The University of Texas System: leadership for reform and rejuvenation of Texas health care.

My strongest beliefs about the practice of medicine had their genesis in lessons learned while watching my father care for his patients. My father has been in practice in Laredo since the 1950s, and he still makes house calls. For me, in any discussion of health care, protecting the physician–patient relationship, as personified by my father, is sacrosanct. At present, I lead a complex system of higher education: The University of Texas System, which comprises 9 universities and 6 health institutions. All make impressive contributions to health education and research. Every year, the UT System awards two thirds of Texas's health-related degrees, and our faculty train 80% of physicians who graduate from public health-related institutions in Texas. Because of our size, scope, and reach, we have a tremendous influence on the quality of medical research and health care in Texas and the nation. With this background, I concentrate on the UT System's current interests in rethinking both the delivery of health care service and the need to reexamine medical education. Specific areas that concern me include reducing costs by focusing on outcomes and on better preventive care; overcoming the shortage of physicians in the primary care fields, particularly in consideration of the 34 million new patients likely to be brought into the system by the federal Health Care Reform legislation; and making the most of what can be an exciting opportunity to expand the education of students in medicine and other health professions. In terms of the need to reexamine medical education, I draw from a presentation made by Dr. George Thibault, President of the Josiah Macy, Jr. Foundation, on the occasion of a retreat held for our Board of Regents and our university and health campus presidents. One hundred years after the Flexner report, Dr. Thibault told us, we are still conducting medical education according to Flexnerian standards. He called our attention to the fact that as rigorous as the current system is, it is not meeting all our needs or helping to solve such problems as the poor geographic distribution of doctors and other health professionals, the shortages of physicians who specialize in underserved areas such as geriatrics and chronic diseases, the need for new content and for training in newly recognized procedures, and the lag time encountered in integrating scientific advances into medical practice. All of Dr. Thibault's suggestions for change deserve our interest and discussion. A few examples are Moving, in medical education, from 2 years of science and 2 years of clinical work toward the full integration of the biological and social sciences into our curriculum, Making quality improvement, patient safety, systems analysis, policy, and medical economics part of the curriculum, Placing greater emphasis on continuity throughout the educational experience and on providing role models for teamwork, Using the admissions process to encourage not only diversity of background but a diverse choice of career paths in medicine, and Reducing student debt and the adverse effect it has on career choice in the profession. The UT System believes that we should approach these and other suggestions with open minds and unfettered dialogue on the possibilities of reform and rejuvenation. We have assembled a task force to recommend innovations in professional health education. We are proud of our leadership in the nationwide movement to improve patient safety and clinical effectiveness. We believe that we must prepare students for the changing needs of our world by providing them the knowledge and skills for solving complex problems, including the challenges of contemporary health care.