MUSC’s separating its academic, health system needs scrutiny

We won’t pretend to know whether it makes good sense for the Medical University of South Carolina to separate the governance of its academic side from its dramatically expanded network of physician offices and hospitals.

But we do know this decision is significant enough — as it will affect the governance of our state’s largest medical school and its growing care network, which combined have a budget in excess of $10 billion —  that it ought to be vetted by state lawmakers, in a thorough and open process.

This potential change comes as MUSC President David J. Cole, who has overseen both MUSC’s schools and its health-care network for the past 13 years, announced he will step down on June 30, and a search committee comprised mainly of MUSC board members begins its search for a new leader.

Dr. Cole’s pending departure has raised this crucial question: Will the interests of South Carolina be better served by maintaining a leadership structure in which one person is the focal point of decision-making for both the Medical University of South Carolina and the Medical University Hospital Authority, or would a committee do a better job? The board is leaning in favor of the latter, as reflected in its presidential job search, but the change won’t become official until its hire is made.

MUSC is an extraordinarily important state-owned institution, whose duty is to provide a superior medical education for South Carolina’s physicians and — because of changes it has made without much if any legislative input — provide a huge chunk of South Carolinians’ medical care, both inside and outside of the hospital. Such a significant change to the way this institution operates demands a full and open debate that the board — which seems already to have made its decision — has not provided us.

Pausing such a monumental change — either voluntarily or at the Legislature’s demand — will allow the input of more people than just a handful of appointed board members, from faculty members who fear this plan will hurt the medical school to independent physicians who want more distance between the two sides of MUSC.

Maintaining the status quo, where MUSC’s president oversees both its academic university and the health-care operation, is the more conservative play, as no one has yet offered what we consider a compelling reason for change. MUSC has made great strides in the recent past under its existing governance structure, which is also used by other states’ academic medical systems. This is also the view of some of MUSC’s leading faculty members.

Dr. Michael G. Schmidt, president of the Faculty Senate, recently wrote a letter to the search committee saying faculty members are concerned that separating the roles would unintentionally weaken one of MUSC’s greatest advantages: its intertwined missions in education, research, clinical care and community service.

“The growth and success of MUSC’s academic enterprise are inextricably linked to the strength of MUSC Health,” he wrote. “Research expansion, faculty recruitment and retention, graduate medical education, innovation, philanthropic investment and the development of new clinical and academic programs all depend upon a coordinated strategy that integrates academic and clinical priorities. A president who maintains direct responsibility for and engagement with both the University and the health system is uniquely positioned to ensure that these priorities remain aligned and mutually reinforcing.” 

On the other hand, as MUSC Board Chairman Charles W. Schulze recently told The Post and Courier’s Tom Corwin, MUSC’s growth may warrant a split, in part because it would be very difficult to find a new president who could do it all. We’re not sure on this point; the dean of the North Carolina School of Medicine is also CEO of its health system. And the same search firm MUSC is using to replace Dr. Cole recently found four credible candidates to serve as dean of Vanderbilt’s school of medicine and CEO of its health system. 

The relationship between MUSC’s two parts involves big bucks. Its health system contributed $315 million toward the academic side in the past fiscal year, almost double the $172 million shared only three years ago. The board plans a joint operations committee with all of the board’s seven physicians to oversee that relationship in the years to come.

Mr. Schulze and another longtime MUSC board member, Don Johnson, responded to Dr. Schmidt’s concerns in their own detailed letter: “The board values the Faculty Senate’s perspective; however, it remains confident that the proposed leadership refinement is appropriate and necessary to support MUSC’s continued growth, strengthen coordination across the Enterprise, and preserve the institution’s academic mission.” 

We don’t doubt that MUSC’s growth has significantly increased the complexity of overseeing and balancing its academic and medical operations, but we do wonder how best to provide public accountability for that oversight and balance in the years to come. Absent statewide consensus to the contrary, the bottom line is not the only consideration here.

MUSC is not only one of South Carolina’s top two health-care providers. It’s also the provider that is owned by and should be answerable to all of us. State lawmakers, who have a larger range of opinion than MUSC board members and a clearer obligation to serve the interests of our entire state, are best positioned to conduct a public debate that ultimately decides what the priorities of MUSC should be. The health of this pivotal state institution appears to be at stake, and it’s not an exaggeration to say our health could be affected as well.

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