Don DiPette, Dean of the USC School of Medicine

January 7, 2009

MidlandsBiz:
Outline a brief history of the medical school.

Don DiPette:
At approximately thirty years old, we are one of the new kids on the block when it comes to medical schools.  We were founded under the Teague-Cranston Act, a federal congressional legislative initiative that created five new medical schools based in association with a VA hospital and designed to enhance the health care of local citizens.  Other Teague-Cranston Schools are Texas A&M, Marshall University, East Tennessee State, and Wright State. 

MidlandsBiz:
Do you still have a direct relationship with the VA Hospital?

Don DiPette:
Absolutely.  That was not only our birth, but it is also our continuum.  We are proud to be directly improving the care of our patients not only at the Palmetto Health Richland campus, but also of our veterans.  We have about 1/3 of our medical students and 1/3 of our residents at the VA.  Recently, we announced a joint VA/ USC School of Medicine initiative in cardiology and have been very fortunate to have recruited a major national cardiologist, Augustine Agocha, MD, who will be hiring additional faculty in what we hope will be a resurgent area for our medical school. 

We continue to explore common missions and programs with the VA and I see this relationship only strengthening in the future.

MidlandsBiz:
What is your vision for the medical school?

Don DiPette:
When I arrived, my role was to act as a catalyst to accelerate a strategic planning process that had already begun to identify our internal strengths by analyzing the quality of our research areas and programs.  Recognizing that we can’t be everything to everyone, our vision is to build on these strengths by recruiting outstanding new researchers in the following critical areas: immunology, cancer biology, neurosciences, cardiovascular development, and geriatrics. That has been our main focus over the past 18 months.

MidlandsBiz:
How many medical schools are there in the state?

Don DiPette:
The only two medical schools in the state of South Carolina are USC and the Medical University of South Carolina (MUSC). 

MidlandsBiz:
How does the medical school at USC compare with MUSC?

Don DiPette:
Our sister institution, MUSC, in Charleston is much older and, because it owns its own hospital and clinic systems, is more vertically integrated. MUSC also has a much larger research and clinical enterprise and because they have well over 100 years in operation, a much deeper pool of alumni. 

The great thing about the two institutions is that we are extraordinarily complementary. The level of communication between the two schools, from the Deans, to the Provosts and right up to the university Presidents, is catching national attention.

MidlandsBiz:
How is the medical school linked with the local push to build up the knowledge economy?

Don DiPette:
We are the poster child of the knowledge economy.  When you factor in four years of undergraduate school, four years in medical school, and residency training for anywhere from 3 to 7 years, there is no higher level of knowledge than that which is necessary to become a physician.

By virtue of their size, their breadth, and their clinical connectivity, the medical schools are major drivers of the research intensity in a region, and the Dean of the medical school has a key role to play in the strategic planning and implementation of that research enterprise.  The medical school is such a large component of the research portfolio of any institution of higher learning, it is natural that it takes on a key role in choosing the endowed chairs that are brought to the university.

Medical schools are an economic engine and a magnet for jobs in the communities that they serve.  For every dollar invested in a medical school, you can return as much as an additional $8 in economic activity.  It’s not a secret that the medical school should be a pillar of the economic development strategy of a region. 

MidlandsBiz:
How do you measure the success of your faculty’s research?

Don DiPette:
Research funding can be obtained through channels such as industry, philanthropy and foundations, but the major source for peer-reviewed, bio-medical research in this country is the National Institute of Health (NIH).  This federal government agency funds only the highest level of science. 

As a small medical school with around 50-60 dedicated research faculty, our total level of NIH funding is relatively small compared to larger and more established medical schools.  But the level of our NIH funding per faculty positions us in the upper echelons of medical schools in the country.   Our faculty is productive and the level of research we are conducting here is outstanding. 

MidlandsBiz:
What is the USC medical school known for?  What can you be one of the best in the world at?

Don DiPette:
Whether it’s general internal medicine, pediatrics, OB-GYN or family medicine, our primary care program is second to none in the country.

