Taking Your Medicine: Realigning New Jersey’s Medical Schools
Rutgers is getting the medical school it needs to compete for major grants, but questions remain about the future of UMDNJ and University Hospital in Newark, and the medical schools in South Jersey.
This is the first article in a two-part series.
Nine years ago, a blue-ribbon commission recommended merging Rutgers University, the University of Medicine and Dentistry of New Jersey, and the New Jersey Institute of Technology into a single research university that could compete more effectively for major federal grants and the jobs they would create. Despite the state's abysmal record of attracting federal research grants, Democratic Gov. Jim McGreevey backed off the plan in the face of strong opposition from Essex County Democrats.
Today, however, with staunch backing from Republican Gov. Chris Christie, Rutgers University is well on its way to acquiring Robert Wood Johnson Medical School, the Cancer Institute of New Jersey, and the School of Public Health -- the three UMDNJ schools located in New Brunswick and Piscataway.
"We're not going to wait for implementation, we're going to begin implementation," Christie vowed a month ago. That's when the UMDNJ Advisory Committee Christie appointed came in with its interim merger recommendations, which echoed those of the 2002 commission chaired by former Merck Chairman Roy Vagelos and the 2010 report of the New Jersey Higher Education Task Force chaired by former Gov. Tom Kean.
Christie declared that the reorganization of medical education at New Jersey's state-run universities was an administrative decision that would not require legislation. Senate President Stephen Sweeney (D-Gloucester) did not challenge the point, although he noted that the Democratic-controlled legislature "does get to vote on all funding issues."
Christie had already made sure that his five-member UMDNJ Advisory Committee, chaired by Celgene CEO Sol J. Barer, provided seats at the table for the two Democratic powerbrokers he has worked with most closely in the past. Clearly, he has their signoff on this first stage of the Rutgers-UMDNJ merger: Advisory Committee members Joyce Wilson Harley, the newly appointed Essex County Administrator who serves as second-in-command to Essex County Executive Joseph DiVincenzo, and Anthony J. Perno, the Coopers Ferry Development Association CEO who works closely with South Jersey Democratic leader George Norcross, both voted for Rutgers to acquire the three UMDNJ units.
The five-member panel is scheduled to come back in December with a final report that will include recommendations on the future of UMDNJ's Newark-based medical and dental schools and its University Hospital -- which are the principal concern of DiVincenzo and Essex County Democrats.
St. Barnabas Medical Center has already expressed interest in adding University Hospital to its network. The panel also will make recommendations on the relationship of UMDNJ's School of Osteopathic Medicine in Camden to Rowan University's new Cooper Medical School, which Norcross played a major role in creating. But Rutgers' acquisition of UMDNJ's New Brunswick and Piscataway units is not waiting for any final report.
Rutgers University President Richard McCormick certainly assumes that Robert Wood Johnson Medical School, which was originally the Rutgers Medical School before it was subsumed into the newly formed UMDNJ in 1970, is returning to the Rutgers fold. The RWJ Medical School pulled in $109.5 million in outside research and other grant money in 2009, while the School of Public Health collected another $9.9 million in grant money that year.
McCormick, who was a strong proponent of the original 2002 Vagelos Plan, wasted no time putting together an implementation plan for the merger. For McCormick, who has already announced his intention to retire as president and take a position on the history faculty, the addition of a medical school to Rutgers represents an opportunity to add a major accomplishment to his nine-year record.
Less than three weeks after Christie's September 20 press conference, McCormick announced that he had assigned three of its senior vice presidents to work on the academic, financial, and legal issues involved in the planned merger. He also said that the university had already issued a Request for Proposals (RFP) for a mergers-and-acquisitions consulting firm to advise Rutgers on the process.
McCormick also promoted Dr. Christopher Molloy, who had been serving as dean of Rutgers' Ernest Mario School of Pharmacy since 2007, to serve as Interim Provost for Biomedical and Health Sciences.
"In this role, Dr. Molloy will be responsible for reviewing clinical, research, and academic strengths among the proposed merged units and developing plans to set Rutgers on a path to become a first-class, comprehensive, university-based health science center for New Jersey," McCormick said.
Molloy is a molecular and cellular pharmacologist who led oncology and cardiovascular drug trials at Johnson & Johnson and holds degrees from both Rutgers and UMDNJ. This unique set of qualifications is particularly appropriate for a health sciences administrator who will be expected to meld two university cultures and help the newly merged institutions partner with New Jersey's pharmaceutical and biomedical companies in attracting public and private research dollars.
