Just days before giving his annual State of the College address, Dr. David Hess – the Dean of the Medical College of Georgia at Augusta University sat down with our Brad Means on the set of The Means Report. He shared many of the key highlights from his address from the nationwide doctor shortage to the need for better healthcare in rural Georgia. It is a firsthand look at the growing medical college and its impact on everyone’s health.
Brad Means: David Hess is the Dean of the Medical College of Georgia. He is kind enough to come back to us in advance of his state of MCG address. Dean Hess thank you for being with us. We appreciate it.
Dr. David Hess: My pleasure, thanks for inviting me Brad.
Brad Means: Well, I know one of the biggest topics that you’re gonna talk about in your address is the State of Georgia when it comes to physicians and doctors per capita. We don’t have enough and with enrollment being so impressive at MCG, why aren’t those docs stayin’ here?
Dr. David Hess: Well it’s true, so Georgia’s about 40th in the country in doctor’s per capita and that’s in the background of a severe physician shortage in the country. So, we’re short of primary care doctors. We’re short of specialists and particularly in Georgia, particularly in rural areas of Georgia and South Georgia where we’re very, very short of doctors. So yes, we have 230 students a year and that makes us one of the top 10 largest medical schools in the country. So we’re a big school but you know, to train a physician takes a lot and really it takes a village, it takes a state in our case. So you have to learn, you know, two year of basic science. You gotta learn the basic science of disease and then your third and fourth year, you’ve gotta get in there in trenches and get a lot of hands-on experience. You gotta deliver babies, you gotta put tubes down patients, you gotta take care of, you know, cancer patients, you gotta learn all that in two years. And so, it takes a lot of doctors, a lot of one on one attention. So to be able to do that and be in Augusta, which is relatively small, you know, we have a state of 10.4 million people and only four or 500,000 live in the city SRA. And we have a distributed regional model so we have a campus in Athens, which is four years with the University of Georgia. Then we have a campus in Rome, the Northwest part of the state. Southwest in Albany, I was just there this week. And then the Southeast we Brunswick and Savannah. So literally, we’re all over the state and we rely on 2,500 volunteer faculty, who we don’t pay, to train our students. In addition, about five or 600 full-time paid faculty.
Brad Means: What happens when they graduate are they lured away by higher pay, do they go home, all of the above?
Dr. David Hess: Yeah, so that’s a good question. So, after you go to medical school you have to do three to seven years of residency training. And so, you know, studies show that where you go to medical school and where you do your residency are the best predictors of where you’ll practice. Now one of the problems is we don’t enough residency slots in Georgia and so we lose a lot of good students to go out of state for residents. And the Board of Regents has had a plan, to put a committee called the Great Committee, to actually start your residencies in hospitals that didn’t have them before. So that’s help but we’re still very short.
Brad Means: Is it as simple as adding residencies where they are currently none or can we expand residencies? Can we say to a doctor, take more people under your wing?
Dr. David Hess: Well we would love to expand residence here but residencies are paid in a very complicated fashion. It’s something called the Balanced Budget Act of 1997, which restrained Medicare spending, also restrained GME spending so we’re fixed at the number of residents that we had in 1997 so that really hurts us. So our, you know, hospital is way over that cap but we have to pay for all those residents over the cap. So, if we had the cap extended and that’s complicated. The state has to help, the federal government has to help. That would really help the doctor shortage.
Brad Means: What about your relationship with the state? Pretty good?
Dr. David Hess: It’s very good.
Brad Means: One day we meet that goal?
Dr. David Hess: Yeah, it’s very very good. They’ve been very, very supportive of what we’re doing
Brad Means: What about the Department heads that you are bringing in left and right, that’s gotta provide a big energy boost to MCG.
Dr. David Hess: Yeah I think we’re doing more recruiting of leadership and faculty. Like Dr. Klaassen, he’s a faculty. We’ve recruited, and we’re tryin’ to recruit the best and the brightest, you know, like Dr. Klaassen and you know, leadership too. So, I think we’re recruiting about 10 to 12 different chairs and other leadership positions. You know, senior associate deans and such. We’ve filled about half of those so far.
Brad Means: What about the Georgia Cancer Center? We would like to touch on that because it is quickly becoming a national force. How are things going there?
Dr. David Hess: It’s going well. It’s really become an destination center, which means patients not just from Augusta come there but we’re getting bone marrow transplant patients from all over the Southeast. All over South Carolina, all of over Georgia. We have some programs where we draw people from Europe, some of their immunotherapy programs. So we’ve hired, including Dr. Klaassen who’s here, I think 13 cancer doctors in the last 14 months. So that’s phenomenal. We’ve more than doubled our size of cancer doctors. We’re still looking for a Director. We have an active search going-on, a national search. We hope them name a director by the spring and have them here by next July 1st. But even without a permanent director, we’re recruiting left and right.
Brad Means: You know I asked you about your relationship with the state, obviously it’s strong. What about with the federal government? And how dependent is MCG on those funds to keep us going?
Dr. David Hess: Yeah, so most of our federal funding is through NIH grants and different grants. And so, NIH you know funding was pretty restrained for many years, now it’s coming up and in certain areas like Alzheimer’s disease, there’s a lot of NIH funding. Cancer funding is still very, very competitive so, you know, we actually look at where we are. We moved a little bit up in NIH rankings and our medical schools were ranked on their funding. We’ve moved up a little bit. We’ll continue to try to do that but what people don’t understand is research requires a lot of investment. You know, for every dollar you get of research dollars, you have to put in $1 and a half to $2 to subsidize research funding. So it takes a lot of philanthropy.
