Leadership: Conversation with Dr. Jordan Cohen
Guest: Dr. Jordan Cohen – Internal Medicine, Washington, DC
Host: Dr. Layton McCurdy – Psychiatry & Behavioral Sciences, MUSC
Dr. Layton McCurdy: I’m Layton McCurdy, Dean Emeritus at the Medical University of South Carolina. I have the pleasure this morning of having a conversation with Dr. Jordan Cohen, who has been, until very recently, Executive Director of the Association of American Medical Colleges, which is an organization of all medical schools; 125 or 130, the teaching hospitals, and a coalition of academic societies in our country. It is, clearly, the nation’s lead organization for academic medicine.
Dr. Cohen’s background includes medical training at Harvard Medical School. And he, himself, was a dean of a medical school for several years before taking the position in Washington. Welcome, Jordy.
Dr. Jordan Cohen: Thank you, Layton. It’s nice to be here.
Dr. Layton McCurdy: One of the things we’re wondering about these days is the role a place like MUSC has in addressing the health-related issues in our country.
Dr. Jordan Cohen: Well, let me speak more broadly, first, before coming to MUSC, about what I view as the role of academic medical centers, generally, in this country. I don’t think there’s any disagreement about the fact that the country’s biggest single issue is how to redesign our health care system so it can really meet the contemporary challenges that are there.
I like to think of the health care system not as being broken, which is I think is the wrong mental model. When you think about something broken, we think, maybe, it can be fixed to work like it used to. I think the problem with our health care system is that it’s outmoded. It’s a legacy system that simply was never designed to do the kind of job that we now know needs to be done. It was a system that was okay when we had mostly acute illness that was often self-limited anyway.
When the cost of health care wasn’t very high, at least not in the same range that it is today, and when the technologies that we had available weren’t very complex, the system could tolerate fragmented, sort of small, units of accountability; single practitioners or small groups of doctors and hospitals competing with one another for patients. This kind of fragmented system that we’ve inherited is simply not well-suited, at all, for the kind of problems that we now have.
First of all, we’ve got mostly chronic, unremitting disease that goes on for a patient’s lifetime, which needs a lot of coordinated, collaborative kind of care. We have rising costs of health care that need to be constrained. We’ve got safety issues and quality issues in the health care system. A lot of these problems, I think, can only be addressed if we have a much more integrated, collaborative set of providers in the system that can work as a team, as an integrate whole. And that’s where I think academic medical centers can really make a major contribution.
When I look around our country and try to envision where the energy and creativity is going to come from that’s going to create this integrated delivery system, that takes responsibility for large groups of patients, I don’ think the government is going to do it. I don’t think that the insurance companies are going to do it. I don’t think that the business community is going coalesce around this issue. I think that the creativity energy should come, and has to come, from academic medical centers that can see this as a real intellectual challenge, every bit as equal to the challenges that we now face in biomedicine and the human genome project, for example. This problem is as complicated as it was to break the genetic code that, we know, has had such a tremendous impact.
Dr. Layton McCurdy: We say that we’ve got the finest medical care system in the world, but it seems, in many instances, many of citizens are dealt out of that care system or get their care in a fragmented and less desirable way. Is funding of the health care system the way it’s done in other countries? Is that a solution for us in the United States?
Dr. Jordan Cohen: Well, I don’t think there’s any question that funding is a big issue. We can’t get the kind of system that we need with the kind of funding mechanisms that exist today. Now, we’re saddled with a system that’s largely fee for service. That is to say, there’s a payment for every episode of care that occurs. And that’s in keeping with this fragmented system that we’ve inherited, again, largely designed to take care of acute illness, in which you could have a fee for service kind of system. It was adequate to that kind of burden.
But now I think we do have to have a different payment system for the kind of integrated system that I’m envisioning. And you’re quite right. I think you pointed out that we do have the best health care system in the world, for those who can afford it and who can get access to it. But, taken as a whole, I don’t believe that we have the best health care system we could have, by far, because of the lack of access that many people have to the system. And even those that can get into the system, I think, don’t get the kind of quality, consistent care that is necessary in order to deal effectively with their problems, particularly with chronic disease.
Dr. Layton McCurdy: I agree with that. I had the good fortune of working with you many years ago, when you were on our visiting committee here. It was an important time in the life of MUSC. What, specifically, from what you know about MUSC, can we contribute to this, as a specific organization?
Dr. Jordan Cohen: Well, I think, geographically and historically, you’re in a very good position to take leadership in this kind of an issue. You’re in a vibrant community. You’re the only academic medical center within the larger region of
South Carolina. And I think by dent of that alone, you’re in a position to begin to work towards having partners in the community who can join together to come to agreement about how to organize the health care system in a way that can meet these needs.
I don’t know specifically about the kind of relationships that exist and what the potential is here, but I would argue that because you’re in a dominant position, relative to your academic programs and the reach that you have through the community, you could, in fact, be the organizing element in a system that really drew people together and had them work in a much more coordinated way.
Dr. Layton McCurdy: On a personal note, you and I have, both, evolved from a sort of fulltime position into so-called retirement. What are you doing with retirement, Jordan Cohen?
Dr. Jordan Cohen: Well, retirement is kind of a funny word. I don’t feel myself as retiring in the sense of leaning back and sort of taking my ease. I’m doing several things, Layton. First of all, I’ve joined the faculty at George Washington University, in Washington DC, where we’re going to continue to live. So, I hope to do some teaching and policy work there. I’m also in the School of Public Health, which has a very active health policy group that I hope is going to have some opportunity to contribute to what, I hope, will be a new round of analysis and consideration of how to get the country moving again toward a more rational health care system.
I’ve also taken over the chairmanship of the board of the Arnold Gold Foundation, which, as you probably know, is a foundation that’s devoted to humanism in medicine. It has sponsored such things as the White Coat Ceremony, which, now, is in virtually every medical school in the country. Entering medical students are sort of initiated to the profession and given a white coat and ceremony that celebrates their passage from the laity into the priesthood, as I like to say.
And the foundation does a number of other things to support the caring aspect of medicine, which we clearly don’t want to lose as we incorporate all the technology. We want to make sure that doctors continue to understand that they have a fundamental responsibility to care for their patients in the traditional sense, of really having a fundamental commitment to doing the best they can for their patients’ interest.
Dr. Layton McCurdy: That sounds like plenty to do. I thank you for talking with us about this issue of leadership and how academic medical centers, such as MUSC, can provide and demonstrate leadership as we move forward and improve the nation’s health care system with new knowledge, to be sure, and a more effective application. Thank you for being with us.
Dr. Jordan Cohen: My pleasure, thank you.
If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at: (843) 792-1414.