Dr. Clifton Meador is director of the Meharry-Vanderbilt Alliance. (Photo by Anne Rayner Pollo).
VU, Meharry tout success
at conference
In a manner symbolic of the effort they represented, a trio of speakers gave a joint progress report on the Meharry-Vanderbilt Alliance last week at the annual meeting of the Association of American Medical Colleges.
Dr. Clifton K. Meador, executive director of the Alliance, Dr. PonJola Coney, dean of Meharry Medical College, and Dr. Steven G. Gabbe, dean of Vanderbilt University Medical School, spoke in tag-team fashion to a roomful of physicians and medical educators on the topic “Two Cultures, Two Traditions: Issues and Progress in the Meharry-Vanderbilt Alliance.”
Moderator Dr. Bernett Johnson Jr. opened the morning session by speaking of the “great polarity” that existed between the institutions when he was a student at Meharry in the 1970s, but which is being dissipated as a result of the Alliance.
“Now we have a fusion of the institutions by this alliance of the two medical schools, one a majority institution and one a minority institution,” he said. “You might think that black and white would make gray, but I think it’s made blue and yellow and orange instead. It’s truly an alliance for progress.”
Meador told the audience he jumped at the opportunity to be involved with the Alliance, largely due to the leadership of and mutual trust between Dr. Harry R. Jacobson, vice chancellor for Health Affairs at Vanderbilt, and Dr. John E. Maupin, president of Meharry. At the time he was approached about directing the effort, Meador, a former dean of the School of Medicine of the University of Alabama at Birmingham, had just retired from 25 years service as chief medical officer at St. Thomas Hospital in Nashville.
“I grew up in the deep South,” he said. “I was in Alabama when George Wallace was there and suffered him. When I talked with Harry and John to find out why they were doing this, Harry said ‘Because it’s just the right thing to do.’”
Discussions between Maupin and Jacobson about an alliance started in 1998 and, Meador said, the dedication was notable. “If I’ve ever seen a clear example of leadership this is it. In the four years that have followed, at no time has Dr. Maupin or Dr. Jacobson wavered one bit.”
Out of those initial discussions came the five initiatives that served as the foundation for the Alliance, and still exist in modified form: sharing clinical services, sharing library resources, sharing biomedical research and training grants, sharing post-graduate residency and graduate education, and community outreach. The aim is that the expertise and experience unique to each school spill over to the other, and then out into the community that supports them.
Meador described in detail the efforts in community outreach that have resulted in the formation of the Nashville Consortium of Safety Net Providers. Because both Meharry and Vanderbilt clinics and emergency rooms were providing an “unusual load of uninsured or uncompensated care,” the Alliance decided to reach out to the five major community health centers, including Matthew Walker Comprehensive Health Center and United Neighborhood Health Services. Discovering that trust within that community was low, Meador recruited the help of Dr. Stephanie Bailey, director of the Metropolitan Public Health department.
Bailey, who is a Meharry graduate, quickly allied the five clinics and then moved the consortium to 23 clinics across the county, all of them providing care to the underserved. The goal is to find a medical home for the uninsured population among the 23 clinics, to provide transportation where needed, and to provide medication.
The consortium has been so successful, Meador said, that the hospitals have agreed to pick up the cost of the care coordinators on a continuing basis. The group will soon be able to track emergency room visits, documenting both the type of emergencies seen and patient demographics of the uninsured population.
As he turned the podium over to Coney, Meador noted that the contagion of enthusiasm for the Alliance is spreading to a new generation of leaders.
“The leadership is shifting in a top down direction from Maupin and Jacobson to Dean Coney and Dean Gabbe, who have given a new breath of life to the Alliance,” he said.
Coney, who began her appointment at Meharry six months ago, said that Maupin had made his commitment to the Alliance very clear to her before her arrival in Nashville.
“That commitment is understood by our faculty, staff, and students, and we expect each of the institutions to maintain its independence and unique identity,” she said. “The challenge is an easy one. We find ways to share and benefit equally from the resources of both institutions to support research and medical education initiatives.”
Coney presented a side-by-side comparison of the curricula for the four years of both medical schools. The third- and fourth-year calendars for the two schools were first synchronized in 2002; the entire calendar has been synchronized for the coming academic year.
Coney mentioned a number of cooperative programs that are in place, including the Dean’s Lecture Series, presenting nationally recognized speakers on the art of medicine, and the Community Scholars Program, in which selected medical students design and complete community-based summer research projects. This past summer, nine of the 12 participating students were from Meharry.
Coney also highlighted the shared resources between the institutions, citing as examples joint library privileges and the numerous secondary and joint faculty appointments that exist.
In his turn at the podium, Gabbe voiced his own commitment to the Alliance, saying the initiative stood out as one that particularly attracted him during his recruitment to Vanderbilt. “It’s something I feel very, very strongly about,” he said.
Gabbe began by reviewing issues in residency education. Currently, the cap imposed by Medicare funding on residency positions at the Metro General Hospital at Meharry is 36, even though the estimated need is for 70-78 residents. The Alliance has thus far sponsored nine new residency positions; there is a plan to recruit, over the next five years, 42 new clinical faculty members.
The Alliance has made strides in building joint graduate level training programs and shared coursework. Vanderbilt faculty members teach basic science courses at Meharry, and Meharry graduate students take part in the cancer biology class offered at Vanderbilt. Dissertation committees have membership from both schools, and joint retreats are held.
Collaborative research has been a tremendous success, Gabbe reported. Since 1992 Meharry and Vanderbilt have received a combined $101 million in joint funding, $83 million of which has been awarded since the establishment of the Alliance in 1999.
“These are opportunities that neither one of the medical schools individually would have been able to take advantage of,” he said, “because many of these are training grants and research opportunities to examine health care disparities.”
The Alliance has 19 active institutional research training grants currently, five of which were funded this past fiscal year, that range from summer programs for undergraduates to physicians-in-training programs. Six of the training programs are dedicated to underrepresented minority students.
“We have decided in the Alliance to focus on racial and ethnic disparities, particularly in health outcomes in cancer, diabetes, and HIV-AIDS,” said Gabbe. “We’ve agreed to establish a national health outcomes conference series, and our first national conference will be next year on diabetes.”
Nearly half of all the research grants that the Alliance has received in the last year and a half have been dedicated to studies in health disparities. Examples include the Southern Community Cohort Study, a $22 million award over five years to examine why African Americans die from cancer at a much higher rate, and the Diabetes Improvement Project, where teams of investigators from Meharry and Vanderbilt are working with community clinics to study diabetes treatment and management in the underserved population.
At the conclusion of the session, the three speakers fielded questions from the audience, most of them about how and why the Meharry-Vanderbilt Alliance succeeded where others had failed. Without exception, the panelists identified the trusting relationships and mutual commitment among the administration, staff, and board members as key to their success.
“It’s pretty much a relational thing,” said Meador. “The only impediment I see now is money — not having enough to match all of the opportunities we can conjure up.”