The Miami Herald
Posted on Sun, Aug. 05, 2007
The best doctors. Better healthcare for all -- even in poor neighborhoods. Groundbreaking medical research. A booming biotech industry. All this is being promised for South Florida by two university leaders.
In a rare moment of dramatic change in both healthcare and higher education, the University of Miami is starting an unprecedented expansion of several programs at its 55-year-old medical school just as Florida International University prepares to open its medical school in 2009.
UM officials say their sweeping plans, which include buying the 560-bed Cedars Medical Center, will help expand top-quality care in South Florida -- making the area a destination for medical treatment as the Mayo and Cleveland clinics are now.
FIU, while just starting, is following an equally bold strategy. From their very first year, doctors-in-training will go into underserved neighborhoods to see how healthcare and economics affect the well-being of real people.
Both efforts have become the personal missions of two hard-charging university presidents, UM's Donna Shalala and FIU's Modesto ''Mitch'' Maidique. They -- along with healthcare and education experts -- say the changes will affect virtually everyone in South Florida. Their main points:
• Many cities with the best reputation for healthcare -- Boston, Houston and others -- have more than one medical school. Although UM's school will be much larger for decades to come, FIU's addition will enrich the community.
• Medical schools are critical to universities' financial health and prestige, and should boost both UM's and FIU's prominence.
• FIU has a unique and fascinating plan, but it's struggling to get the donations needed to make its medical school first-rate.
• UM's hopes to become a healthcare destination and a biotech center face stiff competition because many places have the same ambition.
Both presidents know the stakes are high.
Shalala, a former U.S. secretary of health and human services, says, ''I wouldn't have come here if there wasn't a medical school.'' She hired a new dean last year and told him to push the medical school to national prominence.
Already, Dean Pascal Goldschmidt has hired top researchers from around the country, including 50 genetics experts from Duke, and has initiated an ambitious international program, preparing to open clinics in Latin America and attract foreign patients to Miami. ''We want to be a global leader in medicine,'' Goldschmidt says.
At FIU, Maidique has coveted a medical school for the past decade because he thinks the move will make FIU a major research hub and eventually double the university's budget. He says ''the authorization of the medical school was the single most important event in the history of the university,'' which opened in 1972. ``We are uncautiously optimistic.''
FIU's school will be much different from UM's traditional model. Its neighborhood plan will focus on practical, primary care, dealing with patients with economic as well as health issues. ''It's never been done before in this country,'' says John Rock, dean of the new medical school. ``We're going to learn a lot in this process.''
Rock and Goldschmidt say they talk regularly and are eager to help each other. They say patients get excited about participating in academic medicine. Goldschmidt loves to point out that, if patients are put into a test program and given a placebo, 30 percent will do better -- just because they believe they should.
The two deans hope that eventually South Florida will be able to emulate a place like Houston.
With the M.D. Anderson Cancer Center and other facilities, Houston has become a treatment destination for people in North America and South America.
Its oldest medical school is private: Baylor University's, 100 years old and consistently rated among the top 15 in the nation in quality and research. The public University of Texas is about 35 years old and runs a graduate school with the Anderson center, which itself is part of the University of Texas.
The medical schools split responsibility for indigent care at two hospitals and 13 clinics. They join in research projects and some clinical care. Their leaders, Baylor's Peter Traber and UT's Jerry Wolinsky, say the relationship works well for the most part, although competition for top faculty members can lead to price wars.
The two schools and the cancer center are within walking distance of one another in a cluster called the Texas Medical Center, which includes 44 medical institutions and draws six million patients a year.
South Florida already has considerable heft in healthcare education, but it is quite spread out, with osteopathic medicine and dentistry at Nova Southeastern University in Davie and podiatry at Barry University in Miami Shores. Nursing and allied health professions, such as respiratory therapy, are offered in at least a half-dozen institutions in the area.
A new medical school doesn't mature overnight. ''It does take concerted effort and time to recruit faculty, to build research programs, to build clinical programs,'' said Traber, the Baylor executive. ``It's a long-term effort and it's expensive.''
At present, UM has 660 students, more than 850 full-time physician-faculty members and more than $70 million in research funding from the National Institute of Health.
It is also expanding its campus at Florida Atlantic University in Boca Raton, where it plans to have 264 medical students studying in the first through fourth years. For their postgraduate training, UM is working to establish 320 residency spots in Palm Beach County hospitals by 2012.
FIU will start with 40 students and 25 full-time faculty members in 2009. By 2013, it will have 75 full-time physician-faculty members. It won't have a full complement of 480 students until 2015, and its research budget will still be well under UM's.
Research funds can make a huge difference to any university. UM professors like to joke that they work at a medical school with a university attached. They're not far off. UM's medical school accounted for $900 million of the school's $1.6 billion in revenue last year and $800 million of its $1.3 billion fundraising campaign.
Maidique hopes FIU will eventually approach those numbers, but its fundraising is off to a rocky start. The state is expected to contribute most of FIU's approximately $250 million start-up expenses, but Maidique has been promising that tens of millions of dollars in private donations would build grander buildings and recruit top faculty members with endowed professorships.
So far, the medical school has one known major gift -- a $5 million pledge that doubles to $10 million with state matching funds. By contrast, the University of Central Florida's medical school, approved the same day as FIU's, has commitments worth $113.6 million.
Last November, FIU suffered a major setback when its first big patron, Herbert Wertheim, withdrew his $20 million donation, worth $40 million after the state match. Wertheim and Maidique had a personality conflict.
Seeking money for research, clinical care and biotechnology has become extremely competitive among the nation's existing 125 medical schools -- and more are on the way.
For 25 years, just one medical school opened in the United States, at Florida State University. Now, 14 are in development, intended to solve the physician shortage expected in the coming decades as doctors retire and baby boomers' aging bodies require more care.
Many of these medical schools want to become a destination for treatment, and many of their universities are now battling to become centers for biotech and life-science industries.
Shalala hopes the rapid expansion of the UM medical school could improve the financial health of South Florida by building a ''white-coat economy,'' making the area a center for life-science and biotech industries. ``We are going to create all high-quality jobs.''
The jobs could eventually be located on seven acres that UM owns east of the UM/Jackson campus, adjoining Interstate 95, which it's calling Life Science Park.
Bart Chernow, the UM vice president leading biotech development, says the now empty space is intended to eventually house start-up companies based on the work of UM researchers and existing biotech companies lured from elsewhere, starting with national pharmaceutical firms that want to connect with UM researchers.
Chernow says UM has not yet started trying to lure outside firms to the site. ``We're very much in the late exploration stage.''
Many other universities and institutes, of course, are also trying to attract life-science and biotech companies, notably Scripps Florida in Palm Beach County, and experts point out that not all can be successful.
''I find it hard to believe that biology will be the basis for all the regional economies that are aspiring to make it so,'' said David Blumenthal, director of Harvard Medical School's Institute for Health Policy. ``If I were a university president, I'd make the same bet. But there's certainly a chance that [they will] overinvest.''
FIU has no plans for a biotech park, but the two medical schools are likely to face off in efforts to get state money. Although UM is private, it gets a $12.5 million annual subsidy and, this year, a special $80 million grant to establish a genetics institute. FIU received $5.5 million this year in medical school start-up money, which will escalate to about $20 million a year as the school matures.
Goldschmidt, the UM dean, acknowledges that as FIU grows, ``there will be some competition. And guess what. That's good for the patient. I fully believe in the capitalistic system.''
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