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from Gainesville, Florida Hello, I'm Mike Cannon. And this is conversation. Three years ago, the University of Florida Health Center, with its teaching hospital, was in a state of uncertainty. Shands Hospital accreditation seemed in danger of being withdrawn. The state Cabinet was talking about denying a $40 million loan that was necessary for the construction of a new patient services building.

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And state Senator Jack Gordon was talking about dismantling the medical programs at Shands and in the health center generally and removing them to some part of the southern portion of the state, probably Miami and Miami Beach, his home territory. Well, I'm pleased to report that none of that happened.

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All the best happened. Instead, the Accreditation Commission, which visited Shan's, gave it passing grades. The new Patient Services building opens for use in May of this year, and the health program is alive and well in Gainesville still, three years ago, and in the years which followed the health center, administrators discovered the distressing news that many people who lived in Gainesville intellectual county had no idea what the special mission of the health center was.

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If you happen to be one of those still confused about the special place of Shan's teaching hospital. To take one example vis a vis the other hospitals in the community. I would advise you to watch and listen as I return in a moment with my guest.

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Five. Live presents Conversation from the University of Florida, a discussion of social, political, scientific and religious issues of the day. Your host is Dr Michael V. Gannon professor of history and ethics, an assistant dean of the College of Liberal Arts and Sciences at the University of Florida.

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My guest on this conversation is David Challenger, vice president for medical affairs in the University of Florida and chairman of the board of directors of Shan's teaching hospital. David. Welcome to conversation, Mike, thank you very much. I'm delighted to be here. I'm going to lead with a very direct question, if I may.

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What is the special mission of the teaching hospital? How does it differ from the other hospitals? A lot. You, a general and North Florida regional in our community? Well, all hospitals, of course, exist for patient care. The very special mission of a place like Shan's, which we call a tertiary care or a teaching hospital.

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is that in addition to patient care, they have other missions which are equally important, and that is the mission of research and the mission of student education. The Shands Hospital would not be here if it were not for the fact that there's a college of medicine and other health professional colleges as part of the health center, the community hospitals have a primary mission of patient care.

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We have a very a multiple mission with at least three units, patient care, education and research. Now we use the term tertiary to describe something that is done. Third in order. Isn't that correct? What are the first two things which are done? Could you take a patient through the three stages?

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Well, it's a phrase that is used probably too cavalierly, but I think it has some meaning. For instance, when a patient first sees his or her private local physician, one might say that that is the first order or primary care. And that's the physician that an individual usually sees on an ongoing basis.

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And it's the person that you would the physician that you would point to and say, That's my doctor. A secondary care, maybe when that physician has to refer you into a hospital in most cases, a local community hospital for something that's a little more complicated and out of the ordinary.

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The tertiary care hospital. What sort of hospital that Shan's is, is the hospital to which your primary physician and your secondary hospital may choose to refer you if you have a problem that is more complex and out of the ordinary than they might see or be equipped to handle, So it would be a referral hospital if you could use that term as well.

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That's correct. All tertiary care. Almost all tertiary care hospitals end up being referral hospitals. Now the health center has the hospital, and I want to get back to the hospital in a moment. But it also has six different colleges. Is that correct? Starting with medicine? That's right.

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It's a very large, complex organization. Uh, the six colleges are medicine. As you mentioned. Dentistry, nursing pharmacy, health related professions and the College of Veterinary Medicine is also part of our health center here, with their veterinary medicine teaching hospital as an additional facility. And there is a very close interaction between the teaching and research programs on the one side and the clinical or medical practice aspect of the health center.

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On the other, they are almost. It's almost impossible to tease them apart, like one takes place because the other is occurring there. The health care that is delivered in an institution like ours has a very large component, which is, uh, at or near the cutting edge, as we might say in terms of science and technological development.

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At the same time, getting the complex patients by refer referral means that our faculty, almost in doing their day to day job and taking care of patients, also is asking questions. Are the faculty is asking questions that are at the cutting edge of modern biomedical science, And so they are learning and doing research while they're taking care of the complex patients.

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So it's not just the medical students and those in the other collegiate programs you described who are learning but the faculty themselves conducting, I suppose, research programs to aid in discovering cures for particularly difficult clinical problems. That's right. The exciting thing about being in a place like Shan's is that everybody's learning, including those of us who are administrators at this point, and those of us who are interviewing administrators.

