Katie Hansen has spent the past few weeks backpacking in national parks, including such Western jewels as Zion and Bryce Canyon. Earlier in life, she taught science at a high school in Bolivia. Now, at the age of 28, she’s about to start her next adventure as a member of the inaugural class at the University of Texas’ Dell Medical School.
Hansen also was admitted to the UT Southwestern Medical Center in Dallas, considered to be among the top 20 or so medical schools in the nation. But Dell was an easy choice thanks to its core mission of producing physicians who are passionate about reinventing health care with a goal of dialing back the cost curve and dialing up the results.
“The mission of Dell aligns with my own ideas of what health care should be about,” Hansen said. “I’m excited to be at a place that recognizes the inefficiencies of health care and wants to talk about it and do something about it. I think Dell is in a unique position to make impactful changes in the community.”
Orientation for Hansen and fellow first-year students begins Monday, with something of a preview Sunday at the education building, where finishing touches of construction were going down to the wire. When doors open for the start of classes July 5, UT will have come full circle from Sept. 6, 1881 — the day Texas voters decided that the main university would be in Austin and the medical school in Galveston, at that time the state’s largest city.
There have been efforts over the intervening 135 years to establish a medical school here, and momentum began to build once again in 2003, only to stall out a few years later during an economic downturn. Then, in 2011, state Sen. Kirk Watson, a Democrat from Austin, took up the cause, brokering a kind of tripartite agreement involving UT, Central Health and the Seton Healthcare Family.
Central Health is a taxing authority and Travis County’s hospital district, charged with caring for uninsured and underinsured residents, and Seton, a Catholic nonprofit, is the area’s largest health care system. UT’s governing board is underwriting the school’s construction with endowment-backed bonds.
Travis County voters sealed the deal in 2012 when they agreed to raise Central Health’s property taxes to support the medical school to the tune of $35 million a year. Seton, part of Ascension, the world’s largest Catholic health system, is building a new teaching hospital on UT land that will open in 2017.
“Big things can really happen when this community sets its mind to it,” Watson said.
Central Health officials see the various developments as pivotal to their efforts to ramp up care for their patients, some of whom have had to wait more than a year to see a specialist. Making Austin a “model healthy city,” as Dell Dean Clay Johnston puts it, will be a priority in part because of the taxpayer support underpinning the school.
Johnston, Watson and other officials also foresee economic development benefits from research, related industries and the associated buzz. Among the possibilities: marrying the region’s high-tech strengths with health care to produce new devices, apps and consumer products.
To that end, UT, Seton and Central Health have formed a nonprofit, Capital City Innovation Inc., whose mission is to foster development of an “innovation zone” to attract startup companies, researchers and so forth. Central Health’s 14.3-acre property just south of the medical school and the new hospital sits at the heart of that zone and is expected to be redeveloped into a commercial, residential and innovation hub after the aging University Medical Center Brackenridge is razed.
A work in progress
It remains to be seen whether the medical school will live up to its promise of improving health care for low-income people, or whether economic development will overshadow that charge, said Travis County Judge Sarah Eckhardt.
“The reason for that tremendous local public investment is to overcome hurdles in social equity and health care,” Eckhardt said. “We’re going to have to be really vigilant and honest about this partnership to assure the economic benefit works hand in glove with the improvement of health outcomes all the way down the economic ladder.”
Some community activists and leaders are counting on the Dell school to foster an educational pipeline that would give local high school students, including low-income and minority students, a leg up in getting into the medical school. Discussions along those lines were encouraging in tone and direction but stalled out a couple of years ago, in part because of a changeover in the Austin school district superintendency and the daunting task of getting the Dell school up and running, said Frank M. Rodriguez, a former executive director of the Latino HealthCare Forum and a former member of Central Health’s Board of Managers.
“Hopefully those discussions will get kick-started,” said Rodriguez, now a policy adviser to Mayor Steve Adler.
Medical school officials said they began hosting summer camps last year to help prepare middle and high school students for health-related careers.
