February 28, 1997

Vice Chancellor reflects on 16 years at VUMC

The following is the text of an extensive interview with Dr. Roscoe R. Robinson, Vice Chancellor for Health Affairs, about his upcoming departure.

Why are you stepping down?

There comes a time in the leadership of any organization when its time for that organization to have the benefit of new ideas, fresh thoughts, a re-assessment of the objectives and directions. Sixteen years, I think it's timely that I step aside.

I feel really good about the Vanderbilt Medical Center. And, by any objective criterion, we've had a wonderful run over the last 10-15 years. I think that the medical center is poised well for its leap to the next plateau. Despite the tumult and change in the health care delivery market, the medical center is exceedingly well-positioned to cope with those changes.

For me, now is the time for a good stopping point. It's simply time that I stepped aside.

What will you do?

I don't have any final plans. I hope to continue to serve the university in some capacity. But first, I wish to get out of the way of my successor, and toward that end the university has generously agreed to let me have a sabbatical leave. I've never had a sabbatical in almost 40 years of university service. I'm looking forward to that. Ann and I have talked about spending some time with good friends in England, and we have very good friends all over Europe in nephrology. We talked of spending some time there to learn the current state of medical practice in Europe.

Sixteen years ago when you came here, what did you think when you first saw VUMC?

Well, I had long ago decided to cast my lot with private American medical education as opposed to working in a public university.


I felt that the private sector offered increased flexibility and more opportunity for one to do one's thing. I traded that opportunity for what many at the time thought was the greater financial security of being in a public institution, with guaranteed salary and personnel lines in state budgets.

In a private university system you have to do it on your own. There's no one out there to support you if you fail, or to pick you up if you stumble. Over the years, I had looked at a lot of job opportunities around the country; either a chairmanship of a department of medicine or a deanship or a job like this one. I was asked to look at such jobs at maybe half of America's medical schools over a 10-year period.

Nevertheless, I could never come to grips with leaving Duke. I had considered it a couple of times, but never seriously. I'm not sure why I decided to come to Vanderbilt. I had grown up as a youngster with Vanderbilt in the family lore. My mother was a Tennessean, but I grew up in Oklahoma. My maternal grandparents were from East Tennessee. My mother once taught in the Demonstration School at George Peabody College for Teachers. That is where she met my father, who was there working on his Ph.D.

I also had two uncles who had graduated from this medical school, one of whom practiced surgery in Nashville. So I grew up with Vanderbilt stories. My older sister had lived as a youngster in Nashville while my father was in school at Peabody. I didn't know anything about Vanderbilt and Nashville but I applied to medical school at Vanderbilt and was admitted by Sam Clark, who was then director of admissions. His portrait was hung in 208 Light Hall.

My father died about the time medical school was about to start and I didn't think I could afford the tuition. So I went to the University of Oklahoma instead. It was purely a financial decision, otherwise I might have been in Joe Ross' class at Vanderbilt, class of '54. I received the nicest letter from Sam Clark after I wrote and told him I wasn't going to come.

So, anyway, I did decide to come to work at Vanderbilt. One thing that had always been important to me as I looked around the country was the chance to be part of a university. I especially liked those universities whose medical center was on the same campus, like Vanderbilt. Further, Vanderbilt had just built a new hospital, and I didn't have to go through that again. I had just been through that at Duke.

But most importantly, when I at Vanderbilt, I could see that it had a core of faculty that really understood the meaning of the most abused word in the English language, namely "excellence." It was identifiable. You could get your hands around them. And although the Vanderbilt Medical School had had its good times and its bad times and its challenges, it had never really lost its commitment to quality.

I felt that it basically wanted the right things: it was committed to research and education; the medical center was on the same campus; and I felt that the board of the university was supportive. Looking back on it, I suppose if I took a chance, it was accepting the job knowing there was going to be a new chancellor in a year. And you know the funny thing is, I can't even remember worrying about it. That makes me worry about my ability to evaluate anything.

