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Minnesota Academy of Medicine

University of Minnesota
Robert H. Bruininks, President
May 4, 2004

Introduction

Thank you for your invitation, Dr. (Stanley) Goldberg...we made these arrangements many months ago, and I'm glad, because it means it was much less likely that you, unlike other groups I've been speaking in front of, would call and ask that Lindsay Whalen take my place!

Great to be here...thanks to Stan and Luella Goldberg for their years of commitment to the U. I've appreciate their advice and their generosity since I was appointed. (As outgoing President of the Academy) Stan has an advantage over me as I end the second year since being appointed as interim president; I'm reminded of Dartmouth's Pres. Kemeny, who remarked that the University presidency was an odd position where you are elected first and spend the rest of your remaining years running for office!

I appreciate the chance to talk about the U of M as a statewide resource, as Minnesota's only research university, and its major educator of medical professionals; I will also address the special challenges facing us in keeping the U excellent and strong for future generations.

The U of M—a statewide asset, a wise investment

I'd like to start out with this premise: that development of human capital is what has given Minnesota the edge over the past half century, what has provided its high level per capita income and its high quality of life as measured by many other indicators. Federal Reserve Economist Art Rolnick has pointed out that Minnesota was a state that lagged behind during the first half of the twentieth century, and that the state's economic growth and its quality of life indicators only began to improve from 1958 on.  What changed, he argued, was a new willingness to invest in human capital, to pay attention to education at all levels.

I believe that Minnesota's higher education system and the way our state chooses to invest in higher education will continue to be key to our economic and social future.

The University of Minnesota is an important asset for the entire state; it's Minnesota's only comprehensive research university. It creates new knowledge as well as educates and makes community connections—from economics to engineering to medicine to environmental science.  Getting the value of a research university across to the public is often a challenge, but if there's one thing that the people of Minnesota understand clearly is that research leads to new treatments and new cures—that's true for both the University and Mayo, which are supported by significant research funding each year. And Minnesotans know that those new innovations move quickly into the best practices of the doctors and other health professionals who treat them.

A research university is also a magnet for talent, attracting people who not only attend and work there, but also people who move to the area for the quality of life it helps create. That's especially true in the area OF medicine and health care—people will not move to places that lack strong health care providers and facilities.

In a global economy, then, the quality of the University of Minnesota is critical to our regional quality of life.  Sometimes we forget what an asset the University is; Minnesota is the smallest and coldest state to support a public research university of this quality.

And what are some of the indicators of the University's quality, its excellence? Over the past four years the University has consistently ranked amongst the top three public research universities in a study conducted by the University of Florida. In a recent survey of more than 500 research universities worldwide, the University ranked 35^th.

The University brings into Minnesota more than $500 million in research funding annually—that's more than 95 percent of such research funds that come to MN colleges and universities. (That 95% does not include our colleagues at the Mayo Clinic, who are in a different category of research institution.) At the University, half of research funding is awarded to the Medical School and the School of Public Health.

And what does the public of Minnesota gain by the University's work? By one recent study, the state gained nearly $10 billion in economic activity for its roughly $500 million investment. That's a 16-to-1 return on investment; I think you would be hard pressed to find a better investment for the state of Minnesota (Zhang study, 2003).

The state also benefits from the knowledge created at the University of Minnesota. We are usually within the top 20 of all research universities in the country for indicators of technology transfer, including royalties, patents, start-ups, and licenses (American Assn. of University Technology Managers). That knowledge plays out everything from the pacemaker to the very popular Honeycrisp apple, which we have now licensed to apple growers in New Zealand, to a start up business like Sistina Software, which was developed by Prof. Matt O'Keefe in our Institute of Technology to help astronomers store and manage huge data sets and which now helps large hospitals and health care systems deal with large volumes of information.

AHC Update:

I'd like to make a few moments to talk about the Academic Health Center (AHC) at the University of Minnesota. I know that status of our partnership with Fairview Health System is of interest to those of you here tonight. I'm pleased to report that this relationship is working well:

As was intended, the partnership supports investment in the Medical School, which funds education and research at University of Minnesota.

Joint planning for facilities and clinical service lines is working. We are in the midst of a joint planning to revitalize the clinical campus and developing a long-term plan for health sciences. Ex.: when Fairview is deciding how to meet oncology needs, they speak with University of Minnesota Physicians about its needs, and work with the cancer center

Of course, any partnership like this is not without its challenges, whether those arise over culture or directions. But overall, Fairview-University relationship is a very good example of how an important part of the University of Minnesota has teamed up with another organization to align their resources in order to reach common goals.

Medical School: moving ahead, restoring national position

Recall that in the early 1990s, the University's AHC faced the same problems other AHCs did—medical education funding generated by faculty's clinical practices was squeezed by managed care and changes in federal funding.

With help from a willing faculty, a new hospital agreement, funding from the state's tobacco settlement (funds now converted to tobacco taxes), improved institutional accountability systems, substantial new capital investments and the leadership of people like Nils Hasselmo, Mark Yudof, Frank Cerra, Al Michaels and his successor, Deborah Powell, we have made real strides.