We are also known for a world-class, first of its kind curriculum in ultrasound technology. People are probably familiar with how an OB-GYN uses ultrasound to show babies in the womb, but it has many other applications such as evaluating other organs and structures such as the heart, thyroid, major blood vessels, and joints.  This is a technology that is poised to explode. 

As identified in our planning process, we have a world-class reputation in immunology where we have one of the few, highly competitive NIH centers in complementary and alternative medicine led by Drs. Prakash and Mitzi Nagarkatti. 

As a relatively new school, it is no coincidence that we have put most, if not all, of our resources into education.  Based on the feedback we receive from residencies, the medical student here is second to none in terms of the education that they receive. The original faculty that took a risk to come here and start a new medical school has done an outstanding job educating our students.

MidlandsBiz:
There is much talk about how the three research universities in the state are working together on key initiatives.  Can you elaborate on this trend?   

Don DiPette:
There is another statewide entity called the Health Sciences South Carolina (HSSC) of which USC, MUSC and Clemson are the founding three research intensive universities. 

One exciting new endowed chair program that has come out of the HSSC initiative is Senior SMART ®.  A joint effort between USC’s school of medicine,  school of social work, as well as the engineering department , this is a program designed to come up with innovative and practical solutions for improving the livelihood of our aging population.  It is also a cross-university, team-based program that is captained by one of our faculty members here at USC, Paul Eleazer, MD. 

The first part of the program is centered on cognition or brain function and is called SMART Brain ®. This comprises not only Alzheimer’s, but also stroke and the dementias. 

Our second major component, called the SMART Car ®, comes from the desire by so many of our seniors to remain functional and independent in society.  Investigators from HSSC institutions are designing cars that are more interactive and that have built in components for response time, and visual aids such as cameras. 

The third component is another important pillar of our independence: the SMART Home
®.  Staying in your home as opposed to moving into assisted living or a nursing home is critical to an aging person’s well being and mental health.  We are partnering with Palmetto Health here in Columbia as well as colleagues in Germany and elsewhere to design the SMART Home ® with sophisticated technology to automatically alert emergency care providers when falls occur as well as other technologic innovations.

MidlandsBiz:
How are each of the research universities involved with this program?

Don DiPette:
Clemson and the Greenville Health System University Medical Center (GHS), is taking the lead on the SMART Car ®; we are taking the lead on the SMART Brain ®, and the SMART Home ®.

MidlandsBiz:
What are the main challenges facing the medical school?

Don DiPette:
As we are a small school in a small state, I expected the main challenge at this medical school to be a lack of national name recognition that would prevent us from attracting top talent.  That has simply not been the case.  When people see what is going on here in town with the Innovista and learn how the institutions of higher learning are working together, they want to come to South Carolina. 

The biggest challenge has been the economic downturn.  Obviously, it is unforeseen, but all state agencies are taking significant reductions in state funding.  It’s nice to have ideas, but a vision without resources is a hallucination.  All the partnerships and collaboration in the world won’t add up to much if we don’t have the resources to execute. 

We are trying to mitigate the financial impact in whatever ways possible, but it could affect the upward trajectory of our research growth.  It’s a perfect storm in many ways.  Another area of funding that we have been able to tap into is philanthropy, but as stock values have declined, we are seeing a tightening of capital from this source, too.

MidlandsBiz:
How has curriculum evolved over the past decade in the teaching of medicine?

Don DiPette:
Research and clinical care are also important, but our number one priority is always medical education.  The embodiment of that education is the curriculum. 

If you go back just 10 years, in most medical schools the curriculum was delivered in a very traditional, lecture-based style.  Students congregated in auditoriums and the information flow was one-way – from the lecturer to the lecturee.  While that might be an efficient way to pass on information, it’s also not much fun for either the students or the professors.  The retention rate of knowledge also comes into question through this delivery style.   

We have seen a dramatic change to small group education and a more varied and interactive curriculum.  We have implemented a program that is called problem-based learning (PBL) that involves a more hands-on learning platforms with either real or simulated patients.

