Shiny New Toy

8 Things to Know About Fort Worth’s Medical Innovation District

Fort Worth’s new economic development plan, taking aim at weaknesses and highlighting strengths, recommends the city formally designate the Near Southside as a “medical innovation district,” taking advantage of its health care employment base, access to research and vibrant neighborhoods. The district would come with public investments
to augment walkability and pedestrian and broadband connectivity, and it could “fuel citywide growth,” the plan says. The chief new asset is the new TCU-UNTHSC School of Medicine, which will launch in 2019 with an inaugural class of 60 students at the University of North Texas Health Science Center on Fort Worth’s West Side, and is being billed as a vehicle that will address the region’s physician shortage, usher in new collaboration and research, and help the city draw the kinds of high-paying jobs and creative talent it craves. “For us, it’s just a continuation of what we’ve been doing for 20 years on the Southside,” Mike Brennan, new CEO of the Near Southside, Inc., economic development nonprofit, which the city has put in charge of developing the innovation district, says.

Brennan is identifying a working group that will take inventory of existing relationships, come up with ideas for new ones, and study best practices in other cities. The working group will explore “gaps in the ecosystem” and “how can we work together to fill the gaps,” Brennan says. He sees the final product helping small companies find real estate within the district. The city is re-examining its economic development incentive policy, and the medical innovation district will be a part of that discussion. One thing: Don’t expect overnight returns. “By definition, these kinds of programs have a long-term return,” says Barclay Berdan, CEO of Texas Health Resources, the big hospital operator whose properties include Harris Methodist Fort Worth. “By definition, they will have a lot of fits and starts.” So, what does all this mean? Eight things to consider:

The idea of an innovation district is amorphous – right now – but the med school is the new shiny toy.
The team building the school, led by new dean Stuart Flynn, is in an enviable position of being able to build it from scratch, not hidebound by institutional traditions. Students will be introduced to patients early on, learning how to empathize and communicate. That’s different from traditional medical education, which has slowly evolved two years of heavy science and lectures, followed by a year of clinical rotations, and a fourth year focused on finding a post-graduate residency program.

At TCU-UNTHSC, students will be introduced in year one to a small cohort of patients they’ll follow all four years. In year two, the students will spend 40 weeks in clinics – seven different clinics, a half-day per week per clinic – and be assigned physician mentors in each clinic. Health care has moved aggressively away from expensive hospital stays, but traditional medical training is stuck there. The TCU-UNTHSC has already lined up partnerships with hospitals in the region, but its model will push students well outside of hospitals.

“My training was almost entirely all in a hospital setting,” says Jacqueline Chadwick, vice dean of educational affairs and accreditation. “How much of medicine today is delivered in a hospital setting?” By taking training into the outpatient setting, “now I’m a much better-prepared student, not only to understand medicine, but to figure out what kind of doctor I want to be.” The physicians will be paid stipends by the medical school, which has started recruiting docs. The third year, students will be able to explore their interests more deeply, spending several weeks in an area of their choosing. Students also will be required to complete a four-year research project.

The die-hard hospital-centric model of medical education was developed in 1910. Some med schools have broken out of it in recent years, but the gravitational pull of tradition has been difficult to overcome. “I can go to any other medical school in this country right now, and what I will inherit is basically the training model of 1910 with tweaks and twists,” says Flynn, most recently founding dean of the University of Arizona College of Medicine-Phoenix and previously professor of pathology and surgery at Yale University. The old model has produced great doctors, he says, but with less empathy and connection to patients than could be achieved.

Calling all docs; the new school needs a bunch.
The medical school needs physicians who will serve as the year-two mentors. “If it’s one student per physician, then it’s 60,” Chadwick says. “So, we need 60 family docs and 60 psychiatrists and 60 surgeons” and so on, across the seven disciplines. The medical school started recruiting this spring for those physicians. “We’re anticipating some physicians will want a couple of students, since it’s only a half day a week. Maybe they’d like a student on Monday morning and one on Thursday morning.” The lure: “I think a lot of doctors just innately enjoy teaching,” she says. “If you’re a good doctor, you teach your patients. So, you want to turn around and give it to the next generation.” The prestige of a faculty appointment and access to the med school’s resources are also draws, Chadwick said.

Texas’ doctor shortage: The new med school wants to help.
The new med school aims to help address Texas’ substantial physician shortage. Graduating TCU-UNTHSC medical students who do their multi-year residency – the next step in their medical education – in the region or around the state may be more likely to go on to practice in the same area. The school quotes statistics that say 85 percent of physicians who complete their residencies are likely to practice locally. Tarrant County currently has 250 residency slots, led by 200 at the county’s John Peter Smith Hospital.

“In this county, we have capacity for 500-700 residency slots” beyond the 250, Flynn says. How this will be funded is unclear. The federal government pays for most resident salaries nationally, but Congress capped the number of residency slots it’s willing to fund in 1997, constraining the increase of residency slots in growing communities nationally. “We’ve been at our cap for years,” Scott Rule, JPS’ vice president and chief of staff, says.

TCU-UNTHSC School of Medicine Dean Stuart Flynn

The federal law contains no provision for an expansion of local funding for residencies when a new med school opens. But hospitals that have never received federal funding for residencies can apply. After five years, the program is capped, and the hospital must fund additional slots. Medicare, Medicaid, state funds, and privately raised money are other possibilities. “We are working with all of our hospital partners to explore every solution,” Flynn said.

