Deanships offer physicians chance to advance, serve

If all of the ophthalmologists holding the position of dean of a medical school gathered for a meeting, they could get by with a table and a half-dozen or so chairs. The ranks of this exclusive club, however, have increased by two recently.

Eve J. Higginbotham, MD, assumed the position of dean and senior vice president for academic affairs at Morehouse School of Medicine (MSM) in Atlanta in April 2006, and Carmen A. Puliafito, MD, MBA, began his tenure as the new dean of the Keck School of Medicine at the University of Southern California (USC) in Los Angeles on Nov. 1.

Dr. Higginbotham had been chairwoman of the ophthalmology and visual sciences department at the University of Maryland School of Medicine in Baltimore for 12 years before accepting the position of dean in Atlanta. Dr. Puliafito left his position as professor and chairman of the ophthalmology department at the Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, which he had held for 6 years.

For both, the transition is an opportunity for personal growth and professional advancement, a chance to serve, and an occasion to strengthen ties between ophthalmology and the broader medical community.

Broader impact

Dr. Higginbotham said she began preparing for the move from department chairwoman to dean several years ago when she accepted a fellowship from the Association of American Medical Colleges’ Council of Deans. She also attended the prestigious, in-depth Hedwig van Ameringen Executive Leadership in Academic Medicine Program for Women, a program of the Institute for Women’s Health and Leadership at the Drexel University College of Medicine, Philadelphia.

“I was looking for a way to [have an] impact on academic medicine at a much broader level,” she explained. “One of the turning points for me, in addition to the need to advocate for ophthalmology as a department chair in a large academic medical center, came when I was president of the Harvard Medical School Alumni Council. There, I really had an opportunity to view how influential the dean could be in changing the course of an institution.”

Ophthalmology has been “marginalized,” Dr. Higginbotham explained, in part because it is possible to have a fully accredited medical school without an ophthalmology department. The specialty is a rotation in, at most, only one-third of medical schools, she added.

“We need to reverse that trend if we are going to make sure vision remains an important component [of patient care] in the future,” Dr. Higginbotham said.

“As dean, especially of a school whose mission is to serve the underserved and has a commitment to developing primary-care providers for the future, I felt it was a great opportunity for me to [pursue] my interest in bringing ophthalmology closer to the house of medicine as opposed to having it continue to be marginalized,” she added. “When I have a chance to interact with other deans, I can certainly convey or reaffirm that message as well as [have an] impact on the education of medical students who will be taking care of us in the future.”

Although MSM does not have a department of ophthalmology, Dr. Higginbotham said she keeps up with her specialty by seeing patients half a day a week at the Emory Eye Center. She also plans to begin scrubbing with the residents at Atlanta’s Grady Memorial Hospital to maintain a role in teaching.

She is active, as well, in clinical research through projects such as the Ocular Hypertension Treatment Study. “I still am very much involved in my field,” she said.

As dean of the medical school, however, her responsibility is program-wide.

“We’ve been strengthening the infrastructure and building capacity for research as well as strengthening the clinical enterprise,” she said.

MSM, in partnership with Emory University, the Georgia Institute of Technology, and Children’s Healthcare of Atlanta pediatric hospital, recently was awarded a $31 million clinical translational scientific grant from the National Institutes of Health. Additionally, MSM successfully collaborated with the University of Alabama at Birmingham and Tuskegee University in Alabama to win a grant from the National Cancer Institute for research and outreach.

Because Atlanta is in the “stroke belt,” as is much of the South, MSM also is pursuing a grant to perform stroke-prevention activities.

“In the first year, we’ve been able to compete for major grants that increase our ability to collaborate with other institutions to mitigate significant disease processes that affect communities-particularly underserved communities of color-in terms of stroke, translational research, cardiovascular diseases, and pure sciences,” Dr. Higginbotham said.

“On the clinical side, as the former chair of a clinical department, I was able to strengthen our compliance programs as well as work toward building some of the business fundamentals of the clinical enterprise and continue to recruit key faculty and chairs of departments,” she added.

Dr. Higginbotham also has made it a priority to work with key policy-makers and influencers such as David Satcher, MD, PhD, former U.S. surgeon general and past director of the Centers for Disease Control and Prevention (and interim president of MSM from 2004 to 2006), to make them aware of the importance of eye health. Dr. Satcher is director of the school’s Center of Excellence on Health Disparities.

Dr. Higginbotham received undergraduate and master’s degrees in chemical engineering from the Massachusetts Institute of Technology (MIT) and earned her medical degree from Harvard Medical School. She completed her fellowship training in glaucoma at the Massachusetts Eye and Ear Infirmary (MEEI) in Boston. Subsequently, she was chief of the glaucoma clinic at the University of Illinois, Chicago, and an associate professor at the University of Michigan, Ann Arbor, where she also served as assistant dean for faculty affairs.

In 1994, when she was appointed chairwoman of ophthalmology at the University of Maryland, she became the first woman to head a university-based ophthalmology program in the United States.

