February 14, 2012
I have a question.
It’s an obvious question, but not at all a stupid one. Frankly, lots of people have asked it already.
The question is, why is it so tough to build a medical school in Austin?
There was a good piece last week about my 10 Goals in 10 Years and the work needed to fulfill them. The 10 in 10, as you probably know by now, is the wide-ranging community effort to build (among other things) a medical school, a teaching hospital, modern health clinics tailored to the needs of our neighborhoods, and cutting-edge research facilities in Austin by 2022.
As the article indicates, this isn’t easy. It requires quite a bit of work.
Well, why is that? Shouldn’t building something that the region and the state want and need be a little more straightforward?
I mean, it’s not like folks don’t know what a big deal this is. A medical school alongside the University of Texas, and amid all of the education assets we have in this town, could help all of us live longer and better for decades.
We’re talking close to $2 billion in economic activity and 15,000 permanent jobs from a medical school and affiliated assets. We’re looking at a pipeline of doctors to serve a region that will find them more and more scarce. Heck, just last week, there was an article out of Florida describing how med students are providing affordable healthcare for the under-served and uninsured in their communities.
But that doesn’t answer the question. Because, let’s face it, those benefits have always been clear.
It’s no secret that medical schools have reaped huge health and economic dividends in the cities where they’ve been built. And it’s no surprise that as one of the largest cities in the country without a medical school – and as home to one of the few Tier 1 research universities without a medical school – Austin’s uniquely positioned to parlay our assets into even greater rewards.
So why isn’t it done? Why don’t we have it? What is it about this challenge that’s so imposing?
The short answer is that the State of Texas simply doesn’t build medical schools like it used to.
According to the old way of doing things in Texas, regions and university boosters could just make the case for a medical school and, if that didn’t work, cajole, beg and/or threaten legislators until the state set aside enough money to build a medical school and create the grad student residencies, research labs and other facilities that go along with it.
Such patience has frequently paid off in the past, because the state used its resources to responsibly plan and invest for its future. (For a great historical blow-by-blow, check out this commentary that ran in the Statesman over the weekend.)
But those days appear to be over. The last few weeks have been full of ugly news about the effects of historic budget cuts on our schools and the rank deception that’s been baked into the costs of healthcare.
So there’s not a ton of money lying around the Capitol for even the most worthy causes. And that, in a nutshell, is why this is so tough.
Think of it this way: we’re not just building a medical school in Austin. We’re also forced to figure out how to build a medical school in Austin.
And if areas like Austin and the Rio Grande Valley – which also needs, deserves and is one of the biggest parts of the state without a medical school – are serious about bolstering medical education, we need to figure out a new way to do it. We can’t just keep making the case, asking, hoping, praying, begging and then complaining when it doesn’t happen under the current way of doing things in Texas.
That’s why in going through this process, I’ve put together what I think of as a new playbook for promoting medical education in Texas. It relies on a more community–based approach. I get tired of the word “grassroots,” but it really does involve doing it from the ground up, primarily with the resources we have, instead of asking for something to be given to us from the top down.
That means inventorying assets in every corner of this community and figuring out ways to leverage them for everyone’s benefit. It means increasing the total capacity of our healthcare resources. It means getting creative about joint ventures that various public-sector, private-sector, non-profit and philanthropic partners can embark on to create these new resources and help our community. It means tearing down silos, building bridges, and turning conflicting interests into communities of interest so that everyone can be at the table, doing what they do best, as effectively and efficiently as possible. It means looking at our community’s resources by focusing on the sum instead of each component part.
In Austin, the vehicle for a lot of this work is what I call a Decision Tree. It’s a document that the organizing committee working on my 10 Goals in 10 Years has adopted to help guide this process. You can find it here.
The Decision Tree is really just a device to ensure that the hard questions are asked, that we build on the answers instead of just jumping to conclusions (many times those conclusions are emotional or knee-jerk reactions), and that everyone’s working from the same set of answers.
And as you can tell from a glance, those questions are like a treasure map for fulfilling these 10 Goals in 10 Years, in Austin or any other part of this state. The process will tell everyone on the front end:
It’ll tell us a lot more, too – again, click here to see what’s being asked. I firmly believe any region that goes through this process – that openly, honestly and creatively evaluates its strengths, weaknesses, opportunities and challenges – can get where it wants to go without making anyone (or anywhere) else suffer for it.
As I said in last week’s news article, I’m not going to get caught in a zero-sum, win-lose game in which one Texas region has to suffer for another one to prosper.
In fact, as lousy as that game sounds by itself, it’s even worse now that those in control of the Capitol have all but decreed that due to past budgeting mistakes, there won’t be winners anymore. Period.
So we just can’t count on the state to take care of these sorts of necessities, no matter how important they are or how badly they’re needed. That makes this tough. It means we’re all going to have to work.
But it also means that this might finally happen. Right now, thanks to this new playbook, we have a chance that the old way of doing things never could deliver on. And, this time, it’s a chance we’ve got to seize.