Today our faculty are not only amazingly productive, but they are working in cutting edge areas worthy of Minnesota's tradition of pioneering medical knowledge, procedures, treatments and devices; e.g. transplantation, diabetes, stem cell research and applications, non-invasive surgery, food safety, and biomedical devices to name just a few.

Strategy for Excellence

Our strategy for excellence at the AHC reflects our overall strategy for excellence at the University. It includes strong departments, new interdisciplinary/inter-professional work; an emphasis on efficient operations and best practices; an improved student experience; and strengthened community partnerships

Know I don't have to tell folks here: a research university relies on its excellence—top scholars who win grants, expose students and other trainees to cutting edge of medical science.

Keeping strong departments includes revitalization of our clinical departments. We hope to continue to build on our strengths in areas such as oncology, cardiovascular disease and organ transplantation.

As part of a broader swathe of interdisciplinary priorities, we are building on our breadth—our comparative advantage, which is serving us well today. I have articulated eight broad initiatives, several of which have implications for strengthening the AHC and its connection to the broader University:

The first is Translational Research in Human Health, where the planned Translational Research Facility made possible by a major gift from the McGuire Foundation, will provide scientist with environment/space that provides missing link between basic and clinical research, which has come to be called translational research.

Frank Cerra and Dean Powell are also working to reinvigorate clinical research at the U, making the mentoring and training of prospective clinical researchers a priority within the AHC.

The Minnesota Partnership for Biotechnology and Medical Genomics will bring together Mayo and University researchers. The goal is to collaborate and build on each other's strengths in order to create innovations that promote human health, with particular focus on prevention, detection and treatment of cancer and heart disease. I am pleased to add that this partnership has worked far better than I had initially hoped it would.

Another initiative is Brain Development and Vitality over the Lifespan. University faculty involved with this area will look at aging as well as childhood development. This initiative combines strengths in neurology, Magnetic Resonance (the University has one of the premiere magnetic resonance labs in the country) and other imaging fields that rely on cutting edge digital technology, educational psychology, and other learning sciences. This new knowledge has the potential to help us understand when infants and children are ready to learn and how best to teach them; understand the decrements and declines that accompany aging; and find treatments/practices to diminish the ravages of Alzheimer's and other age-related disorders of the brain.

We are now developing a proposal for a Center for Lifespan (Cognitive) Neuroscience modeled after successful Cancer Center.

Our Healthy Foods and Healthy Lives initiative stems from the recognition that we are one the few US campuses with one of four US campuses with a major AHC and agricultural programs. We are also in a state where nearly 10 percent of the economy is related to agriculture and food production and where we have more than 400 food production companies. To build on these internal and external comparative advantages and to figure our how to proceed, we sat down some of our top scholars in fields from agriculture, food science, nutrition, public health and medicine and looked at where the U could advance knowledge.

Our breadth and the strength of our individual programs recently allowed the University to secure a $15 million, three-year grant from the U.S. Department of Homeland Security to develop ways to protect the nation's food supply from deliberate contamination or terrorist attack. The Center for Post-Harvest Food Protection and Defense (PHFPD) is a national consortium of more than 90 investigators from academic, private sector and government partners, including three other universities (MSU, NDSU, and UWŒMadison).

We've also made some impressive recent hires—Mike Osterholm as head of the Ctr. For Infectious Disease Research and Policy (CIDRAP) and Will Hueston, the worldwide expert on Mad Cow Disease (BSE), who is at our Center for Animal Health and Food Center.

We've received two of the largest USDA grants ever for investigating infectious diseases in animals. I don't think I need to remind this knowledgeable audience about the relationship of emerging disease in animals and those in humans; an estimated 10 out of the last 11 emerging infectious disease in humans first developed in animals.

Under the Healthy Foods, Healthy Lives initiative, efforts are underway to emphasize prevention of diet-related chronic diseases and obesity through diet, exercise and human behavior—think of potential savings and improvement in quality of life if we could cut into a small part of preventable illnesses!

In a related field, our initiative on Children, Youth and Families has led to the establishment of a Center for Excellence in Children's Mental Health, among many other important actions.

We are also continuing to invest in the Consortium on Law and Values in Health, Environment & the Life Sciences. I believe that a public research university is the place for careful examination, discussion and debate over the many new dilemmas and issues posed by medical innovations. Witness: the careful review, discussion and consideration and consultation we conducted before we made our recent decision to go ahead with (privately-funded) research on stem cells from five- or six-day old blastocysts; the fact that we are one of only nine institutions worldwide to be accredited by the Association for the Accreditation of Human Research Protection Programs (AAHRPP); and that we are engaging the public on bioethics issues through art and interdisciplinary work through a current art exhibit at the Weisman called Genesis: contemporary art explores human genomics.

Other interdisciplinary initiatives include the Environment and Renewable Energy; Arts and Humanities; and Biosciences/Biocatalysis (including nanotechnology).

