Chapter 05: Thoughts on Healthcare, Academic Medical Centers and the Medical University of South Carolina
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Description
After a question about education for physician-scientists, Dr. DuBois shares some of his own experiences teaching medical students then explains how the Medical University of South Carolina (where he currently serves as Dean of the Medical College) has moved to create a flexible and integrated curriculum. He notes the institution also offers a MD/PhDs as well as combined degrees in business administration, law and other fields. He explains the "huge need" in healthcare for physicians who are good at business concepts, noting why this will be a "savior for academic medical centers."
Identifier
DuBoisR_01_20181113_C05
Publication Date
11-13-2018
City
Houston, Texas
Interview Session
Raymond DuBois, MD, PhD, Oral History Interview, November 13, 2018
Topics Covered
The Interview Subject's Story - Overview; Overview; Leadership; On Leadership; Professional Practice; The Professional at Work; Mentoring; On Mentoring; On Research and Researchers; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; On the Nature of Institutions; Business of Research; Fiscal Realities in Healthcare; The Healthcare Industry
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey A. Rosolowski, PhD:
I’m interested too, you had kind of had that little throwaway, that you were involved in curriculum development, teaching the medical school and all that, and that brings up the whole issue of how do you create a good environment for the physician-scientist, which was this new creature that was coming into being. You were one of them.
Raymond DuBois, MD, PhD:
Right, right, I was an experiment, yeah.
Tacey A. Rosolowski, PhD:
Yeah. I mean it was a really interesting time. What are your thoughts, when you look back, in putting together those curricula, kind of creating those environments that really fostered success for people who wanted to work in this translational space.
Raymond DuBois, MD, PhD:
Right. Well, when I took on this role to teach the GI Physiology, the class hated that course.
Tacey A. Rosolowski, PhD:
Oh really?
Raymond DuBois, MD, PhD:
I don’t even remember who taught it before I took it over but apparently, it was really and outdated, fairly old view of that whole area, so about that time, a new textbook was written on GI physiology, so I bought it as soon as I could get it. I went through the textbook and then what I tried to do is you know, there are certain basic things you have to teach, like how does the gut—how does motility work and how does swallowing work and how does digestion work, and what’s important for nutrition, so there’s some basic things that med students need to know. What I tried to do was carve out some interesting vignettes about where science really played an important role and how it really advanced the field. Then during my sort of basic facts that I was presenting, to try to infuse that, to get people excited about discovery and how it changed clinical medicine and things like that. I distinctly remember, you know there’s this oral rehydration solution that you have to use in Africa, because they don’t have IVs, and when they have cholera, if you don’t give this, the people get dehydrated and die, because they just have this unrelenting diarrhea. And so the composition of the oral hydration solution was made so that it would get absorbed maximally by the intestine, because there are certain transporters down there that work under certain conditions and not under others, and so just by pure trial and error, they came up with this solution, and so I use that for an example for the med students. You know what are the components in this solution and why do you think it alleviates the dehydration? And so they were able to learn all these transporter systems in the gut because of the process of trying to rehydrate cholera patients. So I think that really made them a lot more excited about the topic and instead of just talking about the transporter and how great it was and all that stuff. That’s an example, I think, of how we can make the material—and they never forget it because they know that people get cholera and they know there’s an oral rehydration solution, and the proper amount of electrolytes in there to make those transporters work.
Tacey A. Rosolowski, PhD:
Yeah. I mean that’s just good teaching, you know just several real world scenarios that kind of bring the theory, like how does it actually work on the ground.
Raymond DuBois, MD, PhD:
Right, right. And then here, we’ve had some major changes in the curriculum. If you look back in the history of—
Tacey A. Rosolowski, PhD:
Here meaning here in South Carolina?
Raymond DuBois, MD, PhD:
In USC, yeah. So in medical schools, the curricula was set around 1910 with the Flexner Report, and Abraham Flexner reviewed all the medical schools and said it had to be a certain way, where you taught embryology, anatomy, biochemistry and physiology, all of those courses were taught individually and by different groups, and then somehow the student was supposed to magically synthesize it all when they got more towards the clinical area, and make it relevant. So before I came even, they integrated the curriculum here, so they don’t have those separate entities. They’re infused within the curriculum so that whenever a disease process impacts a sort of biochemical or anatomical, that automatically comes into the equation. After I got here, we changed the curriculum and we made what we call a flexible curriculum. The flexible curriculum is that they go through this integrated year one, and then year two, they have some choices that they can take different tracks. There’s a sort of public health track, there’s a medical research track, there’s more of a family healthcare track, there’s a humanities track, and so we’ve really—you know it’s not easy to have all these offerings, because it was much more easy when you just had everything siloed in these individual blocks, but so far the students like it. It gives them a lot more opportunities than they had before, and then we’ve been able to create a curriculum where they can actually finish their MD in three years, be completely done, and then start their residency in that fourth year. We’ve had one student who has now gone through the whole thing and he went into orthopedics and he’s doing really well. You have to be very selective about which students can advance on that track, because it’s accelerated and not everybody is equipped to do that in such a short time.
