JOHN LYNCH, MD, (FAR LEFT) AND DAVID PERLMUTTER, MD, (SECOND FROM RIGHT) DISCUSS THE FUTURE OF MEDICINE WITH UROLOGY AND GENERAL SURGERY RESIDENTS, AND A CARDIOLOGY FELLOW.
BY TIM FOX
Academic hospitals—those affiliated with major medical schools and dedicated not only to caring for patients but to research and training the next generation of physicians—make up just 5% of the 6,100 hospitals in the U.S., but they have a significant impact on the communities they serve. According to a study published in the Journal of the American Medical Association (JAMA), people who receive treatment at an academic hospital are up to 20% more likely to survive a complex illness than those treated at a non-academic hospital.
Barnes-Jewish Hospital, St. Louis Children’s Hospital and Washington University School of Medicine are the largest academic health-care providers in the St. Louis region and in Missouri, with physicians at the medical school providing medical care to patients at both hospitals. Given the many challenges inherent in meeting the health needs of residents in a large urban area, how are academic hospitals working to meet those needs? And how are they advancing medicine to meet the needs of the future?
I recently sat down with John Lynch, MD, president of Barnes-Jewish Hospital, and David Perlmutter, MD, executive vice chancellor for medical affairs and dean of Washington University School of Medicine, to discuss the current state of academic hospitals—in St. Louis and beyond.
What is the primary purpose of an academic hospital?
Lynch: The primary difference between a non-academic hospital and an academic hospital is this: An academic hospital exists to combine research and medical care to save lives, while also improving medicine and health care for the future. Academic hospitals have access to the highest levels of treatment and technology that often are not available elsewhere. On our academic medical campus, for example, we offer routine care for people while also offering innovative cancer care, pediatric intensive care, advanced trauma care and other interventions designed to deliver effective treatment to people with the most complex medical conditions.
WE ARE WORKING TO CLOSE THE GAP BETWEEN THE AVAILABILITY OF HEALTH CARE AND THE ABILITY ONE HAS TO ACCESS IT.
Academic hospitals also often serve as “safety-net” hospitals in the community, offering care and treatment to those who are uninsured, to those who are among the most vulnerable in the community and live without many health-care options. In that sense, Barnes-Jewish Hospital serves as a community hospital for many St. Louisans who might not otherwise receive care.
Perlmutter: In academic medicine, there is what I call a virtuous cycle, in which we invest in education and research to bring improvements to patient care, better outcomes for patients and better health for the community. In turn, our clinicians identify important areas for further scientific innovation. And all of this strengthens—and is strengthened by—a serious dedication to public health and outreach into our community.
Our research programs are primarily funded by the National Institutes of Health (NIH), our nation’s premier biomedical research agency. The bulk of this funding supports innovative, investigator-initiated research projects with the goal of improving health, revolutionizing science and serving society. The virtuous cycle of academic medicine means we benefit the community by being great clinicians, great educators and great researchers.
You’ve both mentioned that research is an integral part of academic medicine. How has the research program at Washington University benefited people receiving care at Barnes-Jewish Hospital—and benefited the community at large?
Lynch: Through its research program, the university has developed a host of innovations that affect patient care. For example, thanks to Washington University researchers working on new technology, Barnes-Jewish Hospital now has one of the nation’s few intraoperative MRIs, which allows a neurosurgeon, for example, to conduct an MRI in the operating room as surgery is underway. This innovation offers greater precision to the surgeon and reduced risk for the patient. The need in the community for this technology has proven so great that the hospital soon will be replacing the original machine with one that can treat even more people.
Perlmutter: I can’t think of a time when the value, the absolute necessity, of academic medicine was more apparent than during the COVID-19 crisis.
Academic hospitals across the country were caring for an overwhelming number of very sick people, and they were also the ones making research advances critical to improving treatments and survival, including developing vaccines that saved many lives. For example, the idea of basing a COVID vaccine on mRNA technology—which helps the body mount a response to infection—originated in a small laboratory in a medical school.
At Washington University, we developed a saliva-based COVID test early in the pandemic that was used by the university, the city, the county and the state to detect the virus. Then we developed a nasal vaccine, which has been shown to not only protect against severe disease but to prevent infection—something current vaccines do not accomplish. It is now approved for use in India and should eventually be approved for use in the United States. These are the kinds of groundbreaking advances that can happen at an academic center, even—or perhaps especially—during a time of crisis. COVID aside, many of Washington University’s research and innovation efforts show potential for changing the way we approach major diseases, such as Alzheimer’s, cancer, heart disease and other illnesses.
How do the university and hospital work to ensure that people living in the St. Louis region have access to care?
Perlmutter: Improving access to care is a priority for Washington University and Barnes-Jewish Hospital—and for all academic health systems. We provide a very high level of care to people with complex medical conditions, and we’re aware that we can’t meet the demand for all the people who need that level of care. We continue to hire more physicians, and we’re training the next generation of doctors, but we want to do better to ensure that the people in our community who need our care can access it.
