Breathing New Life into Meharry
The 125-year-old historically Black medical school was on the brink of closing down, but through new leadership and partnerships, the school is financially healthy, and its students’ board scores are the highest in the school’s history.
By David Hefner
On a late July afternoon in 1994, Dr. John E. Maupin Jr. stood outside his new office building, looked over the campus of Meharry Medical College and became a bit emotional.
Things had changed since his days as a dental student at Meharry in the early 1970s. And though change was inevitable, in this case it was frightening.
“I just couldn’t believe that this wonderful place that had nurtured me could have deteriorated so badly with so many good people,” recalls Maupin, who, just a week prior, had been named president of the Nashville, Tenn., medical school.
What Maupin saw that afternoon were deteriorating buildings with leaking roofs, a once-thriving campus hospital in a state of crippling deficits and low patient counts, and a laundry list of
academic and financial woes — the types of problems that threaten the very existence of historically Black institutions. Meharry was at the cusp of
For whatever reason, Dr. David Satcher, now U.S. Surgeon General, had acute problems in steering Meharry away from this abyss during his tenure as president from 1982 to 1993. Paramount among Satcher’s challenges was the college’s hospital, which for roughly 10 years was costing the school about $5 million a year, say Maupin and school finance officials.
Struck by Meharry’s condition, Maupin, 54, set out on a course of presidential action that would eventually breathe new life into the school.
And after seven years, Maupin has not only stabilized Meharry; he has nursed it back to health, due in large part to a merger with Nashville’s city hospital, an unprecedented partnership with Vanderbilt University and the recruitment of some stellar faculty members. But along the way, Maupin has made some unpopular decisions. Further, he has spent so much time keeping the sinking ship afloat that he has at times neglected at times his loyal crew — the
faculty and staff.
“We had good faculty, but morale was low,” observes Dr. Ruben J. Pamies, one of Maupin’s key recruits hired last October as chairman of the department of internal medicine. Before joining Meharry, Pamies was dean of students at Case Western Reserve University School of Medicine in Cleveland, the first African American to hold that position.
“We were having difficulty keeping good faculty (in internal medicine department) and recruiting new faculty,” Pamies continues. “Many of them wanted to leave for the prospects of better income and support in terms of computers and other basic needs. They felt they were working so hard and killing themselves and no one was recognizing it. …I met with every one of them and said, ‘Give me a few months, and if you don’t see a change, I’ll help secure you another job.’ Needless to say, none of them has left.”
At the Brink of Death
Though Meharry was still breathing in 1993, it was obvious that if things didn’t change quickly it would only be a matter of time before the critically injured medical school flat-lined and ended a storied tradition of producing Black doctors, dentists and scientists since 1876.
The school’s injuries were severe: a $49 million deficit; an audit that showed the college had a “questionable” ability to pay debts; a 28-page management letter listing internal control, management and fiscal problems; a steady decline of student performance for the past 10 years, with at times less than a 50 percent passing rate on Step I of the boards and only a 39 percent passing rate on Step II. And, as Maupin says, “Every single building on this campus had a leak. I probably knew more than anyone else here how close to closing we were,” Maupin says. “I had to lead a resurrection with no money.”
In fact, the efforts had begun as early as 1989. At that time, then-President Satcher was given the green light by Meharry’s board of trustees to begin negotiations with the City of Nashville. The plan was to close Meharry’s hospital, relocate Nashville’s declining city hospital to Meharry’s campus, charge the city to lease and renovate the facility, while Meharry provided the medical care.
It wasn’t an easy sell, but it was the college’s only hope for survival.
“The underlying problem was that Meharry, through its hospital, had the responsibility of providing health care to the indigent population of metropolitan Nashville without receiving any
financial support to cover the related cost,” says Donnetta Butler, senior vice president of finance and administration at Meharry, who served as treasurer from 1985 to 1991.
Before integration, Butler says, Meharry’s Hubbard Hospital was turning over marginal profits because well-off Blacks who could pay for medical care offset the losses caused by those who could not. With integration, that balance ended.