Tacey A. Rosolowski, PhD:
Are you finding—well, this is a medical school scenario here at MUSC. Are you finding that there are individuals who want to go through to a PhD program, meaning they’re exposed to some of this basic sciences. Is that, that’s opening their minds?
Raymond DuBois, MD, PhD:
Yeah, so in addition to the other things, we already offered an MD/PhD program, and we’ve had a program going for twenty-five years and it’s been very successful. So now we’re offering MD/MPA, MD Masters of Clinical Science, we have an MD/JD, if somebody wants to get more involved in the legal aspects of it. We’ve teamed up with Clemson University, which is much like Texas A&M, it’s in the upper part of the state of South Carolina. They have strong engineering and physical science, and so we have a three plus four program where the student can do three years at Clemson and then start medical school during their fourth year, and then do the fourth year and Clemson gives them their undergraduate degree after that fourth year, or first year here, and then they get the MD degree if they go through it. Now they could do it in three plus three if they were really accelerated and get all of that done within six years.
Tacey A. Rosolowski, PhD:
What are some other things going on, kind of in healthcare and in education, that are making these combined degrees such an important option for students and professionals at this point?
Raymond DuBois, MD, PhD:
There’s a huge need now, in the way healthcare is evolving, to have physicians who are good at business and administration, and I think it’s going to hopefully be a savior for the academic health centers, because we do get so involved in teaching and research, that people aren’t generally that well trained in the business principles and finance, and mergers and acquisitions and all that stuff. So offering these combined degrees I think will provide people a lot of other options that people in the past never had, and also provide well trained personnel who can manage these complicated health systems and other things that we’re dealing with.
Tacey A. Rosolowski, PhD:
What’s your observation about academic medical centers in general? I mean, they’re under siege for all kinds of reasons. What are you seeing?
Raymond DuBois, MD, PhD:
It’s a general trend across the country. Academic centers aren’t as profitable as they have been in the past and I think even MD Anderson went through issues, even while I was there and after I left. I think they had some significant strains, and so that does put a lot of pressure on the physicians and on the system to perform. Part of it is the way we pay for healthcare, there is less ability to collect payment for things that we do. There’s a trend towards this new system that rewards value and outcomes and things like that, and I think that is the way to go. The problem is, we just have a schizophrenic political system that is --we’re stuck in this fee for service model where the more work you do, the more pay you do. One of the things that really amazed me when I joined MD Anderson was that somebody came up to me one day and said, “Dr. DuBois, do you realize we do 700 CT scans each day.” Because we have such a big clinical enterprise. And we’ve got to read them, and those reports have to be into the medical record by a certain time, and I just hadn’t really thought of anything on that scale, but we did get financial rewards for doing those, but somebody did a study and about 30 percent of them really weren’t needed to make healthcare decisions. So that’s an eye-opening thing. You want to provide good healthcare but you don’t want to do unnecessary tests and other things that cost the system or the patient. So there’s a fine balance between generating what the best clinical outcome for the patient is, and then generating this revenue by doing lots and lots of procedures and surgeries, endoscopies, and all the things that for some reason the health system rewards at a lot higher rate than just talking to someone about what’s going on and trying to help them sort of get through a disease process.
Tacey A. Rosolowski, PhD:
Well I’m sure we’ll come back to some of these issues again. Well, you want to—
Raymond DuBois, MD, PhD:
You want to go on with this story?
Tacey A. Rosolowski, PhD:
Well, yeah, I’m just—well no it was—yeah.
Recommended Citation
DuBois, Raymond N. Jr., MD, PhD and Rosolowski, Tacey A. PhD, "Chapter 05: Thoughts on Healthcare, Academic Medical Centers and the Medical University of South Carolina" (2018). Interview Chapters. 662.
https://openworks.mdanderson.org/mchv_interviewchapters/662
Conditions Governing Access
Open
