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| Vol. 22, No. 3 |
| February 15, 2000 |
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Dr. Jay Noren Talks
by ROGER WIDMEYER Texas Medical Center News
Dr. Jay Noren became president of the Texas A&M University System Health Science Center in January 1999. The System includes the College of Medicine, the School of Rural Health, the Institute of Biosciences and Technology in the Texas Medical Center, the Graduate School of Biomedical Sciences and Baylor College of Dentistry in Dallas. Dr. Noren received his M.D. degree from the University of Minnesota and M.P.H. degree from Harvard University. He held a variety of leadership positions at the University of Wisconsin from 1976 to 1998, most recently serving as vice chancellor for health sciences. TMCN: In a way, it seems natural that the Health Science Center would spring from the agriculture and engineering tradition at A&M. JN: It's very natural. Texas A&M has undergone more dramatic change than most universities in the country. Originally, it was a small agriculture and engineering school with a strong military tradition. In 1960, there were only about 5,000 students. The research efforts then were pretty miniscule. Now it is a huge flagship research institution, the fifth largest university in the country and recognized among the top 10 or 15 research institutions. Today the university goes far beyond just agriculture and engineering, though significant research emphasis is in engineering and agriculture. But there is also sophisticated meteorological research, nautical archeological activity and many other programs. Texas A&M is now a very broad-based research university. TMCN: That's quite something for just 40 years or so. JN: General Earl Rudder was president of A&M from 1959 to 1970. He was a hero of D-Day in World War II. He provided the strong leadership required to change A&M and prepare it to march into the future. He admitted women. He built a research infrastructure, and he invested in capital improvement for a huge number of buildings and enhanced the graduate school. It was one of those times when a single leader had a huge impact. He was a visionary. The health science center model fits well within this tradition. First, the research base is here, and small liberal arts colleges just can't have this kind of effort. There's a research culture here. Secondly - and what makes our health science center so successful - is the very powerful land grant agriculture and engineering extension tradition and service to community commitment, which says, first and foremost, that A&M will educate young people with traditional values and broad education. The university serves the state of Texas not just in terms of educating students but in providing service to the community. There are now extension agents in 250 of the 254 Texas counties, making A&M the largest land grant university in the country. TMCN: Let me interrupt for a moment and ask you about the significance of land grant universities in this country. JN: In the 1860s, there was legislation for federal funding for major universities in most states to ensure that they provided services to those states, particularly in the area of agriculture. Here in Texas, that university was A&M. Some of the other large schools are Michigan State, the University of Minnesota and the University of Wisconsin. Now, land grant universities still serve their states with the mission of agricultural research and outreach, but the most forward-thinking universities have broadened their base to include family and environmental services. Here, we have been moving into nutrition, food and water safety issues, among others. TMCN: So A&M, as a land grant university, pretty well has Texas "covered"? JN: Yes, and that makes the Health Science Center a little unusual. First, we have a community outreach goal, and our partnership with A&M extension throughout the state allows us to address many issues in health promotion and disease prevention. Secondly, this distribution across the state allows the A&M system to play a major role in both access to education and education in the local communities. We have an ability to establish valuable programs with trusted partners. Our new project in the Coastal Bend, the Coastal Bend Health Education Center, includes 19 counties, reaching south of Kingsville to north of Corpus Christi. [See related story, page 9.] One of the features of the Center is providing a career entry track for health care professionals. We want to offer dedicated and talented high school students the opportunity, through scholarships and mentoring, to attend medical school. (Eventually, we want to expand this to include dentistry and nursing.) Students will come from the Coastal Bend area, and we anticipate they will return to practice in their communities, many of them underserved. Also, part of our Coastal Bend Health Education Center will offer continuing education to area health professionals. There is a very real interdisciplinary character to our research, and this couldn't happen without A&M. We have joint appointments, for example, in cardiovascular disease and animal science, nutrition and dietetics, and epidemiology and cancer. These are interfaces which are logical in a research setting, but don't commonly happen. The Institute of Biosciences and Technology is a good example, where Dr. Fuller Bazer is director. His background is animal science, specifically reproductive biology - but he's also our vice president of research and dean of the graduate school of the Health Science Center. The interdisciplinary nature of the Health Science Center resonates in the A&M tradition, and it has been well supported by the board of regents. TMCN: Returning to your thoughts about underserved communities, what are some of the Health Science Center's outreach efforts? JN: There are many. By the Roots is a program of the Baylor College of Dentistry in Dallas, and we think it will have some real significance. We are educating young children - 10,000 elementary school-aged children in 25 schools - about what they can do for their dental health. And we are evaluating the impact of this intervention. Similarly, we have a youth tobacco use intervention project. A&M has a tobacco endowment, like many institutions, and it generates about $2 million a year in funds, which we intend to use in tobacco cessation programs. With A&M's college of education, we're developing an intervention targeting young people in schools. Again, we'll study the impact and, hopefully, develop a model that really works and has a major impact. TMCN: Your clinical faculty appointments are a little out of the "norm," aren't they? JN: There's another element in the Health Science Center that's unrelated to the land grant tradition. It is a model which clearly distinguishes between the teaching, research and community outreach and our clinical business - patients served and the revenue that generates. The clinical activity is not something we own, and that's different from most medical schools. We do not have the financial responsibility for clinical operations. We do have close affiliations with Scott & White Memorial Hospital and Clinic and the Central Texas Veterans Health Care System in Temple, as well as Darnall Army Community Hospital. Most medical schools have faculty who are dependent on the school's clinical resources, but our faculty in clinical disciplines receive their compensation from the institutions where they practice. This may be an advantage. The typical medical school relies very much on patient revenues. In the early 1960s, revenue from patient care for medical schools averaged about 6 percent; today it's approaching 50 percent. So there's an increasing reliance on revenues and that makes it difficult to give faculty in clinical disciplines the time to engage in the kind of research and teaching that a traditional research university requires for tenure. When you add to this the competition in a managed care market, it creates a real tension. We're in a transition. The graduate medical education funding has brought some of this to the surface. In the Senate for a couple years, there's been work on the Medical Education Trust Fund, put forth by New York Senator Patrick Moynihan. This would fund medical schools directly for their teaching and research activities, instead of reimbursement through Medicare. The Balanced Budget Act of 1997 resulted in a huge cut in Medicare funding, and a significant chunk was a reduction in funding for graduate medical education. Some of the cuts were recently restored, but the Medicare funding for residents doesn't make sense anymore. It may have at one time, but not now. Teaching and research must be funded directly. Eventually, something like the Trust Fund bill will be passed. TMCN: What are some of your other challenges, on a more personal level and as a physician? JN: Physicians will be dealing with an increasingly elderly population, resulting in a mix of clinical problems in the population, including dementia. I can envision house calls coming back to life. The physician will take a role more as a team leader, working with nurse practitioners and social workers. Physicians will be more involved in health promotion and disease prevention. Technologically sophisticated physicians will be the norm, and of course, kids in school these days already are quite proficient with technology. But this will be an adjustment for physicians, being negotiators and team players, sometimes acceding decisions to the social workers, for example. And I think another difficult area will be the level of compensation. It may be significantly less. But the clinical practice will be the more significant change. Yet, I do think medicine will always be an attractive profession. It will always be exciting, that's for certain.
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