“And as a result, what had been at least a marginal operation turned into a deficit operation,” Butler says.
By 1989, it was clear that Hubbard Hospital was the college’s Achilles’ heel. And over the next four years, Satcher persuaded the city to go along with the deal as long as Meharry agreed to staff the city hospital with all board-certified physicians. By 1994, Satcher and Meharry’s Dr. Henry Foster, (President Bill Clinton’s 1995 surgeon general nominee), had recruited all board-certified physicians for the hospital, taking care of Meharry’s end of the bargain.
But by that time, Meharry had borrowed $22 million from its endowment and $11 million from banks. Plus, it owed another $15 million to hospital vendors. And academic standards and campus upgrades had begun to give way to fiscal necessity.
“(The accrediting bodies) were very concerned about the product: the students,” says Dr. A. Cherrie Epps, who Maupin hired in 1994 as a consultant to evaluate Meharry’s academic program.
“Students were not demonstrating that their education was sufficient for them to be certified for timely movement. The second thing was that there were fewer students graduating than there were entering the class,” says Epps who later became dean of the School of
‘Stabilize the Patient’
Dr. John Maupin finished dental school in 1972, completed a general residency at Provident Hospital in Baltimore, and spent a brief period in private practice before entering the U.S. Army Dental Corps in 1974. He was assigned to Walter Reed Medical Center in Washington, retiring from the Army Dental Corps Active Reserves in 1997 with the rank of lieutenant colonel.
By 1980, Maupin had earned an MBA from Loyola College in Baltimore. The next year, he served as assistant commissioner of clinical services and then deputy commissioner of medical services in the Baltimore City Health Department.
Though he would eventually become executive vice president of Morehouse School of Medicine, Maupin’s business degree and prior experience working in Baltimore city government may have been better preparation for the challenges he has faced as Meharry’s ninth president.
By 1994, following Satcher’s departure, Nashville Mayor Phil Bredesen and other city leaders were having reservations about moving Nashville’s Metro General Hospital to Meharry, according to Maupin and others. With talk in the Clinton administration of universal health care, leaders were wondering whether the city needed to shovel out money for a publicly run hospital. Later that year, Meharry’s board of trustees named Maupin acting president and asked him to help get negotiations with the city back on track.
We were going to lose Hubbard Hospital and Meharry,” says Willis McCallister, who was a Nashville city councilman at the time. “Many of the city councilmen didn’t want to see Metro General Hospital move to the (Black community). And a lot of Black people didn’t want it. Hubbard had been our hospital, and people who were not aware of what was going on thought it was going to be a takeover. But Meharry would have ended up closing.”
Maupin, who had spent time lobbying city officials in Baltimore, persuaded the Nashville mayor to solidify the merger between Meharry’s Hubbard Hospital and Nashville’s Metro General Hospital. And on Aug. 16, 1994, Nashville’s city council approved the merger in a 24-9 vote.
“If the mayor would have been against it, it never would have passed,” says McCallister. “Maupin was a guiding force when Satcher left.”
People at Meharry have come to realize that Maupin is a very persuasive man. Though he had help in persuading the mayor to go along with the merger, it was one of Maupin’s most significant efforts. Shortly thereafter, he was named Meharry’s permanent president, the first alum to hold the position.
The city now pays Meharry $4 million a year to lease the hospital property and gives Meharry another $8 million for providing the medical service, say finance officials. With a $54 million budget, the 150-bed hospital has been renovated and stocked with state-of-the-art equipment. Using money from the lease, the college issued 30-year bonds worth roughly $50 million and paid off most of the school’s $49 million debt, Maupin says. Since 1994, the college has spent $68 million on school improvements.
“The initial challenge was to stabilize the patient,” says Butler. “We’ve done that. From 1999 forward, we have really been looking more strategically at competing in a dynamic health care environment.”
Partnering for Success
Since June 1995, Meharry has had a clean financial statement, says Butler. For the past five years, students have passed their board exams at rates exceeding 85 percent. Scores are now the highest they have been in the college’s history. Last year, 90 percent of Meharry students received their first, second or third choice in a residency program. The national average is 85 percent.
