Top administrators outlined the most important priorities and challenges facing UC Davis Health System in the near future during a mid-October meeting.

About 150 health system leaders gathered at the Radisson Hotel to hear about the status of the system's traditional missions in patient care, teaching and research; what is needed to continue to succeed in those areas; and the obstacles that must be addressed to achieve that success.

Speakers included Bob Chason, chief executive officer of the medical center; Claire Pomeroy, executive associate dean for the medical school, who was recently named vice chancellor for human health sciences and dean of the school; and Michael Boyd, associate director for facilities planning, design and construction. They will also talk at Staff Assembly's fall meeting on Nov. 10, from 3 to 4:30 p.m. in the UC Davis Cancer Center auditorium.

Much discussion centered on the health system's goals and strategies for the next several years as it responds to rising cost and declining revenues. Chason cited cuts in state and federal contributions to Medicaid as an example. Because of these and other forces putting the financial squeeze on the health system, Chason said that hospitals and academic medical centers already bear the reponsibility for teaching, research, patient safety and care for the uninsured.

UC Davis Health System performs all of these essential services for the community, but does so in a marketplace where other health-care institutions do not, Chason said. The financial climate also makes it difficult for the system to meet the other pressing needs of the Sacramento region, such as new physicians, intensive care unit beds and operating rooms.

Chason said that increasing financial pressure on academic medical centers ultimately affects everyone. He noted that medical schools have increased their tuition by an average of $5,000 a year and medical students have debts totaling between $80,000-$100,000 upon graduation. That debt may be a factor in driving medical students to choose higher-paying sub-specialties, contributing to ongoing shortages in primary care, general medicine and geriatrics, he said.

"We'll continue to do our part," Chason said. "We just need others to do their part, too."

Despite these challenges, speakers pointed to many successes and positive trends for the health system. Pomeroy said the system's reputation in research and education continues to grow. In the area of research, that success is reflected in the growing amount of grant funds received from the National Institutes of Health. In the past five years, outside funding for research at the School of Medicine has nearly doubled, from $53.6 million for fiscal year 1998-99 to a little more than $100 million in the current year.

Pomeroy also noted that the construction of the new Education Building will move the instruction of medical students from the Davis campus to the medical center. "This really is going to transform the (medical) campus," Pomeroy said. "Think of the intellectual ferment that will be happening here. Our students will have many role models to look up to here."

Pomeroy has taken the lead role in developing a new strategic plan for the health system, which calls for an emphasis on four established areas of excellence to achieve national prominence: neuroscience, cancer, infectious disease and vascular disease. The health system has set a goal of obtaining $150 million in research funding for those "areas of excellence" and moving up 10 places in NIH rankings within five years.

Officials have identified the resources needed to elevate the four areas of excellence. Most prominent among them are 300,000 square feet of additional research space, and an increase in the endowment base, especially for chairs and professorships.

Michael Wilkes, vice dean for medical education, said medical education is changing in response to a variety of factors: government policies; social mandates, such as changing patient expectations; new discoveries and understanding of adult learning theory; managed care; an aging population; health-care disparities between different population groups; and the need to concentrate on chronic illness versus acute illness.

The School of Medicine is adapting to a different kind of student and is altering methods of instruction, Wilkes said. Students of today, for example, are much more comfortable using new tools and technologies than students of the past. As a result, medical school officials have been rethinking a number of long-established approaches, such as the model of two years of basic science followed by two years of clinical science. Lectures where students sit passively, and are assumed to be at the same level of understanding, are being replaced by active learning.

School officials also are examining topics that once were considered of minimal interest, such as the health of specific populations, the cultural aspects of illness, the importance of epidemic and environmental hazards, and the psychological aspects of health.

Progress noted by Silva included an increase in FTEs in basic science departments, from 29 to 59, and a big jump in partnerships with agencies including the Lawrence Livermore National Laboratories, USDA Western Human Nutrition Research Center, VA Administration and Shriners Hospital.