Leaders in Medical Education

Dr. Robert Alpern, Dean of the Yale University School of Medicine

Osmosis Team
Aug 21, 2016

Dr. Robert Alpern was appointed Dean of Yale School of Medicine in June 2004, continuing a career that has combined his interests in research, clinical practice and teaching. As Dean, he oversees one of the world’s leading institutions for biomedical research and advanced medical care.

Dr. Alpern attended college at Northwestern University, where he majored in chemistry. He received his MD degree from the University of Chicago Pritzker School of Medicine , and then received residency training in internal medicine at Columbia Presbyterian Hospital in New York. Following this, he was a post-doctoral fellow in nephrology in the Cardiovascular Research Institute at the University of California, San Francisco (UCSF). Before coming to Yale, Dr. Alpern held faculty positions at UCSF and at the University of Texas Southwestern Medical Center in Dallas, where he served first as chief of nephrology and then as Dean from 1998 to 2004.

A board-certified nephrologist, Dr. Alpern has conducted research focused on the regulation of kidney transport proteins.

How did you decide on a career in medicine?
I was always interested in science and in helping others. Medicine provided an opportunity to combine these two goals.

What were a few key steps in your journey from an aspiring medical student to your current position as Dean of the Yale University School of Medicine?
The path for me came with many surprising and unexpected turns. College and medical school transformed me from a student who could do well on tests into an aspiring scholar. I am forever grateful to these schools (Northwestern and the University of Chicago) for showing me this path. As a resident I aspired to be an outstanding clinician and educator and then as a fellow I came to enjoy research. When I joined the faculty at UCSF I felt that I had the dream job, performing research, caring for patients and teaching, and much to my amazement being paid to do so.

I was then recruited to UT Southwestern to become Chief of Nephrology. This was my first entrance into administration, but in those days the administrative burden was minimal. I did enjoy the opportunity to work with junior faculty, fellows, residents and students, now in a leadership role, but still focused most of my time on research, clinical practice and education.

Things changed somewhat when I agreed to chair the Admissions Committee at UT Southwestern. At that time there was a court decision (the Hopwood decision) that barred Texas schools from using race and ethnicity in admissions. I worked very closely with the dean in addressing diversity and a few years later I became the dean at UT Southwestern. While I had seen myself as becoming a chair of medicine someday, I had not ever thought of becoming a dean. In fact, because I had never been a department chair, I was not familiar with what was encompassed by the dean’s position. I served as dean at UT Southwestern where I was surrounded by outstanding mentors, and I came to enjoy the position, especially the profound impact that one could have in so many important areas. Then in 2004 I moved to Yale as the dean and have served there for 12 years.

What made you choose nephrology as your specialty?
In college I was a chemistry major and became very interested in physical chemistry. In medical school I became fascinated by the fact that one could use principles of physical chemistry along with a knowledge of membrane transport mechanisms to understand, diagnose and treat many fluid and electrolyte disorders related to the kidney. It seemed to be the specialty that most allowed you to use science in the practice of medicine. 

What is the greatest difference between the clinical side of medicine and the administrative side?
As a clinician, researcher, and educator, one has the opportunity to interact personally with patients, trainees and students. This was something that I found very rewarding. Administration removed me from this personal interaction, but provided me with the opportunity to have a greater impact on a broader scale. I always wished I could have done both, but there is not sufficient time.

Given your multifaceted research interests and duties as Dean, how do you balance cutting-edge research, clinical care and administrative duties?
When I became dean I had to give up direct clinical care, but I continue to read extensively to stay up to date in clinical medicine. I did keep my research lab for about 10 years while dean, but then found that the dean’s job required too much time for me to perform research at a level I considered acceptable. Thus I presently spend most of my time on administration. I do regret this, but have come to accept it.

I found it ironic that one spends their entire career working to be outstanding in clinical medicine, research and teaching, and then suddenly I was focused on something else, administration, for which I had little training. In spite of this, I think it is important that deans have these experiences, as it provides the academic taste that is required to make the right decisions.

What was/were the most memorable experience(s) during your medical education?
I remember being fascinated by the second year of medical school when we took what we had learned in the first year and translated it to an understanding of disease.I then remember in the third year learning how this knowledge could be taken to the bedside. I found this all very exciting!

What do you think is the biggest challenge facing physicians today?
The biggest challenge facing physicians today is how to combine the economic exigencies of medical practice with the reasons we all went into medicine. How can we provide the excellent clinical care and develop the personal relationships with our patients that we seek, while running our practice in a manner that is economically sustainable?

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?

We need to do both. It is always better to prevent disease than to treat it, but as physicians, we must also treat disease.

What are most the important facets of an undergraduate’s application to medical school from an admissions perspective?
First, one needs to demonstrate that one has the intelligence and drive to succeed in medical school and as a physician. Second one must demonstrate that they have the compassion to serve their patients. Lastly, at Yale we want to know that the applicant will be a future leader and scholar in some aspect of medicine. We therefore, look for examples of where the applicant has shown leadership and committed themselves to excellence in some aspect of their lives.

How do you foresee medical education changing in the next few years?
There should be a number of changes for the better. Medical education will benefit from new proven approaches to teaching, taking more advantage of technology and more interactive teaching in smaller groups. In addition, with the increasingly rapid pace of changing knowledge there will need to be an increasing emphasis on the physician as a continuous learner.

I am a little concerned that with the emphasis on turning out more and more physicians, we could lose sight of the physician as a scholar of medicine. While there are many people who participate in healthcare, the physician has always been a scholar of medicine. We cannot allow medical schools to become trade schools, returning to the pre-Flexnerian era.