Dean's Newsletter
Archive of previous newsletters
People, Space and Money: Part 1--Interdisciplinary research teams
November 09, 2006
We are out of space. (Temporarily!)
We have wonderful opportunities to recruit new investigators, but have little readily available research space in which they can work. Many current faculty are successfully expanding grant support for their research programs, but there is little readily available space into which they can expand. We have two hospitals that are 100+ percent full on any given day, with patients waiting for inpatient beds in the Emergency Department or en route through the Transfer Center, but we have no additional beds in which to care for them. Faculty members who have developed successful outpatient programs are attracting more patients to their practices, but our clinical office space currently available can’t accommodate further growth. And, if we wanted to expand the number of students in our medical educational programs, we would have to create new space in which this could be done.
An oft-repeated truism about a variety of enterprises, including medical schools and medical centers, is that success depends on people, space and money. It goes without saying that if there were unlimited funds available, more space could be constructed and more people could be hired. Problem solved.
Clearly, the unlimited budget solution is a fantasy; other solutions are needed. Indeed, we have a genuine space crunch that needs to be addressed in a fundamental manner. No doubt, this is the kind of problem others would like to have: the difficulties associated with having more funded investigators than readily available space in which to put them is preferable to having empty labs and the need to recruit investigators in a very tight funding environment; and having more patients seeking care at our hospitals and faculty practice offices than is possible to accommodate in the space available, while a critical problem, is preferable to a half-full hospital and many unfilled appointment slots in the schedules of our clinical faculty. Before we conclude that the only solution is simply to construct more space for research, hospital care and office practice, however, we owe it to ourselves to analyze the ways in which we currently bring together space and people—our physical and human capital—to advance our missions. Can we do it better?
In the next several newsletters, I will provide some background for such an analysis. Think of the main outputs of the medical school and medical center as our four mission areas. The key question before us is: How can we produce more and better research, provide improved care to more patients, provide better quality education to our students and house staff, and better foster community health, given the people, space and money available to us? Important related questions include: As we invest additional resources to advance our missions, what is the correct proportion in which people and space should be added? What kinds of people and what kind of space would be best?
The issue of space utilization has the greatest immediacy. In this multi-part newsletter, I will focus on research and patient care, the two areas in which space constraints are the most problematic. The topic for this week and next is research. In this newsletter, I will provide some historical context and then introduce the importance of multidisciplinary collaboration. Next week, I will attempt to provide a framework for thinking about people, space and money using some fundamental tools of economic analysis.
In the mid-1990s, under the leadership of Jay Stein, MD (then Senior Vice President for Health Affairs) and Lowell Goldsmith, MD (then Dean), the School of Medicine and Dentistry embarked upon a major strategic plan to increase basic science research. Plans were developed to renovate existing research space and to build two new laboratory research buildings. Between 1996 and 2001, 60,000 sq ft of existing SMD laboratory space underwent major renovations, and 385,000 sq ft of new laboratory space was constructed in the form of two new research buildings—the Kornberg Medical Research Building (KMRB, which opened in 1999) and the Medical Research Building Extension (MRBX, which opened in 2002). Since 2002, an additional 50,000 sq ft of SMD research space has been renovated. Moreover, a new, 85,000 sq ft facility that will house the University of Rochester Cardiovascular Research Institute (CVRI) is currently being renovated with a target opening date of Spring, 2007, and the new Wilmot Cancer Center, slated to open in Spring 2008, will contain two floors of clinical and basic science research space totaling 45,000 sq ft.
In addition, several departments were quite creative in their use of research space and available funds for renovation. Notable, for example, were the innovative approaches to space renovations led by Gary Paige, MD, PhD, Chair of Neurobiology and Anatomy, in preparing research space for at least 6 new faculty members. The Departments of Biochemistry and Biophysics, Environmental Medicine, Microbiology and Immnology, and Pharmacology/Physiology also used renovation funds to upgrade space for new and existing faculty in functional and cost-effective ways.
