A conversation with the former dean: Michael E. Cain, MD

Prior to coming to UB, I had two successive leadership positions at Washington University, each of which I held for about 13 years. Based on those experiences, I came to understand that if your intention at the outset is to make a difference, then you have to be willing to devote a sustained amount of time to building infrastructure and programs. Then, of course, you have to do a job that satisfies the people who are employing you, and you have to feel that you have and are building a team that has a common vision, which is probably the most important element.

What I have seen at UB is a very serious commitment on the part of our faculty and leaders in the school and university to constantly work to achieve excellence.

Our shared purpose is to graduate the next generation of the best physicians and scientists and to work collaboratively to improve the public health of Western New York and beyond. I firmly believe that we are doing that.  My efforts and the efforts of the faculty excite me and make this worthwhile.

Another factor is that we have been able to bring really outstanding leadership to the school.

When you put all these things together, it has been fun to come to work.

I’m clearly managing a much larger, more proactive institution than existed in 2006. And it’s not just at the level of the school. We have stronger partnerships with UB’s other health sciences schools and with our affiliated hospital systems. Working together we have made progress in creating the Buffalo version of an academic health center. As a result, I am spending more time in a good way with our hospital programs, which are true partners in delivering better care.

The other area that is different today is that we have many more community partners: we benefit from them, and they benefit from us.

So, the Jacobs School has grown into a much more mature, much more comprehensive institution than it was 15 years ago.

One of the biggest challenges is going to be the business model of academic health centers. This business model is going to be closely coupled to whether or not there is a national health policy and program.

The largest source of income for the school is revenue that comes in through our clinical departments as our medical faculty provide care for patients. We need a national health policy that simplifies reimbursement of physicians and hospitals for clinical care and recognizes efforts to promote wellness. The fact that such a policy does not exist is the biggest threat to the current economic model for academic health centers.

Research is becoming more expensive, and it’s never been completely covered by NIH grants. Today, competitive research programs require such things as complex informatics systems, a biorepository and a clinical research office. There are also rising costs associated with medical education, which has become a specialty now. It’s based on science and not just personal opinion. One needs to hire people who are trained in how to share and deliver information and how to analyze and assess whether or not you are delivering a better product.

These increased costs associated with building and maintaining the infrastructure needed to support medical education and biomedical research weren’t apparent or as critical 15 years ago.

Philanthropy is and will continue to be a critical component in providing resources necessary for an academic health center. We are all aware of the cost to go to medical school. Accordingly, we need more scholarships. We’ve been able to bring renowned people here to build and sustain excellent programs because of the prestige that goes with an endowed professorship or an endowed chair. We need more.

Support for research is also critical. More and more there are essential things you need—equipment and facilities, such as an electron microscope, or a biorepository—that are not funded by grants, so the institution has to be able to support most of that infrastructure.

We have four very aggressive, forward-looking strategic plans, all of which require an infrastructure and funds to help support, so philanthropy is clearly one of the keystones in providing the resources needed to realize these plans.

First, there is the emotional component, which I think everyone can relate to. This is a virus that kills people and causes severe illness. The pandemic is not something occurring in another country that we read about in the newspaper. We are directly experiencing it. We each have fears and concerns.

Then there is the toll that it has taken on day-to-day operations for the school—every decision is impacted. I haven’t had a textbook that I could check out of the library that says ‘this is what you do when you have a pandemic’.

COVID-19 has been, and continues to be, a situation that requires a team response. We have needed to build a team that works together and that is nimble and resourceful—even inventive at times—so I have learned how to do that.

I have also learned that a world crisis such as this puts tremendous stress on individuals, as well as on systems, and it has made me appreciate how dependent we all are on each other.

The school’s strategic plan for inclusion and cultural enhancement that we completed in 2018 required six months of regular meetings to develop. We put tremendous effort into the plan because we understood there are health care disparities, racial injustices and inherent biases that we needed to address. Our energy was driven by the desire and need to develop a plan. We had confidence that implementation of the plan over time would have a favorable impact. There was urgency, but not an emergency to fully implement the plan.

Then we saw two catastrophes unfold in 2020. With the pandemic we saw firsthand health care disparities. We realized that the infection rates, the severity of the infection, and the death rates differed among populations in Western New York. We observed firsthand that the response to treatment differed among different populations of people, whether you looked at it by age, by gender, or by race.

Then we witnessed multiple episodes of racial injustice and the murder of people. These events acted as an incredibly powerful catalyst. We may have previously thought, ‘Boy, we have a great plan,’ but we realized such a plan is useless unless we accelerated its implementation. We realized we had to take action immediately and we had to identify people whose responsibility it is to get this done now.

What has impressed me the most about our medical school community is how rapidly and without contention people from diverse backgrounds and different levels of training realized that this is something different. The impact of the pandemic is bigger than moving the medical school. They understood that this was life-changing disruption and instead of running from it, everybody—our students, our staff and our faculty—everybody rose to the occasion and said, ‘If we stick together as a team and we keep in mind our four strategic plans and why we exist, we will come up with alternate ways to do what we do and get it done.’ And that’s what happened. We modified every one of our educational programs, every lecture, every lab experience and every patient encounter.