So those are some of the things that made Vanderbilt attractive to me. It seemed to provide an opportunity to refurbish the faculty and re-affirm the rich traditions of this institution academically. I seriously under-estimated the resources that would be necessary to do that job, and as it turned out, the resources really weren't there. They had to be created. There wasn't even the beginning of enough space to accomplish the job that needed to be done. My first year here I even wondered if it was possible.

Today, this is an exceedingly strong medical center. If I made one mistake, it is that I have not worked hard enough at acquainting the local community and the rest of the nation with the fact that this medical center is such a major player in research and all of the other programs of an academic medical center. I have never done as good a job as I would have liked to have done in explaining to all constituencies outside the medical center just what an academic medical center really is, and its value to the nation. Can you imagine our country without institutions such as ours? Institutions that produce all of the doctors, most of the nurses, and carry on the bulk of the nation's basic medical research, and provide the largest percentage of unique special services.

I'm very proud of the fact that the responsibility for carrying out this nation's commitment to basic ‹ underline the word basic ‹ medical research was placed on the shoulders of the faculties of American medical schools. In that respect this institution is a major player on the national scene, far more than sometimes seems to be recognized, locally or regionally.

The National Institutes of Health is a major funder of basic biomedical research and four of our basic science departments rank in the top 10 among counterpart departments in 125 medical schools across the country.

I'm proud of the fact that U.S. News and World Report says we're number 14 among 125 medical schools. I honestly think we're a Top 10 school.

I'm proud of the fact that the Vanderbilt Medical School has maintained a wonderful commitment to the prosperity of medical students. Dean John Chapman and his team deserve great credit for that fact.

I'm proud of the fact that we were number one among al 125 medical schools in terms of the satisfaction of last year's national class of graduating medical students with their curricular experience.

I'm proud of the fact that U.S. News and World Report says that Vanderbilt Hospital is the top hospital in Tennessee.

I'm proud of the fact that our research enterprise ‹ the growth of grants and contracts in support of research ‹ has grown from less than $20 million to $120 million a year. The total investment in research at Vanderbilt is probably double that figure.

I'm proud of the fact that we are a national leader in the production of advanced nurse practitioners.

I'm proud of the fact that our School of Nursing is setting the pace in bringing on-line nurse-managed primary care clinics.

I'm proud of the fact that we have been able to add more space for the clinical and academic enterprises in the last 10 or 15 years than in the preceding 50 years of this medical center.

I'm proud of the fact that we have grown, in the medical school, from 450 to almost 1,000 full-time faculty.

I'm proud of the fact that in the medical center today, there are working, including house staff, more than 1,500 M.D.'s.

I'm proud of the fact that the medical center contributes $1.2 billion to the Nashville economy.

I'm proud of the fact that the medical center alone is the largest private employer in Nashville.

I'm proud of the fact that the medical center and her people have contributed so generously in support of many of the activities in this community.

I'm proud of Vanderbilt Children's Hospital and I'm equally proud that we are the only full service facility in our region.

I'm proud of the fact that our commitment to primary care has grown tremendously over recent years, reflected only in part by our growth in adult primary care and our commitment to the creation of a Department of Family Medicine.

I'm proud of the fact that the Vanderbilt faculty operate almost 100 specialty clinics, and that our specialty services are second to none.

I'm proud of the fact that thus far we have been able to maintain our commitment to the region's poor, despite increasing financial hurdles.

I'm proud of the fact that Vanderbilt Hospital has worked so effectively to become increasingly price competitive, patient friendly and quality driven. And I'm proud of our new credo and all of those signatures on the wall in the hospital.

But, most of all, I'm proud of our people, faculty and staff. They make us go.

Do you want to be remembered by your peers, colleagues and friends as a top-notch physician, a scholar, educator, or a person who has taken a medical center to the heights that you have taken VUMC?

You know, one of the wonderful things about academic medicine is that it has provided me with an opportunity to do all of those things. And I have loved it all. I enjoyed being a doctor. I enjoyed working in a research laboratory. I enjoyed teaching. I have enjoyed administration. It has been a wonderful opportunity.

So, I'd like to be remembered as someone who tried his hand at all those things and at a given time in my life I'd like to think that I did each of them reasonably well.