Meharry has enhanced the teaching and learning center, established a computer lab for national board testing, introduced a clinical skills assessment center and improved the structure of Meharry’s five-year program with neighboring Fisk and Tennessee State universities.
All of Meharry’s four colleges — medicine, dentistry, graduate studies and allied health — have been fully accredited for the maximum period afforded by their accrediting bodies.
“Phenomenal,” says Dr. Pamela C. Williams, vice dean of student and academic affairs in the School of Medicine. “To see our graduates going to the residencies of their choice is absolutely great. Our students are getting more competitive positions.”
In 1999, Meharry entered an unprecedented partnership with Vanderbilt University Medical Center, a move that has received some criticism from faculty members. Maupin says Meharry had to team up with a major player in cancer research in order to compete for more research dollars. The Vanderbilt-Ingram Cancer Center is among the best in the nation and is the only comprehensive cancer center in Tennessee.
But Maupin also asked Vanderbilt to manage Metro General Hospital, with Meharry faculty still providing the medical care. The chief executive officer, the chief operating officer and the chief financial officer are all from Vanderbilt.
Critics are worried about Meharry being swallowed up by the larger institution.
“The alliance is very promising in terms of research, but more and more is expected of our faculty,” says Dr. John Estrada, president of Meharry’s Faculty Senate. “We can complement each other, but we have two different missions and we need to be careful.”
The alliance has already proven successful in Meharry’s research efforts. In March, the National Cancer Institute awarded the schools a $7.5 million project grant, of which Meharry will get $6.5 million over the next five years. Meharry also wants to open a new cancer treatment unit. And, according to Meharry officials, 24 grants were funded last year as a result of the Meharry-Vanderbilt alliance, compared with only 10 in 1998 and 8 in 1997.
Now, Meharry is seeking $25 million for a comprehensive epidemiological research initiative to study the causes and conditions that contribute to disparities in cancer. Meharry is partnering with Vanderbilt, 26 community health centers and the International Epidemiology Foundation in Rockville, Md.
“It’s a masterful partnership,” says E. Ramone Segree, senior vice president for institutional advancement, who is using the alliance to raise money toward Meharry’s five-year, $125 million capital fund-raising campaign.
But beyond the Vanderbilt alliance, faculty members are encouraged by the college’s improvements but still have some deep concerns.
“We have made major strides in improving our academic program,” Estrada says. “We have done very well with accrediting bodies, and financial issues have been improved. But it’s now time to pay more attention to the faculty, because many of us are overworked. Salaries are very low, and many of our young faculty are leaving.”
Maupin and his top officials admit that faculty and staff have been somewhat neglected for the last few years.
“Dr. Maupin had to make sure the institution survived,” says Butler. “And he was not always in a position to perhaps spend as much time cultivating a good relationship with employees and others. … Now that things have been stabilized, we’re all in a better position to spend more time in cultivating the kind of relationships that we would like with our employees.”
Maupin says he’s committed to paying more attention to faculty and staff needs. Estrada says he believes Maupin.
Meharry celebrates its 125th birthday in October. It was 1876 when Samuel Meharry, a White man, and his four brothers gave more than $30,000 in cash and real estate to help fund Meharry.
Since that time, Meharry has enjoyed several distinctions: In 1980, a study showed that 40 percent of all Black physicians and dentists practicing in the United States graduated from Meharry. Today, Meharry produces 15 percent of all Blacks each year who graduate with degrees in medicine, dentistry and biomedical sciences. Meharry is one of only four historically Black medical schools.
So in 1994, when Maupin looked over Meharry’s campus and cringed, it was a brief but solemn moment in Meharry’s long and distinguished history. For his part, Maupin says he’s just glad to have been a part of keeping his alma mater alive.
“While Meharry has sustained itself for 125 years, it has done it with much struggle, much pain, much suffering and very few reserves. But she did it,” Maupin says. “But there’s no reason why Meharry should have to go through that kind of struggle to contribute to the country and to African American communities ever again in its life.”
© Copyright 2005 by DiverseEducation.com