MidlandsBiz:
How has technology affected the delivery of curriculum and the medical profession in general?

Don DiPette:
It’s been extraordinary.  When I went to medical school we did not even have computers.  It has impacted us in ways that people will be very familiar with at this point: laptops in the classroom, delivery of materials and content by the professors over the Internet as well as rapid attainment and dissemination of information. 

When you think of DNA analysis and gene screening, technology has advanced our research capabilities immensely.  When you think of how CAT Scans, MRI, endoscopic surgery, molecular biology, and biologics have revolutionized clinical care, it gives me tremendous hope for the future.  When you think of how we can operate on a patient a thousand miles away through robotic surgery, it’s unlimited now what we can do.
 
One of the biggest ways that we have been impacted by technology in the classroom through our use of simulation centers.  We have sophisticated very expensive mannequins that simulate all types of clinical procedures from cardiac arrest, to resuscitation, to surgery and even birth.

MidlandsBiz:
Do you have concerns about the state of the national medical delivery system, or is that simply beyond the scope of the role of the Dean?

Don DiPette:
Access to care, affordability of care, geographic disparities of care, overuse of care, comprehensiveness of care – there are so many major issues facing our healthcare delivery system.  

As the CEOs, so to speak, of the institutions tasked with creating the future physician workforce, who better than the Deans to be at least part of the team discussing the future of our national care situation?  It is simply a major part of our responsibility.

MidlandsBiz:
What is the opinion of the Deans?  Is there any consensus?

Don DiPette:
Getting a group of physicians to agree on any one topic is like herding cats, but if you got us all in one room, you would probably find a uniform opinion supporting universal healthcare.  Where we might differ is on how best to deliver universal healthcare: single payer, national health system, industry based, private sector based, etc.

MidlandsBiz:
What is the number one issue facing the medical profession?

Don DiPette:
There has been some national press about the shortage of nurses and other healthcare providers, but what people are less aware of is the critical shortage that we will face in the number of physicians.  An increasing gap is being created between the demand for physician services and the supply.  A shortage of 125,000 physicians in this country in ten years is predicted.  As we will be attracting a relatively higher share of retirees to this state, South Carolina is in the bull’s eye when it comes to this problem.  If we have a physician shortage today, it’s a crisis because it takes about 9-17 years to produce a practicing physician. 

Consider primary care.  So many physicians have chosen to specialize that we will face a severe shortage of primary care doctors.  I don’t blame the physicians. Faced with significant student loans upon graduation from medical school, physicians could gravitate to the more lucrative procedural subspecialties such as radiology, orthopaedics, cardiology, and anesthesia.

All the healthcare professions are facing a shortage because many factors—one of which is our aging population. 

MidlandsBiz:
How much does it cost a year to go to medical school?

Don DiPette:
Our tuition is around $23,000 a year, plus expenses; we are about average for a public school.  Private school tuition is as high as $40,000 – $50,000 a year, plus expenses. 

It has been estimated to cost about $130,000 a year to produce a physician, but obviously we can’t charge that in tuition.  We have to make up that gap through mechanisms such as state funding, clinical care, and philanthropy.     

MidlandsBiz:
How do we solve the shortage?

Don DiPette:
One innovative way that we are looking at is to expand our medical school class size is by partnering with other healthcare institutions.   We already send many third and fourth year medical students to Greenville Hospital System University Medical Center for their clinical training.  We are presently planning to increase our medical school class which could necessitate increasing the number of students that train at GHS as well as partnering with other medical communities such as Florence.

The main message I would like to p
romote is that the USC School of Medicine can, and should, be a part of the solution for the physician shortage. 

Particularly in these tough economic times, we have to take advantage of the resources and the infrastructure that we already have in place. We are a small medical school that has room to produce more physicians in a very efficient manner.  We could expand from graduating 85 students a year to 100-110 students utilizing our current facilities and our community healthcare partners.  While that might not sound like a lot now, it’s a beginning.