Med school is a cut above
SIU School of Medicine remains a leader among medical schools worldwide
Founded in Springfield in 1970, Southern Illinois University School of Medicine has seen 2,818 students graduate (with 42 percent of those currently practicing medicine doing so in Illinois). That same year, the medical school – part of the overall Southern Illinois University system, with campuses in Carbondale and Edwardsville – began partnering with the former Springfield Memorial Hospital (now Memorial Medical Center) and St. John’s Hospital (now HSHS St. John’s Hospital) as part of its mission as a clinical “safety net” institution, providing health care for underserved patients throughout central and southern Illinois. Along with medical education and health care, SIU is also a world leader in medical research, with groundbreaking work in the treatment of Alzheimer’s disease only one jewel in its crown.
“We are the only medical school in the history of American medicine to get full, consecutive eight-year accreditations with no citations,” said Dr. Jerry Kruse, M.D., who serves as dean and provost of SIU School of Medicine as well as CEO of SIU Medicine, the institution’s clinical division. Recently, the Southern Illinois University system has undergone a major administrative facelift, with Kruse having taken over as dean of the medical school at the beginning of 2016, right around the same time as Randy Pembroke took over as chancellor at SIU Edwardsville. Most recently, Carlo Montemagno became chancellor at SIU Carbondale. “From an academic standpoint, that’s the SIU leadership team for President Randy Dunn,” Kruse said.
There are other changes in the SIU air, some administrative, others more cosmetic. “You’ve probably noticed the change in our brand, from green to purple, along with, the new logo and the ‘Forward. For You. tagline,” said Dr. Harald Lausen, chief medical officer at the school of medicine. “We have also initiated a reporting system internally so that anybody with an SIU email account can send us a report on anything that they see that is a quality or safety issue for a patient or an employee.” Lausen says that the number of reports making their way through the new system is ever-increasing, but they consider this to be a good thing. “The only way you can work on improving is if you know what’s going on. It could be something as simple as, ‘We saw a rip in the carpet over here and we’re afraid somebody’s going to trip’ or something far more serious. We’re trying to bring everybody up to a higher level.”
For the school’s employees, a recognition program called “Forward Together, ” echoing the outward “Forward. For You.” catchphrase, has been started.Lausen says the program focuses on internal safety and involves periodic raffles and other rewards.
As with all Illinois state institutions, the school of medicine suffered under the recent budget impasse but things are starting to get somewhat back to normal, according to Kruse. “We’re now operating with state funding at 12.25 percent less than we did in fiscal year 2014,” he said. There are a couple pieces that still remain very difficult, he says, including the fact that the school still hasn’t been paid for care provided to state of Illinois employees.
“We are now about 500 days behind for that one.” Being a community-based medical school, he explained, means that SIU doesn’t own its own hospital, instead relying on its formal affiliation agreements with Memorial and St. John’s, which are even further behind on receiving their state payments than the school is. “Since we work in a collaborative arrangement, when they have that kind of issue it certainly affects us as well,” Kruse said.
Also included in the new state budget was a significant pension shift regarding medical doctors, which Kruse said disproportionately affects schools of medicine beyond other state institutions “Our teachers are by and large physicians and so that’s been a difficult one to budget for as well. Our budgetary issues and challenges continue but they aren’t as bad as they would have been without a state budget for sure.”
Some things that had been neglected during the state budget impasse, including leaving positions unfilled, have since been addressed. “I think we, as an institution, were about to hit the wall with that – everybody had done about all they could do at that point and it was good that the budget arrived to release the pressure valve on those kinds of things for sure,” he said. “A much greater portion of our entire budget consisted of state funding 10 years ago than it does right now.”
Lausen described a recent safety and service program being implemented at the institution’s clinical sites which has been a particular success. “We go through, on an ongoing basis, and look for anything that would be a potential quality or safety risk,” he said. “We’ve had a phenomenal improvement in our implementation of HIPAA (Health Insurance Portability and Accountability Act of 1996) privacy issues – we’re much better than we were and patients are happy about that. We’ve had some really phenomenal results which at the end of the day results in safer patient care.”
“When the school of medicine was founded,” Kruse said, “one of our core foundational principles was social accountability to the people of southern and central Illinois – that’s 66 counties, 2.2 million people.”
