Former Chairman of Department of Osteopathic Medicine-UNTHSC
Former Tenured Professor-UNTHSC
Former UNT Health Board Member
Former Director of Physical Medicine Research Institute
Perhaps like many of you, I read with great interest and anticipation the letters recently written by Dr. Scott Ransom dated 9/14/09 and 9/25/09 (Official version of the MD school initiative timeline). Dr. Ransom distributed these letters via email to a wide audience of individuals invested both in the future of this campus and the provision of medical education in this community. Overall, I am struck with somewhat conflicting impressions. I am heartened by Dr. Ransom’s belated yet important effort toward truthfulness, however; I remain disappointed that Dr. Ransom does not directly acknowledge and accept responsibility for his deceptions which have so painfully divided our campus and community. The latter part of Dr. Ransom’s letter dated 9/25/09 is a refreshingly direct depiction of the current rationale for an MD school at the UNTHSC, however; the misunderstanding and prejudice expressed are frankly embarrassing and insulting to the both MDs and DOs alike. Our students, staff, faculty, community leaders and citizens deserve an honest and frank discussion of these issues. Unfortunately, the atmosphere at UNTHSC still seems to preclude an open and honest debate.
Regarding Dr. Ransom’s belated yet important effort toward truthfulness; in his third paragraph, Dr. Ransom states, “It took more than two years and many lengthy and involved discussions with key Fort Worth civic, business, and health care leaders to be convinced of the need to consider this new school.” In November 2008, Dr. Ransom told the TCOM Chairmen and the UNTHealth Board of Directors (and many others) that it had just been decided to initiate an investigation of whether to create an MD school on our campus. We were told that the decision to investigate this possibility was a direct consequence of ‘DOs in the community recently claiming that UNTHSC was becoming too allopathic.’ Dr. Ransom now formally admits what many have suspected all along - that this drive to create an MD school on our campus did not begin in response to DOs’ concerns in the Fall of 2009, but instead began at least 2 years earlier (Fall 2006) at the direction of powerful and connected members of our community. What has yet to be admitted, yet seems equally obvious, is that the UNT System Board of Directors, the UNT Chancellor, Dr. Ransom, and many community leaders decided to create an MD school on the UNTHSC campus. They then proceeded to orchestrate this change by removing the TCOM dean and initiating a hurry-up ‘survey’ and ‘study group’ to promote the appearance that this was not a predetermined course of action. Again, our students, staff, faculty, community leaders, and citizens deserve to be treated better than this. It is this deception (and others) which have so painfully divided our campus and community.
Having worked as a TCOM Clinical Chairman and UNTHealth Board Member during Dr. Ransom’s entire tenure as our President, I have seen this modus operandi enacted by Dr. Ransom repeatedly. He commonly decides what changes he desires, involves a wide constellation of individuals to provide ‘input’ and then proceeds to implement his predetermined course of action while describing the process of gaining input as transparency. Alternatively, he simply enacts important decisions without even the pretense of seeking input. These types of maneuvers were utilized in a variety of high impact actions including the selection of Kathleen Forbes, MD as the President of UNTHealth against the recommendation of the UNTHealth Board, the selection of Thomas Yorio, PhD as the UNTHSC Provost, the determination of the UNTHSC’s 5-year strategic plan metrics, the recent shift of substantial state salary return dollars to boost the UNTHealth FY09 bottom line, and now of course, the issue of whether to create an MD school on our campus. Although I greatly appreciate the hope inherent in his new honesty approach, I am understandably guarded and concerned that this is but a new strategy to achieve his goal of an MD school on this campus.
Regarding Dr. Ransom’s refreshingly direct depiction of the rationale for an MD school at the UNTHSC, I have taken the liberty to paraphrase some of the reasons listed in his letter dated 9/25/09.
1) Paragraph #5: ‘Local hospitals have provided the UNTHSC the right of first refusal to be their comprehensive partner to support the growth of graduate and undergraduate medical education programs.’ Should we decide not to create an MD school, the threat is that they will partner with a newly created, local, non-UNTHSC associated, MD school instead. We are told that TCOM is respected for its accomplishments, yet it is clear that local hospitals would rather wait for and then partner with a 3rd rate startup MD school than the top DO school in the nation.
2) Paragraphs #7 and #8: ‘Medical residents stay where residents train’ (#7). ‘The local hospital community wants the opportunity to train MDs’ (#8). It is true that medical residents stay where they train. However, it is irrelevant to the discussion. If Texas Health Resources (Harris Hospital etc) were to partner with UNTHSC-TCOM tomorrow and open hundreds of new federally funded residency training slots, the current MD physician staff at these hospitals could immediately open and lead ACGME approved primary care and specialty (and sub-specialty) residencies with TCOM as their academic partner. These residency programs would be open to both MD and DO graduate applicants from around the country (as are all ACGME residency programs). As these DO and MD physicians complete their residencies at these local hospitals, they will largely stay here in the metroplex which is what these hospitals and our community needs. These ACGME residency programs would also attract MD medical students from around the state who would use elective rotations to demonstrate their interest and competence to these local ACGME program directors in the hopes of securing coveted training slots. All of this can occur without the duplicative expense of creating another medical school on the UNTHSC campus.