“Our goal, as demonstrated by Dell Med’s health science summer camps, is to introduce students to a broad range of health professions — including medicine, nursing, pharmacy, social work, public health and a host of future careers at the interface of medicine, technology and social services, Johnston said.
Bob Ozer, an activist and retired lawyer in Austin, questions the school’s funding model.
“The problem with the new medical school is that its funding from Central Health consists of tens of millions of dollars annually that by law is intended exclusively for the provision of health care services for the poor in Travis County,” Ozer said. “That money will instead be used for faculty and staff salaries devoted to research for global markets, instruction for medical students at an elite institution and for costs associated with a private teaching hospital Seton will own and profit from.”
UMC Brackenridge, the oldest public hospital in the state, is owned by Central Health and operated by Seton. Its successor, the Dell Seton Medical Center at the University of Texas, will be owned and operated by Seton, which is underwriting and raising funds for the $310 million project.
“What Central Health does to bring care to this community is not done without partnership, every step of the way,” said Patricia Young Brown, the agency’s president and CEO. “It’s not just about direct responsibility to the uninsured. It’s the larger benefit that comes to a community that has a top-flight medical school, making our whole health care ecosystem stronger for the partnership.”
Greg Hartman, Seton’s president of external and academic affairs, said, “No one is disputing the fact that health care is going to undergo fundamental disruption,” including an emerging payment model that seeks to reward providers who keep patients healthy. “To have the leading disruptors of the next generation of health care training in our town is a huge opportunity and really exciting.”
At the same time, Hartman said, “This is really nerve-wracking. The economic model, the business model, is kind of unproven. We’re a well-established health care company that has put our bet on being part of the disruption.”
A team-based approach underlies the curriculum and the philosophy of health care in which the Dell school’s first 50 or so students will be immersed. The students will work not only with each other but with students in other health professions.
John Bedolla likens the approach to the operation of ancient Polynesian canoes, which explored vast stretches of the Pacific thanks to paddlers rowing in unison. Bedolla is assistant director of research education and assistant professor of emergency medicine at the Dell school, and he will also serve as a mentor to five students he will track through all four years of their education, the better to spot burnout and other problems.
He plans to infuse his teaching with a heavy emphasis on communication between doctor and patient, which he said is just as important as the physical examination and medical history. “Part of what makes the whole thing go with a doctor and a patient is emotional; it’s not purely a transactional thing,” Bedolla said.
While administrative positions, department chairs and other key jobs are being filled and funded by UT, Seton is paying much of the rank-and-file clinical faculty. All told, about 350 physicians have faculty appointments, and that number will gradually rise to anywhere from 600 to 700, said Sue Cox, executive vice dean for academics.
Many of those doctors will wear multiple hats. Mrinalini Kulkarni-Date, a Seton endocrinologist, is a case in point.
Her Seton duties include medical director of a clinic for uninsured patients with multiple chronic conditions and director of inpatient and outpatient diabetes programs. As an associate professor at the Dell school, she oversees residents — recent medical school graduates undergoing additional training — and will mentor students and teach the endocrinology section of a first-year course. She also participates in research, including a project looking at immune cell function in diabetics. UT will reimburse Seton for some of the time she spends on medical school duties.
“I’m thrilled to be involved,” said Kulkarni-Date, who previously was on the medical school faculty at the University of California at Davis. “What’s great about this medical school is we are starting from the ground up.”
Students will take their classes in the Health Learning Building, which, thanks to more than 2,000 panes of glass, is bright and airy. A 118-step open stairway from the first floor to the fifth is intended to encourage physical activity and chance meetings of students and teachers.
“I love the design,” said Garrett Johnson, 23, an incoming medical student who, as an undergraduate at UT, served on a committee with other students, faculty members, architects and engineers to help plan the building. “Another thing that I like is the cadaver lab isn’t in a basement where it’s very gloomy. Ours is up on the fourth floor where you get a lot of sunlight. I think it’ll make it lot easier to spend time in lab.”