Letter to P&S Faculty

 

January 15, 2016

Dear P&S Faculty,

It has now been about three years since we published 2020 Vision, our strategic plan for Columbia University’s College of Physicians & Surgeons. In that document, we reinforced our vision of being indisputably in the top five schools of medicine and arguably the best by focusing on four key goals.

  1. Clinical care: Be the destination location for clinical care in partnership with NewYork-Presbyterian Hospital.
  2. Research: Be a research pioneer and innovation engine.
  3. Education: Be the leading research-based educational center.
  4. Campus and community life: Make CUMC and our local community a great place to work, study, visit, and get medical care.

We have made tremendous progress over the past three years. Our accomplishments are the direct result of the combined hard work of our faculty, staff, students, and partners. Many of our efforts are supported by generous donors who ensure that our faculty, staff, and students can continue to innovate and thrive. Without the support of these individuals and foundations, our impact could not be what it is today.

I would now like to share with you our progress toward each of these goals.

Clinical Care

Since patients are at the heart of everything we do, we must recruit and retain top clinicians whose eminence drives patient referrals. I am pleased to report that our full-time CUMC-based faculty has grown by a net of 6% per year during each of the past three years. Strategic recruitment is our number one priority at P&S. Since 2011, we have named five new clinical chairs:  George Cioffi, MD, of Ophthalmology; William Levine, MD, of Orthopedic Surgery; Lawrence Lustig, MD, of Otolaryngology/Head and Neck Surgery; James McKiernan, MD, of Urology; and Kevin Roth, MD, PhD, of Pathology & Cell Biology.

During these three years, we opened our new 51st Street clinical practice site and have grown that practice by 33% over the volume of patients seen in our final year at our former 16 East 60th Street location. In the past two fiscal years (2013 to 2015), both total visits and new visits to ColumbiaDoctors at all of our sites grew by 30%.

Working with NewYork-Presbyterian Hospital, we have greatly expanded our presence in Westchester County. Major new initiatives include the recent opening of the new 22,000-square-foot ColumbiaDoctors ambulatory site in Tarrytown. We are in the process of greatly increasing our faculty numbers at Lawrence Hospital in Bronxville, which recently has become part of the NewYork-Presbyterian family. We also have begun staffing parts of Hudson Valley Hospital in Cortlandt. Overall, our clinical practice sites in Westchester, Hudson, and Rockland counties include seven Northstar internal medicine practices in Westchester, five ColumbiaDoctors Medical Group practices in Westchester, two Rockland County locations for ColumbiaDoctors of the Hudson Valley, surgery and physical therapy practices in White Plains, and an obstetrics and gynecology practice in Scarsdale.

Just several examples of major new programs include the new Spine Hospital of NewYork-Presbyterian/ColumbiaDoctors, a major focus on precision oncology (including the use of humanized mouse avatars to test therapeutic options), and the first use of 3D printing to guide congenital heart surgery in newborns.

A number of new projects are also on the horizon. We are about to finalize a joint venture in radiology with NewYork-Presbyterian Hospital at our 51st Street practice site, with the expectation of a second radiology joint venture soon. We have committed to a 37,000-square-foot expansion of an ambulatory site in White Plains. Before the end of this academic year, we also hope to finalize a joint venture with NewYork-Presbyterian Hospital for an ambulatory surgery center and related clinical practices on the west side of Manhattan.

Even as we expand and grow beyond our 168th Street location, we remain committed to enhancing our local neighborhood. Major renovations have created new space for primary care, otolaryngology, and other services as the opportunities arise. In the past five years, NewYork-Presbyterian Hospital opened the new Alexandra & Steven Cohen Children’s Emergency Department and is in the process of totally refurbishing the adult emergency department. We also have expanded and opened practices on Columbia’s Morningside campus, giving more Columbia faculty, staff, and students access to our brand of care and prevention.

Our focus on quality is exemplified by our declining malpractice premiums. In 2016, the ColumbiaDoctors per-physician premium will drop by an average of 4.0%.

Research

The P&S research vision focuses on Precision Medicine, which now is not only a medical school priority but also an initiative adopted across Columbia University by President Lee Bollinger. With President Bollinger’s help, we received a $75 million pledge from Herbert and Florence Irving to create professorships, current-use funds, and enduring endowments for Precision Medicine at Columbia, which is led by Tom Maniatis, PhD, our Chair of Biochemistry and Molecular Biophysics. In partnership with President Bollinger and Dr. Steven Corwin (CEO of NewYork-Presbyterian), we recruited David Goldstein, PhD, to head the new university-wide Institute for Genomic Medicine, centered at P&S. Two other key leadership recruitments since 2011 include Dr. Stephen Emerson, who directs the Herbert Irving Comprehensive Cancer Center and led our a very successful renewal of the Center’s NIH grant, and Dr. Muredach Reilly, who joins us this year as the director-designate of the Irving Institute for Clinical and Translational Research.

Although it is not possible to summarize all the outstanding research performed by P&S faculty, this link will allow you to see publications in several of the most prestigious journals as well as video clips about research discoveries that have been in the press.

