Medical History: UMDNJ’s Long Path to Reform

Merging the University of Medicine and Dentistry of New Jersey with Rutgers University could benefit healthcare education and NJ's pharmaceutical industry. Can Gov. Christie make it happen?

The University of Medicine and Dentistry of New Jersey — more familiarly, UMDNJ — has been under the microscope ever since it suffered a series of scandals alleging kickbacks, patronage and fraud.

The scandals have subsided, but the school is under no less scrutiny.

Three statewide studies in the past decade — the most recent issued in December — have come to more or less the same conclusion: The sprawling facility that stretches over five campuses in north, central and south New Jersey would benefit from a closer relationship with Rutgers University.

UMDNJ is the nation’s largest standalone heathcare university. Merging it with the state university, backers contend, would allow both institutions to attract research dollars and raise the profile of each. They argue that consolidating the schools — in whole or in part — would advance healthcare education, biomedical research and New Jersey’s critical pharmaceutical industry.

This isn’t the first time these arguments have been advanced, but the result has always been the same. Political turf battles, regional squabbles and opposition from staff and students have led to the same outcome: stalemate.

The key difference this time? It may be Gov. Chris Christie himself.

Not only has the governor proved himself to be willing to take on tough battles like this, but also he is intimately familiar with UMDNJ’s problems. As U.S. Attorney he led the investigation into the Medicaid fraud and other allegations that resulted in more than $10 million in fines and a federal monitor being assigned to oversee the school for two years. (In reaching its settlement, UMDNJ did not admit any wrongdoing.)

“The project needs a champion,” said Sen. Raymond Lesniak (D-Union) a longtime advocate for higher ed reform. And although he has tried to be this champion in the past, leadership will have to come from the governor this time, he said. “The Senate doesn’t have the juice.”

A Blueprint for Reform

Christie has already appointed an advisory committee that will examine these ideas once again and report back by September with a blueprint for improving the state’s system of medical education and strengthen its connection to the pharmaceutical and biotech industry. The goals include increasing federal and private research dollars flowing to the university and finding ways to keep graduates from the program in state.

The committee will build on previous reform efforts and a list of suggestions made by a Higher Education Task Force chaired by former Gov. Tom Kean. The task force issued a 140-page report in December with dozens of recommendations for improving higher education in New Jersey in general, including specific ideas for structural changes at UMDNJ.

The report stated that “The need to reform medical education in New Jersey, and the institutions that serve it, is an important public policy and educational issue that has been discussed for years and left unresolved,” and it noted: “Immediate resolution is imperative for the public good.”

The report noted with concern that UMDNJ was 92nd nationwide in terms of federally financed research, receiving around $116 million in funding last year, which is hundreds of millions less than schools at the top of the list and a 20 percent drop from its 2005 funding level.

The UMDNJ System

The University of Medicine and Dentistry of New Jersey, a system of eight healthcare schools that serve nearly 6,000 students, making it the nation’s largest healthcare college not associated with a larger, general-studies university. Critics say these factors are harming UMDNJ’s ability to attract financing for research and facilities and, in the long run, the quality of medical education.

Others, including UMDNJ leadership, question the need for such drastic change, suggesting that the school’s size in actually an asset. They point to successful efforts, like research on Alzheimer’s disease and the development of a novel tuberculosis test, and successful partnerships with drugmakers.

Some university staff members worry about pension and benefit changes, and educators at other state schools fear their programs could lose out in a new focus on biomedical research. There is also a question of cost; a reform plan nearly a decade old was estimated to cost over $1 billion, reports show.

“We can’t keep saying it’s broken,” said Assemblywoman Pamela Lampitt, (D-Camden), who leads the higher education committee. Lampitt fears a reform plan that cherry-picks and splits off successful elements of the university, “we’re eroding it. And what’s going to be left?”

But reform advocates and leaders at Rutgers University, insist that UMDNJ needs a major structural overhaul. They believe that by combining all or parts of UMDNJ with Rutgers, or other state colleges, like the New Jersey Institute for Technology (NJIT) in Newark, the sum will be greater than the many parts. And healthcare education, biomedical research and the private industry that depend on these graduates will all benefit in the long run.

“It’s clear to me that to become world class in higher education, a research university needs a medical school. And to be a world-class medical school, you need a research university. And we have neither,” said Lesniak.

Combining UMDNJ and Rutgers to create a more comprehensive medical education program is, he said, “a slam-dunk winner for the state.”

Medical Problems

Academic concerns, however, are not the only major issues that UMDNJ is facing.

Gov. Kean’s report also indicated that UMDNJ has one of the two lowest bond ratings in the nation for public universities, in large part because it also runs a struggling hospital in Newark, University Hospital.

Although the report did not offer any specific action items, it underscored the important role University Hospital plays and called for the university to be “fundamentally transformed while sustaining the integrity of medical education and healthcare delivery in the city of Newark.”

