As I contemplate my tenure as Dean of the Faculty of Medicine at HMS—a role I began in September 2007 and from which I step down in July 2016, I am reminded of all that we have accomplished together and of the lessons I have learned about this great institution.
The nine years I have held this post certainly have passed rapidly. Although I served on the faculty of what is now Beth Israel Deaconess Medical Center for nearly three decades, and held roles of increasing scope during that period, nothing prepared me for the excitement and the responsibilities that awaited me as the School’s dean.
HMS is widely considered to be the leading medical school in the United States and, possibly, the world. Being entrusted with its leadership is an honor and a privilege and carries with it the responsibility for safeguarding that preeminent status. How to fulfill this responsibility raises many questions. But I think the key question is, Should one take a conservative path to maintaining the School’s hard-earned stature, or should one pursue innovation? I have learned that success requires a constantly evolving mixture of both.
Lay of the Land
The HMS dean, who oversees an enterprise with an annual operating budget of $700 million, is chosen by and reports to Harvard’s president. The deans of the University’s professional schools have limited direct interactions with the University’s fiduciary governing boards. Although we strive for One Harvard—a worthy goal with some notable achievements—HMS and its sister schools function in a manner long characterized as “tubs on their own bottoms.”
HMS differs from other Harvard professional schools in several respects. First, rather than being co-located with the other Harvard schools in Cambridge or Allston, the medical school shares a geographic location on the Longwood campus with the Harvard School of Dental Medicine and the Harvard T.H. Chan School of Public Health. Second, HMS is unusual in having more than 98 percent of its faculty—almost 12,000 full and part-time members—employed by one of fifteen independent, affiliated hospitals and research institutions that together make up the Harvard medical community. HMS directly employs fewer than 200 of these faculty in its basic and social science departments located on what is familiarly known as the Quad. So while the School’s leader oversees the entire faculty of medicine, that leader’s responsibility for Quad faculty is substantially greater than it is for faculty at the affiliated institutions.
HMS could not exist as a medical school, let alone the world’s leading medical school, without the involvement and accomplishments of its entire faculty, who contribute to the training of our medical students and the academic reputation of the School. For HMS to remain successful, the dean must engage effectively with, and lead, the entire community. No one else can, or does, play this unifying role.
At its core, HMS advances education, research, and service. It is the dean’s central responsibility to strengthen and sustain the School’s leadership in each of these areas. I learned early on that there are challenges associated with coordinating within and across these efforts.
Within the sphere of education, for example, I perceived a need to improve coordination across medical education, graduate science, and continuing medical education, as well as with Harvard Health Publications, our consumer-publishing arm. I also saw the need to better integrate research efforts across the Quad and between Quad and affiliate-based faculty and programs. It was also vital to achieve greater integration between research and education. Introducing such changes within this venerable institution posed challenges that required a multiphase process for analyzing the situation with input from all constituencies, fostering collaboration among key participants, ensuring organizational and budgetary alignment, and, finally, implementing change.
The ability to implement change is heavily influenced by the financial context of the institution. One year after becoming dean, the world experienced a severe financial crisis that affected economies worldwide as well as those of Harvard University and HMS. This crisis significantly altered the plans I hoped to develop as dean.
Although we had developed a strategic plan during my first year as dean, the financial crisis occurred as the plan was about to be introduced, requiring us to reduce operating expenses to tackle an unanticipated deficit. Pursuing new initiatives, and even some previously planned programs, required us to simultaneously reduce expenses and generate new revenue.
Five factors further complicated our financial situation. First, we had established a generous new financial aid plan for middle-income medical students. Second, NIH funding was stagnating. Third, HMS assumed support for the Wyss Institute for Biologically Inspired Engineering and the Department of Stem Cell and Regenerative Biology, two new cross-University initiatives. Fourth, the School assumed substantial debt financing for the New Research Building. Fifth, HMS needed to address infrastructure maintenance issues; the care of many of the School’s facilities had for too long been deferred.
Acorns to Oaks
I’m proud to say that despite these obstacles, we advanced many new initiatives.
In education, we created new programs, strengthened existing ones, and spurred powerful synergies. The Program in Medical Education launched a sweeping preclinical curriculum reform with revised content, a new structure, and fresh pedagogy. This new curriculum, which promotes greater exploration and depth of study, has received high initial praise from both students and faculty.
Graduate science education also was refreshed. Leaders of a new program in graduate education developed initiatives to address gaps and respond to opportunities. Among these opportunities are new tracks for therapeutics and cancer biology. In addition to invigorating the MD-PhD program, we launched several new masters programs, including programs in global health delivery, bioethics, medical education, and immunology. These programs help build faculty communities as they educate.
An effort that will have lasting impact is the new Office for External Education, which coordinates continuing medical education, Harvard Health Publications, global education, the HMX online learning program, and new programs for executive education in health and science. Created for lifelong learners of all levels worldwide, the programs will generate new revenue that will strengthen the School overall.
Harvard Catalyst has created new programs in clinical and translational research that bring faculty together in new ways. In fact, I have been thrilled with the fact that our deans of education regularly meet to explore common issues and potential synergies.
As exciting as these educational initiatives are, we are seeing equally exciting progress in research at HMS.
The Quad faculty, which welcomed twenty-eight new members to its ranks in the past nine years, continues to achieve the highest level of bioscience discovery. We recruited outstanding new chairs for the Neurobiology, Biological Chemistry and Molecular Pharmacology, and Cell Biology departments, and launched a new Department of Biomedical Informatics and a reconfigured Department of Microbiology and Immunobiology. The Laboratory of Systems Pharmacology was created within a broader therapeutics initiative, and an enhanced Ludwig Center at Harvard Medical School for cancer biology research was brought under the HMS umbrella.
In a move I considered essential to maintaining the School’s status as a leading research institution, we welcomed an external committee to review bioscience research on the Quad. This was an important review, the findings of which have stimulated fruitful strategic discussions that will help shape the future of our basic science enterprise.
Apart from bioscience, the Department of Global Health and Social Medicine received a new name and a new chair and initiated a new vision, while the Department of Health Care Policy continues to excel at a time when its work is increasingly necessary. The HMS Center for Primary Care, launched with a major philanthropic gift, continues to strengthen our involvement and leadership in this critical field.
The Office for Faculty Affairs has improved our promotions and appointments processes, and initiatives in faculty development and diversity are making steady progress.
Just Up the Road
Much remains to be done by my successor, who will face opportunities and challenges, expected and unexpected, similar to those I have faced. As we move forward, we must ensure that the School continues to renew and expand integrated educational efforts to retain preeminence while reaching for new audiences and opportunities. We must maintain the highest standards of bioscience and social science research while enhancing interdisciplinary collaborations in new and evolving fields of study. And we must further leverage strengths across the world-class life-science ecosystem that is Harvard medicine. With a strong management team, smart investments in new programs, support for new and established faculty, generous philanthropic backing, and effective partnerships with Harvard University, there is no doubt that HMS will continue to excel.
HMS has been my academic home, and so much more, for many decades. Through this School I have so many valued colleagues and close friends—relationships that I cherish. I have been enriched by the opportunity to serve as dean and, in the process, have learned so much about health, science, education, and service. I have, as our mission states, worked with the best people to alleviate human suffering caused by disease. After stepping down as dean, I will happily return to the ranks of HMS faculty to pursue the next phase of my career. It will be a great honor to work as your colleague and friend to advance these noble goals in new ways in the years ahead.
Jeffrey S. Flier is the twenty-first dean of Harvard Medical School.
Image: Mark Ostow