Strings to the
he letter goes straight to the point. Written by John Burton, director of geriatrics, it calls on private-practicing M.D.’s who accept the plums that go with a Johns Hopkins faculty title to give back to the institution by participating in teaching, research, clinical work and/or committee activity.
For the first time in a lot of people’s memories, deans and department heads at the School of Medicine are determined to winnow their lists of community faculty to those who have a true commitment to the University ethos. “It’s something a number of department chairs have tried to do over the years, but it’s proved difficult,” admits Catherine DeAngelis, vice dean for faculty and academic affairs. “Once the title is bestowed, it’s viewed by some as a title for life.”
Of the 1,300 physicians on the part-time faculty roster, less than half take part in scholarly activities, estimates Gaylord Clark, the Baltimore County orthopedic surgeon who serves as assistant dean for part-time faculty. Many, in fact, received their honorary titles years ago as part of the institution’s effort to build networks with community physicians and haven’t crossed Hopkins’ threshold in years. But, Clark says, “It’s a question of fairness. If I’m a part-time faculty member spending 200 hours a year contributing to the missions of Hopkins, and I came across others with the same title who are doing nothing, I’d be damned angry.” A lack of involvement, he adds, doesn’t reflect well on the institution.
In pediatrics, after taking up the directorship, George Dover found that earlier department heads had accorded scores of local doctors part-time faculty status to build a feeder network of pediatricians without requiring them to do anything except refer patients. Like Burton, Dover is putting the issue before a standing committee of his department’s part-time faculty. “I’ve already discussed with them my discomfort with not having clearly defined criteria,” he says. “I may not make some people happy by doing this, but I’ll take that responsibility.”
Part-timers can contribute to a department in vital ways, Dover makes clear, pointing to one group of community pediatricians who have taken a lead role in advocating for child-health issues. “They’ve been willing to give conferences to my faculty and house staff about the importance of advocacy, and I consider that immensely important. Holding part-time faculty status should be a privilege that is earned. Many community physicians have sacrificed their time to do research and clinical work at Hopkins. I’m proud to call these doctors my colleagues.”
Not all the blame for lack of involvement can be put on community physicians, Dover acknowledges. “We’ve sent mixed messages to them because each department has different criteria for part-time faculty, and that’s created confusion.”
Burton, meanwhile, reports that his effort to get his part-timers more involved has actually gone rather smoothly. “None of them said having criteria is inappropriate, including those in private practice who felt they couldn’t put in the time and gave up the title.” Of the 19 part-timers in geriatrics, six have severed their faculty ties because their schedules simply wouldn’t allow them to meet the requirements. But those who remain, Burton says, make enormous contributions.
-- Patrick Gilbert
End of a Tradition
une came and went this year with no sign of an event that’s been a fixture on calendars here for as long as anyone can remember—the annual dinner meeting of the Medical Board of the Hospital. “I’d guess that it probably goes all the way back to the 1890s,” said Thomas Turner, M.D., who served as dean of the medical faculty in the ’50s and ’60s and has written extensively about Hopkins history.
Hampered in recent years by poor attendance, the Medical Board finally bit the bullet this year and decided to end its traditional get-together. The annual meeting became a victim of changes in the structure and style of Hospital administration, in the judgment of Chris Ponticas, who recently retired as director of medical staff services. In earlier eras, when the faculty was predominantly part-time and when the Hospital and School of Medicine were separate entities, the meeting drew overflow crowds eager to hear institutional updates from executives and to rub shoulders with such a broad gathering of colleagues. Today, the mostly full-time faculty enjoys numerous opportunities—from town meetings to social gatherings—to get that information and collegiality. “These are different times,” says Ponticas.
-- Jim Duffy
The Voice from the Back of the Hall
ver the last two years, the “y’all come” noontime town meetings introduced by Dean/CEO Ed Miller to keep faculty, staff and rank-and-file workers in the loop at this huge medical center (a “must-do,” according to business gurus) have become something of a fixture on campus. Still, by their very nature, the every-other-month get-togethers are pretty straightlaced affairs. Miller and Hospital President Ronald Peterson present updates on the institutional financial picture, talk about what’s going on throughout the health system and offer an overview of legislative developments in Annapolis.
