Monday, March 08, 2010
Years in the making, the new medical school takes shape
Money, staff, students: The pieces are all falling into place for the Virginia Tech Carilion School of Medicine.
Scott Rivenback, project executive for Skanska USA Building Inc., stands in what will be a classroom at the new medical school. He said he first heard rumors about the project six years ago. "I've built this thing in my mind I don't know how many times," he said.
Scott Rivenbark, who is managing the medical school project for Skanska USA Building Inc., walks past a row of decorative metal column covers. Skanska is the general contractor on the project, which was designed by Hayes, Seay, Mattern & Mattern.
Jared Soares/FILE 2009
Cynda Johnson (right), dean of the Virginia Tech Carilion School of Medicine, reacts after being notified in June that the school had been given preliminary accreditation. She is joined by F. Terri Workman, senior associate dean for operations, and other staff.
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The Roanoke Times
It was the brainchild of a small group of health and education leaders, representing some of the region's most powerful economic engines.
When the school opens in August with its first class of 42 students, it will be one of just a handful of new medical schools nationwide.
Here's how it all happened.
Dr. Cynda Johnson remembers with striking clarity the day in October 2007 when she learned she would run Roanoke's new medical school.
She was in St. George, Utah, waiting for her son, a professional dancer, to perform at a local outdoor amphitheater.
Johnson had a scheduled call with Carilion's chief medical officer, Dr. Mark Werner, to talk about a new career prospect. But by the end of the conversation, the prospect turned concrete: Johnson, dean of a medical school in North Carolina, agreed to take on a similar role at a small, research-oriented institution nestled below the Blue Ridge Mountains.
It wasn't built yet. It wasn't accredited yet. The money wasn't there yet. And as many of the characters in the story would learn, had the events in 2006 and 2007 been delayed, the building that soon will house the Virginia Tech Carilion School of Medicine might not be standing on South Jefferson Street today, nearly complete.
Johnson admits that if she had given it more thought, she would have been daunted by the task. Instead, she went to dinner that night and celebrated with her family. She returned to the East Coast and soon packed her bags for an arrival in Roanoke the following January.
"Luckily, I didn't consider being intimidated," she recalled. "If I thought about it too much, I think I would have scared myself out of doing it."
The story begins earlier for Charles Steger, who left his post as dean of the architecture school at Virginia Tech to become university president in 2000.
From his office in Burruss Hall, Steger would watch over the next few years as the research output at Tech plateaued and even declined in some instances. Federal dollars were shifting to the life sciences fields, and Steger didn't want to miss that train.
"It didn't take a lot of reflection to figure out that if you're going to grow your research program, you better have strengths in areas that are being funded," he said.
Steger didn't personally know Carilion CEO Dr. Ed Murphy at the time. But 40 miles away, in his office at Carilion Roanoke Memorial Hospital, Murphy was struggling with a challenge of his own.
Murphy in 2006 announced a vision for Carilion to be the next Mayo or perhaps Cleveland Clinic, and he knew he needed the best doctors to drive the idea. Roanoke had to become a place where physicians wanted to live and work. And what better environment to harbor such successful minds than academia?, he thought. Besides, Carilion had always been a place the University of Virginia's medical school sent its residents to learn.
Murphy and a small group of colleagues explored ideas. Take over another medical school? Become a satellite campus? A pharmaceutical institution? But it was all talk. "Explore" was almost too definitive a word to describe what was going on, Murphy later pointed out. Accreditation would be too tough, anyway.
But Murphy and Steger started to brainstorm together. And they wouldn't let the idea go.
"Charles and I had talked for an extended period sort of almost wishfully -- 'Gee wouldn't it be good if we could have a medical school here?' " Murphy recalled. "The reason it was thought to be impossible is that the last time there were any schools started was back in the late '70s, early '80s."
There are four other medical schools in Virginia: Eastern Virginia Medical School, University of Virginia School of Medicine, Virginia Commonwealth University School of Medicine and the Edward Via College of Osteopathic Medicine in Blacksburg. Nationally, there are more than 100 medical schools.
The two men would chat on the phone or meet in one or the other's office about how nice it would be to do something -- anything -- together. And then, in June 2006, the Association of American Medical Colleges came out with a gem of a report.
The country needs more doctors, it said, and more medical schools. In fact, the group called for a 30 percent increase in medical school enrollment by 2015.
The policy statement was the culmination of a sort of back-and-forth among medical professionals on whether there were too few or too many doctors. Johnson said previous reports had called for fewer doctors because it was believed that the then-popular managed care system would need fewer doctors in order to work. That projection was way off.
The AAMC hoped the new policy position would fill what it considered a growing need for medical professionals. During the 1980s and '90s, only one new medical school had been established. Johnson said a lot of that had to do with the increasing costs of doing business in the medical profession.
It was the window Murphy and Steger had waited for.
The two men agreed to build a small medical school that would focus on research, a strength of both institutions.
Finding the funding
One thing became clear very quickly: the need for cash.
The country wasn't yet gripped by a recession, but even in a good budget year, bringing a new project to the top of the General Assembly's priority list isn't easy.
Enter the dynamic combination of lobbying efforts by Carilion and Tech.
Among those on the ground in Richmond were Ralph Byers and Laura Fornash from the university and Mark Lawrence for Carilion.
The three brought decades of experience at the state capitol.
Lawrence and Byers had worked together before on smaller issues affecting the entire region. They brought very different personalities to the negotiations: Byers a little on the shy side, Lawrence working the room with multiple handshakes.