Overall, NIH grants to P&S increased by 24% in the past 6 years, during which time the NIH budget has been absolutely flat.  In just the past year, our NIH grants increased 11%, while the NIH budget went up by less than 2%. One of the major reasons is the remarkable 30% successful funding rate—far above the national average—for NIH applications by P&S faculty. As a result, the overall P&S NIH research budget (not including the New York State Psychiatric Institute or other schools at CUMC or Morningside) has been among the fastest growing nationwide, trailing only several schools that have opened major new research buildings in recent years. With the opening of the Jerome L. Greene Science Center and the Mortimer B. Zuckerman Mind Brain Behavior Institute on the Manhattanville campus as well as the new Medical and Graduate Education Building (see below), about 70,000 net assignable square feet of research space will become available at our 168th Street campus.  In preparation for that additional space, we are now literally “bursting at the seams” with 93 new tenure and tenure-track recruits recruited under the auspices of our 2020 Vision and growing programs. A number of these recruitments resulted from our participation in Columbia University’s diversity initiatives, with additional Dean’s office funds matching these University funds to recruit outstanding new senior and junior faculty.

As we grow our research portfolio, we have focused on several areas of emphasis: the Cardiovascular Research Initiative; Cancer and Precision Oncology; Stem Cell Research; Systems Biology and Big Data; the Columbia Translational Neuroscience Initiative; the Initiative on Immunity, Infection, and Inflammation; Metabolic Disorders; Health Practice Research, and the creation of an academic research organization. To achieve these goals, we will continue with our aggressive program of renovating space (over 500,000 net assignable square feet have been renovated on campus in the last 8 years), and we will use the newly available space as an opportunity to create clusters of scientists whose collaboration is fostered by proximity.

Education

The past several years have seen the graduation of the first cohorts of P&S students in the “new” curriculum with a shortened pre-clerkship period and a required scholarly project. With the help of three training grants led by Rudy Leibel, Qais Al-Awqati, and Richard Mayeux, students can begin their research during the summer after their first year.

We have worked within P&S and with other Columbia schools to increase dual degree opportunities. For example, we pioneered a 3-year MD program for students who already have a PhD and have enrolled three such cohorts of four students per year. In addition, we have a new combined degree program, MD/Master of Medical Science in Biomedical Sciences. Students enrolled in the combined degree program must complete 32 credits for the masters degree with some overlapping credits. The degree may be completed in four or five years at P&S.

These new programs join our outstanding MD/PhD program, in which more than 100 students are enrolled at any given time. Most students now complete this program in seven years and, after residency and fellowship training, go on to full-time faculty careers in leading academic medical centers around the world.

Students’ scholarly projects have run the gamut from basic medical research to clinical research, global health, population health, narrative medicine, and social and medical education. The Scholarly Projects Program has enabled students to present their work at regional and national scientific meetings, and more of their work now is appearing in the peer-reviewed literature. Because of this program, the number of students who feel they need to stay for a fifth year to do research has declined. Furthermore, our students’ results in the internship match have not only held steady but actually improved despite increased competition as the number of medical schools and the sizes of their classes have expanded much more rapidly than the number of available internship spots.

The caliber of our medical school class remains unmatched, with about a 4% acceptance rate and “yield” rate on accepted applicants that is consistently at the very upper end among peer medical schools. In addition, we have a remarkably diverse medical school class, including 24% underrepresented minorities in the entering class, one of the highest rates among our peers.

The Medical and Graduate Education Building will officially open this summer. The building will have a state-of-the-art simulation space and a marked increase in informal space for the small-group, team-based learning that is an increasing part of the curriculum. In joint programs across the four CUMC schools, we are promoting interdisciplinary collaboration and inter-professional education.

The cost of medical education remains daunting. During the past three years, our scholarship endowments have increased from $176M to $210M, thereby permitting us to increase scholarship aid from $8.9M in 2013 to $11M, an increase of 24% at a time when our tuition rose by 11%. These funds are essential to provide the assistance our medical students need and deserve.

Community Service

We look to partner with our elected officials and community leaders as we strive to improve the health and well-being of our immediate and extended neighborhood. Our faculty-led community clinics in collaboration with NewYork-Presbyterian see nearly 300,000 patient visits per year in nine different settings. Working with NewYork-Presbyterian and as part of the New York State Delivery System Reform Incentive Payment (DSRIP) Program, these hospital-based practices have coordinated multi-disciplinary care to reduce avoidable hospitalizations and emergency room visits among our highest risk patients. In 2015, Columbia, NewYork-Presbyterian and Weill Cornell established NewYork Quality Care, an accountable care organization to improve access to high-quality, coordinated care for Medicaid and Medicare beneficiaries.

We open our campus to the neighborhood and to people from throughout the city through a number of programs. Project Medical Education brings hundreds of local residents, community leaders, and the staff of elected officials to learn about the day-to-day activities of an academic medical center. Community Research Forums, which have invited our neighbors to learn more about some of our latest research in cancer, hypertension, oral health, Alzheimer’s disease, and other topics, also attract hundreds of neighborhood residents.