During the meeting’s last 10 minutes or so, Miller does work hard to get some dialogue going with the audience, and presses for questions. His request, however, doesn’t usually draw an instant waving of hands, as speaking out in front of hundreds of strangers in cavernous Hurd Hall isn’t most people’s idea of fun. What follows, in fact, is often stark silence. Eventually, one or two braver types will ask for progress reports on such ongoing projects as on-site day care or tax breaks for mass-transit expenses. And that, generally, is that.
This summer’s otherwise staid town meeting, however, ended with a bit of excitement. During the Q & A, Miller spied a hand go up in the back of the auditorium and called on an intense-looking, dark-haired man. “I don’t know whether I’m supposed to be here or not,” the man began. “I’m the father of a patient. My daughter has cancer, and I moved my family up here six months ago from Atlanta because of the research behind the name Johns Hopkins.” The youngish-looking father then complimented the medical care his daughter was receiving but added that he had grave concerns about another issue. Why were conditions at the Children’s Center so appallingly shabby? “Children should have equal rights.”
Miller looked surprised for a second but didn’t miss a beat. Calling on George Dover, director of the Children’s Center, who happened to be seated about halfway up the center section, he asked the top pediatrician to address the point. Leaping to his feet, Dover made clear that replacing the outmoded pediatric facility (which opened exactly 35 years ago this summer) was at the top of his and most other Hopkins lists. “A new children’s center was part of what I worked out when I took this job in 1997,” he reassured the man from Atlanta. Institutional leaders, he said, are committed not only to putting up this building (actually a Women’s and Children’s Hospital) in the early 2000s but also to dedicating funds to upgrading the current structure so improvements can begin immediately.
The man seemed relieved, and everyone left feeling bolstered. Being able to encourage someone for whom Johns Hopkins has become the source of all hope made this not your run-of-the-mill town meeting.
-- Edith Nichols
New Man at the
Med School Gate
im Weiss didn’t become a renowned cardiology researcher and clinician to spend hours sitting through committee meetings. And yet, in the wake of the news that epidemiologist Leon Gordis was stepping down as associate dean for admissions (and thus chair of the committee that oversees who’s accepted to the School of Medicine each year), it took the reserved Weiss, the Michael J. Cudahy Professor of Cardiology, only a few hours to agree to Dean/CEO Ed Miller’s request that he take over the post, one of the most time-consuming committee assignments on campus.
Is Weiss a glutton for punishment?
Actually, after working on the committee for nearly a decade (most recently as vice chair), he’s more of a true believer in the cause. “I think this is the most important committee in the medical school,” he says firmly. “The whole tone of this place is determined by who comes here as medical students. So often, it’s those students who become the house staff and then the faculty members.
“Whom we select,” he continues, “can help shape the future of the medical institutions and, potentially, the leadership of American medicine.”
Colleagues are confident that Weiss will be up to the challenge. “He has all the attributes you need for that job,” says Dean Emeritus Richard Ross, Weiss’ onetime mentor. “He’s a good clinician, he’s done research and he’s good with people. He really understands the broader definition of the term physician.”
“He’ll bring a lot of fresh ideas,” adds Gordis, “but at the same time he’s been part of the process so there won’t be any discontinuities.”
Plenty of challenges await Weiss on the admissions front in the months ahead. Starting with the class that will enter in the fall of 2000, the School of Medicine is revamping its application process by requiring prospective students to file applications from the American Medical College Application Service, the standard in use at all but a handful of U.S. medical schools.
