The Warren Alpert Medical School is in the first stages of streamlining its structure to more closely align the school with its clinical faculty and teaching hospitals. Centralizing the current system to improve co- ordination between the three actors will make delivering health care in the state more efficient and improve health outcomes for its residents, said Edward Wing, dean of medicine and biological sciences.
The Med School garnered criticism last October when Darrell Kirch, chief executive officer of the Association of American Medical Colleges, visited the school and said he was “shocked at our antiquated, fractionated structure,” Wing wrote in a departmental newsletter last month.
In the newsletter, Wing cited a “historic” lack of coordination be- tween the Med School and hospi- tals and called for better integration among the three actors to enable more strategic decision making re- garding health care delivery.
Three main actors
Under the current structure, there are three main actors involved.
First is the Med School, which was founded in 1972 and has grown in size considerably since its launch. In 2011, it moved its operations to a new, larger office, a stylish building in the fast-growing Jewelry District that has received positive reviews from faculty, students and architects alike.
The second actor is the clinical faculty, who technically belong to the Med School but work in the various teaching hospitals. Though “full- time, voting members of Brown’s faculty,” Wing said, they are unlikely to be found roaming the green.
There are about 600 clinical facul- ty members in total, spread out across 14 different clinical departments, in- cluding the Department of Medicine, the Department of Radiology and the Department of Emergency Medicine, Wing said. These faculty are respon- sible for teaching medical students, interns and residents. They also work with fellows conducting research.
The third group involved is com- posed of seven affiliated teaching hospitals. Five of these seven hos- pitals belong to the two main health systems in Rhode Island — Lifespan and Care New England. Lifespan runs Rhode Island Hospital, the Miriam Hospital and Emma Pend- leton Bradley Hospital, while Care New England runs Butler Hospital and Women and Infants Hospital. The Med School strengthened its affiliation agreement with Lifespan in 2010, designating Rhode Island Hospital as the principal teaching hospital.
But the current state of coordina- tion between the Med School, the clinical faculty and hospitals leaves room for improvement, Wing said.
“At most other medical schools,
the hospitals, the clinical faculty and the medical school are more tightly aligned structurally,” he said. Har- vard Medical School, where Wing received his medical degree, boasts a more organized structure, where “they all move together and they all have a single governance or leader- ship,” he said.
In a Dec. 16 op-ed in the Provi- dence Journal, Wing discussed the failed merger between Lifespan and Care New England in 2010.
“That was a mistake,” he wrote of thefailuretoreachadeal.”Asaresult, they compete rather than work stra- tegically with each other. The truth is that our competition, both academi- cally and clinically, is with Boston, not within Rhode Island.”
This threat of competition from other academic medical centers lends urgency to the proposed reforms. “It’s a risk for us … we’re not as strategic as they are,” Wing said.
First steps to coordination
Better integration requires instituting a single practice plan for the Med School, its faculty and affiliated hospitals. A practice plan resembles a contract between doctors, Univer- sity and hospital administrators that stipulates the terms for the doctors’ roles in the medical program, bills and collects revenue for them and dispenses their salaries, Wing said, describing it as a “business model.” Many of the more integrated medical programs in the country work within a single practice plan, he said.
Wing has experience with integrating a medical program under a single practice plan. “I spent most of my career at the University of Pittsburgh, and we actually formed a practice plan when I was there,” he said, adding that the plan was an intensive process that required the help of consultants and financial contributions from participating hospitals.
To that end, some of the Med School’s clinical departments are currently working together to create a new practice plan.
“Five different departments, which had their own practice plans, have formed a practice plan called University Physician’s (Group), Inc. that is actually a loose confederation of the (original) five practice plans,” Wing said.
Lifespan has also approved a new practice plan, called Lifespan Physician’s Group, for community physicians and employed physicians tightly linked to the hospitals, Wing said. “There are two early practice plans, and how those will play out along with the Medical School is not clear at this point,” Wing said.
In its attempts to improve co- ordination, the Med School is also nearing a strengthened affiliation agreement with Care New England, according to Wing’s newsletter.
The Coordinated Health Care Planning and Accountability Council could also play a role in efforts to improve coordination. The council is a legislatively-mandated task force charged with making recommenda- tions to Gov. Lincoln Chafee ’75 P’14 and the state legislature on how to improve health care across the state.
Though the council
was established in 2006, it is currently rede- fining its principles and goals. Fox Wetle, associate dean of medicine for public health and public policy, has just been appointed to serve on the council. The council may play a role as the Med School tries to implement these structural reforms, Wetle said.
But the council is still far from delving into specific issues, Wetle said.
The proposed organizational changes are in their infancy.
“You can’t ask for a more complicated landscape,” said Wing. “It’s going to be a long political process.”