Dr. Paul G. Ramsey, CEO, UW Medicine and Dean of the Medical School at the University of Washington
Feb 6, 2015
Dr. Paul G. Ramsey is the CEO of UW Medicine, Executive Vice President for Medical Affairs and Dean of the School of Medicine at the University of Washington. He has served as the senior executive leader of UW Medicine since June 1997. UW Medicine includes the UW School of Medicine, four hospitals (Harborview Medical Center, Northwest Hospital, Valley Medical Center and UW Medical Center), a network of primary care clinics (UW Neighborhood Clinics), a large physician practice plan(UW Physicians) and a fixed wing and helicopter air ambulance service (Airlift Northwest).
Dr. Ramsey graduated from Harvard College in 1971 with honors in Biochemistry and received his M.D. from Harvard Medical School in 1975. Following completion of residency training in Internal Medicine at Massachusetts General Hospital, he came to the University of Washington in 1978. He served as acting chair and then chair of the UW Department of Medicine from 1990 to 1997 when he was appointed to his current administrative leadership position. Dr. Ramsey was the first holder of the Robert G. Petersdorf Endowed Chair in Medicine in 1995. He has received the Distinguished Teacher Award from the University of Washington School of Medicine’s graduating class three times (in 1984, 1986, and 1987) and the Margaret Anderson Award from the University of Washington graduating class of 1989. The latter Award recognizes exceptional support of medical students.
Dr. Ramsey’s research has focused on the development of methods to assess physicians’ clinical competence. He has been the Principal Investigator on multiple research grants related to assessment of physicians’ clinical skills and served as a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine for five years. Dr. Ramsey received the John P. Hubbard Award from the National Board of Medical Examiners in 1999 in recognition of his research contributions in the field of evaluation. He has served on many national committees and is a member of multiple organizations, including serving as an elected member of the Association of American Physicians and the Institute of Medicine of the National Academy of Sciences.
How did you decide on a career in medicine?
I had experiences in high school in science and medicine that led to my initial interest in medicine. I did not actually make the final choice to pursue a medical career until the middle of my undergraduate time in college. During that time, as I engaged in academic research, I gained more experiences in science and the decision was made because I was very interested in science and medicine.
What were a few key steps in your journey from an aspiring medical student to your current position as the CEO of UW Medicine?
My career path that has led me to my current administrative role as CEO of UW-Medicine began during my internal medicine residency and fellowship after medical school, where I had substantial experience with research and medical care. After I began my career, I was interested in research and teaching as well as patient care. For the first ten years of my career in which I was faculty member, I was responsible for multiple research grants, took some different directions in my research that were enjoyable, and gained in-depth experience in research, education and patient care. I was given responsibility relatively early in my career for administration of teaching, as well as teaching myself. I was also a very active clinician for the first fifteen to twenty years of my career. In 1990, I assumed increased administrative activity in research, clinical care and education as chair of the University of Washington Department of Medicine. In 1997, I was appointed to my current position of CEO of UW Medicine.
What is the greatest difference between the clinical side of medicine and the administrative side?
Rather than focus on differences, I believe that it is very important to have integration of the three activities in the academic setting: research, education and patient care. I believe that people involved in administration should be involved in hands-on activities; the best training for an administrator should be to do the work that one administers.
What made you pick internal medicine as your specialty?
That was a difficult choice; as a medical student I was really undecided until early in my third year of medical school; I enjoyed everything; in my third year of medical school, I enjoyed all of my clinical rotations. I also enjoyed teaching and medical research. Although I did not do much teaching in medical school, I envisioned a career where I could do a combination of research, patient care and teaching. Several role models who specialized in internal medicine during my third year of medical school helped guide me and I ultimately chose internal medicine as a specialty because I identified most with these mentors.
What does an "average" day look like for you?
Busy! Every day, I am doing something related to the three critical activities of academic medicine: research, patient care and education. However, I try hard to balance my calendar. I exercise every day early in the morning and every day, I try to have time for family; I have two wonderful grown children in the Seattle area and two grandchildren; I really do my best to balance my calendar between my work activities, family activities and my love for exercise.
What was/were the most memorable experience(s) during your medical education?
I can’t say there was a single most memorable experience; in terms of what experiences led me to improve, and especially experiences during medical school that helped me improve, I would say that it was when I was involved actively in the learning process. I gained the most from when I made mistakes as a medical student; the most important part of the medical education process is for a student to be actively engaged. As a medical student, you do not make decisions independently, and the more active you are in experiences with someone to guide you and give you feedback and the more you engage in activities hands-on, the more you learn as a medical student.
