Jul 082015

It has been quite some time since I last posted to this blog. Contributing to my sluggishness in completing my assignment has been the hot, humid – some would say lazy – days of June? It seems everything in the world is changing, even the climate. But some of it bodes well (though perhaps not the weather).

A lot has happened at Brody since I last shared my thoughts with you. All of it is good, thanks to the extraordinary humans that make up the Brody School of Medicine family. It is your dedication, commitment and effort that is transforming Brody into a model for other medical schools to emulate.

I would be remiss if I did not comment on the success we are enjoying from work we have done in the recent past. We have begun to turn the financial tide against which we were struggling. Although there is still much work to do, our redoubled efforts are resulting in ECU Physicians anticipating a modest financial positive margin by the end of the fiscal year. The Governor and the Legislature are supporting this turnaround. While a final state budget is still weeks, if not months, from being finalized, I am very pleased that all three budget proposals – the Governor’s, the House’s and the Senate’s – each contain $8 million in new funding for Brody. With the strong support of university friends, trustees and others, our very effective advocacy for Brody in Raleigh will not abate.

In order to continue this turnaround, key hires have been made. Organizational structures have been better defined, revamped or added to. A new compensation plan has been put in place and continues to be refined. To learn more about the new roles and to understand the composition and inter-relationship of the boards, committees, teams and groups that are guiding our course, please spend a few minutes looking at materials in the ‘Recent Updates’ section of the Preserving the Mission webpage.

Now, let’s turn our attention to work we must do to secure our future.

For several months we have been engaged in meaningful conversations with Vidant leaders. Both organizations have come to a clear understanding that we are each stronger and better positioned to deliver on our respective missions. Vidant Health’s new CEO, Dr. Mike Waldrum, and Brian Floyd, president of Vidant Medical Center, both entirely share that view. The shared vision we have for meaningful alignment has led ECU and Vidant to jointly engage Huron Healthcare to gather, review and analyze information provided by both Vidant and ECU to develop options and recommendations about how our two organizations might more closely align our medical services, educational activities and research.

Huron has begun this work and will continue their limited engagement with us for approximately 12 weeks, with an anticipated report toward the end of September. To efficiently sift through information, Huron has requested four specific committees be created to help gather information, provide advice and context, and suggest direction for their project. Both Vidant and ECU will have equal representation on these committees. From ECU, the committee representatives will include a mix of faculty and administrative leaders. If you’re interested to know who serves on these committees, that information is also available on the Preserving the Mission web page under ‘Recent Updates.’

I expect the result of Huron’s work to be a report with options or recommendations on how the two organizations might consider pursuing enhanced alignment and how that might be accomplished. In all meaningful ways, whatever set of options and recommendations are presented will mark the beginning of a process of consideration, decision and implementation that will take substantial study and time to reach conclusion and will involve all of us, including the Chancellor, ECU Board of Trustees and the UNC Board of Governors.

The variations we experience in the daily weather resulting from global climate change can sometimes make us uncomfortable or even nervous. Similarly, the possibility of change at Brody, particularly in the midst of an industry-wide upheaval, can be unnerving and anxiety-producing. I advise you to take great comfort from the knowledge that at the conclusion of this effort, Brody faculty and staff will continue to do on a daily basis what we have been doing for over 40 years. We will teach students, we will train residents, we will care for patients, we will conduct important research and we will continue to improve the lives and health of eastern North Carolinians. In short, Brody will preserve the mission we have so successfully championed.

Stay cool, y’all!

Mar 062015

The sort of weather we’ve experienced lately prompts contemplation. I thought we were in the warm South until last week. What is all this “polar vortex” stuff about?

Since I can’t seem to figure out the weather, I have been thinking about the work that is being done to implement our new faculty compensation plan. The objective for this work is to fairly measure clinical and educational efforts with logical parameters, then link compensation with value.

We have been through one cycle of this with the faculty. I am forecasting it will take several cycles for us to become completely familiar with all of the nuances.

To facilitate that process, I have appointed a Compensation Advisory Committee chaired by Senior Associate Dean for Academic Affairs Dr. Elizabeth Baxley. The team is broadly constituted to bring a variety of perspectives to the work. Despite all the support and thought that went into creating the compensation plan, implementation still has been a significant challenge.

A compensation plan is not just a data-driven exercise. “Culture” also comes into play. Compensation is clearly linked to money and pay, but that is not all.

When I was in Syracuse, I helped develop and implement a physician compensation plan. It was a culture-changing exercise.

Physician Compensation PlansThe picture illustrates the relatively thick book titled, “Physician Compensation Plans – State-of-the-Art Strategies,” by Bruce A. Johnson, JD, MPA, and Deborah Walker Keegan, PhD, FACMPE. It is published by the Medical Group Management Association.

I bought this book in Syracuse, and even though it is a few years old, it is still relevant. The book describes all the dynamics and complexities likely to occur with any rationally-conceived compensation plan.

To quote a couple of sentences from the introduction:

“Why would medical directors or practice executives decide to champion a new compensation plan for their medical practice? Just the mere thought of tackling the complex, emotionally laden, legal minefield of physician compensation puts fear in the hearts and minds of otherwise rational beings. It is fully recognized that the process of changing a physician compensation plan may not be top on the list of career-enhancing events.”

Now that is encouraging!

But having a well understood and implemented compensation plan is essential in the orderly execution of our mission. It goes well beyond the satisfaction of individuals. This is a hugely important cultural transformation for us all.

Most of us speak about transformation in the third person. The reality is that the landscape we’ve become accustomed to is changing all around us, and we must individually accept this in order to prepare ourselves for our shared future.

We must personally adapt.

Which leads me to the concepts of Authority, Autonomy and Accountability.