At a time when applications to U.S. medical schools are declining slightly, the switch to AMCAS is expected to nearly double the annual applicant pool at Hopkins, from 3,000 to 5,500. Such an increase may necessitate the introduction of computer-driven prioritizing to help a screening subcommittee select which 650 candidates win on-campus interviews, but Weiss still wants every application reviewed by a faculty member with admissions experience. “I know students personally—perhaps they did badly on their MCATs—who we might have missed had they been screened out by a computer,” he notes. “But if we set up our criteria and our process properly, we will miss very, very few excellent applicants.”
Beyond the switch to AMCAS, Weiss is not looking to make dramatic shakeups. “I think our structure is quite strong,” he says. “What it guarantees in our classes is not just a high degree of academic excellence but compassion and leadership and diversity.”
One procedural change Weiss would like to introduce is the addition of a second interview session with a committee member for each applicant. Such a move would require recruiting new members to serve on an expanded committee, which is one reason Weiss is looking for ways to spread the word that faculty members get academic credit for admissions work. If he can get new members in the door for a few meetings, Weiss is confident that they, too, will join the ranks of true believers.
To carve out time for his new post, Weiss has stepped down as director of the echocardiography lab and cut back slightly on clinical work. But he plans to continue as director of the Heart Station and of the cardiology fellowship program. “What I’ll probably end up doing,” he concedes with a wry smile, “is adding a few hours to the clock each day.
“Admissions work is really a lot of fun,” he adds. “The psychology and sociology of the process are truly fascinating. There’s no doubt that this is a totally different occupation from what I do in cardiology, but that’s what makes life interesting—brand new challenges.”
Report on the Kitchens of the Valley
t was wrong, we knew, to leave work at noon to ogle other people’s houses. But my office mate and I reassured ourselves that the $55 we’d paid for our tickets for the Great Taste Kitchen Tour (along with a prettily packaged box lunch) on this early spring day would go straight into patient care at The Johns Hopkins Hospital. This peek into the plush houses of Baltimore County was one of several fund-raisers sponsored by the hard-working members of the Johns Hopkins Women’s Board to support the Hospital.
So, burying our guilt, we headed into the lush countryside of the Greenspring Valley and before you could say Sub Zero, found ourselves in the midst of gently rolling hills that were a balm to our urban eyes. Beautiful estates lay far apart, secluded amid the greenery. Property lines, but for the occasional rail fences that ran like long white ribbons along the roadside, were impossible to identify.
Dutifully following the map that had been mailed to us, we navigated the curvy roads and turned into private drives marked by jaunty bunches of pink balloons proclaiming the 12 houses on the tour. Freshly mulched gardens perfumed the air; beds of pachysandra looked as though they’d been planted yesterday; urns of begonias were so fresh they’d obviously just been delivered from the garden center.
The kitchens were awesome—some spacious, slick and dramatic, others wearing cozy charm. They shone with sparkling black granite, oak floors with oriental rugs, glass-paneled cabinets with shiny brass pulls and elegant French faucets—but, remarkably, no evidence of cooking. Even the larger appliances were inconspicuous: refrigerators concealed behind cabinetry, stove tops blended with countertops, sinks were sunk, and microwaves were all built in.
How I love a house tour. At every turn, you feel surprised, charmed, inspired. It’s pleasant, it’s passive, it’s an experience you can simply surrender to and, spongelike, soak up.
For this tour, the Women’s Board, we discovered, nets nearly $20,000—not as much as from its coffee shops, or its fabulously successful gift shops and annual autumn Best Dressed Sale, but still, back by popular demand. The trick in setting up a tour, we learned, is in knowing who has the fabulous kitchens, the space for parking, the willingness to open her home to the public.
But kitchens were not all that were on view that day. Entire first floors, full of slipcovers and swags, were also fair game. And here no one, we discovered, really chintzed on the chintz. There were needlepoint rugs on gleaming floors,
and one house had floors so polished that visitors were instructed to don paper booties over their shoes before entering. My co-worker said it reminded her of the time she observed in the O.R.
When it was all over, of course, we both felt vaguely discontented with our own houses and sensed a new, restless energy mixed with admiration—and yes, a bit of envy. Which I expect is just what the women who thought up this fund-raiser were counting on. A bit of legitimate voyeurism can be a great way to raise a few dollars for a good cause.