What are most the important facets of an undergraduate’s application to medical school from an admissions perspective?
For our admissions process there are at least three very important parts. The first is academic performance in the classroom and on standardized tests. We place about half the weight of our admissions decisions on what can be measured through academic performance and standardized tests. The other half is the individual’s experiences, the connection between his or her experiences and what his or her career plan is at the time they are applying to medical school, and his or her communication skills. In terms of connection between his or her experiences and career plan, the undergraduate who has done well academically and has volunteered time at an underprivileged clinic and is interested in serving as a primary care physician is an example of a good candidate; an undergraduate who has research experience and is interested in both clinical practice and some type of medical research is another. We also place a fair amount of weight in the interview, a time where we can assess a person’s communication skills, professionalism and commitment to medicine. We attempt to assess the potential for the applicant to communicate professionally.
How do you foresee medical education changing in the next few years?
I believe it needs to change rather dramatically. Our medical school is in the process of changing our curriculum. We are converting what occurs in the classroom setting during the early part of the medical school into a much more active learning process in all settings that integrates the basic sciences with clinical application. In the coming year, we are introducing a new initiative to reduce early classroom time from two years to eighteen months. The traditional curriculum involves two years in the classroom before typically beginning the required clinical portions in the third year. Under this new initiative, we are reducing the classroom portion by half a year and giving students earlier access to clinical training. We have a system where we break up our relatively large medical school class into multiple small colleges, each with individual mentors that help oversee smaller groups of students. The briefer time in the classroom will lead to more integration of training across disciplines. Research is rapidly changing the knowledge base, and we need to build in a continually changing medical school curriculum. This new curriculum will allow students undecided on their career an additional six months of experiences to inform their decision. In our new curriculum, we also plan to incorporate more interprofessional training.
What do you think is the biggest challenge facing physicians today?
There are many challenges. Perhaps the major challenge for practicing physicians is adapting to how quickly things are changing. The information learned during medical school is changing, the knowledge base is increasing, and the organizational and business sides of medicine are changing. Electronic health recording is also changing; for some, this is difficult and for others, it is welcomed. The challenge is to understand how changes will affect medicine going forward. For a large number of physicians, residents, current medical students and recent graduates from medical school, there is a huge opportunity to create positive change, change for the better and improvement of health for all. There are opportunities to make health care better and to develop improved practices that will lead to more satisfying outcomes. There is the challenge for the profession as a whole to reduce the high cost of care. Physicians must embrace a leadership role; change is challenging, but it can also be a source of enjoyment where physicians can help lead the charge to create positive outcomes and satisfaction for patients. It is an opportunity to do the right thing, to improve patient care while reducing costs.
There is an enormous debate these days as to whether resources should be primarily allocated to fighting diseases or the distal causes of diseases. What are your thoughts on this issue of proximal causes versus distal causes?
Both are needed; I think one of the challenges in a time of scarce resources is to avoid competing in a way that would lead to a substantial withdrawal of resources from one area. Money should definitely be invested in research, but those research investments should be guided by what the major causes of diseases are. Research should be funded in ways that best improve the outcome of care and reduce costs. Research investment is important, as is investment in education is important. Since our mission as an academic health system is to improve health for all people, we have to focus on population health and social and environmental determinants. Therefore, it is very important to have balanced investment in all areas.
In light of President Obama’s new “precision medicine initiative”, where do you think the line should be drawn between advances in the medical field and individual civil rights?
I am a strong believer that precision medicine has tremendous potential to improve health for individuals and populations and ultimately reduce costs. However, as some critics are saying, we do have to be careful about overselling what precision medicine can do. I believe that precision medicine should be pursued primarily in a setting where there is a balanced consideration for its potential, in a setting of an academic health where one can be considering questions about how it will change diagnosis, improve treatment and prevention and how it can reduce the costs of health care. In regards to precision medicine here at UW Medicine, we have strong involvement from our Department of Bioethics and Humanities. I am very supportive of more federal support for precision medicine but the design should have very careful bioethical review and guidance in the early developmental stages.
Are there any final thoughts you would like to add?
I have had the good fortune of being in health care for forty years and I believe now is the most exciting time in human history to go into health care. There is so much potential for the transformation of health care over the next ten, twenty, thirty years. The message I try to convey to applicants to medical school is that it is an extraordinarily exciting time to go into medicine. As an individual student, one must define his or her own path---the opportunities are tremendous.