Each of us “wears a hat” in the organizational structure. It is the authority vested in us by the organization. Similarly, as professionals we wield a significant amount of autonomy in our practices. Likewise and inevitably, each of us is accountable. We may point defensively to someone else, but in reality, in reflection, who is that someone?

This is where individual and personal introspection in these last (hopefully) dark days of winter may bear fruit.

We have full authority to support our mission, individually and collectively. We have autonomy that is evidenced by the faithful execution of our medical profession. We are accountable for the financial viability of our school. We are fully accountable for our individual actions.

Because excellence is our only acceptable standard, we are accountable for activities across the whole spectrum of work – not just the clinical activities. We champion graduate medical education and the advancement of science itself. All of this, of course, is intimately linked with our own personal desires for achievement and success.

Obviously, most of us balance these three principles in very practical and acceptable ways. The exciting challenge is when we all commit to converge our energies and actions for the most superlative implementation of winning strategies. That is how we can remain competitive in a volatile and complex medical world!

The weather has clearly complicated all of our lives, but it is nothing compared to the hugely transformative changes we have purposefully implemented. I also realize that “change happens at the speed of trust.”

As spring arrives, I am confident we will enjoy a renewed sense of commitment and all of the courage necessary to embrace a bright future of opportunity.

I hope to see you soon. Stay warm! And dry!


Feb 042015

The humerus is a funny bone.

Being totally fascinated by everything to do with the human body, I am trying to fully understand the functional anatomy of this bone. It’s designed to transmit energy from the largest muscle masses in the human body, and to conversely transmit and dissipate reactive forces. This is a wonderful thing.

In times of complexity, there are a few approaches I find helpful. I’ll list them here:

  1. Study, explore to achieve understanding.
  2. Take postitive action to work on and resolve the complexity.
  3. Recognize the very irony of life itself – there is always humor in it!

Using these approaches, I have found it is possible to create valuable meaning, even in the presence of immense challenge. This is the secret to being “undaunted.” It is not about laughing off challenge, it’s about being in touch with reality in the most meaningful way. It takes hard work and effort to understand.

Our administrative team had the opportunity to meet with professor Dan Ariely at Duke University. He is in charge of the Center for Advanced Hindsight. Yes, that’s funny! (He is quite a serious person, ironically.)

Please consider taking a moment to watch one of his talks on TED: “What makes us feel good about our work?”

With all the stresses we have experienced over the last year, this talk provided me some insight and understanding, supported by data.

Ariely explains:

  • We should probably add all kinds of things to (our understanding of work): meaning, creation, challenges, ownership, identity, pride, etc.
  • People seeing the results of their labor – even for a short time – is important.
  • The less appreciated we feel our work is, the more money we want to do it.
  • Eliminating motivation seems to be incredibly easy, and if we don’t think about it carefully, we might overdo it!

Without meaning, most of us would not do much of anything – it’s certainly true of me. And I appreciate all of the folks here who display their pride and commitment to the mission and the meaningful work of “the Brody,” right here in Greenville.

Take care,




Jan 142015

This is the time for the traditional New Year’s resolutions. Let me take this one step further.

What do you want to be when you grow up? This is a question I was asked many times in my formative years. This question may not be so personally relevant today, as there are clear signs that my personal “growing up” is not as much of a distant and long term future destiny. However, I think the question still has value – for us individually, and for the organizations we are committed to work within.

Over the holidays, many institutions send their greetings and wishes our way, using the opportunity to brag about themselves and their accomplishments over the last year. To their credit, there are some really good things happening in academic medicine across the country.

We have also realized that it is important to speak about all of the positive accomplishments that are ours to celebrate over the year. It remains an exciting and positive environment for me to have the privilege of leading. These accomplishments are really too numerous to catalog here within the blog, and many, if not all, of these have been acknowledged separately.

We can acknowledge that we have never existed in such highly competitive environments as some of the institutions across the nation. This competition, at the national level, may fuel the need to loudly advertise any advantage that can be perceived in what may be called the “medical marketplace.” Brody’s own Annual Report is linked to the academic calendar and rarely gushes with immodesty. We need to understand that the level of competition in the future will inevitably increase and will occur at the national level. Our benchmarks for performance are no longer measured at the local level.

Our own approach in reporting our performance will continue to be as realistic as possible. This does not preclude championing the positive accomplishments, but we will also fully acknowledge the challenges we must face. To me, this sets the stage for the work that will be necessary to take advantage of the opportunities that we can imagine and see.

One has to work within a strong foundation of reality.

This is why the question – “What do you want to be when you grow up?” – is so relevant. The dynamic of this question focuses attention on the present, and at the same time, projects into the future with anticipation of something rewarding. The future aspiration is what we can become excited about, and is inherently energizing and motivational. The future state is worth the effort as we work towards the goals.

We can all take stock of our many accomplishments over the past several months. Our clinicians have risen to the challenge of increasing access for our patients. This has been close to a “double digit” response over the last six months.

There are success stories from every component of the enterprise. They include our students presenting research, faculty attaining tenure and promotion and staff demonstrating their leadership and loyalty to the mission of the school.

With these in mind, we can commit to working energetically now with a positive vision of the future. Some of our work will consist of “must do’s” and some will be based on our own creativity and imagination.

When the Brody School of Medicine “grows up,” we will be broadly acknowledged as the most effective medical school in North Carolina dedicated to the health and wellness of its region’s citizens. We will be fully recognized as contributing to the economic health of eastern North Carolina in even more meaningful ways. We will be seen as a valuable partner within the state and in all that pertains to the provision of medical care and service and the health maintenance.

I am excited by this continuing work and look forward to all that can be seen as opportunity in the New Year.

I wish you all the very best for 2015!