So, when you look back and ask how did that group of people in 2020 and 2021 do, you will see that all of them rose to the occasion and every one of them, when it was time to step up and to shine—guess what? They stood up and they shined and they met the challenge.

I try to avoid the word ‘new’ because it makes you think, ‘Oh, I’m learning from an old curriculum’ [laughs], when in fact revisions to the curriculum occur regularly in medical school. For example, you need to learn about COVID-19 now, but you didn’t need to know about it two years ago.

Beginning in August 2022, revisions to the curriculum will be clearly visible. The curriculum will have three phases instead of the current two. Certain topics such as health-system operations, scientific literacy, and preparation for residency will be expanded. We will take full advantage of the many innovative learning venues in the new building. By fall 2023, the redesigned curriculum will be fully implemented.

The primary focus of this effort is to reinforce the importance of integrating learning objectives horizontally across a year and vertically across the four years—mapping out how and when those learning objectives are going to be met. In doing so, we will better incorporate the basic sciences into clinical medicine and make the basic sciences more relevant to clinical medicine. This involves shortening the time that students learn basic sciences in the traditional, didactic format and moving the recouped portion of time into the clinical realm. This change will allow students to enter their clinical rotations during the second half of their second year. During the clinical clerkships, basic sciences specifically useful to the care of patients will be stressed.

The award establishes the Jacobs School for what it is—a National Institutes of Health-designated center for clinical and translational research. By awarding this grant to UB, the NIH has acknowledged that we have created the infrastructure necessary to successfully conduct a wide spectrum of state-of-the art clinical research programs. We have graduated to the big leagues, and this is testament to UB having done so.

With that said, one of the foremost deliverables of the Clinical Translational Science Institute at UB is that our work has a favorable impact on health care disparities in our community—it is a structure that maximizes our ability to formulate and implement action items that make a difference when confronting these disparities.

This positive trend was on full display at this year’s Match Day, when 54 students—30 percent of the Class of 2021—chose to stay at the Jacobs School for their training.

It is an endorsement of the school and its relations with our hospital partners, and it speaks to the fact that we continue to evolve as a  more mature and integrated academic health center that provides a growing number of clinical care services that people want to be part of.

Ten or 15 years ago, if you were a student who was graduating and you asked, ‘Do I want to stay here for graduate medical training?, there were many things that were not in Buffalo. There was no Clinical Translational Science Institute, no comprehensively organized clinical research program, no truly collaborative partnerships with area hospitals, and minimal relations with our other health science schools.

We didn’t have the depth of clinical expertise that we do now. If graduates did choose to stay here, they accepted the fact that they would have to refer patients to other medical centers to receive a fairly wide range of specialty and subspecialty care that we didn’t offer here. We still have a few gaps in clinical services to fill, but much fewer than was the case 15 years ago. So, it speaks to the maturation of our academic health center.

Over the last 175 years, many physicians who have practiced in Western New York—particularly in Buffalo and Erie County—earned their medical degree at the University at Buffalo. For almost two centuries, we have consistently provided the physicians who take care of those of us who live in this community.

One way to train future physicians to deliver the best clinical care is to have them be part of an institution that asks questions, challenges traditional paradigms, creates new knowledge and uses that new knowledge to advance the standard of care. The Jacobs School has consistently delivered this benefit throughout its 175 years of existence.

The Jacobs School has also been a consistent voice for public health in our community. We are an institution that advocates strongly for advancing public health measures at the local, state and federal levels of government and through businesses and community outreach. A good example of the latter is our Mini-Medical School.

We are champions of public health and as a school, we have done and will continue to do everything we can to educate the public in a timely way about best practices in health and well-being.

Over the last 10 to 15 years, another favorable impact that the medical school has had on the community is the role it plays in the development of the region’s economy. As we have grown, we have attracted people from around the country and world to live and work here and support the economy.

This influx of talent has also served as a catalyst for the launch of start-up companies in our region and for established businesses to relocate to Western New York. This is evident in the growth of the Buffalo Niagara Medical Campus and the synergy that is created there, which impacts our entire region.

As this issue of UB Medicine was going to press, Michael E. Cain, MD, announced that he is stepping down as vice president for health sciences at UB and dean of the Jacobs School of Medicine and Biomedical Sciences, effective August 31, 2021.

Cain will assume a faculty position in the Division of Cardiovascular Medicine in the Department of Medicine and focus his effort on continuously enhancing the school’s educational, research and clinical care learning environments.

In an announcement to the UB community on April 27, President Satish K. Tripathi stated: “An exemplary leader and a true visionary, Dean Cain has left an indelible mark on our university community, and our broader region, by elevating every facet of medical education and training, biomedical research and clinical care. His enduring commitment to UB’s mission of excellence has profoundly enhanced the impact and stature of the Jacobs School and all of UB’s health science schools—and this, in turn, has contributed immeasurably to the health and vitality of Western New York.

“Quite simply put, Cain is peerless,” Tripathi says. “As we celebrate our university’s 175th anniversary this year—a university, I note, that was founded as a medical school—we can also celebrate the extraordinary legacy that Cain leaves as dean and vice president. I am deeply grateful that he will continue to contribute his wealth of knowledge and expertise to our Jacobs School students, our university and our broader community as a faculty member.”