Med School Audit Critical of Dean, Family Practice Finances

GRAND FORKS, N.D.

A new audit is critical of the management of the University of North Dakota medical school and says family practice centers in Bismarck and Minot are on shaky financial footing.

The medical school dean, H. David Wilson, has alienated faculty members and state lawmakers by making decisions without consulting others or considering their public impact, the audit says. Wilson disputes the criticism.

The audit also suggests restarting a family medicine residency program in Fargo that was shut down five years ago. The state needs more training opportunities for new doctors, and federal Medicare aid may be available to subsidize expenses, it says.

Bismarck’s family practice center, which is located downtown, is difficult to access, while Minot’s center is “burdened with high fixed costs and high faculty turnover,” the audit says.

“Although the Centers for Family Medicine provide excellent services to the communities, they do not represent good business investments for the medical school,” the audit says. “Based on current revenues and projections, their long-term financial viability is doubtful.”

The report says the medical school has done “an admirable job of recruiting talented faculty and assembling an environment supporting faculty research interests.”

Wilson said he spoke to associate deans and department chairmen before making major decisions. Any top administrator of a large, sprawling organization risks making people unhappy, he said.

“If I make a mistake, I try to admit it. The bottom line is, this is an outstanding medical school that’s been benefited by its administrators, including me, and I stand by our record,” Wilson said.

The 2005 Legislature ordered the audit in the wake of complaints about the 2002 closing of Fargo’s family medicine residency program, and the merger two years later of its departments of family and community medicine.

The audit described Wilson as “vested personally in all decisions without relying on formal, faculty-driven processes and without at least in some circumstances an appreciation for the political consequences of these decisions.”

Wilson said he accepted the criticism, but added: “Will I try to be more soft and cuddly? I’m not sure that’s the way a good manager handles a complex organization.”

The Board of Higher Education’s Budget, Audit and Finance Committee is expected to review the audit report and the medical school’s responses to its conclusions Tuesday. The Legislature’s Audit and Fiscal Review Committee is scheduled to examine the audit Nov. 19.

The report says the medical school lacks an adequate system for monitoring its own operations or its compliance with state laws. The school does not appear to be following laws governing its operation that were written in the 1940s and 1950s, it says.

For example, the school does not identify state mental health agencies’ psychiatric staffing needs, compile lists of communities that lack a doctor or dentist, or coordinate health and welfare activities in the state, the audit says.

The medical school’s 14-member advisory council meets rarely and for only a few hours at a time, when state law gives it the responsibility for making recommendations about how the medical school can better meet the state’s needs, the audit says.

“The advisory council does receive a large amount of information regarding (the medical school) and does discuss such information,” it says. “However … (the council) does not adequately advise or make recommendations.”

The medical school, in a response to the audit’s statements, said steps were being taken to give the council a stronger advisory role. The laws that guide its operations appear to be outdated and should be revisited by the Legislature, a response says.



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