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David, uh, what is the connection between what we've described so far, the health center and its teaching hospital and the Veterans Administration Hospital across the street? Well, that's a very interesting relationship, and this is one of the more unique ones in the country and one of the healthier affiliations between the university and the Veterans Administration.

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The Veterans Administration very deliberately placed this large veterans care institution here at the University of Florida as part of its health center at its inception, and the tradeoff goes something like this. The Veterans Administration uses the university to obtain faculty and interns and residents to help care for the veterans, which is their obligation.

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And then the university, in turn, has these beds and other WVA facilities that have a makes available, uh, for the teaching programs to educate the future wave of physicians, medical students, interns and residents. So we get teaching opportunities and research opportunities, and the Veterans Administration gets the physicians.

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But the V A hospital has its own staff of physicians. It has its own staff of physicians. But almost two, uh, a man the staff at the V A hospital, our faculty members of the University of Florida. So basically the V A in that sense becomes an extension of the University of Florida and its health programs.

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All right, now I want to get back to the hospital. We've always used locally the term Shan's teaching hospital. And now I hear repeatedly, and I use the term myself in a little teaser with which we began patient services building. What is a patient services building euphemism, perhaps for hospital.

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Yes, I'm not even sure how why that name was put on it. It was on it before I arrived here. It simply is the, uh, new construction that I'm sure many of our viewers have seen at the health center, which will serve to house the serve as new housing for the 460 bed 76 beds for which the Shands Hospital is licensed.

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We're simply moving the beds out of the old facilities which in 25 years have basically become un renewable and un Ramada wible into new modern space. So you're not augmenting the number of hospital beds, you're simply upgrading the quality of those beds and rooms. That's correct.

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Uh, all but 26 will have been moved. That means the older building can be used for what offices are during the last 25 years. As I'm sure many of the viewers realize the technological support that is necessary to have a teaching hospital at the forefront has expanded X ray facilities need more space, laboratories need more space.

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And what was happening at the Shan's is that we had the space that was built 25 years ago. But the supporting space necessary to take care of those 476 beds began to absolutely but up against any ability to expand. So what will happen is we'll move the beds into the new building, and then the old bed space well, for the most part, be used to, uh, allow for the appropriate expansion of the supporting activities necessary to take care of the beds you mentioned.

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X ray. You you have some new equipment state of the art cutting edge equipment, including a cat scanner that is very different from anything in that particular field before. What is that called again? Well, this is the n m. R. As we call it nuclear magnetic resonance.

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And this is a as you, as you mentioned, a state of the art machine that uses an entirely new methodology of imaging, which will give better pictures of the body than any other instrument. There's only there are about 10 of them that will be placed in various health centers around this country over the course of about the next eight or 10 months, and the University of Florida and its health center will be one of these 10 locations.

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It's a very, very exciting clinical tool that everyone thinks and ourselves included is going to be the future of imaging technology so that you can make diagnoses of what is occurring inside the body without surgically entering the body. That's right, and we'll be able to see things like, for instance, the blood flowing through the heart or be able to tell which parts of the brain are functioning.

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Not only will we be able to see the anatomy of the brain, but we'll be able to say that this lobe right here is the one that is turned on or turned off in such in such a situation. That's a very sophisticated and exciting instrument. It gives a three dimensional picture, as against the one dimensional, flat X ray with which many of us are familiar.

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That's right. What are some other things? Didn't I hear that you are incorporating into the technological side of your program? A new ultra sound device that breaks kidney stones into micro fragments? Those who have had kidney stones would be delighted to hear that there is something coming into Gainesville of that character.

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Well, I hope that's not any problem that you have had, but it's something called the lift a trip to and that basically means stone smasher. I suppose we could call it that. It's a German made instrument, but it focuses sound waves from a variety of areas around a patient, specifically onto one point.

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So when all the sound waves crashed together on that point, it literally explodes the stone without damaging any of the area the surrounding kidney area. Yes, we would hope without damaging any of the surrounding area. That's right. It's a multimillion dollar instrument, but for the sufferers of stone, I'm sure that they will come as they already have been to our stone center for this new treatment.

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Well, it answers the question that every person who has had a stone has asked. I'm sure isn't there some way you can just break the thing apart? And until now, there has not been such a device or means That's right. You have a number of tie ins with other colleges, and I think of engineering.

