President's Page June 2005   A World Class Medical Community— Becoming Medical Leaders in North Texas

by Leslie H. Secrest, MD 2005 DCMS President

As your president, I point out that this article contains my opinions and reflections, which are not necessarily the policy or the opinions of Dallas County Medical Society.

Serving as your president has caused me to look at Medicine from many perspectives that previously had produced only a passing interest. My focus had been on individual patients and their needs. It now has shifted to include a larger frame of reference—our community and the processes by which we value, treat, and fund our medical assets which ultimately affect the quality of patient care. The budget process of our taxing entities may reflect policies and philosophies that may not attract medical-related opportunities to Dallas. Too often physician taxpayers view the completion of their civic obligation with the paying of their taxes, and they overlook the advocacy necessary to ensure a reasonable allocation of tax dollars to medical entities.

The Dallas-Fort Worth area is blessed with many medical assets that combine to provide our healthcare delivery system. We need to support some of these assets with our enthusiasm as well as our tax dollars. Our communities require a steady supply of physicians. The first step to ensure this is the presence of strong medical schools whose graduates are ready to undertake postgraduate training programs that will produce highly skilled physicians in quantities sufficient to meet the needs of our growing communities. The tax funding necessary to support the University of North Texas School of Osteopathy and the University of Texas Southwestern Medical School come from federal, state, and county taxes. Other important funding comes from philanthropic giving, without which a medical school or a medical-related enterprise cannot rise to leadership. The last source of funding comes from the activities of a medical school or medical enterprise in the form of fees for service or from grants supporting clinical and research activities. In order for us to have a world-class medical community with research and a clinical delivery system, we citizens and the elected officials of North Texas must have it as our goal. If that could be our collective goal, then funding and operations of medical entities could be aligned and balanced such that all medical enterprises will rise and prosper.

Much like DFW airport, which has benefited all North Texans with a better standard of living, a growing business community, and a philosophy that we can be world class by working together, a united vision to make North Texas a world-class medical community will benefit everyone. Adoption of such a philosophy and vision begins an irresistible force attracting others with can-do attitudes to North Texas. At times it appears that the united community attitude that produced the DFW airport needs to again awaken, develop, and propel us to greater levels of medical accomplishment. The adoption of such a vision and goal provides a new framework for consultations to our community, allocation of tax dollars, negotiations of contracts, obtainment of grants, and attraction of philanthropic dollars. The vision of a medical community second to none will bring forth efficient operation of our medical entities and foster a culture of learning and quality. As a medical community, we are much like we were before the vision of a DFW airport. We all are seeking world-class quality and distinctions for ourselves and our individual entities to provide the best possible patient care. Multiple airports striving for individual world-class distinction was not an efficient way to obtain a world-class air transportation system for North Texas; it was the vision of an air transportation system second to none that brought solutions. A vision of a medical community second to none from a community unified and striving to obtain the vision will put us above others who do not have such a vision or who are unable to unite and align.

Now that Dallas County commissioners are working on the 2006 county budget, it is important that we inform our commissioners that the Parkland Health & Hospital System and Southwestern Medical School will require extra tax dollars to contribute to a world-class medical community. A Parkland Hospital with a medical staff independent of the medical school will produce another medical enterprise operating in a silo— striving for efficiency and clinical effectiveness but not aligned to developing a world-class medical community. Any physician who has tried to operate a medical practice on revenue generated primarily from Medicare and Medicaid knows that those revenues alone never cover the direct costs of the most efficient enterprise, much less contribute to the indirect costs. To survive in such an environment, other revenue sources are required. County taxes must be allocated so that the direct and indirect costs of Parkland Hospital and the direct and the indirect cost of the medical school physicians are covered. To have a world-class medical school will require the pass-through of county taxes via the contract for physician services with Parkland Hospital. This alone will not produce a premier medical community, but will continue to produce great medical students and contribute to the fine graduate medical education in the community.

It is time that North Texas develops a vision of a medical community that is world class and develops the processes that move us from silos of excellence to ones that will align our resources and produce a community of excellence that is a leader in education, research, and clinical care. What gives a competitive edge in delivering medical care is not the medical excellence developed in any particular silo, but the human relationship a patient experiences. If we share our expertise throughout the medical community, we will improve our quality of care. The human element, more than expertise, is the competitive edge that draws patients to a particular physician or facility. It is time we adopt a vision and formulate the processes that will allow us to develop a medical community that is second to none in medical expertise and human kindness.

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