Leaders in Medical Education

Leaders in Medical Education - Dr. Anthony Silvagni, Former Dean at Nova Southeastern University College of Osteopathic Medicine

Thasin Jaigirdar
Mar 9, 2015

Dr. Anthony Silvagni served as the Dean of Nova Southeastern University College of Osteopathic Medicine, where he had served for more than 16 years. He will begin his tenure as Dean Emeritus in the coming months. He has also previously served as Vice President for Academic Affairs and Dean at University of Health Sciences College of Osteopathic Medicine. He received his bachelor’s, master’s, and Doctor of Pharmacy degrees at the Philadelphia College of Pharmacy and Science. He has also served as Administrator for Appalachia Regional Hospitals for the Lakes Area Health Education, Medical Director of a state drug rehabilitation center, and Associate Medical Director of an HMO.

What is your background and how did you get interested in medicine?
My background is in pharmacy. I have a bachelor’s, dual master’s and research based, PharmD degrees within various fields of pharmacy. I have also worked with underserved population as well, spending 3 years in Appalachia developing healthcare delivery systems and providing clinical pharmacy services.

I am an active person and have been a competitive skier, played ice hockey, flew airplanes and gliders with aerobatics, whitewater canoeing, etc. since I was a young man Obviously, I like the adrenaline surge and have high energy. I had a major skiing accident in my early 30s. At that time I was working at Harvard/Peter Bent Brigham Hospital and Massachusetts College of Pharmacy in both medical and pharmacy fields. After this injury, I was treated by the usual menu of physician specialists at the Brigham and about 1½ years later took a position at the University of Arizona and went through the same process. No one was able to stop the post-injury pain and slow atrophy of the muscles of my left arm as nerve conduction was being affected. Finally, after almost four years of chronic pain and loss of muscle strength, an Osteopathic physician, whose specialty was cardiology, at an affiliated hospital offered to treat me after he evaluated the problem. In two months the pain was minimal and in four months the nerve conduction studies were normal.  From that point, I decided I wanted to become an Osteopathic physician at the age of 38. I had to give up a lot to get this done: retirement, pensions, etc. After completion I practiced for 5 years in rural South Dakota in a town of 1,400 people without financial assistance and was solo for three and a half years.  By the fifth year the practice had grown so much that I had three other physicians and two other offices in smaller communities.  The New York Times somehow heard about our success with government assistance or loan repayment that they came out and wrote about it.

I eventually left the practice and returned to education, where I had spent most of my career since starting pharmacy school in 1958. I have taught at 8 medical schools and I became a dean in 1992 because of all of the previous experience and administrative education and experience.  On February 1, 2015, I stepped down as Dean after serving a total of 23 consecutive years between two different medical schools.  When I return from my sabbatical, I plan on overseeing our international medical outreach programs and work on inter-professional programs.

How did you become involved in medical education?
I think all procedural medical change comes from academic medicine. In the private practice environment, most change is the result of insurance company/government rules and payments. The academic world needs to facilitate meaningful change. Academic medicine also has the ability to influence the attitude and practice habits of future physicians. You can influence hundreds of thousands of patients in medical education versus a couple thousand in private practice.

It does take a while to transfer a change in practice from the controlled academic world to the private practice world such as the use of SOAP notes which were developed in the 1970s in Boston and look at how long it is taking to become universal in the practice world. The same thing applies to interprofessional care. If we don’t all work together and give up our prejudices and egos, the healthcare system and our patients will pay dearly for it.

In football, a guard learns to be a guard, a tackle to be tackle, a QB to be a QB. They all come together and perform their jobs as a team. Pharmacists, Nurses, PTs, OTs, etc. need to come together and work for the patient in the best way possible. Otherwise, we will run ourselves into bankruptcy. Everyone is trying to be independent now instead of working together. We need to look at models that show cost reductions, improve quality of care, and overall better outcomes.

