Leaders in Medical Education

Dr. Jeffrey Balser, Dean of the Vanderbilt University School of Medicine

Osmosis Team
Published on Aug 4, 2016. Updated on Invalid date.

Jeffrey R. Balser, MD, PhD. President and CEO, Vanderbilt University Medical Center. B.S. Engineering, Tulane University, 1984; M.D./Ph.D. (pharmacology), Vanderbilt University, 1990. Dr. Balser undertook residency training in anesthesiology and fellowship training in cardiac anesthesiology and in critical care medicine at The Johns Hopkins Hospital in Baltimore, MD. He joined the faculty at Johns Hopkins in 1995, where he practiced cardiac anesthesiology, ICU medicine, and led an NIH-funded research program aimed at the genetics of cardiac rhythm disorders, such as sudden cardiac death. He returned to Vanderbilt in 1998 as Associate Dean for Physician Scientist Development, and soon was appointed Chair of the Department of Anesthesiology, directing one of the medical center’s largest clinical service programs. He became the Medical Center’s chief research officer in 2004, leading a period of scientific expansion that moved the Medical Center into the nation’s top 10 in NIH funding, launching big-science programs integrating health informatics and genomics that stimulated the Medical Center’s national leadership in personalized medicine. In 2008 he was elected to the National Academy of Medicine, and later that year was named the eleventh dean of Vanderbilt’s School of Medicine since its founding in 1875. He has led the Medical Center through a period of marked service-volume growth with major inpatient expansions of the children’s hospital and the adult critical care areas, bolstered by 4% compound annual growth of outpatient visits (over 2.1 million per year), and by the creation of region’s largest, multi-state provider-led network (over 50 hospitals and 3000 clinicians: the Vanderbilt Health Affiliated Network).

How did you decide on a career in medicine?
Like many others who are drawn careers in healthcare, an early experience involving someone very close, my mother’s death from pancreatic cancer when I was 16, influenced in my thinking about becoming a physician. I was also very much drawn to math and science, and was interested in both the practical applications of science and the discovery process that engenders scientific understanding. The opportunity to pursue a dual track through MD/PhD training at Vanderbilt felt to me like the ideal way pursue both interests though a single integrated program.

What were a few key steps in your journey from an aspiring medical student to your current position as Dean of the Vanderbilt University School of Medicine?
After MD/PhD training, I was fortunate to have the opportunity to pursue residency and fellowship training at Johns Hopkins. In those days, Hopkins was one of a small number of places well known for supporting young people to pursue post-graduate research throughout clinical training. There, I was able to build the foundation for my career as a physician scientist, and later in 1998 I was given the opportunity to return to Vanderbilt to lead efforts to develop similar programs for supporting young faculty pursuing careers in both research and clinical care. In 2001, I was appointed chair of our Department of Anesthesiology, an experience fundamental in developing my skills and interests in clinical enterprise administration. I later had the opportunity to serve as the Medical Center’s chief research officer, which provided a comparable opportunity to more deeply understand how a large organization like ours can best support the creativity of our investigators. These growth experiences were formative in my later service as Dean.

What made you choose cardiac anesthesiology as your specialty?
My PhD training at Vanderbilt, which focused on the mechanisms whereby drugs impact cardiac rhythm, spawned my interest in the heart and the myriad ways the drugs we take for many diseases can influence cardiac function. A residency in anesthesiology and fellowship in cardiac anesthesiology allowed me to further develop that interest while pursing clinical training. Cardiac anesthesiology is among the few medical specialties that requires direct, minute-to-minute pharmacologic management of the heart, in a setting of complex dynamic monitoring. It is an exciting area, where the real time application of engineering and science is life sustaining.

