University of Minnesota

Academe, Nov/Dec 1999 by Miller, Robert F

In the name of accountability, Minnesota's administration tried to "re-engineer" the medical school, but undermined it instead. The teaching hospital was sold without faculty consultation and tunure nearly eliminated.

FROM THE 1970S UNTIL THE 1990S, THE UNIVERsity of Minnesota's medical school ranked among the top twenty medical schools in the country, based on research grant dollars awarded from the National Institutes of Health (NIH). In the 1990s, however, a scandal provoked doubts about the medical school's integrity and gave rise to an attempt to reorganize the College of Medicine. Relying on the business model known as "re-engineering," the reorganization eliminated faculty governance in the medical school and ultimately led to the sale of the teaching hospital in 1997. In the last two years, the medical school has slipped from twentieth to twenty-sixth in the NIH ranking. This drop is greater than any other over the twenty-year period from 1970 (when the ranking was fifteenth) to 1990 (when it was nineteenth). The medical historian Leonard Wilson, who wrote Medical Revolution in Minnesota: A History of the University of Minnesota, agreed in a conversation we had recently that the sale of the hospital was the single largest disaster in the hundred-plus-year history of the institution. How did it happen? Can the medical school recover?

The creation of the American medical school represents one of the twentieth century's great institutional achievements in professional education. From its formation in 1888, the University of Minnesota medical school was a pioneer in fostering historic innovations in medical education and training. These changes were initiated by William Welch of Johns Hopkins University in the 1890s. Hopkins was the first American medical school to have its own teaching hospital and emphasize strong science education for physicians-in-training.

In 19 10, Abraham Flexner, a nonphysician teacher, was commissioned by the Carnegie Foundation for the Advancement of Teaching to survey medical schools and make recommendations for improvements in medical education.

In 1911, the year that Flexner's report appeared, the University of Minnesota medical school opened its teaching hospital, the Elliot Memorial Hospital, on the banks of the Mississippi River. Flexner knew about the progressive developments taking place at the University of Minnesota based on his visit to the medical school in 1909, and he praised the institution in his report. Thus Minnesota's medical school helped to advance and sustain the new American model for medical education and research.

In the eighty-five years following the opening of Elliot Hospital, growth and development at the University of Minnesota medical school encountered several setbacks. The most serious began in 1913, when George Vincent, the president of the university, failed to support needed expansion of the medical school and its treatment facilities, Recovery from this "active neglect" began in the late 1920s, but the medical school never regained the elite status it enjoyed at the beginning of the century (it was once touted as among the top four or five medical schools in the country). This early disaster for the medical school was not to be the last time that poor or vindictive administrative leadership would greatly diminish the school's stability and stature. Re-engineering in the 1990s would far outdo the disaster under Vincent.

Expansion and Financial Pinch

AFTER WORLD WAR 11, FEDERAL SUPPORT FOR RESEARCH expanded. American medical schools benefited through increased revenues from the NIH, which helped them show the world how to carry out biomedical research and implement new discoveries in clinical practice. At Minnesota, the post-World War 11 expansion of the medical college led to historic developments in basic science and clinical medicine, including the first open-heart surgery and pioneering innovations in organ-transplant surgery. Even today, the department of surgery at the university ranks as one of the outstanding surgery departments in the country.

Once the Great Society programs began in the 1960s, Medicare and Medicaid provided increased revenue that flowed into the university's clinical departments and put pressure on the university to construct a modern hospital facility. Although it proved difficult to finance, a new university hospital was completed in 1986. The clinical departments continued to prosper until the late 1980s, when their revenue began to erode under federal budgetary constraints.

But a sharp decrease in federal revenues was not the only threat to the financial stability of the medical school. In the late 1980s, under Nils Hasselmo, the new university president, the central administration began, through a process labeled "reallocation," to withdraw millions of dollars from the medical school to rebuild a long-neglected undergraduate education program. This reallocation was financially stressful to the medical school at a time when income from all sources was strained. In addition, the rise of health maintenance organizations began to draw patients away from the medical school hospital, placing extra pressure on the university to sustain its patient population. The hospital continued, however, to show a profit until the time of its sale in 1997.