Friday, January 25, 2008

A Look at the Present and the Past

There's no denying that OHSU has been much in the local news lately, as ramifications of the ruling on the tort cap are made public. In times like these, I find it profitable to look at records of the past to attain some historical perspective.

What struck me today was this little pamphlet from December of 1957, just a shade more than 50 years ago, which was produced by the Research Committee and the Dean's Office of the University of Oregon Medical School in order to promote expansion efforts.

The jazzy cover captures the excitement and potential of the new space age; I love the way that cover image contrasts with the "sphere of influence" diagram: it looks like it's raining across Oregon, Idaho, and parts of Montana. (New state motto? "Oregon: we've got enough rain for three states!")

But the numbers presented along with the charts are telling:
The population of the State of Oregon is 1,760,000
The population of the City of Detroit is 1,890,000
And, we are told, the state population was expected to increase 43% by 1975 while industry diversified, leading to an increased demand--and increased support--for "the research, education and service functions" of the University. Recognizing this trend, the State Board of Higher Education had just "adopted the new policy of increasing the service and educational potential through the creation of a core of full-time faculty members in each of the clinical departments."

As the brochure dryly notes: "This decision had unforeseen secondary effects. GOOD FACULTY MEMBERS ARE ALSO INVESTIGATORS." So, the University began to run out of research space. The idea, supported by the argument presented here, was to increase the size of the facilities at UOMS to achieve a research population of 461 by 1967 and a research population density of 148 sq. ft. per investigator.

So we see that even in 1957, research was driving clinical innovation and more and more clinicians were conducting research and space was becoming an issue. Today, as we look at the NIH grant rankings and consider the enormous amount of clinical care still being conducted on this tiny parcel of land atop this Hill, we can see how a major event such as the loss of the tort cap sends ripples throughout the entire enterprise.

Just last week, a longtime faculty member was telling a group of listeners that Dean David Baird and the 45 or so full-time faculty on staff here at UOMS in the 1950s and early 1960s had decided that if they could not compete with the big medical schools in grants and research--and it seemed clear to them that they could not compete, with a state the size of the city of Detroit to support them--if they could not compete in research, they would become the best in clinical care. The Best. And for a time, they may very well have achieved that goal, with Howard P. Lewis in Medicine and J.E. Dunphy in Surgery molding a culture of caring that was nationally recognized.

Well, we have begun to compete with the big schools in research, and we still strive for clinical excellence (both of which then feed into the educational mission). The loss of the tort cap, representing indirect state support to the tune of about $30 million per year, represents a significant change in the university's fiscal landscape.

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