Breaking bread with the new brass

Every other Thursday throughout the academic year, students, faculty and staff file into the Beaumont Room for an experience that is half culinary and half food for thought. During its lunch-hour meetings, Medical School Council hosts sessions on every topic from curriculum development to cancer research to the latest in computer-based teaching.

Last fall this elegant, wood-paneled room was the place to be for dean-watchers. In October and November, Dean David A. Kessler, M.D., and two newly appointed top administrators made presentations to overflow crowds. "If ever there was a case for new facilities, I think you've made it," the dean joked as they squeezed into the first of the two sessions. "There's not a lot of oxygen left, but come on in."

Dr. Kessler and Ruth J. Katz, J.D., M.P.H., the new associate dean for administration, spoke Oct. 16, followed Nov. 20 by Irwin M. Birnbaum, J.D., the school's new chief operating officer. They introduced themselves, discussed some of the school's most pressing issues, and answered questions about school finances, faculty appointments, teaching, clinical care and student life.

"I am here, I believe, to serve the collective wisdom, and I want to be doing what you want me to be doing, focusing on the things you think I should be focusing on," Dr. Kessler told the group. "I'm good at getting things done, but what we get done needs to come from those who have the best ideas–whether it's someone in the mailroom, a first-year student, or someone on the senior faculty. The best ideas deserve the most attention."

In order for Yale to remain at the forefront of American medicine, "there are some major infrastructure issues that we need to address," he said, referring to the school's operating deficits over the past two years. Yale has seen a decline in clinical income under managed care compounded by problems with the school's computerized billing system. On the positive side, the federal office of the Inspector General gave the school a clean bill of health in November subsequent to an audit regarding its Medicare billing practices, and NIH grant income rose nearly 8 percent this year with larger growth anticipated in future years.

"This is a great institution, and it has a long history," Dr. Kessler said. "And we will do well, better than well. But we have to get certain things in order, so I am spending a portion of my time on the fiscal side of the house, making sure this place is vibrant and can compete with the best, and have the resources to do that."

The medical school needs additional space, including a new anatomy lab and new research quarters, issues that will be addressed in a facilities plan now being formulated, he said. New buildings are part of that plan, as well as renovations of existing space following the model of the physiology wing of Sterling Hall of Medicine that was completed in the fall. Other priorities for the medical school include aggressive searches for a number of department chairs, recruitment of senior women to the faculty, new fund-raising initiatives, and improvements for students.

"I take our responsibility to teach very seriously," Dr. Kessler said, "I care less about what we teach as opposed to how we teach. There is a core of knowledge that keeps changing. You're not going to learn everything. But I'd like everybody to be well trained. There is no reason to sit in any lecture, go to any course that isn't excellent here."

Dr. Kessler and Ms. Katz, a former congressional counsel and an expert in health policy, have been meeting with students to discuss financial aid, housing, security and other issues. Since arriving in July, Ms. Katz has coordinated the formation of new student affairs committees, served as the liaison between the medical school and the VA Connecticut Healthcare System in West Haven, and worked on several fund-raising projects.

"On a daily basis, I work with the department chairs and faculty members to help address the issues they face in getting their own jobs done," she said. "In brief, I work to make the dean's office the user-friendly place it can and should be."

Mr. Birnbaum, who Dr. Kessler introduced as "the best in the field of medical and hospital finance," was the long-time chief financial officer of New York's Montefiore Medical Center. He recalled meeting Dr. Kessler there in 1982, when Dr. Kessler was applying for the job of special assistant to the president. "In came a guy with red hair and a scraggly red beard, and I asked him, 'Why do you want this job?' He told me that in 10 or 15 years, he wanted to be the head of a major medical center or dean of a medical school."

Along the way, Mr. Birnbaum said, Dr. Kessler was sidetracked. They prepared together for Dr. Kessler's Senate confirmation testimony before he was sworn in as U.S. food and drug commissioner in 1990. After Dr. Kessler announced in late 1996 that he would leave the Food and Drug Administration, and accepted the deanship at Yale, he phoned Mr. Birnbaum in late March 1997 to ask him to come to New Haven. "The No. 1 reason I wanted to do it was David Kessler," Mr. Birnbaum said. "He just wants to make change, and make change in the right direction. I wanted to be a part of it."

Mr. Birnbaum said the financial challenges to the medical school are significant but manageable. Beyond the bottom-line concerns, he said, are fundamental questions about how to educate students and residents in the era of managed care, when patients are discharged earlier from the hospital. "The question is not whether Yale will survive. Yale will not only survive, it will thrive," he said. "The changes will be in how we teach."