Molloy will work with Dr. Kenneth Breslauer, Rutgers' Vice President for Health Science Partnerships, who played an important role in coordinating other inter-institutional initiatives, including the Cancer Institute of New Jersey, the New Jersey Biomaterials Center, and the Stem Cell Institute of New Jersey, McCormick said.
While academic considerations are important, there is no question that the poor record of New Jersey's universities in attracting research grants has been the driving force in merger discussions for the past decade. The recommendations of McGreevey's Vagelos Commission Report in 2002 were revived by Democratic Gov. Jon Corzine in 2006, and Kean was one of the leading proponents in urging the New Jersey Higher Education Task Force last year to go beyond its original mission to recommend that Christie appoint a task force to revisit the Rutgers-UMDNJ merger idea.
Despite boasting one of the nation's largest pharmaceutical industries (tied with California at 13 percent of market share), a strong emerging biomedical sector, and large chemical and telecommunications sectors, New Jersey last year ranked 23rd in the nation in federal research grants from the National Institutes for Health, the Centers for Disease Control and Prevention, the National Science Foundation, and the Agency for Healthcare Research and Quality. That ranking is even more shocking considering New Jersey's status as the third-wealthiest state in the nation and the 11th-largest state in population.
The poor ranking in attracting research dollars can be blamed on two principal factors. The first reason is that although New Jersey ranks first in spending per pupil on K-12 education, it ranks annually in the mid-40's out of the 50 states in state support for higher education per capita. Christie recognized this failing in his first year in office when he pledged to invest more tax dollars in higher education once the state dug out of its persistent budget crisis. It is a pledge he has yet to fulfill.
The second reason is more complicated, and it is one that the addition of the three UMDNJ units to Rutgers is designed to solve at least in part. The National Institutes of Health, the Centers for Disease Control, and other major grant providers in the health sciences prefer to award projects to a comprehensive research university that can supervise and control all elements of the grant project.
In New Jersey, neither Rutgers nor Princeton University has a medical school, and UMDNJ is the only stand-alone state medical school in the nation other than one in Oregon. Consequently, the Vagelos Commission noted, New Jersey's universities are at a disadvantage because they have to put together working groups between schools to submit collaborative grant applications, while Harvard, Yale, and Stanford, and the comprehensive state research universities such as Michigan, Wisconsin, Texas and those in California do not face the same difficulty. That is one of the major reasons that Rutgers (64th), Princeton (80th) and UMDNJ (92nd) ranked so low on the list of the top 100 schools for federally financed research and development initiatives in 2009.
"It is our view that the current organization divide between Rutgers University, and Robert Wood Johnson Medical School and the School of Public Health is an obstacle to collaboration of the magnitude New Jersey should expect and demand from academic research entities engaged in activities that should complement and enhance each other," Christies's UMDNJ Advisory Committee concluded.
UMDNJ's low ranking of 92nd on the research list represented a drop from 72nd place five years ago before a series of scandals at the Newark–based institution both damaged its reputation and created internal institutional turmoil as the school tried to operate under the supervision of a federal monitor appointed by Christie while he was still serving as United States Attorney for New Jersey. "UMDNJ's reputation – and ability to rebuild and enhance its programs in a period of resource constraints – has not recovered," Christie's task force stated flatly.
Partly as a result of the shortcomings of its higher education sector, New Jersey for the last 15 years has been steadily losing market share in the pharmaceutical industry that had made the state the "medicine chest of the nation." While some of that loss of market share is attributable to the wave of multinational mergers that swept through the industry, former Governors Corzine and Kean both noted that New Jersey has been losing pharmaceutical market share to states like California and Massachusetts whose higher education R&D clusters are attractive to both established firms and the new biomedical startups.
"More than a decade of uncertainty about the governance structure of our medical education system has led to missed opportunities and an inability to develop long-term strategies for our institutions to improve and grow, and UMDNJ's schools at Piscataway that have not met their full potential," Christie said in his September 20 press conference. "By beginning the process of merging these institutions, we can provide that certainty that was lacking and really place medical education in this state on a path to real sustained excellence."
Christie emphasized that the reorganization of medical education in New Jersey is "geared not only to address present challenges and opportunities, but to ensure that medical education in New Jersey has a clear, bright and collaborative future." The final realignment needs to "ensure that the system is structured to make every dollar count, to be better positioned for research breakthroughs, be better positioned to attract high tech jobs to the state and to deliver a world-class education to its students."
The governor added that he hoped that adding a medical school to Rutgers would draw a higher-caliber pool of applicants to replace McCormick at Rutgers in a search that is already underway. "As Governor Kean said," Christie concluded, "we need to move Rutgers from 'good' to 'great.'"