Residency slots are often less than the cost of recruiting a new physician, something the new med school is pointing out, given the shortage of doctors. “Nationally, those costs are estimated at $500,000 to $1 million each,” Flynn says.

Another, more important challenge: Whether a hospital can fold post-graduate training of new physicians into its culture. “It’s not something you can put your toe in and then decide it doesn’t work,” Berdan says. Texas Health Resources has 10 internal medicine residency slots in Dallas; its Fort Worth residency slots are owned by JPS. Cook Children’s in Fort Worth has long participated in clinical rotations for medical students and has committed to participating in the TCU-UNTHSC second-year teaching program, but it has long resisted residencies in favor of having its patients interacting with veteran doctors. Cook declined to be interviewed for this article.

TCU’s expected to become a feeder school for the new med school.
That’s if national statistics hold up locally. “If you have an undergraduate feeder, a third of your class comes from that institution, one-third regional, and one-third elsewhere,” says Tara Cunningham, associate dean of admissions and student diversity. Many “students like to go to medical school where they have support.”

The Phoenix Rises in Fort Worth – in case you haven’t noticed.
Fort Worth is now home to a rising number of ex-Phoenix educational and health care leaders who are now playing key roles in this region’s future: Kent Scribner, Fort Worth schools superintendent; Eugene Giovannini, Tarrant County College chancellor; and Flynn and a half-dozen deans who helped build the University of Arizona-Phoenix medical school and now have moved to the new school. The group is said to know each other, and they expect the relationships to facilitate collaborations in Fort Worth. For one, the new medical school this summer will run a camp for students at four Fort Worth ISD middle schools – Young Women’s Leadership Academy, Young Men’s Leadership Academy, J.P. Elder, and Stripling. In summer 2019, the junior high school program is expected to expand with the selection of a school in south Fort Worth and with a camp for students at the O.D. Wyatt and Northside high schools.

Camp Bowie isn’t the permanent home of the new med school.
The med school will open in about 60,000 square feet of space in a new tower UNTHSC is building on Camp Bowie Boulevard. That’s to be a temporary home. Are talks underway about a permanent home? “Conversations are underway,” Flynn said. “They are conceptual.” Where might the permanent location be? “If you want to look at it logically, the Southside,” Flynn said, in the heart of the city’s health care hub. How much space is a question. “If you’re looking just educationally, 120,000 to 150,000 square feet,” he said. “That’s to build it and optimize virtual reality opportunities, to augment the training of telemedicine.” Faculty could train med students and residents in the same building, which would also facilitate "interprofessional" training with nursing, pharmacy, social work and business students, Flynn said.

How does John Peter Smith fit into all this?
JPS owns a lot of real estate, recently purchased more, is rethinking its land uses, and would be an ideal home for the new med school, Rule, vice president and chief of staff, says. “I think it’d be a great site for the med school,” he said, looking at a map showing several blocks north of Rosedale Street and on the east side of South Main Street that the hospital purchased last year.

JPS, Tarrant County, and the county Commissioners Court have moved to the next stage of what’s been a lengthy conversation about the hospital’s needs and what could go into the package for the hospital district’s first bond election since 1985. Rule says JPS isn’t thinking about a building it could share with the new medical school. “We view them as separate,” he said. (Flynn declined to discuss specific sites.)

A citizens’ committee that studied the hospital district’s needs recently made several recommendations, based on estimates of population growth, the ongoing shift to outpatient care from hospitals, and JPS’ old and outdated facilities: four new community health centers; new outpatient surgery center on the main JPS campus; new JPS Center for Cancer Care relocated to or near the campus from an outdated location; new JPS main tower; and new behavioral health center that would consolidate operations now in the main tower and two other locations. Ideally, the new tower would go on the east side of South Main, putting all acute patient care – emergency, surgery, and trauma care – and support services on one side of South Main, Rule said. The tower would increase the number of beds and convert patient rooms to private, augmenting teaching and patient privacy, Rule said. “We know these facilities are no longer adequate for acute care,” Rule says. “It presents opportunities.”

Mike Brennan, new CEO of Near Southside, Inc.

Brennan of Near Southside would like to explore the possibility of JPS housing all of its needs on the property it owns south of Rosedale, with a strong level of density, freeing the several blocks north of Rosedale for other use. “Can we fit all of their expansion needs south of Rosedale?” he says.

Are the naming rights for the new school in play? “Absolutely.”
Want to put your name on the new med school? Its leaders are looking for such a donor and have put out feelers to the usual suspects. “That is absolutely in play,” Flynn says. “I think a very fair, spirited dollar amount based on national norms is $100 million,” for the right to name the school in perpetuity. Prior to Flynn’s arrival, the TCU-UNTHSC leadership group offered the rights for $50 million to some number of potential donors, Flynn said. Those offers remain in place. “We can’t change the ante, so to speak,” he said. Assuming the medical school eventually moves to a permanent home, the naming rights for the building itself would go on the auction block, Flynn said. Interest in naming the new med school will likely heat up once the inaugural class is recruited and arrives, Flynn said, basing that on his experience in building the Phoenix school. “Once they arrive, it becomes real. And when it becomes real, then Fort Worth, who has already been phenomenal, will now see their little ducklings. There’s something very powerful to that.”