Fresh challenges

For Dr. Puliafito, the new leadership opportunity at USC came at a time when he had achieved many goals and was ready for fresh challenges.

“I’ve been an ophthalmology chairman for 16 years at two different places, which is a long time. We took Bascom Palmer to the unquestioned number one position in the U.S. News & World Report rankings, and I’ve accomplished much of what I had set out to achieve in terms of building the faculty and the practice and building a new eye center at Palm Beach,” Dr. Puliafito said. “I was quite happy at Bascom Palmer.”

Nonetheless, when a search committee from USC contacted him, he was receptive.

“The Keck School of Medicine is at a very pivotal time in its history,” Dr. Puliafito said. “A lot of things are coming together in terms of its hospital, its clinical practice, and its research enterprise, so there’s a tremendous opportunity to lead a transformational expansion of the school.”

According to Dr. Puliafito, the USC leadership team has committed more than $100 million in university funds for recruitment and program development, and several hundred thousand feet of new laboratory research space has been completed in recent years. Another significant new development on the Keck campus will be the Broad Institute for Integrative Biology Stem Cell Research, for which ground is scheduled to be broken in 2008.

Several new clinical facilities also will open over the next 2 years. They include a new tower at USC University Hospital, a new 800-bed hospital at Los Angeles County Hospital, a replacement clinical facility at Children’s Hospital Los Angeles, and a new facility at Huntington Hospital in Pasadena, a major community hospital affiliate of the school.

Dr. Puliafito noted that Los Angeles has only two major medical schools-Keck and the David Geffen School of Medicine at the University of California, Los Angeles-despite being a metropolitan area of 15 million people. That fact means each school has an opportunity to have a significant impact on education and health-care delivery. In addition, the Los Angeles County Hospital + USC Medical Center, a partner institution of the Keck School of Medicine, is one of the largest providers of indigent care in southern California, and that partnership means involvement in public health-care issues. (The Charles R. Drew University of Medicine and Science, specializing in training students to work with underserved populations, also is in Los Angeles.)

Dr. Puliafito also praised the Doheny Eye Institute (an independent, non-profit organization affiliated with USC) which is located across the street from the dean’s office, making it convenient for him to see patients a half day a week. He also plans to continue his research on optical coherence tomography-which he co-invented-and retinal imaging.

“I’ll keep my interest in ophthalmology. In medicine, or in whatever you do, you need to be who you are, and what I’ve always been is somebody who is interested in organizing and leading but someone who enjoys clinical practice at the same time,” Dr. Puliafito said. “I’ve always done that, even when I’ve been doing administration.”

His presence among the ranks of medical school deans also will enable him to represent ophthalmology as an essential part of medicine.

“That’s important, because the future of ophthalmology has always relied on our position within the whole medical enterprise,” Dr. Puliafito said.

Ophthalmology has changed dramatically over the past 20 years, he said, adapting technologies and therapeutic advances from basic science, engineering, and oncology, to name a few fields. Yet despite those important ties, he added, ophthalmologists risk becoming isolated because they increasingly perform office-based surgery and see little need for hospital privileges or interaction outside their immediate circle.

“That’s a problem for us in the long term,” Dr. Puliafito said. “You need to be part of medicine, and this [new position] is my slight contribution to doing that.”

He said he also expects to use skills he learned in the MBA program at the Wharton School of the University of Pennsylvania as he helps USC establish new models for research, teaching, clinical care, and community service. Dr. Puliafito also holds the May and John Hooval Dean’s Chair in Medicine and serves as professor of ophthalmology and health management at the institution.

Before earning his MBA, Dr. Puliafito earned his undergraduate and medical degrees at Harvard. He served his residency in ophthalmology at MEEI and a fellowship in ophthalmic pathology at the MEEI/Harvard Howe Laboratory of Ophthalmology. Subsequently, Dr. Puliafito served on the faculty of both Harvard and MIT. In 1991, he became chairman of the ophthalmology department at the Tufts–New England Medical Center, Boston, where he founded the New England Eye Center.

Advice for aspiring deans
Only four or five ophthalmologists are currently deans of U.S. medical schools, and for those who aspire to join that select group, Dr. Higginbotham offers some advice: Unless you have been the chairperson of a large department and responsible for managing a substantial budget, it might be best to obtain additional training, such as a fellowship, to prepare for the challenge of leading a medical school and persuading the search committee of your qualifications.

“It’s a bit harder for individuals from small departments of ophthalmology, but [it’s] certainly not impossible,” she said. “And having been in this position for the past 15 months, it’s certainly worth it. On a personal level, I’ve had a sense of renewal in my own professional career and have been really excited by the new opportunities that I’ve had to contribute.”

Dr. Puliafito suggested that strong organizational skills and business training would be assets for an ophthalmologist with administrative career goals. With overhaul of the health-care delivery system likely to become an important political issue as well as a pressing need, and sensitive issues such as stem cell research also on the agenda, a medical school leader will need much more than a good bedside manner to succeed, he said.OT