What are some changes you would like to see in the way medical education is handled today?
There are proposals to reduce medicine to 3 years usually related to going into primary care. It has been tried before and was quite unsuccessful.  We have put in more and more clinical experience for students and tried to increase the didactic work simultaneously, which increases the load on students even more. Most students feel overloaded. The amount of work they have to accomplish in four years is outstanding. It’s unreasonable to assume you will have a knowledgeable graduate who can be a life-long learner in three years without the time to learn the scientific foundation of the biomedical sciences and humanities/behavioral aspects of medicine while simultaneously the advances in medicine are skyrocketing. A realistic alternative is to reduce pre-med to three years.  Current accreditation standards state that an applicant is eligible for admission to medical school with 90 hours of coursework. This will reduce the time and cost of a medical education if we implemented an existing standard.

We all want a quality physician with a good understanding of both pathology and wellness. By having a better approach, we can reduce the hours by focusing on the essentials what you need as a physician versus teaching a course by going through every chapter of the textbook. Also, we must increase the use of simulations. Becoming a private aviation pilot requires 40 hours to get a license and a significant portion can be done in an approved flight simulator. Cruise ships and freighters use special simulators for the training of their crew and captains. Medicine is just beginning to realize the value of simulators in training and for refreshing skills. The proper use of simulators can ensure more reliable clinical skills experiences and allow more opportunities to practice and thus increase skills and confidence.

What were the biggest challenges and the most gratifying moments of your tenure as a dean of medical schools?
The students are the most rewarding component of academic medicine. Being a dean in a school which is good and watching the faculty and students make it into something special is the outcome that makes everything worthwhile. In a recent five-year study of all colleges of osteopathic medicine, our school, NSU-COM was found to be  number one in NIH funding and among the private and public COMs, number one in citations per publication.  We also graduate a significant number of students with additional degrees and our students do a lot of community service as well. Many students do international work every year.

Medical students today are compassionate and caring students and their knowledge and commitment is my fuel, giving me energy every day. Watching the change in how students are being treated is great as well. More attention is being paid to the stress of medical school and the type of physician we want to practice. Research and academics are very important, but the human element is the most important.

I personally met with applicants as a group whenever I could and shared with them how medicine is magic. The opportunity to change people’s lives, to have an impact on the quality and sometimes quantity of their lives and to be the first hands to touch a new life and then to care for them as they grow up.  And for all this magic they pay you well.  To me, the only unhappy physician is the greedy one. I tell the applicants that these physicians can’t be helped. It’s important to not give up your dream because of meeting a physician who has forgotten how blessed they are. Don’t focus on the difficulty of school or the debt. It’s tough, but all jobs are tough. Everyone has challenges, there are no easy jobs. It’s just that some jobs are more satisfying than others. And I believe medicine ranks number one in that category.

Nothing gives me a sense of joy, purpose, contribution and quality of life that medicine has given me and I feel very sorry for those that have loss that magic of medicine.

Another challenge is the legal issues. Every affiliation agreement and clinical outreach must be reviewed by the legal associates which mean extra time and money has to be budgeted for them. Budgets are also tough. We don’t want to make school too expensive, but we have to be able to operate. We have to find ways to reduce costs such as moving more towards simulations or interprofessional care rather than external institutions and practice silos.

What advice do you give undergraduate students seeking a career in medicine?
Everyone has been told by someone, “I have always wanted to be a doctor but....” As I said before, medicine is like magic. Don’t worry about your debt or earnings. You will make enough money to pay off the debt. The debt isn’t that bad when you come down to it. Even the lowest paid specialties make good money.

Any final thoughts you would like to add?
I really like this whole initiative. It’s a good thing to get people who might disagree on things to present their ideas on certain topics. It’s a healthy thing. People will have the opportunity to evaluate alternatives to their thoughts. People are afraid to speak their mind because they don’t want to offend someone. Being able to express yourself without an adversarial environment should never be minimized. Independent interviews and not a panel allows individuals to speak comfortably and usually with greater clarity.  I wish to commend you on this project and just state that you are examples of the students I was describing.  I hope we will have the opportunity to meet some time.