In the state of Illinois there are two “safety net” state medical schools, Unversity of Illinois and SIU, with most of U of I’s activity centered in the Chicago area. “Both schools, as safety nets, are dependent on additional funding,” explained Lausen. “That means we can see the disproportionate share of Medicaid and Medicare as well as underserved patients. That’s who we are there for, ultimately.”
Kruse has had a front-row seat for the ongoing controversy surrounding the Affordable Care Act (popularly nicknamed “Obamacare”), including the national circumstances which led to its creation. “In the late 1990s in this country, we weren’t positioned very well,” he explained. “Health care in the U.S. cost a little bit more than in most countries, our outcomes were a little less than you’d expect for that cost and we had a lot more people uninsured.” This was followed by a period which Kruse characterizes as “the decade of shame” for American medicine, which lasted through 2008. “The gap between the United States, for the amount spent on health care, became wider and our overall outcomes – particularly for people aged less than 65 – became dramatically worse compared to the rest of the world. Our number of uninsured grew even higher. It got up to almost 50 million uninsured at one point,” he said.
Given this, it is unsurprising that Kruse saw the passage and implementation of the Affordable Care Act in 2010 as a positive development. “The idea was that it would authorize and appropriate things as a start and that then there would be a need for continuing, ongoing legislation to fix some things that weren’t exactly right.” Of course, further legislation was not forthcoming, and despite the current administration’s ongoing attempts to repeal the ACA, there continue to be positive outcomes for SIU’s clinical wing.
“We actively sought out people in the community who would qualify for the health insurance marketplace or expanded Medicaid and worked very hard to get them signed up,” said Kruse. “We saw dramatic declines in emergency department use, our number of uninsured went down by more than 80 percent and bad debt went down by more than 80 percent.” Kruse said that for the country as a whole the insured rate is up from 82 percent to about 91 percent, leaving about 28 million still uninsured.
However, the recent tax proposal currently under review in Congress could lose any ground gained over the past seven years, according to Kruse, who points out that every version of the legislation has contained so-called Medicaid block grants. “This saves the federal government about $340 million over 10 years but shifts almost a trillion dollars, $900 billion, to the states over that period of time by doing these grants,” Kruse said. “Obviously, that money is going to become a state obligation.” The Congressional Budget Office (CBO) has reported that different versions of these plans could cause up to 35 million people who became insured under ACA to again become uninsured. “We might go above the 50 million uninsured we had before,” Kruse said.
The medical school continues to advance in terms of research, including innovative work on microbiome footprints. “Every person has a certain set of bacteria, viruses and fungi that live around various places in the body,” explained Kruse, “and when diseases are starting to occur, or are progressing, that footprint changes and we can now measure that footprint.” Doing so will provide information that could lead to better diagnostic tests for early detection of diseases such as endometrial, ovarian and prostate cancer.
Another foundational principle of the medical school was that of innovation in medical education and excellence in curriculum delivery. “The school of medicine started off by being the first of all U.S. medical schools to adopt a problem-based learning curriculum,” Kruse said. “We were also the first to use standardized patients for the senior comprehensive examination for our students.”
Most recently, the school completely changed its approach to the students’ “clerkship year” – year three of the curriculum, often considered the major piece of a medical school curriculum. “We’ve changed that to focus on shorter, hard-hitting educational experiences,” Kruse said “The student will see twice as many patients, they won’t have any tests at all, there won’t be any lectures and they’ll have a 15-week period of time where they can develop rotations that can help them with their career choice. All of the outcome indicators are better than we would have anticipated.”
Recently the Association of Medical Educators of Europe, which includes 92 member nations, invited two of SIU’s medical students to make a presentation about that curriculum. “We have amazing students,” said Kruse. “It was really fabulous. I was there for the seminar and there were people there representing 24 different nations. The people from Denmark were really, really excited about it. That program is just another way in which the SIU School of Medicine moves those things forward.”
“We want to continue to increase our path of improvement,” said Lausen. “The slope that we’ve had so far is good but we want to kick it up a notch and so we are dedicated to improving our services. There will be more to come. Keep an eye out for us.”
Kruse agreed. “With research, clinical service and the systems of care that we’re delivering to improve the health of communities and the teaching methodologies that we do, what we have is a well-rounded medical school that is making a big impact.”
Scott Faingold’s father, Carl L. Faingold, is a professor and chair in the SIU Medical School Department of Pharmacology as well as the longest-serving faculty member in the Southern Illinois University system. Scott can be reached at firstname.lastname@example.org.