"Ralph's probably just a little more measured and not as easy to read as I am. I tend to be more visible and wear things on my sleeve a lot more than Ralph does," Lawrence said. "I just felt like our styles were complementary, the perspectives were also complementary."
The first hurdle would be to get the attention of then-Gov. Tim Kaine, who supported higher education construction. Lawrence said that a small group from Tech and Carilion had a private discussion with the governor to gauge his interest shortly after the LCME came out with its report.
Just a few months later, Kaine would travel to Roanoke and be part of the first official announcement related to the medical school: 3:30 p.m., Jan. 3, 2007, at the Riverside Center office building at Jefferson Street near Reserve Avenue in Roanoke, the site of the new school.
Nancy Agee, president of Carilion Clinic's hospital division, remembers the coldness of the air as she and Murphy walked over together from their first-floor offices at Carilion Roanoke Memorial Hospital.
"Our hearts were beating really hard and it was like, 'We're really going to do this,' " she recalled.
With the support of the governor, Lawrence's and Byers' next priority was to ensure that there would be an infrastructure package in which to place their project. Although getting the medical school bumped to the top of the list was difficult, Lawrence said that the group was fairly confident it would have strong support. Kaine had, after all, responded well to the idea pitched in the earlier meeting.
In December 2007, nearly a year and a half after Kaine had stood next to Steger and Murphy, the governor made a pitch for a $1.6 billion bond package that would fund college building projects, including a $59 million Roanoke medical school building.
Kaine kicked off that campaign when he appeared with college presidents and business leaders at Virginia Commonwealth University in Richmond. Standing at the governor's shoulder was Roanoke businessman Heywood Fralin, a member of the Virginia Business Higher Education Council, indicating the governor's commitment to higher education in the region.
Voters had last approved a major college building initiative in 2002. This one, however, would only need the approval of the state's lawmakers.
Representatives from both groups -- Byers, Fornash, Lawrence, Steger, Murphy -- often met with key lawmakers and staff on the money committees to get the bond passed with the money earmarked for the medical school. They won significant support from House appropriations Chairman Lacey Putney, I-Bedford, who lauded the public-private nature of the Tech-Carilion relationship.
"It's like the Chinese circus guy with the plates and the sticks -- you got to work them all together at the same time," Steger recalled of the lobbying effort.
But the General Assembly closed its 2008 session without voting on the bill, after focusing much of its attention on transportation issues.
"There were very anxious moments towards the end," Byers said. "There was a real threat of losing this bill at the last minute because of the impasse over transportation."
Agee remembers sitting in the lobby of a hotel in Williamsburg, looking out at the crocuses, as she skipped out of a business meeting and spent the day on the phone dealing with the situation.
At the time, university provost Mark McNamee recently recalled, both groups would have been satisfied to put off the project for another year. But in retrospect, the deep recession most likely would have kept the state from forking over any money.
"There's no way the state would have been able to fund a building a year later," he said.
But there would be no delay. In April the General Assembly returned for a special session and passed the infrastructure bond. The money was earmarked to pay for 75 construction projects at state colleges and universities to build facilities and make additions to the campuses.
And in that bill, sitting below a line item to expand and renovate Hunter McDaniel Hall at Virginia State University, was an earmark for Virginia Tech to construct a medical school and research institute.
"We said to the state, 'If you'll build us a building, we'll do a medical school, and it's not going to cost you anything.' And that's a pretty good deal for the state," Byers said.
Putting the pieces in place
Concurrent with late-night lobbying sessions and back-door horse trading in Richmond were the efforts to get the new school accredited.
It was a bold move. The money had not been secured, but a dean had already been hired.
A high-tech new building, a one-of-its-kind public-private partnership and years of discussion would be futile if the school didn't get a stamp of approval from the Liaison Committee on Medical Education, the accrediting body for medical schools.
That's where Johnson's experience would pay off. She knew the process and she knew she needed help.
Johnson began quietly hiring faculty for the school. Together with numerous other education and health volunteers, she helped author a 1,200-page document detailing every aspect of the medical school. It was submitted at the end of August 2008 to the LCME.
The LCME came back to Carilion and Tech and asked for more information: The committee needed a detailed list of every day's school activities for an entire year.
"You actually have to have in place most of the faculty that are going to be there to teach the program and you have to have a complete curriculum plan lined up -- basically hour-by-hour the entire medical education process," McNamee said.
They were not alone. In fact, the local medical school would become one of nearly two dozen medical schools that have recently opened or might open across the country, the most at any time since the 1960s and '70s, according to the LCME.
The extra requests, which gave the LCME a way to weed out less-than-serious contenders, also meant prepping the school for a site visit from the accrediting body. Johnson organized a mock visit so faculty and others involved with the process could have a taste of what was coming.
"This was an unofficial opportunity for us to practice what it might be like, and I think everyone agreed that the mock site visit was horrific," McNamee said.
The group decided to push back the official visit a few months to regroup.
It paid off.
On June 3, 2009, Johnson got a phone call that the school had received preliminary accreditation and could begin recruiting students. There were cheers, hugs and smiles from the medical school staff gathered in her office.
The medical school has since been admitting its first class of students. They will be here for four years and pay about $30,000 a year.
But the start of classes in August won't yet signal final success for all those who helped make this vision a reality. The Virginia Tech Carilion School of Medicine won't be fully accredited until it graduates its first class.
"I can't say 'phew' until we've gone through every class and graduated our first class," Johnson said. "Because every year, now until then, we will be doing one of the years for the first time."