Brad Means: Georgia is has no shortage of health issues. We’re in the stroke belt, we have all sorts of health challenges ahead of us. As one of the leading institutions in the state and the country, what can we do to make Georgia healthier?
Dr. David Hess: You know, that’s a great question and you’re right. We’re 40th in physicians, we’re between 40 and 45 in most health measures and that’s at the bottom. And it’s particularly bad in the rural areas and South of I-16 where we’re one of the sickest areas to live not just in the country but in the world. You know, global health is South Georgia. So to address this question, one of our campus deans, Doug Patton who is in Albany, got together with our AHEC Director, Denise Kornigay. They complained about this to me, “Why don’t we do something?” So I do what most dean’s that way I put them on a task force to head and they got together members of the CDC, Department of Health, people from Mercer, Morehouse, and they’ve got what they call three game changers to start effecting public health. Now, many of these are immediate. Some is to really train something called ECHO to train, be a hub and a spoke on its CME to train primary care doctors how to deal with things like prostrate cancer or how to deal with specialty things. Another one is to work on healthy policy. You know, one of the big issues in Georgia is we didn’t expand Medicaid and that’s been very, very difficult. It’s hurt a lot of hospitals so but not expanding Medicaid, it’s been very, very tough on indigent care hospitals and academic health centers like we are so having a voice at the table’s important. And the third thing is to work with federally qualified health centers, which we totally are siloed from in academic medicine. You know, federally qualified health centers are all over the state and they’ve dealt with a lot of primary care and we’ve been walled off from them. So what I’ve been tryin’ to do is break down those walls, work with them, do research with them, and have our students train in them. So those are some three game changers we’re gonna start with.
Brad Means: Alright so let’s say we accomplish those three goals and more, and that we do continue to be a statewide force. It starts right here in Augusta and those other campuses that you mention but certainly to a largest extent here. How do you feel about class sizes? You touched on it at the top of our interview. Are you they where we want to see them? Should they be smaller, bigger? How do you feel about class size?
Dr. David Hess: Medical school class size?
Brad Means: Correct.
Dr. David Hess: Well we’re actually have a are planning to expand the Athens campus. And that was always in the, kind of, in the cards–
Brad Means: We shouldn’t be fearful of that in Augusta?
Dr. David Hess: No, no no in fact we wanna expand here too we’re just not sure how much. We wanna look at any ways to expand, you know, right now medical school is four years. Does it have to be four years? We’re lookin’ at maybe three years and combining with family medicine or primary care training. But these are still things we’re thinking about. We haven’t had, we haven’t implemented yet and we’d have to get LCME, which accredits medical schools, would have to vet that and make sure we can do it so now we’re expandin’ Athens and we wanna expand here. We probably need to get somewhere between 260 to 300 in a class. The good thing is, everybody wants to go to medical school. And we turn so many good applicants away. We lose sleep over the people as, as Kelly Broad, our Admissions Director says, that don’t get in because we turn many qualified students away. We get 3,500 applicants for 240 positions and these kids are all great.
Brad Means: Don’t most Georgia parents want their kids to go to MCG–
Dr. David Hess: Yeah.
Brad Means: Stay here, stay close?
Dr. David Hess: Yeah, yeah they do and it’s a good buy, the tuition’s less than a lot of private medical schools and it’s a great education, I think, educationally you can’t beat MCG. I mean, a student can come here or go to Athens or they can go to one of our regional campuses. It’s not unusual for a student down there to deliver forty babies in a month. They get tremendous hands-on experience.
Brad Means: What do you hear from candidates, whether it’s people being recruited for med school or people, you know, students or whether it’s doctors being recruited as department heads, as researchers, what do they want out of a town and what do they see when they look at Augusta?
Dr. David Hess: Well, Augusta you know, Augusta’s a place once you live here you never leave.
Brad Means: Right, it’s true.
Dr. David Hess: It’s hard to get ’em to come here and I think particularly people West of the Mississippi and in California and the Northeast, they’re a little bit unsure of it. You know, they’re just not sure, you know, a lot of ’em, they’ll only know about the Augusta National but they don’t really know much about Augusta. When they come down here and take a look and they get a real estate tour, they look at our housing prices and our schools, alright and then we’re selling the spouse as much as we are the person so the spouse, you know, I’ve learned to spend as much time on the spouse as I do on the candidate.
Brad Means: Yeah.
Dr. David Hess: That’s not as much of an issue with medical students who all wanna come here but when faculty are in short supply, there’s a physician shortage. And academic physician shortage is even more severe. I mean, finding specialists who do research in diabetes or Alzheimers, I mean, they are really, really rare.
Brad Means: Is our town fun for students? Dr. Keel, when he was here, talked about how whether it’s housing or whether it’s entertainment offerings for the students to take advantage of. He wants those kind of things in Augusta. Are students happier these days?
Dr. David Hess: I think it’s getting better. You know, I think the married students tend to be happier in Augusta than maybe the single ones. That’s what I often hear. But you know, we have a lot of students go to UGA and they get to choose the Athens and the Augusta campus, you know, they can choose. A lot of ’em choose Athens but a lot of ’em choose here ’cause they want Augusta so you know, it depends upon the student.
Brad Means: Well, I can’t thank you enough for what you’re doing at MCG and I know you touched on the highlights of your state of MCG speech and I know a lot of people are looking forward to hearing the particulars when it’s delivered, but thanks for what you’re doin’ to put us on the map.
Dr. David Hess: Thanks a lot Brad, I appreciate bein’ here.
Brad Means: Absolutely, anytime, honored to have Dr. David Hess, Dean of the Medical College of Georgia.