From Dinosaur to Cheetah -- The Evolution of the Academic Medical & Health Science Center

The emerging paradigm of medical education and clinical research is shifting towards a rapidly evolving model that forgoes dependency on state and federal grant funding in favor of strategic industry partnerships, aggressive technology investments, and maximized operating efficiency. According to Paul Umbach, principal with Tripp Umbach, development of this lean, rapidly changing educational approach is accelerating business plans in medical organizations of all sizes and forcing slower institutions to revise their approach to education if they hope to stay competitive.

The evolutionary shift in approach is typified by the University of Arizona which recently went through a dramatic transformation when it moved from Tucson, where it was the biggest player in a town of one million, to Phoenix, a city of more than four million where it had little clinical presence and no facilities. Adapting to this radical change in climate required creatively maximizing partnerships with other universities, hospitals, and private industry partners.

“The University of Arizona is a great example of how a traditional educational institution evolved from a dinosaur to a cheetah in a very short period of time,” says Umbach. “Since there was no money available to build a teaching hospital in Phoenix, the University had to partner with existing hospitals and attract private research funding. They’ve probably built $200 million in facilities through private research partnerships and partnerships with other universities like Arizona State. Back in Tucson they were coming from a traditional model where everything was funded by the state. When they wanted to go to Phoenix they had to rapidly adapt to a new world to survive.”

Umbach says that cheetah organizations focus on inter-professional education (where students from different medical professions train together with the object of cultivating collaborative practices and patient-centered care), and proactively develop sources of non-traditional private funding and foundation support.

Follow the Funding

One of the biggest climate changes in the landscape of academic medical research in recent years has been a tectonic shift in funding sources.

“Medical schools are not getting the support they were 30 years ago, when they were largely funded by states. If you’re going to build a new medical school today, you can only depend on the state to provide about ten percent of it. Back in the old days, the state would have covered as much as 70 percent. As a result, the new generation of medical schools must find new ways to develop more stable funding through private industry partnerships, research foundations, and community support.”

A good example of the new “cheetah” style medical school in action is the newly opened Commonwealth Medical College, in Scranton, Penn., which was made possible by large contributions from private organizations and local community support. Half the tuition of the college’s first class, which started in the fall of 2009, was paid for by community leaders and private organizations sponsoring medical students.

“One of the big drivers in these communities where new medical schools are opening—like Scranton, Grand Rapids, or Athens—is that the community leaders really want the economic development that comes along with health science and research. So they are really willing to get behind making things happen,” says Umbach.

According to Umbach, rapidly evolving organizations are succeeding more with a private sector approach where significant funding is generated through healthcare industry partnerships.

One example of this is the Scripps Program, a medical school that has a company supporter instead of the state of California or the state of Florida.

“We will likely see more cases of healthcare companies putting their names on new programs or medical schools because they perceive these new medical schools will be able to move faster to get their research results out the door,” says Umbach.

Rise of the Super Hospital

According to Umbach, one of the most significant trends impacting the future of medical education is the rise of the “super hospital.”

“Super hospitals are sort of like the parent of the leaner, more partner-oriented collaborative cheetahs. These big multi-billion dollar community health systems are starting to move past being just large, powerful health systems and are also wanting to develop very lean medical schools that could have a significant impact on education and research,” says Umbach.
A good example of the super hospital is Lancaster General outside of Philadelphia, which recently engaged in the evolutionary process with Tripp Umbach.

“Hospitals like Lancaster General are bringing in volumes of patient specialties and tertiary care that match or exceed those of comparative teaching hospitals. They all have residencies or some kind of community educational programs, but what happens when these hospitals want to become more aggressive teaching and research centers?” says Umbach.

Because they already have considerable resources, budgets, and community support, super hospitals are in an unprecedented position to deliver truly integrated education and research.

Keys to Evolution

In the five years since Tripp Umbach was hired to assist in planning Scranton’s Commonwealth Medical College, the firm has been involved in a wide range of new or expanded medical schools, from large state-funded projects, to completely new private and community facilities. In that time, Umbach has identified a number of key features that separate the cheetahs from the dinosaurs.

“One of the key differentiators is that cheetahs move fast. They don’t spend time or money wondering if it will work. They collaborate with whoever they need to and do whatever is necessary to get the medical school started. This enables them to not get distracted from the goal of developing an accredited osteopathic or allopathic medical school,” says Umbach.

According to Umbach, enabling this kind of light-footed organizational mobility means leveraging partnerships, exploring opportunities to grow revenue while limiting long-term exposure, and maximizing technology and resource investments across different disciplines.
Dinosaurs fight for closed, segregated departments in separate facilities and rely on outmoded, irregular funding sources such as state and federal grants to survive. But one of the most critical keys to evolution has proven to be an interdisciplinary approach to education.

“Interdisciplinary models are more cost and educationally effective because you avoid the traditional approach of having separate schools for pharmacy, dental, and public health programs—which is very expensive,” says Umbach.

Having the opportunity to start from scratch, or to start over with existing resources, as was the case with the University of Arizona, is also beneficial to success.

“Interprofessional education models occur more easily in new settings than they do in a traditional university setting, and you can be more successful when you are starting with a clean slate,” says Umbach.

Another key feature of the evolving cheetah medical school is a focus on networking with existing hospitals in the region to avoid owning and operating medical infrastructure.

“Many traditional academic health science centers have gotten out of the hospital business and much more into education and research, which has made them a lot stronger. And I think that is a trend we will see continue because most universities don’t want to be in the business of owning or operating a hospital, and, ultimately, there are smarter ways to do it,” says Umbach.

By Johnathon Allen

This report is based on a presentation by Umbach at Tradeline’s Academic Medical and Health Science Centers conference held in October 2009.

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