an era when many academic medical centers are faced with drastic choices
in the organization and management of their faculty practice plans,
the University of Miami is making a renewed effort to bolster its plan.
Last spring the School of Medicine recruited the new managing director
for its University of Miami Medical Group from a somewhat unlikely placethe
Georgetown University Medical Center, which merged its university-owned
hospital and clinical faculty with a regional hospital organization.
Minor Anderson shares his initial impressions of the University of Miamis
patient-care programs with Jerry Lewis, assistant vice president for
communication for the School of Medicine.
What kind of challenges do you face here that you might not have faced
at Georgetown or elsewhere?
Most definitely the multicultural aspects of the marketplace, which
are both a special opportunity and a special challenge for us. An additional
challenge that all academic medical centers face is that historically
our delivery of patient care really has been focused more on the physician
than on the patient. Economic conditions were such that we didnt
have to worry about the business of medicine, and we concentrated more
on teaching and research. That may not have been right, but it worked.
Now, we have to realign some of our priorities so we can compete in
the marketplace and deliver a level of service that is on a par with
our level of medical care.
How do you begin to do that? Obviously you cant turn things around
It is tough. First and foremost, we have to be sure that service is
a clear priority throughout our organization. Dean John Clarkson and
I have talked about various ways of doing that. Clearly it is high on
his priority list. Were painfully aware of our service problems.
The approach I intend to take is to start with the issue of access,
which is just a subset of the larger service issues. We are in an incredibly
luxurious position in that we have more patients than we can easily
accommodate. What we really need to do is to focus on the constraints
to accommodating those patientsthings like difficulty in getting
an appointment, confusing signage, run-down parking garages, billing
errorsall of which are part of the service continuum.
Aside from the physical changes to our environment and systems, youre
also talking about changing human behavior.
Youre absolutely right. Its about changing the culture of
our organization. You cant just flip a switch and say, Ive
changed it. It involves recruitment, training, and retention.
Is this a typical problem for urban academic medical centers? Is there
a good model that we can emulate?
Thats part of the challenge. There are 125 medical schools in
the United States. Perhaps 60 percent of them are academic medical centers.
Theres a popular saying that if youve seen one academic
medical center, youve seen one academic medical center. Each academic
medical center has its own idiosyncrasies and characteristics. We have
to design a system thats going to work for us given our patient
population, employee base, and physical layout.
You mentioned that we are in an enviable position of having more patients
than we can possibly see. Is that true?
Well thats the popular belief. Im testing that theory. I
want to see if that is really the case or if our systems are just so
problematic that the patients cant get in. It certainly looks
like were turning away patients. You can talk to virtually any
doctor in this medical center and theyll tell you the same thing.
They have three-month waiting lists because there are just that many
patients who need to be seen.
Have we been diligent enough in going into the community with our satellite
The simple answer is no. Academic medical centers have a mission of
service to the community, and our community has given us a lot of support.
Dr. Robert Schwartz, chairman of family medicine, and I have talked
quite a bit about this, and I think both of us would like to see a larger,
more robust primary care and multispecialty network throughout the community.
Its good business, its good service, and its good
mission to do that.
How do you define our community? What exactly is our market?
Unlike most metropolitan areas that are fairly circular, our market
is longitudinal. We have the ocean on one side, the Everglades on the
other side, and a strip of dense population that runs down the coast.
Certainly for any tertiary and complicated care we should be drawing
from as far south as Key West and well into Broward County, possibly
West Palm Beach. That may account for 10 percent of what we do. For
the other 90 percent of what we do, the rule of thumb that health planners
like to use is that patients will drive 20 minutes to see a primary
care physician and 30 minutes to see a specialist. We need good solid
market research to help us assess that.
What about the International Health Center? What are our opportunities
The sky really is the limit. The International Health Center has grown
nicely in the past couple of years. Because of our geography and our
diverse character, we are ideally situated to capture the Caribbean
Basin and Central and South America for many services. Miami is a second
home to many people who live in those regions.
What characteristics are you finding here that are similar to Georgetown?
Like Georgetown, our medical school is the largest single unit in the
University. The University of Miami also is a private university with
a modest endowment. And we have a large and aggressive research component.
But thats where the similarities end. Georgetown owned its teaching
hospital and got no public support at all. There was no state support,
because there was no state. The District of Columbia couldnt provide
either regulatory or financial supportan insurmountable problem
that Georgetown eventually had to confront.
What is one of the biggest misconceptions you have discovered here?
Its amazing to me that people tend to slam the medical centers
location. I think we have an outstanding location. Were right
on the Metrorail. Were right on Interstate 95, easy on and off.
Everybody coming in from the airport has to drive right by our front
door. We are not capitalizing on location.
What external factors make it more or less difficult to elevate our
clinical practice to where you want it to be?
Clearly, and these are not prioritized, our relationship with Jackson
Memorial Hospital, our teaching hospital, is crucial. We have to be
able to interface smoothly and efficiently with Jackson. Im also
meeting with all of the CEOs of the top managed care plans we do business
with. Those relationships are important in helping us understand how
they view us; Im not sure weve had solid relationships at
that level before. And Im getting to know our competition better,
so I have a better appreciation of what were up against in the
In terms of a private university with a medical school as large as ours,
what role should we play in the care of unfunded patients in our community?
Academic medical centers have been heavily oriented to indigent care.
The University of Miami is the rule when it comes to that, mostly because
of geography and because of our close relationship with Jackson. No
one would question that our physicians are the principal providers of
indigent care in this community, and I couldnt imagine that ever