I'd like to think that when I was taking care of patients that I was a good doctor. I'd like to think I was a good teacher, an acceptable researcher. And I'd like to think I was an acceptable leader of an academic medical center ‹ at different times in my life.

If a medical student came in here to you and he or she was going to graduate next week, what piece of advice would you give, knowing what you know in today's health care climate?

I think the excitement of being a physician is still there despite all the changes. Some of the changes that are occurring have been difficult for some in my age group to accept or understand. I am enormously impressed that young people remain committed to the true precepts of the ideal physician, as most did in my generation. There is tremendous individual reward in the practice of medicine. And so if you wish to be a physician, and care for people in health and disease, I think it's a wonderful career opportunity and I would encourage all to look at it.

Medicine provides such wonderful opportunities to do so many different kinds of things ‹ community practice, specialty practice, primary care, military service, government service, academia, business ‹ all those are opportunities for the physician. So pick your choice.

So, do you miss being a doctor?

Yes. A little bit. When I first came to Vanderbilt, I tried to do a little teaching ‹ clinical teaching. But I finally realized that's not what Vanderbilt was paying me to do. That was for me alone. And it just became harder and harder. But, in the end, I believe that people end up doing what they want to do. I was ready to leave clinical medicine. It was hard because I liked being known as a clinician. I liked that. And the farther I've moved away from involvement in clinical practice, I've missed being known as a clinician.

Why did you pick nephrology?

That goes way back. I was in medical school and someone introduced me to the writings of Homer Smith when I was a fourth-year medical student. Homer Smith was the father of modern renal physiology. He had written a book called The Kidney, a wonderful book. I became attracted by that, and after some of my house officer training at Duke, I looked around. "Nephrology" was a word that had not been coined yet. Nephrology as a specialty and discipline really didn't come on-stream until 1960 when Belding Scribner in Seattle dialyzed the first patient on an artificial kidney ‹ chronic dialysis.

Up until that time dialysis had only been used for people with acute renal failure. His was a landmark presentation in Atlantic City. Gosh, it was standing room only. You can't imagine the impact that that had. Front cover of Life magazine. I mean, it was major stuff.

But even before that I had become interested in the kidney. I thought about other fields, but that gave it a big impetus when I returned to Duke around 1960. It was about the same time.

I made one personal choice when I came to Vanderbilt. I had been involved on a national and international stage in my chosen discipline in nephrology, I had been head of the American Board of Nephrology, president of the American and International Societies, editor of their major journal, and all those things. I decided when I came to Vanderbilt, I was going to turn all my attention, to the best of my ability, to the development, growth and prosperity of the Vanderbilt Medical Center. I wasn't going to spend a lot of time trying to dance on the national scene in administrative or public policy. My challenge and focus was going to be the leadership of this medical center.

The job is never done in a place like this. I said one time to (the late Chairman of the Vanderbilt University Board of Trust) Bronson Ingram, "You know, my successor will look around the place and say, 'Gosh, I wonder why ole Dr. Robinson didn't do this or that? Any idiot can see it needs to be done.' "

Well, I'm leaving a lot of things at Vanderbilt that need to be done, that anyone can identify, including me. A lot of them are working, headed in my judgment in the right direction. Others have not yet been addressed.

But even so, I feel that we have been able to address a lot of things, and one of the things that makes that easy for me has been the collegiality of this institution.

I don't consider this retirement. All I'm doing is stepping out of this job and going on a sabbatical. On my return, I want to stay available and useful to this university in any way possible.

Can you give me a ballpark figure of how much development or endowment has been bestowed upon VUMC since you came here in 1981?

The number of chairs is a good index. In terms of fundraising, I think there were about eight chairs when I came here. If you count the ones that are committed, the ones we know are going to happen, it's almost 50 today.

To a lay person, what does a "chair" mean?

An endowed chair provides permanent financial support for faculty from the income of at least $1 million. They are permanently endowed.

But what about total fundraising?

It has grown for the medical center from $5 million to $8 million a year to about $40 million in the current year. Approximately 65 percent of the university's revenue is in the medical center. The medical center budget has gone from nearly $160 million in 1981 to $700 million today.