For a while, we had more research space than people to fill it. When I began as Dean in April, 2002, Drs. Stein and Goldsmith took me on tours of the empty floors in the new research buildings—Kornberg was only about 2/3 full, and MRBX was 3/4 empty. No doubt, there was overhead to fund—we needed to cover the costs of all the heat, electricity and maintenance of the new buildings. But more important, we embarked on an effort to recruit scientists who were not only superb investigators in their own discipline, but who would foster an environment of cross-disciplinary collaboration. Thus, using the Cancer Center as a model, research centers were created in which the different members hold primary academic appointments in a variety of departments, and the new (and renovated) laboratory space was constructed as "open" laboratories that encouraged collaboration among the scientists who worked there. It was also hoped that this collaborative spirit would cross the atrium from the new buildings into the old ones. The goal was not only to foster multi-disciplinary research, which was seen as the direction of science generally, but to improve the rate and quality of scientific output—that is, to bring together people and space with the amount of funds available to produce the greatest amount of high-quality science.
At first, the road was quite rocky because of a perception that a world of "haves" and "have-nots" had been created. Across time, however, collaborations began to occur and the overall scientific enterprise across the old and new laboratories began to coalesce. Indeed, as examples one can point to success in collaboration on many projects across the Center for Vaccine Biology and Immunology, the Department of Microbiology and Immunology, and the Divisions of Infectious Disease and of Rheumatology in the Department of Medicine; across the Center for Aging and Development and the Departments of Neurology, Neurobiology and Anatomy, Biochemistry and Biophysics, and Biomedical Genetics; across the Center for Musculoskeletal Research and the Departments of Medicine; and across the Center for Cardiovascular Research and the Department of Pharmacology and Physiology. Previous newsletters have described some of these cross-disciplinary efforts—for example, April 27, 2006 on the orthopaedic NIH Center of Research Translation (overall P.I., Randy Rosier, MD, PhD); and April 28, 2005 on the NIH Program Project Grant on the neurobiology of coordinated movement (overall P.I. Marc Schieber, MD, PhD).
More broadly, as another measure of cross-disciplinary work, some data are available from our research resource survey. Each P.I. is given a list of 22 keywords for disciplines that characterize a particular project, and is asked to check as many keywords as apply. In our last (2005) survey, of 1,526 projects, 318 had two keywords listed, and 280 had 3 or more keywords listed.
To make the best use of our existing research space, and the new or renovated space that will come on line in the years ahead, in my opinion we must extend this spirit of collaboration even further across our entire research enterprise. There will always be a role for R01-based one-scientist laboratories—indeed some of the most fundamental discoveries emanate from such laboratories—but in thinking about bringing together people and space to produce the best research in the medical school as a whole, we must be mindful of the direction in which science is headed, as reflected in the direction taken by NIH.
Dr. Elias Zerhouni, Director of NIH, has often commented that the extramural academic world has been entrusted with much of the money appropriated by Congress to the NIH. In fact, 83% of the NIH budget goes to extramural research. In a 2003 speech at Dartmouth that represented a preview of what was to come, he stated that: "The landscape of disease has changed. Twentieth-century medicine was very successful in dealing with acute lethal conditions, but today's health care system is experiencing a growth in chronic long-term conditions as the population is aging. Important priorities include accelerating the pace of life science discoveries and developing novel approaches to disease that are orders of magnitude more effective than current approaches." To do this, Dr. Zerhouni has emphasized—both in public presentations and in setting funding priorities—a re-engineering of the research enterprise and building cross-disciplinary research teams. "There has been a swing of the pendulum from reductive approaches in favor of integrative approaches to systems biology," Zerhouni said at the Dartmouth conference, and "multidisciplinary team science is an important hallmark of the successful research team of the future."
How can we continue to foster collaboration in the spirit of advancing science while making the best use of our limited supply of available space? Here is a great example from last week. Gail Johnson, PhD, was making a second visit to UR SMD for a position in the Department of Anesthesia to become part of the Mitochondrial Research Interest Group. She has 3 R01s plus Foundation funding, and will probably work in a "vintage" lab in the Pharm/Phys area of the medical school that is in need of renovation. I’m pleased to report that Dr. Johnson signed her offer letter by the end of her visit. Even though she will be working in a "traditional" lab space in the old part of the building, however, her work will extend to scientists across many Departments and Centers working on Alzheimer’s disease, Huntington’s disease and insulin resistance. In this case, adding one scientist in one renovated laboratory will have marked effects, through collaboration, on scientific output throughout the medical school.
Thus, one way to continue to expand our scientific work despite limitations on space is to use our current space as efficiently as possible, including the maximization of scientific interaction through active cross-disciplinary collaboration. In the next newsletter, I will present a conceptual model of how this and other initiatives can be analyzed in the context of economic modeling tools.
Meliora,
David S. Guzick, MD, PhD
Dean, School of Medicine and Dentistry