-- Anne Bennett Swingle
ith physicians at academic medical centers pressed to see increasing numbers of patients, young M.D.’s are finding themselves with little time for carrying out the research necessary for advancing their careers. To combat this block to getting ahead, the School of Medicine has rethought its promotion process and is discussing creating two linked and balanced paths that would give clinical faculty both a professorial status and a professional one.
While their professorial appointment would allow them to move through the traditional ranks of Instructor, Assistant Professor, Associate Professor and Full Professor, the parallel steps on the professional side would be labeled Instructor, Clinician, Senior Clinician and Distinguished Clinician (this last title would hold the same contract to retirement and other privileges that a full professor currently enjoys).
Faculty physicians could advance up either path (the titles aren’t yet official)—simultaneously or at different times, but couldn’t be more than a step out of sync on the two tracks at any point—with rigorous criteria applied to each.
To move up the clinical path, for instance, would require demonstrated excellence in a medical specialty, as well as meaningful contributions to teaching and research. What it wouldn’t require is the level of acclaim in research publishing the professorial track traditionally expects. Clinicians could also reach the top of the two tracks at different times. And that, said Edward Benz, director of medicine and a member of the subcommittee that made the recommendation, is a fundamental difference from two-track systems found in peer institutions.
“This proposal doesn’t answer all our problems,” said Elias Zerhouni, executive vice dean and chair of the subcommittee. “What it tries to do is answer our own unique institutional needs.”
The proposal now goes to the agenda committee of the School of Medicine’s Advisory Board, which will decide whether to place it on the table for the full advisory board’s consideration. If the board approves it, the new system would require changes in the Gold Book, the manual defining policies and guidelines governing appointments, promotions and professional activities of the faculty. And that’s when the details will have to be spelled out. Gold Book changes require approval of both the Medical School Council and the Advisory Board.
eturning to his home in the Guilford section of Baltimore after a scientific meeting in Montreal last spring, psychiatrist Paul McHugh settled into a comfortable chair, relishing the chance to savor the latest issue of one of his favorite publications, The American Scholar, the prestigious quarterly put out by the Phi Beta Kappa Society. Little did he suspect that the moment would mark the beginning of the end of his long association with the magazine for which he’d served both as an occasional contributor and a longtime member of the editorial board.
Inside that Spring 1999 issue was an essay by James Trilling, the son of the late, renowned literary critic and Columbia University professor Lionel Trilling, in which the author—an art historian by trade—detailed a litany of his father’s shortcomings as a parent and person and attributed them to an undiagnosed case of attention deficit disorder. “It was an abominable article that breaks all the rules I have for psychiatric material,” says McHugh, the Henry Phipps Professor of Psychiatry and director of the Department of Psychiatry.
First, McHugh says, the essay offers a formal psychiatric diagnosis by a writer untrained in diagnostic techniques. Then, there’s the matter of a son settling old scores with a dead—and, hence, defenseless—parent. And, finally, there’s the question of whether the piece stigmatizes mental illness: “What he says is that my father was a stinker because he had A.D.D.,” McHugh points out. “What that means is that if you get A.D.D. you’re a stinker, too.”
A week after McHugh spent that decidedly un-relaxing evening with the Trilling piece, he appeared at a Washington, D.C., meeting of The American Scholar board and resigned. Within weeks, the Chronicle of Higher Education got wind of the contretemps and ran an article titled “Doctor Resigns Over Trilling’s ‘Diagnosis’.” That, in turn, sparked reports in Commentary, The New Republic, The Wall Street Journal, The New York Times and elsewhere on the famous psychiatrist’s response to the article.
McHugh was shocked by the force of the uproar. “It’s a tempest in a teapot, to some extent,” he says. “I loved being on that board and met some wonderful people there. I was very sorry to leave.” But he had no other choice, he adds—as long as the journal declined to seek his input on decisions about content as intricately related to his expertise as the Trilling piece. “That just makes me window dressing,” he says.
