Medical Transcript

Foresight is 20/20

T here are few things more important to us than our eyesight. Our eyes may well be our most vulnerable organs, protected from the elements only by occasional blinks and tears. Last summer the School of Medicine put our eyesight in good hands, recruiting one of the nation’s preeminent ophthalmologists to chair the Department of Ophthalmology and lead the venerable Bascom Palmer Eye Institute. Carmen A. Puliafito, M.D., M.B.A., has eagerly and aggressively taken the helm of the prestigious eye center and is confident he can take the perennially top-ranked institution to even higher levels of excellence. Dr. Puliafito discussed his move to the University of Miami and articulated his vision for Bascom Palmer Eye Institute in a recent discussion with Jerry Lewis, assistant vice president for communication at the School of Medicine.

JL Miami is very different from Boston. Why did you decide to come here?
CP It is indeed very different. The main difference that strikes you immediately is that in Massachusetts everything is old. Very old. Here, everything is new. Very new.
     I took the job here for one reason: I think Bascom Palmer is the best department of ophthalmology in the world. The faculty here has contributed more to the field of ophthalmology than anyone else, period, and the facilities and financial resources are tremendous. The bottom line is that Bascom Palmer is a big and very complicated place to run, and anyone would have to be practically insane to take on the challenge. I figured I was qualified!

JL Now that you’re here, what are your first impressions of Bascom Palmer?
CP One of the first things that struck me is that it is a huge institution with really interesting patients. That’s a challenge and an opportunity. There are definitely some rough spots, and the place has had a little bit of a jangling kind of personality. One of the biggest challenges I face is that, for so many years, Bascom Palmer was run like a family business, and I need to help advance it to the next level.
     What impresses me most is that the critical resources at Bascom Palmer are tremendous. You need three things for battle or for business: leadership, commitment, and firepower. We certainly have the commitment from our faculty, the staff, and the dean; that’s without question. And Bascom Palmer most definitely has the firepower; our endowment is fairly rich. But we need leadership, and I intend to provide that.

JL What makes Bascom Palmer special?
CP Bascom Palmer is one of the top eye centers in the world—without question. For instance, we have eight of the world’s best glaucoma clinicians, which makes us extremely strong on the clinical side. But I’m also interested in promoting and developing more eye research. In terms of research, we need to rebuild. Our basic research faculty must complement our stellar clinical faculty. It’s a logical complement.
     At Bascom Palmer we have the best of all worlds when it comes to patients. We have great balance, a good mix. We have a large and loyal private patient base, and we see a significant number of unfunded patients. We also are blessed with a large international clientele. About 15 percent of our patient base is international. That’s phenomenal.
     We serve all of our patients very well. In Miami-Dade County there’s absolutely no reason for anyone to suffer from untreated eye disease or blindness. No reason whatsoever.

JL You had a long and successful tenure at the New England Eye Center. How did that evolve?
CP I had been at Harvard my entire career—Harvard College, Harvard Medical School. But a handful of us went down the street, literally, and found we could do something more. We created the New England Eye Center, and I discovered I could do something very different that I enjoyed immensely. I had ten wonderful years there that will never be replicated.

JL And Bascom Palmer seemed like a natural follow-up to that?
CP Bascom Palmer was created in much the same spirit as the New England Eye Center. But there is no story like Bascom Palmer’s in all of the history of ophthalmology. This place is legendary. This was my destiny.

JL Why did you choose ophthalmology as a profession?
CP I really like ophthalmology. As a matter of fact, I thoroughly enjoy it. It’s a great subspecialty. I like the patient care aspects as well as the research components. Besides, ophthalmologists are really smart people, and I like hanging out with them.

JL In my first meeting with you, you warned me that you could be my worst nightmare—someone with an M.D. and an M.B.A. Why did you go for an M.B.A.?
CP In the mid-1990s I watched some very ugly things happen at hospitals in Boston, all kinds of cost-cutting and reimbursement issues. I remember thinking that there must be a smarter way to do this, a smarter way to run these businesses. And make no mistake, health care is a huge business. So I decided to enroll in the executive M.B.A. program at Wharton, commuting between Boston and Philadelphia on weekends. Wharton is a very New York finance-oriented business school, but it also has a long-standing health management program. And although I was in the general M.B.A. program, the faculty there liked for doctors to get a strong dose of management.

JL How have you found the M.B.A. helpful?
CP In my current job, that training is invaluable to understand the complex relationships that exist on every level—from general accounting to strategic planning. The M.B.A. gives you a toolbox of stuff that you can use. You simply choose the right tool for the right job.

JL What trends are emerging in ophthalmology? What does the immediate future hold for your profession?
CP There are two things that patients fear most. One is cancer; the other is blindness. Eye diseases are going to be pervasive in the 21st century because they’re chronic diseases of older people. There will be a doubling of the population over the age of 65 in the next 30 years. All the doctors being trained today are going to be looking at a world in which very common eye diseases are even more prevalent than they are now—diseases like macular degeneration and glaucoma. For instance, we have one faculty member who is in the process of writing an NIH grant to look at the epidemiology of the prevalence of age-related eye diseases, with Miami-Dade County as our laboratory. The payoff will be a huge yield in terms of improved quality of life for our older citizens.

JL It’s sometimes hard to show measurable strides at an institution that is already established and has a good reputation. How will you make a noticeable difference at Bascom Palmer?
CP I think one area, for sure, will be that I intend to focus heavily on the public health aspects of eye disease. We’re going to outreach aggressively from this organization, on a lot of different levels. And public health research will be high on the agenda. We will study eye diseases in our general population as well as in the Hispanic and African-American populations. There are a lot of interesting things that can be done here.
     Access also is something I think I can improve. Because we are the only academic medical center for five million people, we have the challenge of making it possible for five million people to access us. We must improve access for patients so we maintain our value to them.
     And finally, we absolutely must focus more on patient satisfaction at Bascom Palmer and at Anne Bates Leach Eye Hospital. We definitely need to give a facelift to our customer service programs, focusing not on what’s best for doctors and employees, but what’s best for our patients.

Photography by Donna Victor
University of Miami Medicine Online
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