Each summer we join the College of Dental Medicine in hosting the six-week Summer Medical and Dental Education Program for 80 college students interested in becoming health professionals. For the past 14 years, the Summer Program for Under-Represented Students (SPURS), led by Dr. Andrew Marks, has provided a mentored research experience to more than 165 college students, many of whom have gone on to medical school or pursued advanced biomedical degrees. Each summer, we also provide jobs to more than 150 high school and college students through a city employment program.

Our medical students also spend impressive amounts of time and energy in service to the community. Examples include CoSMO (the Columbia Student Medical Outreach clinic for uninsured neighbors); Young Docs, in which medical students visit local schools to educate school children about medicine as a career; the Columbia Harlem Homeless Medical Partnership; and, more recently, a new clinic to help homeless LGBT youth in New York City.

Campus Life

Under the leadership of Vice Dean Anne Taylor, P&S has instituted several initiatives in faculty development, including programs for women and minority faculty. To show appreciation for all faculty and diminish the distinctions among faculty who are focused on different parts of the P&S mission, we created a new academic track “at CUMC,” and eliminated the “clinical” prefix and suffix from the titles of all full-time faculty members. These prefixes and suffixes are still used for voluntary faculty, and their use clearly distinguishes these faculty from full-time Columbia faculty.

The Kenneth A. Forde Diversity Alliance, led by Dr. Hilda Hutcherson, focuses on creating a multicultural diverse campus community of faculty, students, and staff. The Virginia Kneeland Frantz Society for Women Faculty serves, supports, and celebrates women faculty at CUMC and sponsors lectures and peer mentorship groups for women faculty.

To recognize outstanding teachers, the Virginia Apgar Academy of Medical Educators, led by Dr. Deborah Cabaniss, was created as a component of the four-school CUMC Glenda Garvey Teaching Academy. Annual elections recognize outstanding P&S teachers, whose membership also commits them to helping improve teaching across the entire medical school. We also expect to initiate a new Academy of Clinical Mentoring and Excellence, under the leadership of Dr. James McKiernan, before the end of this academic year. This academy will formally recognize outstanding clinicians and emphasize our commitment to clinical excellence across all of our departments.

We have continued our commitment to improving physical facilities at P&S and across CUMC. Our SWAT team specifically focuses on corridors, bathrooms, and hallways. Since 2013, our SWAT team has improved over 106,000 square feet of space.  A new streetscape project in collaboration with NewYork-Presbyterian will markedly improve the external environment along 168th Street. Working with NewYork-Presbyterian Hospital and the City, we have helped bring about substantial renovations to the 168th Street subway station.

The new Medical and Graduate Education Building, which will be a major addition to the campus, also includes green space that will open up to the Hudson River. We also have begun working with the neighborhood and City for a possible closure of one block of Haven Avenue (between 168th and 169th Streets) to vehicular traffic to create a pedestrian area—Haven Square—that, in partnership with NewYork-Presbyterian Hospital, will provide gathering space and a campus center—space that will be public and shared with the community.

We have renovated the Bard Hall gym, opened new 24-hour study space on the main floor of the library in the Hammer Building, and are looking at possible improvements in common space in both the Black Building and Bard Hall. The new Barnes and Noble bookstore and cafe has already become a destination for all members of our campus and community.

An important part of campus life is understanding the aspirations and addressing the needs of faculty, students, and staff. A recent faculty focus group project has reinforced that faculty are proud to be at P&S, and that is certainly one of the reasons why our faculty is growing at a net rate of about 6% per year. However, the project also identified a number of areas for improvement if we are to maximize faculty vitality—the energy, enthusiasm, and satisfaction our faculty get from working here. Key themes cited by faculty include: streamlined systems and processes; reduced administrative bottlenecks/burdens; further improvement of faculty mentoring and support; optimized communications; reinforcement of a culture of respect, recognition, and commitment; clarification of performance and promotion expectations; and development of processes to build communities and opportunities for faculty collaboration. In response to that focus group project, I expect to appoint five task forces before the end of the month. The five task forces will focus on: simplifying systems and processes; faculty development, collaboration, and recognition; communications and connectivity; the campus environment (facilities, work life, and benefits); and building a culture of collaboration and common mission. As this project on faculty issues progresses, we also will look at analogous ways to understand important issues for students and staff and to create ways both to reinforce our strengths and address any areas for improvement expeditiously.

Our goals at P&S are clear: to partner with NewYork-Presbyterian Hospital, our local community, our fellow CUMC schools, and all of Columbia University to be a great place to work, study, and get clinical care, in an environment that is committed to being outstanding today and to doing the research and training the leaders who will make the world better tomorrow. I thank each and every one of you for your commitment to these goals and look forward to working with you to achieve each and every one of them.

Sincerely yours,

Lee Goldman's Signature

 

Lee Goldman, MD

Dean of the Faculties of Health Sciences and Medicine

Chief Executive of Columbia University Medical Center