effort. Assumptions are an important tool to communicate current realities and likely trends, they identify factors that frame and influence our choices, and their implications provide a framework for our goals, objectives, and strategies. - The Feinberg School of Medicine is committed to aggressive growth in size and stature as it moves into the ranks of the nation's very best medical schools. This commitment to growth now runs counter to prevailing near-term economic trends. These trends include pressure on philanthropy, public and private funding of clinical care, costs of regulatory compliance and malpractice insurance, and federal support of basic research.
- Society’s investment in biomedical research is paying off with a revolution in medicine. Increasingly powerful tools are creating new opportunities to prevent, diagnose, treat, and cure. Our ability to use these tools to greatly improve the effectiveness of patient care depends on overcoming issues in the financing and delivery of, and access to, health care services.
- The rapid pace of change in biomedical science, technology, and medical practice presents responsibilities and opportunities across all our missions: to modify how we practice medicine and care for patients, to reduce medical errors, to remain on the cutting edge of research, to develop outstanding educational programs that prepare physicians to keep pace with ever-expanding frontiers in science and medicine, and to teach patients and the general public to improve overall health.
- The plans for accelerated growth of the school pose significant challenges to institutional leadership and management. Improvements in accountability are necessary to enable us to simultaneously retain our decentralized character and balance the achievement of individual, departmental, and institutional goals. We must develop a culture of managing growth, which includes the will to end unproductive programs or nonperforming investments and even decline external support in areas not consistent with our vision for growth. The department structure and roles of chairs will evolve. Systems and decisions must provide the necessary information, incentives, and disincentives.
- Significant changes—and constraints—in the scope and direction of federal funding of biomedical research are likely in response to competing governmental priorities and the prevailing economic and political climates. Historical patterns of the types of research funded and types of awards made will no longer hold, and while some areas will grow, many traditional areas and funding mechanisms will not. Several new factors should be considered, such as political pressures favoring disease-based applied research over basic research, biodefense initiatives that have reduced overall NIH funding available to other areas, and the new NIH Roadmap, which has outlined new initiatives and directions.
- We are faced with a range of choices in research directions and must continually evaluate the intersection of our strengths and needs, areas of growth in scientific impact, and the moving target of funding opportunities. Most importantly, we must strike a balance between the historical approach of opportunism and a need to establish strict priorities and a measured approach for institutional investments in new and current research and associated infrastructure. We need to refine our analytical framework for selecting our investments and improve our processes for communication and collective decision making about the inherent trade-offs.
- The regulatory and legal environment will increasingly influence institutional and individual actions. Our internal culture must evolve to one that embraces, rather than tolerates, more stringent safeguards for research subjects and staff members, and compliance with regulations in research, admissions, and recruitment.
- In a break with historical tradition, we must implement an aggressive faculty recruitment and retention strategy. A significant number of recruitments will be driven by programmatic rather than departmental needs and mechanisms. The best way to overcome administrative and cultural barriers to this evolution is for new recruiting models to generate a noticeable improvement in quality of recruits.
- New dimensions of supply and demand will drive increased competition for the best faculty members and residents. Of particular note are a building boom of research space at top-tier institutions; the clinical capacities of our affiliated hospitals, outpatient sites, and physician practices; and relatively stable numbers of medical and graduate students and residents. While most competition for talent will be between institutions, some will be internal as a limited pool of institutional resources for recruiting must be spread across our entire enterprise.
- An increased demand for medical and graduate students, combined with uncertainty about the future size of the applicant pools, will lead to increased competition for the best students. The size of the medical and graduate student applicant pools has been declining in recent years, although an upturn may occur, at least in medical school applications. Two new medical schools have been announced, and a third has been proposed, and the Council on Graduate Medical Education has proposed increasing the number of medical students nationwide by 15 percent. The research building boom in academic medicine will further fuel the demand for graduate students.
- Traditional factors such as salary levels for faculty and financial aid packages for students will be eclipsed by nontraditional factors, such as support services, housing costs, spousal recruitment, intellectual quality of life, and leadership, in attracting and retaining talent.
- Substantial barriers exist to the meaningful involvement of faculty in high-quality educational programs. These can be overcome with a combination of heightened focus on educational commitment during the promotion process, training and support for faculty members in their teaching role, and by continuing to modify reward and recognition systems.
- In addition to the demands placed on medical education curricula by scientific and technological advances, we must expand our education programs to incorporate areas of ethics and professionalism, cultural diversity and social context, and use of information systems and other technologies to enhance patient care and safety.
- Space is a limited, performing asset that must be carefully managed. Planning for the use of space is difficult—but necessary—as we use relatively fixed structures to accommodate increasingly dynamic programs. Space is among our largest costs, and efficiencies and increased productivity will directly advance the institution. Space belongs to the institution, not to component units, and its use must be constantly evaluated and adjusted to further institutional ends.
- Like space, the deployment of information technology is a limited, enterprise-wide resource and a potential competitive advantage. How we use information technology—in physician and researcher tools, administrative and decision-support systems, and patient information and population-based research—will affect our performance and faculty recruitment and retention.
- The pending closure of the Jesse Brown VA Medical Center's Lakeside facility strikes at all our core missions, which must not be allowed to suffer as a result.
- Technology transfer is one of our largest untapped potential revenue sources, yet the school is currently not well positioned to take advantage of these opportunities. We must examine and remedy the contributing factors to this critical disconnect.
- The strong trend towards internationalization should drive the school and its academic medical center partners to evaluate what it means—and what it takes—to be a global presence. Outstanding clinical care can draw international patients to U.S. medical centers. High-quality biomedical research is being done in other countries, and the regulatory and legal environments are more conducive overseas for some types of research (for example, stem cell and clinical trials). Disease epidemics do not respect national borders. Corporations and their workforces are increasingly international. Positioning an institution for success in the coming decades requires considering an international perspective.
- Our collective and continued success is inextricably intertwined with that of our clinical affiliates. Achieving a shared vision of pre-eminence is beneficial to all the institutions in our academic medical center (University, school, hospitals, and physician practices). It will require the philosophical, cultural, and financial support of the medical school by all the clinical affiliates. All academic medical center partners must be attentive to each other’s needs for maintaining a strong competitive and financial position.
- Medical schools and academic medical centers that leverage their traditional missions to be mutually supportive and reinforce and productively deploy limited resources will thrive and prosper. Others will wither and die, abandoning one or more of their missions and/or constituencies.
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