Lynch: The university and hospital work together every day to maintain quality of care while meeting the needs of the community. We collaborate to provide complex care for people who need it, and we promote innovation and research. In our role as a safety-net provider, we meet the health-care needs of those who might not otherwise receive care—an important part of our mission. And that mission requires collaboration with other groups, schools, hospitals and initiatives in the community, which is another differentiator for academic hospitals. When we collaborate with the community, we’re expanding access to care.
For example, we’ve worked with Washington University’s Brown School of Social Work to address the very significant problem of health-care disparities in the community. We’ve also partnered with the university’s James McKelvey School of Engineering, the Olin Business School and other schools and programs on a variety of community-focused initiatives aimed at improving health care—and access to it. Both the university and hospital have worked with the University of Missouri-Columbia, the University of Missouri Extension Service, the Regional Health Commission, the St. Louis Integrated Health Network, community churches and other groups to help us reach even deeper into the community.
How has preparing the next generation of physicians and health-care leaders changed over the last 30 years?
Perlmutter: We’ve seen an important change in the culture of academic medicine. In the past, medical schools had what we call a “triple-threat culture,” which meant that we expected individual faculty members to excel in all aspects of academic medicine: They needed to be productive scientists, inspiring teachers and exceptional physicians. But triple-threat culture will not win the day in the future, and we’ve replaced it with one that supports every kind of medical professional. We need research scientists who can focus intensively on a specific disease or scientific problem. We need faculty to teach and inspire a new generation of doctors and scientists, and creative thinkers who will use their medical and scientific training to improve public health and public understanding of science and medicine writ large.
To better prepare future physicians, we also recently revamped our curriculum for MD students to intentionally address health disparities, as well as the social and economic barriers to good health. We are hoping to graduate physicians and physician-scientists prepared to meet the challenges of the present and the future. The new curriculum also looks outside our walls, building upon existing community and university partnerships—and developing new ones—all with the goal of improving the health of the St. Louis region and beyond.
Lynch: At Barnes-Jewish Hospital, we’ve seen significant change in the way medicine evolves and moves forward. Today, it’s not just scientists and physicians making discoveries and fostering innovation: Nurses, pharmacists, physical therapists and other specialists serve as catalysts for change, too. Now, when we need to hire someone to join the team, we look for the person with a certain phenotype, someone with an innate determination to find ways to make things better, to drive innovation. We work to attract those kinds of people, then offer them the resources they need to make medicine better.
What inspires you about the people you work with—the physicians, researchers, nurses and other specialists who are committed to improving the health of our community and our world?
Lynch: I’m inspired by the collaboration that takes place on our campus. Early in my career at Barnes-Jewish, I was the medical director of the ventilator unit, the first of its kind in the nation. The unit was designed to care for chronically ill people using ventilators to breathe. To improve outcomes for them, we created a standardized protocol for care, adopting a team-based approach that included experts from various fields: technology, nutrition, physical and occupational therapy. We all worked together to improve the lives of the people on our unit. And our coordinated efforts saw results: Many of our patients were liberated from their ventilators, something virtually unheard of at the time. That experience taught me early on the value of working across disciplines to build great teams that change lives.
Perlmutter: People don’t do trivial things here; they do big things, and they don’t sacrifice the quality of what they do when facing a daunting challenge. That kind of drive is absolutely the most inspiring thing. I live in a world where people come to me with good ideas many times a day—good ideas that can address tough problems.
What is your goal as health-care providers, educators and researchers?
Perlmutter: We want to be even more effective at what we do: patient care, education and research. That’s why the virtuous cycle means so much as a paradigm. Part of my mission here has been to achieve even better results for patients, and the best way to do that is to improve our research program. I love how interconnected it all is, how one challenge, one change, affects everything else.
Lynch: Our pursuit of those three elements of the virtuous cycle can result in better health-care outcomes for the community. I believe outcomes are the “fourth leg” of the model we’ve been talking about. Here’s the challenge: Even if you live right down the street from an academic hospital or other great health-care provider, your outcome—your health—is affected by a variety of other factors. Your neighborhood, the color of your skin, your accent, your financial means—all these affect health because they can limit access to care.
We are working to close the gap between the availability of health care and the ability one has to access it. We’re making conscious efforts to apply our resources and make choices that show we won’t tolerate being part of those disparities. And we’re doing this in partnership with Washington University.
Perlmutter: And we also are considering ways we can elevate the economy of our neighborhoods. We believe we can do that through a commitment to our mission of patient care, education and research. How do we use the incredible talent we have here to improve people’s lives?
Lynch: Our community members are our investors. We offer them a return on their investment through improved care, improved outcomes, improved access and improved community well-being.
On this medical campus, we employ tens of thousands of people who come to work here every day. We pay everyone at least a living wage, and we offer them opportunities to advance in their careers and continue their educations. We are not only health-care and discovery engines of our region, we’re also an opportunity engine. And we’re not going anywhere; we’re here to improve the health of the people we treat and the community as a whole.