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And Larry Hench and Engineering has participated in the development of bio glass. Would you describe a little bit about what that is and what you're doing with it in the health center? First of all, I'd make a general comment before we started that this follows off of your question.

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The one of the important relationships and reasons for the existence of an academic health center like ours in a university environment is the opportunity to bring other disciplines to bear on our research, education and patient care programs. You've mentioned one that specifically ties into the collaboration between faculty members in the College of Medicine and the College of Engineering Larry Hinch.

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Being the person he has developed, a very interesting material, that is Ah, basically it is a glass ceramic and it is compatible with human tissues, so It's not rejected, like many various, many other kinds of implants might be, And it can be modeled into a variety of replacements of solid structures in the body, everything from something as small as the little what we call the obstacles or the ears, the ear bones, bones in the inner ear, uh, to as large as bone replacements.

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And this material is compatible with human tissue. In fact, human tissue will even grow into it if you give it the appropriate holes or porosity. So there are a number of applications that are going to be looked into from the point of view of development in patients of this material.

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So I think it's a very exciting, uh, future for University of Florida and these two units, the College of Medicine and the College of Engineering. I'd like to put in a word for my own college of liberal arts and sciences in which I serve there. We have in training all of the University of Florida students who are pre medical uh, students taking a specialized pre med program.

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All of the basic sciences and all of the mathematics that are learned by pre med students are learned in our college. And so we like to think we're full partners with you to in the enterprise of creating new physicians and other health professionals more than just in in preparing them at the baccalaureate level.

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We have a series of collaborative educational ventures in the humanities, humanities as they relate to health professional education, in which University of Florida has been a national leader, I think so are medical humanities Program has been very sound. It began with a program funded originally by the National Endowment for the Humanities for Humanities Perspectives on the Professions.

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And it not only helped people in medicine, but also people in engineering and in business administration and law to understand the humanities dimensions of what they were doing professionally. And while that program has run its course, there are some lingering residual good programs in place, including yours in the medical center.

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And I hope that we will continue to build on that because, quite rightly, as you point out, we're a leader in the field. It's very high in this year's College of Medicine budget requests. In order to replace the grant funds for support of the program with state dollars at this point, So it's very high on our priority list.

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David, I heard you speak once about ah, the question. Is there a doctor in the house? And you said that that is about as useless a question in Gainesville as What is your favorite football team? And this because of the fact that we have one of the highest ratios of physicians to persons that is positions per capita of any city in the United States.

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I think we ranked sixth. And wherever you go, every six, uh, well, 300 person is a physician or something of that order, is that correct? That's just about exactly right. It's just a little over 300 persons for per physician in Gainesville. Now, the national average is about one physician for every 550 persons, so that we have plenty of doctors in Gainesville Now.

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Many of them are obviously occupied, not full time in patient care, because many of them are the physicians on the the staff and faculty at the health centre, spending time doing research and education in addition to taking care of patients so that that statistic is a little bit skewed for Gainesville.

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But we have plenty of doctors in town, which explains the number of beepers going off in restaurants and church services all over town. That's right. In fact, I would think many of our fellow citizens will look forward to the new generation of beepers, which won't make noise.

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But we'll just have digital readouts on them so that you don't get the verbal message. There's a a question which has occurred to many, I'm sure, and I'll put it to you. Is there so competitive situation existing among physicians in Gainesville? Owing to the large numbers of people in the health professions that we've created a major problem?

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Uh, is it possible for a person going into the medical profession to expect to earn a decent living in a town where there are so many people competing for now, so few patients individually? Sophia Well, that's a very perceptive question, Mike. I think. First of all, it's worth pointing out to the viewing audience that this number, this ratio that we're dealing with now the plentiful number of physicians, is a big change from where we were in this community 25 or 30 years ago.

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Prior to the establishment of the health center and its colleges. At that time, we had something like one physician for every 1600 or 1700 people, and we're one of the most poorly physician areas in the entire United States. Now the numbers that we're dealing with at the moment, uh, in Gainesville are generous.

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But as I said, in terms of, if you want to look at in terms of full time equivalent, something university people are used to talking, we really don't have that many full time equivalent practicing physicians because of that group at the university. Nevertheless, Gainesville is a very attractive medical community with two fine community hospitals, in addition to the hospitals that are part of the health center and that has attracted people into practice here.