3) Paragraph #9: ‘Some patients have a preference for an MD for tertiary and quarternary care such as transplant surgery, gene therapy, retinal surgery, neuro-radiology, etc.’ This statement speaks volumes about the misunderstanding and prejudice of our president (and others who support this argument) and is frankly embarrassing and insulting to the both MDs and DOs alike. Both MDs and DOs make competent primary care and specialty (and subspecialty) trained and board certified physicians. Yes, TCOM is proud of its ability to provide physician graduates who enter residencies (primary care vs. specialties) proportionally better aligned with the needs of our community than any other Texas medical school. However, to interpret from this that TCOM graduates are less competent or competitive for subspecialty training or success than MD graduates is simply false and prejudicial. MDs are more commonly associated with tertiary and quarternary care because of the tremendously superior numbers of MDs in practice and the historic bias against accepting DOs into these training programs. Given equal opportunity access to this training, we would see proportionally equal numbers of DOs as MDs competently practicing in these specialties and subspecialties in the future.
4) Paragraph #11: ‘The potential to grow research and related commercialization efforts would be improved with a Medical College.’ Aside from the semantic fact that TCOM is a ‘Medical College’, this statement (or a variation of the same) has been erroneously repeated publically ever since it was first announced in November 2008 that we would formally investigate the possibility of creating an MD degree on campus. Research growth and success are directly proportional to the resources invested. This is true at all MD and DO schools (as well as in private industry). The assertion that given the same resources that the faculty at an MD medical school will have greater research success than the faculty at a DO medical school again speaks volumes about the misunderstanding and prejudice of people who support this argument and is again embarrassing and insulting to the intelligence of both MDs and DOs alike. This is especially true when you consider that the current model for an MD school on this campus is to utilize predominantly the same clinical and basic science faculty that currently works at UNTHSC-TCOM as a cost saving strategy.
It is generally believed that even with maximal leveraging of current UNTHSC resources (space and personnel), that the startup costs of an MD school will be ~$50 million. Once started, the ongoing annual budget for the MD school will likely be ~$20-30 million. Over 10 years, this is a total cost of at least ~$250 million. Imagine, if you will, how much research growth and related commercialization could occur on campus at the already established UNTHSC-TCOM and associated Graduate School for an investment of $250 million. Or to consider this another way, $250 million dollars will establish and run the administration and educational programs of a new MD school on UNTHSC campus for 10 years. The desired research growth and commercialization will then require substantial investment capital on top of the $250 million. These are dollars that currently cannot be found to support and enhance our current research efforts.
5) Paragraphs #14, #15, and #19: ‘Community leaders have expressed their desire to make Fort Worth a medical destination city and an MD school appears to be a basic requirement’(#14). ‘Having a top MD-granting medical school in Fort Worth would strengthen our appeal to our local community leaders and funders’(#15). ‘The Fort Worth Community must show their monetary support for a new MD program’ (#19). Despite his mistakes, Dr. Ransom (as well as UNTHSC and our community) has been treated unfairly in one important regard. The individuals pulling the strings behind this push for an MD school at UNTHSC have remained anonymous. It now is clear that there are ‘community leaders’ who have a preference for an MD school and have enough money and influence that they usually get what they want. They are committed to change the course of this public institution using promises of large dollar funding contingent on the creation of an MD school on the UNTHSC campus. I personally support an individual’s right to spend their own money as they see fit even if it includes the secretive buying and selling of private companies. However, it seems inappropriate to me that this debate as to the future of this great public institution should be so heavily driven by the promise of hundreds of millions of dollars by anonymous wealthy individuals with a personal preference for MDs over DOs.
Finally, I would like to express my concern regarding the oppressive atmosphere on campus regarding this debate. Over the last three years, I have repeatedly attended a wide variety of rapidly conducted leadership meetings wherein Dr. Ransom would invite questions on a controversial topic and then move the agenda after a three second pause. He has improved somewhat over the last six months and now allows five seconds for someone to initiate a conversation regarding controversial issues. To be fair, if someone initiates a conversation in this brief pause, it will be allowed to be carried to its conclusion. My concern is that over the last couple months, I have attended a TCOM Chairs Meeting, a UNTHealth Board Meeting, Dr. Ransom’s monthly UNTHSC Institutional Leadership Meeting, and even a UNTHSC institution wide Faculty Meeting all where Dr. Ransom gave brief updates on the ‘MD medical school’ issue and then briefly invited questions. At none of these meetings was there a single issue or question raised. Many faculty friends have frankly told me in private that they feel that to speak negatively about this MD plan (or to be perceived as speaking negatively) is to be seen by administration as counterproductive and to be subsequently sidelined professionally. In parallel to concern over being considered unsupportive, there is a significant amount of learned helplessness among the students, faculty, chairmen, associate deans, deans, and vice-presidents at UNTHSC when it comes to attempting to influence Dr. Ransom’s decisions. If UNTHSC is to create another important school on campus, we need to get beyond our paralysis on this issue and once again embrace honest, open, and productive debate among our institutional leaders.
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