Bridging the gap
UTHealth interim president Giuseppe Colasurdo navigates budget cuts & the futureof health care
After Dr. Larry Kaiser stepped down as president of the University of Texas Health Science Center in April, officials turned to Dr. Giuseppe Colasurdo to serve as interim president. With the search for a new president not slated to begin until next April, Colasurdo leads UTHealth at a pivotal time, with a smaller budget after recent legislative battles just as planning for the implementation of the new health care law revs up.
As dean of the University of Texas Medical School, the seventh largest in the nation, and a member of the UTHealth faculty since 1995, Colasurdo knows the in's and out's of the institution well. During a recent interview, he talked about doing more with less funding at the health science center, which also includes schools of public health, nursing, dentistry and biomedical informatics and sciences, and how he's bridging the gap between permanent presidents. Here are some excerpts:
CultureMap: What does it mean to be interim dean?
Giuseppe Colasurdo: I'm not sure I can answer what interim means. (UT System executive vice chancellor for health affairs) Dr. Shine told me to be Giuseppe and that's what basically I've been trying to do. I don't think the title keeps you from doing what you believe is the right thing. I believe that was the intent when they literally twisted my arm to fill in. It was also driven by a very difficult legislative session all the health-related institutions were facing. We did want not to miss a single beat.
CM: How would you assess how UTHealth did in the legislative session?
GC: We have a reduction of about $30 million, or about 9.14 percent, for the biennium, so it's a significant reduction when you compare it to 10 years ago. We will have to be very smart in finding new revenues to protect what we do. We made a strong case in Austin that we have a state that is growing tremendously and education and health care obviously are the foundation for any infrastructure.
In Massachusetts, you have 400 physicians for every 100,000 people. They rank No. 1. In Texas, you have less than 200 physicians for every 100,000. That puts us 42nd for the total number of physicians per population. For primary care, we're 47th. Our single most important item is to continue to enroll and train health care professionals in a growing state.
In No. 1 Massachusetts, there are 400 physicians for every 100,000 people. In Texas, there are less than 200 physicians for every 100,000. The state ranks 47th.
CM: How do you do that with such a sizable reduction in the budget?
GC: It's not easy. We will have to ask many people to do a lot more for less (money). The single most important challenge for us is to find dollars to fund competitive first class education. All of us, from all over the world, come to the United States for the best undergraduate and graduate education in medicine. There is no country like the U.S. And now we have to protect that.
CM: You originally came from Italy to do your residency at University of Texas Medical Branch at Galveston. Why did you pick UTMB?
GC: It was late 1988 when I came. I had some friends of my parents in Houston. UTMB had several unfilled positions. One of the most common specialties in Italy is pediatrics. Everyone wants to work with children. My intention was to train here and go back to Italy.
CM: How did that experience shape your career?
GC: You learn about the value of relationships with other residents, with faculty, with patients and family. I learned that operating as a physician in this environment really gives you unlimited opportunity to diagnose, to prevent and to treat, and you have to be able to do that now at a lower cost. The cost of quick innovation and new technology, that's what we are paying for right now. We have got to learn how to reduce our costs.
CM: What are some of things UTHealth is doing here to alleviate the health care crisis and reduce costs?
GC: The first thing is increasing enrollment. What you call the health care crisis is really a crisis of providers in a growing population. I will challenge you to find any institution in the state that has the infrastructure we have, with six schools. Our School of Public Health has grown nearly 40 percent in the last three years; the nursing school 20 percent. At the medical school, we get 4,000 applicants for 240 students. Ninety percent of our students have to be from Texas. The new state-of-the-art dental school opens in spring 2012.
Then there is the type of providers. We have an aging population. The geriatric doctor has become the primary care doctor. We have opened a center for the aging in Bellaire, and plan to open a half-dozen of them. In the next 18 months, we will have 20 sites in the community that are comprehensive primary care-based with needed sub-specialties.
One of the main challenge academic institutions have is the lack of primary care networks. It's not in the mission of medical schools to have a primary care network. Now at these six sites and others we will have a strong presence of primary care. We have recruited over 350 physicians into our group practices over the last four years. We don't employee them; we work with them. We assist them with the specialty needs they have to maintain that community. And if they like to teach, we offer them a joint appointment so they can come and lecture our students. We can send our students and residents into those sites.
And we are trying to be aligned more closely with our hospital partners, because most of the cost in health care occurs as you walk into the hospital building. The example I give, you have an asthma attack, you come to see me in the clinic. My cost to you will be $80-$100. If you walk into an emergency room in a freestanding hospital, that cost is estimated to be over $5,000. And you probably get the same medication.
CM: Are you interested in being a permanent president?
GC: Clearly I have been honored to serve this university but I really love my dean job. I have a tremendous attachment and pride for what the medical school has done. I accepted the (interim presidency) for 12 months and I will complete it and then go back into my dean job that I actually do every day anyway. When they say, 'Should I call you President or dean?' I say, 'I'm still a humble pediatrician. Call me Giuseppe.' "