The future of the School of Medicine and the medical center was a dominant topic at a town-hall meeting last Tuesday. Called by School of Medicine Dean Philip Pizzo, MD, the forum was the first of two scheduled town-hall meetings to hear faculty, student and staff comments and to let people know how the school’s strategic plan is shaping up after a recent retreat of faculty, staff, students and executives in Carmel.

A second town-hall meeting is scheduled for tomorrow at noon in the Fairchild Auditorium lobby.

Among the most significant issues, Pizzo said, was a review of the future size of the medical school and whether it should remain on one campus or expand to an offsite location. Stanford has a small medical school compared with Harvard and other schools in its league, Pizzo noted. "Having a small, high-quality medical school has both advantages and disadvantages," he said.

"It gives us more chances for interaction among departments and between the medical school and the university," but being a small school ensconced in the larger university also brings with it quandaries over land use, fund raising and relationships with surrounding communities, he added.

The Clark Center and the Bio-X initiative are two examples of programs that came to pass because of Stanford’s emphasis on fostering interaction among researchers from different disciplines, Pizzo said. So too is the recently announced joint Department of Bioengineering between the schools of engineering and medicine.

Stanford has also recently announced the formation of the Institute for Cancer/Stem Cell Biology and Medicine and is planning additional research institutes that will take advantage of the school’s multiple strengths.

The importance of interaction among researchers also means the medical school will do well to remain on the Stanford campus in Palo Alto rather than moving to facilities elsewhere, Pizzo said. "The single campus is part of what makes Stanford unique, and moving part of the school off campus would divide that interactivity," he noted. "It is clear we are best served by having the school contiguous to the hospitals and to the rest of the university."

On the other hand, the medical school must develop new facilities, both to replace aging laboratories and clinics and to make space for new programs, he said.

The new facilities are being planned in two stages. Phase one is a 10-year plan, lasting from 2003 to 2013. Phases two and three are part of a 15-year plan that would last from 2003-2018.

One issue that will affect the building and fund-raising plans is the national and local economy. "If strategic planning had been done three to five years ago, we would have had a lot fewer problems" raising funds, Pizzo said.

In addition to having the resources available to renew its aging educational resources and laboratories, Pizzo believes that the school needs to work with the university and the hospitals in a unified manner.

"Being unified is the ticket to success because otherwise we will have competition among groups at Stanford," he said. The school’s emphasis on an interdisciplinary approach to medical education and research figures heavily in this effort.

Audience members also asked questions directed at the school’s present situation. One person asked about dwindling endowments and how that would affect people and departments. "That’s a challenge for the university as a whole as well as our academic medical center," Pizzo answered. "For instance, tuition covers only about 50 percent of the cost of a medical education and research costs require us to put in 15 percent more than we get from full-overhead grants."

Income from clinical revenue once made up for such gaps in funding to support mission-critical areas like education and research, but academic medical centers can no longer rely on that. "We will have to make choices," Pizzo said. "Now that we have defined broad goals for the future through our strategic plan, ‘Translating Discoveries,’ we can make more informed funding choices."

Another audience member asked about ambulatory-care planning. "One of our challenges is to have more outreach, and one of the ways we want to do this is with an ambulatory-care capability that enables us to provide patient care closer to our communities," Pizzo said.

"An active consideration is to move some of the ambulatory-care facilities offsite. The medical center is actively exploring options and you will hear more about that in coming weeks."

When asked how residents and fellows fit into the strategic plan, Pizzo noted that the school needs to spend more time integrating them into its mission. "Residents and fellows are essential to the future of the medical center and we want them to feel more a part of the planning," Pizzo said. "I think they have not been in the past."

Lastly, an audience member asked about helping faculty, staff, fellows and residents stay better informed about what was going on in the school. Better communication among people in the medical center is important, Pizzo said. "The reason for having meetings like this is to get more information out and back," he said.

"We know that when we falter it’s often because of a lack of data and communication. We have tried hard to establish a bold agenda for the school and its future and we are eager to receive input and feedback from students, faculty and staff. Together we can make Stanford a role model among research-intensive schools of medicine."