Student Services/Learning

Across the University, we have made a priority of improving the student experience and continue to work to ensure affordability for them. We have revitalized our undergraduate experience, creating a new sense of community by having more of our undergraduates housed on-campus. We have improved services by putting many of them online, allowing student to register for classes from anywhere in the world and allowing advisors and advisees more convenient communication. We are doing what we can to help "trickle up" many of these improvements to graduate and professional students.

At the AHC we are working on:

• Developing inter-professional education and training opportunities. Traditionally, physicians trained with other physicians; now moving to train in teams with other health care professionals, inc. nurses and pharmacists. Better mirrors the world doctors will be working in, and ultimately better serves patients.
• Career development and counseling.
• Revitalized classroom environments including a medical learning simulation center where students can practice on realistic "simulated person"; and a skills development center, where students work with "fake" patients, are videotaped and then can work on their communication/ diagnostic skills.

Efficiencies and best practices

It has long been my view that the University must do its part to solve financial challenges through improved service and productivity. At the AHC, we are implementing evidenced based practice, best practices, and competencies; and improving information systems, including electronic medical records.

Continued partnership with MN's communities and organizations:

We are also continuing to engage public and community needs throughout the state.

Through the Itasca Group, we are looking at long-term issues related to metro area development. Recently the University joined the MN Business Partnership, and I think that's evidence of our commitment to cooperation with industry.

The University's AHC is moving ahead to meet provider shortages in MN communities by:

• Expanding class sizes in nursing, pharmacy, public health, veterinary medicine and dentistry with some expansion in medicine.
• Developing/testing new models of care delivery that are team based.
• Taking advantage of competencies of clinical pharmacy and nursing.
• Building partnerships for interprofessional experiential and service education.
• Creating Area Health Education Centers
• We live in a world of limited resources. Minnesota is a relatively small state (population), we have "interesting weather"; that means we must partner to leverage what we have!

Challenges:

The University faces financial challenges as a result of the unprecedented two-year, $185 million cut we took from the state in 2003. The paradox is that the University today has never been stronger, but we are facing a long-term trend of eroded state support, both in terms of percentage of the state budget and percentage of personal income, and where he cost of education is increasingly being paid by students. (In the past year, many of my colleagues have seen me walking down the hall grumbling Woody Allen's adage, " Money is better than poverty—if only for financial reasons!")

We took those cuts responsibly with the university's long-term health in mind; we shared the pain across students (increased tuition), employees (wage freeze, increased health care costs) and program cuts and reorganizations, including changes to the organization of the University Extension Service.

Today we face a particular problem related to medical education, where clinical revenues can no longer subsidize medical education in the way they used to do.

We have a capital budget request before the Legislature today, one that is largely devoted to major renovation and maintenance projects focused on "taking care of what we have." Within those improvements are renovations for our AHC classrooms. (I was recently in Mayo Auditorium at the AHC and I have to say that it is one of the most decrepit facilities in the English-speaking world!)

You have undoubtedly heard in the news that we are seeking a chance to build an on-campus football stadium on our Twin Cities campus (a project that is not part of request).  Under our legislative proposal, we would raise some 60 percent of the total cost of a stadium and needed infrastructure upgrades, and the state would contribute the rest once we raised that amount. We believe that a new stadium would provide a lasting asset for students (who have voted to support funding part of the project), alumni and other fans that would continue to build a sense of community amongst our many diverse constituencies. It would be a place where the entire campus could come together for commencement activities, where the marching band could have a permanent home and where other student activities such ass soccer could take place. I would add, however, that our academic priorities are paramount and that we will not compromise them in order to create a stadium.

Hope you can help with the University's legislative priorities. More information is at www.supporttheu.umn.edu .

Access and Affordability—Global economy

In the context of a global economy, I remain concerned about our state and our nation's commitment to education and the human capital needed to compete.

According to the National Center for Public Policy and Higher Education, more than 250,000 US students were shutout of higher education in the fall of 2003 because of rising tuition or cutbacks in admissions or course offerings. We have an unenviable position in medical education at the University; today we have no elasticity left in Medical School tuition; we don't believe we can charge higher rates without causing serious problems for our students. And by the way, I believe it is unconscionable that medical students are leaving school with hundreds of thousands of dollars of debt.

Financial aid for students at all levels has simply not kept up. The value of the average Pell grant is about half of what it was in the mid-1980s (Pell Value has gone from 98 percent of tuition in 1986 to 57 percent of tuition today at 4 yr. Public institution, according to National Center for Public Policy and Higher Education, 2002).  Our policymakers need to pay new attention to this problem.

Our Objective at the University is to keep moving forward, even in a time of financial difficulties, to continue to compete for top faculty & students and keep the U affordable (scholarships and fellowships are a top fundraising priority for us). We will continue to make difficult decisions in order to keep investing in excellence and new interdisciplinary opportunities; to keep investing in students; and to find new sources of productivity.

In the end, investment in higher education is essential in a global economy. The University creates ideas, advances them for the public good and transforms lives! Strong investment in the U's future must remain a top public matter in order to maintain and grow Minnesota's economy and quality of life.

I hope we can enlist your help in supporting the University. Thank you.

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