Slide 2:OU College of Medicine, Tulsa Structure Established as a branch campus in 1972 using community based model. Purpose – workforce and service for northeast OK. OU Clinics 250,000 visits / year OU Departments / Divisions 186 OU employed faculty Pediatrics, Psychiatry, Surgery Internal Medicine, OB/Gyn Family Medicine, Emergency Medicine, Geriatrics, Dermatology, Physician Assistant, Sports Medicine Additional OU Programs Nursing, Pharmacy, Public Health, Allied Health, Social Work, Human Relations, Engineering, Telecommunications, Computer Science, Organizational Dynamics, Knowledge Management Community Partners Specialist Physicians 3 Large Private Hospitals Residencies 200 residents in 13 Residencies / Fellowships Medical Students Average 40 students each in the 3rd and 4th year classes. 50 Physician Assistant Students

Slide 3:We thought we were doing fine….OU College of Medicine, Tulsa alumni practicing In Oklahoma

Slide 4:…fine until we saw the death curve….

Slide 6:If you ask the public, what should a medical school do?? AAMC – 2000 Survey Educate the next generation of physicians. Advance care through research. Take care of complex patients. Take care of the poor. LEAD IN SOLVING HEALTH CARE PROBLEMS.

Slide 7:We needed a plan….. OU College’s of Public Health and Medicine came together. More data on health parameters, workforce, student satisfaction / trends. Pilot Projects - Access. Critical Mass – Clinical Services and Students External Consultants Prepared for Next Transformation

Slide 8:Health Status

Slide 12:Tulsa Area Health Status Varies Dramatically By Income

Slide 15:Rationale for Change Responsibility to Improve Health (continued)

Slide 16:Tulsa County Prenatal Care and Infant Mortality Rates

Slide 17:Initial Pilot Efforts:Focus on Access

Slide 18:Access to Care Expansion Primary Care 2005 - New 60,000 sq ft Family Medicine. 2007 – New 100,000 sq ft multispecialty clinic 2003 – 2008 Network of 35 Bedlam Outreach Clinics, free pharmacy program, nursing and social work case management Schools / Head Starts Housing Authority Apartments Mobile Clinics Specialty Care 2003 - Mobile Psychiatric Team 2007 - New 10,000 sq ft Diabetes Center 2008 – Perinatal Outreach Initiative 2008 New 22,000 sq ft Cancer Center satellite 2008 - New 10,000 sq ft Surgery Clinic 2010 - 50,000 sq ft North Tulsa Specialty Clinic.

Slide 21:OU PACT Team and Community Mental Health PACT Team provides mobile psychiatric care and rehabilitation to those with the most severe forms of mental illness (e.g homeless mentally ill). Pre PACT 1 Year in PACT Hospital Days / year 2898 Days 671 Days Jail Days / year 1196 Days 535 Days

Slide 22:Emerging Workforce Trends

Slide 27:Combine Workforce and Health Status Data

Slide 29:Student and Resident Attitudes and Skills

Slide 30:Resident Physician Skill Sets: System-based Practice Core Competencies 151 OU Resident Physicians: Wrote the Dean a paper on the worst health care problems in the region. Excellent at identifying health system problems. Excellent at innovative solutions to these problems. No skills for researching, testing theories, developing a plan, implementation, financing strategies to carry out their unique interventions.

Slide 31:Medical Students: Perceptions of and Needs of the Poor

Slide 32:Medical Students: Student’s Professional Obligation to the Health of the Poor

Slide 33:AAMC Graduation Questionnaires “ The experiences in community medicine, particularly the Bedlam Clinics (student run free clinics), rekindled the spirit of why I wanted to be a physician.”

Slide 34:In 2006 – 2 Driving Factors for a Dramatic Transformation…. Physician Work Force Trends: Future National Shortage Existing Oklahoma Shortage Expansion of medical education would happen. Oklahoma Health Status: Although access to care was improving, much more needed to be done. A different type of physician was needed.

Slide 35:Many academic… Divisions Departments Centers Institutes 1 “School of Community Medicine” in New South Wales Australia ? http/:”Community Medicine”

Slide 37:Nuts and Bolts of what we think may be the Nation’s First School of Community Medicine….. Transform ourselves from branch campus status to a School with a unique purpose within the OU College of Medicine. Renamed as OU College of Medicine’s School of Community Medicine – “improving the health of entire communities.” Tulsa Public Schools shadowing programs and Undergraduate pre-med fast-track at University of Tulsa and OU. National recruitment of students with dedication to the underserved to this specific medical education track that merges traditional medical education with public health curriculum ? MD + Public Health Certificate or MD + MPH. Creative use of “Summer Institutes” for in-depth work. If possible and funding available, expand medical student class size from 40 to 70 per year, add Physician Assistant students – initial class of 25, expand residents from 201 to 251. New scholarship program with incentives to establish career serving underserved and at-risk.

Slide 38:February 2008 Announcement “With this health data known, it is morally offensive not to act.” George Kaiser, February 2008.

Slide 39:The Gift….”The Grand Experiment” $ 50,000,000 from the George Kaiser Family Foundation: $ 35,000,000 dedicated to new endowed chairs. Matched with $ 35,000,000 from state funds to create $ 70,000,000 endowment for faculty expansion. $ 7,500,000 for school infrastructure expansion. $ 7,500,000 for student scholarships.

Slide 40:6 Lessons Learned Physicians in training are very smart but need additional skills to tackle the toughest problems out there…. Altruism can be preserved with the right teaching / clinical environment. Public health data and physician manpower data drove our planning and influenced philanthropy. Important for us to create something complementary and not competitive with existing medical education and clinical services. Planning: Intimately involved students and philanthropy in planning. Everyone Involved - Primary Care, Specialty Care, Bio-medical Researchers, Community Partners, DO and MD….and other Colleges….because team care works. At the end of the day – one writer of the master plan. 180 pages and a 15 page executive summary.

Slide 41:6. Had to create a “Business Plan for our Social Contract” Mission (+) Finance (-) Finance (+) Mission (-)