New dean reviews Dell Medical School

Alex Wilts

Clay Johnston started in March as the dean of the Dell Medical School, which is set to open in fall 2016. Johnston previously served as the associate vice chancellor of research at the University of California, San Francisco, and is a practicing neurologist who specializes in preventing and treating strokes. Some answers in this Q&A have been edited for brevity and clarity. 

The Daily Texan: What have been some of your duties as dean since you started in March?

Clay Johnston: Well we’re starting from scratch, so it’s a little different than the usual dean job. That means bringing in the team, so a lot of hiring. Tuesday, we added our fourth faculty member, but we’ll go from four to 250 in the fall as we accept faculty members that have been part of UT-Southwestern’s team. And then we’ll hire a couple hundred new positions over the next two years, so it’s a lot of team building. We have fabulous partners, but laying the foundations for how we’ll partner is really complicated. So how do we work with Seton [Healthcare Family]? Where do their responsibilities stop and ours start? All of that stuff is what we’re working on now. 

DT: What have been some of your biggest challenges since becoming dean?

Johnston: It’s more of a bandwidth issue. More at this stage — the expectations are so high for us, and they continue to grow, such as this Livestrong gift. It’s a wonderful gift, but also with that comes, 'Okay, what does this mean for cancer care in Austin?' [It’s] something that we would not have taken on this soon. We have so many things to get done that it’s about how we focus our energy without getting too distracted by demands that are placed on us elsewhere. We’ve got to be really careful with limited bandwidth as we grow things out, to make sure we focus on key functions. Accreditation is a good example. We can’t admit medical students until we get preliminary accredited. There’s a lot of work that goes into setting that up. We shouldn’t be distracted by cancer programs unless we’re ready and confident that accreditation is going to come through. We haven’t [run] into any major barriers. Partners have been really welcoming. The UT community is very welcoming. No major challenges at this stage.

DT: When you received the donation from the Livestrong Foundation, they intended for the money to go toward cancer research. What was your original plan for how the new medical school would reinvent health care in Austin?

Johnston: It doesn’t distract us from how we will change health care in Austin, but it does bring cancer as an earlier focus than what we otherwise would have chosen. We know Austin wants high-quality cancer care here in Austin, so that’s a priority for us. Cancer is unbelievably complicated in terms of the number of different practitioners that are involved, the number of health care settings that are involved, and also the way finances flow and the motivations of different groups to keep finances flowing the way they currently are. And so, it’s one of the more challenging areas of medicine, so if we had our choice, we wouldn’t have picked cancer as a early priority, but the community kind of picked it for us.

DT: What are some other things that you plan to focus on besides cancer research?

Johnston: In general, we are sort of driven by the notion that health care isn’t what it should be. Not just for the underserved, but for people with insurance as well. One example of that is how slow and difficult it’s been to have technologies be integrated within the health care industry. So, one example I like is that I can find a restaurant and, right now, know the quality of it and how it’s rated and be able to book a table anytime today. Now, try to do something even close to that with a physician. That’s true throughout the health care system, and it impacts the way that we provide care — the physician-focused care. A lot of the problems we have could be dealt with by technology — on email, on the phone and with pharmacists and practitioners. So, it’s trying to take a step back and to say, ‘What’s the health care plan that we would really want if we could blow up our system, and what pieces need to be in place for us to achieve that?’ And it has to do with creating an ecosystem where the money flows based on our values as people. That’s really challenging to set that up. No other place has really done that well, but if we can achieve that, that would be huge.

DT: What will the application process for medical students be like?

Johnston: We can’t start recruiting students until we have preliminary accreditation, which we do not have today. Those applications went in, and they’ll come visit us in the spring, so hopefully by next summer we’ll have approval to recruit. How we’re thinking about it is, UT-Austin is a really special place. We’re put in great position here at the Dell Medical School being able to work within UT-Austin and the great community of Austin, and we are bringing together really creative people excited about this opportunity in a way that’s only possible because of the foundation the community set for us here. So, that means we’re getting fabulous teachers, and we’re going to have a really cutting-edge curriculum. We do recognize that medical education is really expensive, and we need to have diverse people from a variety of socioeconomic backgrounds, and we also need to make it so that the financial burden on students isn’t so great that students feel obligated to go into more lucrative areas of medicine — like procedure-based areas — because we desperately need primary care doctors, and they currently don’t get paid as much. So, given all of that, we also know that we’ve got to keep tuition low and also provide targeted support for students. We’ve already raised a fair amount of money to do that, so we’ll have a number of different scholarships for our students, and as we’ve looked at our tuition, we’re hoping to keep it quite low, and we’re evaluating how to best do that right now.

DT: How do you think the Dell Medical School will select from UT applicants?

Johnston: I would say we’re going to be neither negatively nor positively biased. Definitely not negatively biased. We know that there are fabulous students and a ton of pre-med students here at UT. For us, the key is the fit. I suspect that we’ll get a lot of students from UT because there are so many great students here. We do get some pressure from politicians to think about how we really are here in part to train physicians that will work here in Austin primarily — but also more broadly in Texas — and so, we will get more of them if we continue to take Texans and think about them as being critical to our programs.

DT: Are you going to continue practicing neurology while being dean?

Johnston: I am going to try. Looking at my schedule recently, it may not be so easy. I love the practice of medicine. It keeps me grounded. Over the last three months, I have not seen a patient. I miss caring for people, so I’m going to do the best I can to get that back into my schedule. The president and the provost don’t pay me to see patients. With the skill sets and position that I have, it could be seen as a distraction from getting the job done. On the other hand, being on the ground and understanding what medicine is like today is important for making the right decisions. I’m not sure on how to create that balance, but I’m ready to get back into the hospital.

DT: What are you most looking forward to in opening the medical school?

Johnston: I’m most looking forward to welcoming that first set of students. Just 50 students in that first year. That’s truly going to be a monumental point.