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So that my guess is it would not be easy for a young physician as easy as it was a decade ago, to enter into practice into Gainesville or any number of other locales around the state of Florida or the country. The fact of the matter is, is that classical economics works and all the data shows that with our increased production of physicians over the last couple of decades in this country that physicians are now moving into a variety of smaller communities that they were not in before.

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Would the high level of health care and the large numbers of physicians in Gainesville tend to attract retirees? And if that turns out to be the case, is it likely that some will object to retirees moving into Gainesville because they tend not to be major taxpayers?

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UH, do not, according to allegations, contributes substantially to local economies and so on. Well, my view on, I don't want to take a position on whether it's good or bad to have retirees in the community. Uh, I doubt very much whether the availability of a large number of physicians or specific health care facilities like the Shan's teaching hospital, at least is a factor that would make the person retiring from Minnesota decided to settle in Gainesville versus settling anyplace else in the state of Florida.

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I think good health care facilities available within the state of Florida is an important thing for the elderly as they look to the possibility of moving, but I don't think the particular geographic area is important, just so we're accessible as a tertiary care center referral center.

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They need to know that when they're special help available that two or three hours by car or less, they can get what they need. But they aren't. We aren't bringing them to Gainesville. I don't think, David. I want to take advantage of your presence on campus as a newcomer on campus, more specifically to ask you some questions in closing about your reaction to the State University system and the University of Florida's place in it.

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You have been on our campus for a little over one year and a half. I came July 1st. So we're listening. I'm a real newcomer. My word. And you came here from ST Louis University and its medical school. You come into a state where there are large number of universities serving a rapidly growing population.

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You are situated in the oldest and largest of those universities. How do you see this universities place in the state at the present time? Well, uh, it is called the flagship university, and I think by its age and size and the maturity of its academic programs, graduate and research programs, it is think that the troublesome observation, if any, If I could call it that is that the state has done very well over the course of the last 20 or 30 years in expanding its state university system to be widely available from and looked at from an egalitarian point of view that was probably appropriate at that stage in the State University Systems history.

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The problem that it must deal with now is that Florida is going to be very soon the fourth largest state in the country. It's looking to highly technological based industry. Uh, it is a state that by its size and wealth alone, deserves a world class university.

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It does not have one. I think it would be honest to say that we're not there yet. And I concerned that the governance structures that were appropriate at a time of expansion and geographic spread and availability are not necessarily the same kind of governance structures which will lead us to excellence.

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And are you speaking of the Board of Regions and other sections? To a significant degree, the Board of Regions tends to be a leveling influence in which the various bureaucratic procedures, accountability procedures that we are all subject to are designed for the lowest common denominator in the system, not the high class act that I would like to see and that we have in most places at the University of Florida.

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Would you agree with the statement that there is no such thing as a great university system? The only thing that can exist is a great university or great universities within a state system. Somewhere, a choice has to be made that here is where you replace your quality because you cannot have quality everywhere.

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Is that what you're saying? That's what I'm saying and that also, you need a sense of freedom and institutional individuality in order to bring about that ambiance for true excellence. And, uh, I think we have some. I have some concerns about that in the face of the current Florida system, possibly looking toward the organization of individual boards of trustees or boards of regents for the individual institutions.

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Some how each university needs a little bit more of its own constituency and the ability to compete on their merits for students, for dollars for research resources. At the moment, that system is for competition, where the best may win out is not in place, you say.

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And I agree with you that we are not yet a world class university. How would you rank our medical program nationally? Well, now you're gonna talk about College of Medicine or the health center. Do it any way you want. Well, let's talk about I'd say the health center might be a good way of looking at it.

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We, I think, are within the top 20 health centers in the country. We are. It's a very large health center. It has a diverse number of programs. It still needs greater strength in the research area. We are doing reasonably well, but we are not one of the outstanding research universities in the country.

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Um, but we are moving towards it. And that's the reason I came. I saw the potential here to build a true world class academic health center in the decade of the eighties. I hope we can do it. I hope so, too. And I thank you very much, David, for being with me.

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David Challenger, vice president for medical affairs in the University of Florida. Mhm. Mhm. Mm. Uh huh. Mm. Mhm. Mm. Thank you. Mm hmm. Baby