Beefing Up the
fter seven months of study, the President’s Council on Urban Health formed by University President William H. Brody has proposed the creation of an institute charged with helping the neighborhoods around the East Baltimore campus combat public-health woes and revitalize their communities. The institute should be an independent entity led by a full-time director reporting directly to Brody and bolstered by base funding significant enough to ensure its credibility, according to the recently released “Report on an Urban Health Initiative. (A full text of the report is available on-line at www.med.jhu.edu/urbanhealth.)
Priority number one for East Baltimore, it says, is reducing drug and alcohol addictions that affect 10 percent of the neighborhoods’ population and are linked to a number of the area’s other public-health woes, such as violence, heart disease, sexually transmitted diseases and unemployment. Other priorities outlined in the report include facilitating economic growth, developing new community-based health care facilities and lobbying on behalf of governmental programs with a proven track record. Next up for the council is developing a detailed business plan and financing strategies; it reports back to the University trustees in October.
Bringing Minorities to the Bench
altingly, Kerrick Nevels begins his presentation, his face partially hidden behind the report he’s discussing on a new influenza drug. In a barely audible voice, he recites a section of the text to the dozen or so fellow researchers seated in front of him, then he waits uncertainly while classmate L’Aurelle Johnson wrestles with a reluctant overhead projector.
Not the most impressive of starts, perhaps, but it is a start. And that is what this unusual internship program is all about—introducing minority undergraduates like Nevels to the rewards of research in basic science through a summer-long immersion at Johns Hopkins. Now in its fourth year, the program aims to encourage these college students to pursue careers as biomedical scientists.
“There is no joy like the joy of discovery in my opinion,” says James Hildreth, associate dean for graduate studies and director of the program. “I want more young minorities to know that joy.”
For decades, minorities have been underrepresented in the ranks of basic scientists. Take away historically black medical schools like Howard and Morehouse, and there are fewer than 100 minority basic science faculty among the remaining 117 U.S. medical schools: less than 1 percent of the total. In part, Hildreth attributes this to a paucity of role models.
“These students seldom have a chance to see scientific investigators as tangible models that they might aspire to,” he says. “They don’t get the chance to see what it is scientists do and to learn about their successes.”
The 22 young people in the 1999 program arrived on the East Baltimore campus in early June, hailing from as far away as the University of Hawaii and as nearby as northeast Baltimore’s Morgan State University and ranging in ethnic background from African American to Native American to Latino. Students immediately were paired with mentors—the 30 faculty members who volunteered for this role represent a dozen different departments—and assigned a research project for the duration of the nine-week session. In Hildreth’s Pharmacology and Molecular Science lab, for instance, Wade Ivy of Grambling State University in Louisiana set out to clone a gene that may help protect monkeys from SIV, the primate version of AIDS.
Every Tuesday afternoon, the young people leave their labs to attend Journal Club, where they team with a faculty member to present a scientific paper. That’s what Kerrick Nevels is embarking on in such uncertain fashion on this hot June day under the supportive eye of pharmacologist Ronald L. Schnaar. As his presentation progresses, Nevels rapidly gains confidence. Soon, he is flicking his pointer around the projection screen like an old pro and tackling detailed questions from Schnaar and audience members with instant citations of paragraphs and page numbers buried deep in the study.
There’s no doubt that such experiences are important in helping students decide on science careers. In 1997, Terri Taylor arrived for the program from Florida A&M University, uncertain of where her postgraduate education might lead. Because her summertime mentors “made science seem much less intimidating by making it fun,” Taylor is now a first-year student in Hopkins’ cellular and molecular medicine Ph.D. program.
Hildreth is gratified by such individual success stories, but he’s also aiming at the long term. “One of the things we try to impart to students is when they go out in their careers they should remember what effect the mentors here had on them and that they should provide mentorship in turn to the young people they interact with,” he says. “Then this thing will have a snowball effect and become self-perpetuating in the years to come. That’s the ultimate goal.”