What is the greatest difference between the clinical side of medicine and the administrative side?
Certainly the profound responsibility of direct patient care, where the lives and well-being of people are at stake, is a key difference. However, there are some similarities. While the administrative side of medicine doesn’t directly engage patients, the decisions and processes we engage in administration certainly do impact our patients in fundamental ways. Consider our work in support of patient quality and safety for VUMC, a major focus of administrative effort. Furthermore, patient care is about listening to people and trying to help them. Likewise, administration is a team sport, and performs best when we listen carefully to goals and challenges of our colleagues.

What does an "average" day look like for you?
Communication is an important aspect of what I do each day. I might be meeting with members of our Board of Directors, community groups, donors, the press, chairs and other members of the leadership team, and many others. I regularly speak in front of groups, large and small, here on our campus and around the US. I greatly enjoy that aspect of the work, as VUMC has such a great story to tell.

What was/were the most memorable experience(s) during your medical education?
There are so many, but I will never forget one of the first times as the “senior” fellow I was called to assist a patient who was unable to breathe and required intubation. The patient had a swollen airway, making the situation far from routine. It is one of those moments where you look around for reassurance, and you recognize in an instant that the outcome depends on you. In those moments, we default to our training, using the methods we practice and rehearse hundreds of times. The patient did fine, but I do remember feeling the cold perspiration soaking through my scrub shirt after we finished. All of us go through those moments in medical training, and we never forget them.

What do you think is the biggest challenge facing physicians today?
Relentless and ever-increasing documentation and regulatory requirements are daunting for physicians and are negatively impacting job satisfaction. In addition, the move from a fee-for-service reimbursement model to a population health fee-for-value model will further exacerbate the challenges as we transition to a new set of reimbursement systems. This will be felt most acutely by independent clinicians and small practice groups, although even the largest and most capable facilities like ours have a challenge in assuring the practice of medicine remains enjoyable, fulfilling, and patient-focused as we move through these industry-wide changes.

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?
It is essential that a broad healthcare program like ours at VUMC focus on both causes of disease. We are particularly capable of addressing the full spectrum, given not only our physical resources, but also our ability to discover and train as we provide care to patients. Patients will always have diseases that progress, despite our best efforts at prevention, and VUMC will always be the leader in caring for the most acutely ill patients in this region. At the same time, we play a vital role as a leading academic medical center conducting research yielding new treatments that prevent or cure the most pervasive diseases, such as cancer, obesity, and heart disease. Those efforts include public health solutions aimed at preventing illness, and thereby reducing the burden of disease.

What are most the important facets of an undergraduate’s application to medical school from an admissions perspective?
At Vanderbilt we consider the whole individual. We currently accept approximately 88 students to each incoming class, while the number of applications for these positions has risen in recent years to more than 7,000 each year. The average GPA and MCAT scores for our students are exceptionally high, so a very strong academic performance in college is a must. Beyond academic performance, our admissions committee looks at prior life experience, and in particular, evidence of exceptional dedication to causes applicants have embraced over time. Our goal is to identify students who will not only be outstanding technically, and will practice medicine with sensitivity and emotional intelligence, but also who have the drive and potential to be leaders in changing health care for the better.

How do you foresee medical education changing in the next few years?
We’ve spent a portion of the past decade creating and implementing a brand new curriculum for our medical school, known as Curriculum 2.0. While the name isn’t flashy, the curriculum redesign was extensive and acts to immediately place our new students out into the clinical setting when they start medical school. It moves us away from the older model of medical education, where the first two years were spent almost entirely in the classroom before the third year entry into supervised patient care. The new curriculum also lets our students tailor their learning to spend more or less time on educational modules, depending on their learning style and needs. This freedom lets each student, based on continuous assessment of their learning achievement, create their own unique learning experience. Our new curriculum has been incredibly well received by students and faculty, and is being used as a model for change by other leading medical schools. We will continue to see more innovation in the training of physicians, leveraging new learning and simulation technologies, informatics, team-based training, with an understanding that physicians are coping with an escalating spectrum of data as they consider the best way to care for patients.