Leaders in Medical Education

Dr. Eric G. Neilson, Vice President for Medical Affairs and Lewis Landsberg Dean of the Feinberg School of Medicine at Northwestern University

Alan Tang
Apr 3, 2015

Dr. Eric G. Neilson, Vice President for Medical Affairs and Lewis Landsberg Dean of the Feinberg School of Medicine at Northwestern University

Dr. Eric G. Neilson is the Vice President for Medical Affairs and the Lewis Landsberg Dean at Northwestern University Feinberg School of Medicine. Before coming to Chicago, he was for 23 years at the University of Pennsylvania and then at Vanderbilt University for 12 years as the Hugh Jackson Morgan Professor and Chairman of the Department of Medicine.

Dr. Neilson is a member of numerous elected societies, including the American Society for Clinical Investigation and the Association of American Physicians. He is also a past recipient of the President’s Medal, and the John P. Peters Award from the American Society of Nephrology, and a MERIT Award from the National Institutes of Health. In 1998, he was the recipient of an A. N. Richards Distinguished Achievement Award from the University of Pennsylvania School of Medicine and, in 2010 was awarded the Robert H. Williams, MD, Distinguished Chair of Medicine Award from the Association of Professors of Medicine.

Dr. Neilson is an active teacher of clinical medicine. He has a special interest in the training of physician-scientists and mentoring women interested in biomedical research. Twenty-one of his former laboratory students or fellows have become full professors, twenty of his former fellows or faculty are now department chairs, and twelve have been associate deans, vice-chancellors, or provosts.

Dr. Neilson has published over 300 scientific articles, reviews, commentaries, editorials, and books, in the areas of kidney disease and medical science. He recently completed his term as Editor-in-Chief of the Journal of the American Society of Nephrology, the leading kidney journal in the world.

How did you decide on a career in medicine?
There was not a set, defined moment. When I was a little kid, I wanted to be a doctor for uninformed reasons that escape me, and that notion stuck with me throughout my undergraduate years.

What were a few key steps in your journey from an aspiring medical student to your current position as the Lewis Landsberg Dean of the Feinberg School of Medicine at Northwestern University?
Well, I did not start out to become a dean early in my career. I started out to be a good physician and faculty mentor training students and fellows. I wanted to improve human health beyond the individual patient, so I did research and acquired administrative assignments along the way. I found my skill set fit nicely with how administrative effort could dovetail with other more traditional academic tasks and those experiences accumulated over time to lead me to where I am now.

What is the greatest difference between the clinical side of medicine and the administrative side?
The hard science and practice of medicine is more a learned profession, while health care delivery is a real business today. Both are necessary for successful health care, but they are very different. We have to accept that both aspects are critical to success. The business aspect of health care delivery requires attention to managing practices and managing needs of an organization, making sure the work one is doing is affordable and efficient. The administrative side is really fundamentally different from practicing medicine or taking on transformational research.

What made you pick nephrology as your specialty?
I thought the kidney was an enormously complex and wonderful organ when I first became acquainted with it. When I was in early training, some of the best and brightest people in medicine were in nephrology; they were brilliant and thinking about problems that affected patients in extraordinary ways. I felt that it was a good place to hang my hat. It is not for everybody, as it is very complex, but it is indeed a fabulous field of medicine for the few, the proud and the brave.

What does an "average" day look like for you?
Today, as dean, I can’t do many things clinically. I don’t have time to practice and I cannot be that available for research anymore; I take morning report in the hospital with medical residents and give lectures in the medical school. It is hard to balance all of those things as a dean; people try, but I do not think it is a good use of one’s time at that level. As dean, I solve vexing problems for the medical school, recruit faculty, build or remodel facilities, and raise money for their programs. I have to try and find time in my life for all these tasks. Having had a lot of life experiences over the years, I have been able to multitask with some level of comfort.

What was/were the most memorable experience(s) during your medical education?
It is hard to put my finger on any one or two experiences. It is very rewarding to help people and be there with someone through a good outcome; my memorable moments have been seeing their happiness at getting well. It is also very rewarding to mentor students and residents and watch them become great faculty on their own. Around twenty-one of my former trainees are full professors and twenty of my former fellows and faculty are department chairs around the world. I have been lucky to associate myself with such superb people who have been able to do many great things themselves.

What are most the important facets of an undergraduate’s application to medical school from an admissions perspective?
The modern medical school curriculum is relentless, and a medical student has to really be fluent in the language of science to enjoy this relentlessness. A candidate needs to have good fundamental skills in math and the hard sciences. He or she also must be a nice person with empathy who can relate to the human condition, be nonjudgmental and incredibly tolerant to the failures and needs of others. A candidate must learn most those things during his or her young life, and if you do not have those traits by the time you leave college, it is very hard to be a really great physician.

How do you foresee medical education changing in the next few years?
Curriculums always get revised and improved. We just went through a big curriculum change at Feinberg. Most schools do that to keep up with the times; the pressure of completing a good medical education in four years is immense. More and more knowledge must be put online to make room for new information in the classroom. Students have to be strongly motivated as self-learners to get through the medical school curriculum. When I went to medical school years ago, we spent the first ten weeks relearning biochemistry and cellular biology; now a student must come fully prepared because the curriculum starts beyond that and right in with new and unfamiliar material. There is a lot of simulation training used today, which is good for developing clinical skills without hurting anyone. There is a shift toward small group work, so one has to learn to communicate well with colleagues. There is a renewed emphasis on team-based learning and a team-based practice, which I think is incredibly important for future. These are all big projects within the medical school curriculum that will almost certainly evolve.

What do you think is the biggest challenge facing physicians today?
The greatest challenge for physicians today is their willingness to adapt to new environments. While physicians will always have a job, almost everybody who leaves their training right now is looking for employment in a health system or a large group practice. There are very few people going into solo or small group private practice, as it is difficult to sustain independence financially. The idea of looking at employment with an organization as a way of practicing your craft is a very new thing in medicine. I have always been an academic and employed by an academic health center so I never had a problem with this. For trainees who first try private practice, it is sometimes difficult to come back into employment groups without fully accepting the ethos of the organization. Those who cannot adapt to organizational structure will be hamstrung and disappointed.

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?
This is the thing that everyone forgets: the most pressing health care problem today is diseases for which we have no answers. If health care were free and fully accessible to everyone right now, people would still die from all known common and rare diseases. The science of medicine is critical to making our future brighter for patients; everything we know in medicine today started as an experiment somewhere and those advances have to continue if there is to be any progress. We are distracted today by the delivery of health care and forgetting that a fundamental understanding of disease and how to treat it is a huge part of any promising future. There is plenty of money in the system for all this now; we just do not allocate it very well. Some of the new research in social sciences and outcomes and epidemiology are very helpful in framing new questions at a basic level and we must have open mind to that pursuit. We should strive for as much intellectual diversity in medicine as possible, but we need to pay a lot more attention to the fundamental science of diseases.

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 not sure that is the useful contrast. Precision medicine has been around for over a decade. It is not new; the temptation to invest in it is new and that is good. As long as we accept that preexisting medical conditions should not affect our insurability, we ought to be very interested in how our genetic differences create risk for various diseases, and as a population, become more committed to understanding how to tailor treatment to those who will benefit the most. I do not see it as a civil rights issue although privacy is important. The only question I wonder about is whether we have done enough basic research to take full advantage of the promise of precision medicine; we do not know enough about variance and regulation of the genome to be fully effective in all areas of medical science. Some day we will; we have to start somewhere. I think this is the right direction, and as long as we have privacy securities in place so that people who do not want to be identified are not, then we are fine.