Despite financial concerns, new CMED dean reorganizes school to help serve Michigan's sick
Near the edge of campus works a man on a mission to help take care of Michigan’s poor and sick. To accomplish that, he is going to have to stabilize and grow Central Michigan University’s College of Medicine.
In a building unfamiliar to most students, Dr. George Kikano spends his days in a neat, almost sterilely-clean office. He can come across as intimidatingly intelligent, which might be one reason is appears as a guest commentator for national news outlets like ABC News and FOX News.
This summer Kikano moved to Mount Pleasant to begin his tenure as dean of one of the newest medical school in Michigan. Recently ranked by his peers as one of the best doctors in America for the 12th consecutive year, Kikano has a crystal clear vision of what he wants the Central Michigan University College of Medicine to be.
"We are one of the richest countries in the world, and there's still lots of disparities in healthcare delivery and access to care," he said. "If you drive between Mount Pleasant and Northern Michigan, all of these communities are underserved from a healthcare perspective."
CMED will train its students to serve as primary care doctors who will practice in rural Michigan’s underserved communities. This vision was in place when the medical school was founded, and that mission is why Kikano says he was drawn here to lead the college. So far, Kikano said he's felt supported by President George Ross and Provost Mike Gealt.
But just believing in the mission isn't enough. Kikano said CMED’s success depends on receiving additional financial support.
Port Huron second year med student, Devin Simon listens to the simulation mannequins heart and lungs as Livonia second year med student, Laura Bou-Maroun examines the mannequins pupillary reflex in the college of medicine's simulation room at Health Professions building on Sept. 25, 2015.
"They've invested a lot, but what it takes to put this college on the map is lots more. Colleges of medicine are very expensive ventures," he said.
When it opened, the university’s plan was to have CMED fully self-funded within five years. Kikano said this goal is unrealistic.
The College of Medicine's clinical operations are listed in the university's operating budget under subsidized auxiliary centers, or areas of the university that don’t operate entirely on general fund dollars, but instead with money created by academic programs and tuition.
Initially, CMED was to operate with dollars from medical student tuition, private gifts, endowments and revenue generated through faculty research and the care of patients at clinics it planned to establish. It missed its revenue projection in 2014-15 and decided against purchasing clinics that will help it earn revenue and allow students practical work experiences.
In 2011, then-provost Gary Shapiro said the university had “ample resources” to fund CMED.
"We won't be using any undergraduate tuition to pay for anything," he told the Academic Senate during a 2011 meeting.
In 2015, the College of Medicine's four clinics were subsidized for $5.2 million. On its own, CMED makes $11.9 million in tuition and $150,000, listed in the operating budget as "other revenue."
The university promised CMED $30 million in donations through a capital campaign for the college, but fundraising came to a halt after CMED's development officer left the position. Vice President of Development and External Relations Kathy Wilbur said the campaign is about 87 percent complete. Wilbur is assisting CMED by helping them find a new development officer. A handful of interviews have been conducted.
"We brought in a number of new donors. When they saw we were working hard to meet a significant public need, they wanted to make a gift," Wilbur said. "We've interviewed people already, and have more this coming week."
Wilbur, who lobbies in Lansing and Washington D.C. on behalf of CMU, said when the creation of CMED was approved by the Board of Trustees, the university knew state funding wasn't likely. There was support from legislators who were interested in securing a one-time grant to launch the college.
Then the recession hit the nation in December 2007. It was clear then that the university would not receive any financial support from the cash-strapped state.
"With changes in the stock market, any additional grants or programs that weren't viewed as critical didn't make any further advances,” Wilbur said.
Since the first discussion about establishing the College of Medicine occurred on campus, many faculty and students have questioned its value and the amount of resources CMU has devoted to it. Those investments continue, though Vice President of Finance and Administrative Services Barrie Wilkes said the university has not altered its plan to gradually decrease its subsidies of CMED.
“Right now I can say that the plan is we have built into the budget at $3 million annual subsidy for the College of Medicine," Wilkes said. "What I would like to see is (it) to break even with that subsidy included in their budget. If we look five years out from now, that gives them a reasonable timeframe. I guess things have to settle down and get to a steady state as opposed to a growth state.”
Kikano said making CMED financially self-sustaining is not among his most pressing concerns. Cutting CMED funding would be a disaster.
CMED receives an annual $3 million from CMU each year. It’s Saginaw campus, a $12 million project, opened this summer. The project was funded through donations.
Earning an annual salary of $500,000, Kikano is increasing the number of administrators working for him. He already has hired four new senior associate deans who will supervise their respective areas. The college also is recruiting candidates to fill two additional dean positions. After Kikano was hired, he said he realized he needed to change the structure of the medical school and his reports.
"I think the (former) dean had too many direct reports, and there was a lack of delegations of responsibilities. There was also a lack of clarity of reporting structures and responsibility of different tasks,” Kikano said. “Now it's clearer, more delegated."
Students in the college have a medical school curriculum unique to CMU. They work in smaller groups, utilizing simulation and interactive experiences with patients early on. Clinical rotations begin during their first year. During year four students choose elective areas and explore their specified medical interests.
CMED students pay more than $33,000 per semester for in-state tuition and almost $70,000 for out-of-state tuition. This year CMED welcomed it's fourth class of students. Each class is capped at about 100 students.
Second-year medical student Sean Masters said he and most of his classmates share the same vision for CMED as Kikano. Masters said he chose CMU because it is a new medical school.
"There's no momentum keeping it the way it has been like at an older medical school," he said. "With a new school, you wonder, 'Is this the best choice for my education?' I attended a conference last year and heard medical schools are moving more toward this team-based approach. That was really reassuring to hear."
While its financial stability remains open to criticism, Kikano is focused on the part of the mission he can control. As students share their experiences at CMED, each year the number of applicants continues to grow. To Kikano, it shows the school is moving in the right direction.
"Last year for a class with 104 students, we had 4,600 applications," Kikano said. "That means only 2 percent of the applicants made it here, and they are very qualified. Our applicant pool is on track to be more than 5,000 applicants this year, and we haven't even started interviews yet. I'm impressed with the amount of qualified applicants we have.”