All together, the university includes three medical schools, plus dentistry, nursing, public health and biomedical programs. In addition to University Hospital, a Level-One trauma center that serves tens of thousands, UMDNJ also operates a hospital in New Brunswick and a network of behavioral healthcare facilities throughout the state. All told, these facilities treat 2 million patients a year.

Some have raised concerns about the impact a University-wide reform could have on its role as a healthcare provider, especially in urban Essex County. University Hospital provides around $130 million in annual charity-care services to poor residents, more than any other hospital in the state, and it has become even busier in recent years as two nearby hospitals closed.

But while the hospital is struggling financially, the University has more lucrative operations that can underwrite it, including the Robert Wood Johnson Medical School in New Brunswick and the School of Osteopathic Medicine in Stratford, Camden County.

“The impact on the hospital is something that really frightens me about this model” of combining elements of UMDNJ with Rutgers, UMDNJ President Dr. William F. Owen told the media in January, noting that Robert Wood Johnson Medical School provides 20 percent of the University’s revenue.

“Our current structure and dynamic interplay among schools provide the best model to continue the successful transformation of health education, healthcare, and life sciences research in New Jersey for the 21st century,” Dr. Owen wrote in a January 7 letter, now posted on the University’s website.

UMDNJ officials — and several other key stakeholders in medical education, including the Medical Society of New Jersey and the New Jersey Council of Teaching Hospitals — declined to discuss the University or the potential reform this time around.

Protecting University Hospital is “a very, very big deal,” agreed Sen. Loretta Weinberg (D-Bergen), chair of the health committee. “The hospital and the medical school… their role can’t be underestimated.”

This concern was also clear to former Gov. Kean, who returned to Trenton recently to address the Senate Budget and Appropriations Committee as part of hearings on the upcoming state budget. While the bulk of the hearing concerned higher education funding in general, Gov. Kean addressed several issues specific to the latest UMDNJ reform plan.

“We believe, all of us on the [task force], that University Hospital is absolutely essential not only for the city, but for the region,” Gov. Kean said. “We have to make it viable and we have to keep it doing its job.”

The Task Force report listed various options for the hospital’s future, including transferring its ownership from UMDNJ to a state-owned hospital corporation, selling it to a nonprofit or for-profit hospital system, or having a university – it did not suggest which one — continue to own and operate the facility. Regardless of the choice, the report urges other Newark organizations, like NJIT, to “step up and provide the leadership needed” during any changes.

But Gov. Kean also admitted to the Senate budget committee that an actual road map to achieving this massive UMDNJ reform – while protecting University Hospital and other commitments to Newark – would still need to be developed. Another group with “more resources and more time” needs to work out the details, he said.

“We don’t know how to do it,” said Gov. Kean, a former Drew University president. “We made the recommendations that others made in the past…. and they seemed to make sense.”

Christie appears eager for the challenge.

He said, when announcing the members of the UMDNJ advisory committee on April 4. “You have a governor now who understands UMDNJ better than most of my predecessors. I understand the institution and its issues and I’m already committed to transformation.”

The governor asked the group to examine several possibilities for a state-wide reform, including:

  • Merging Robert Wood Johnson Medical School and UMDNJ’s School of Public Health with Rutgers University’s New Brunswick-Piscataway campus, where a number of UMDNJ facilities are already located.
  • Combining elements of UMDNJ’s Newark campus, which includes the New Jersey Medical School, with another state university, like Rutgers Newark or the New Jersey Institute for Technology; another option is to let NJIT start its own medical school.
  • Overhauling UMDNJ’s structure in South Jersey; possibilities include merging its School of Osteopathic Medicine, in Stratford, with Rowan University’s new medical school, slated to open next year, or Rutgers-Camden.
  • The advisory committee will be chaired by Dr. Sol J. Barer, executive chairman of biotech giant Celgene, and will also include: Robert E. Campbell, former vice chair of Johnson & Johnson; Joyce Wilson Harley, Esq., Essex County administrator; Anthony J. Perno III Esq.; president and CEO of Cooper’s Ferry Development Association in Camden; former Princeton University President Harold T. Shapiro. The advisory committee was created by an Executive Order issued in January.

    Many involved suggest that there is the most momentum for change in the New Brunswick area, where UMDNJ and Rutgers already share space on the Rutgers campus in Piscataway. A merger is strongly supported by Rutgers leadership, as Rutgers President Richard McCormick told the media in January: “reuniting Rutgers with Robert Wood Johnson Medical School would create an academic powerhouse that would significantly enhance the quality of New Jersey higher education and benefit residents across the entire state.”

    “It’s the right way to go,” McCormick added to the budget committee Thursday.

    In South Jersey, matters are complicated by the fact that UMDNJ’s osteopathic school has long partnered with the Kennedy Hospital system to provide its students hands-on experience. Rowan University’s medical school — New Jersey’s first new medical program in three decades – has allied itself to Cooper Hospital. Bridging this divide to create a single research university in Camden County may be difficult, observers say.

    No Superschool

    It was nearly a decade ago that, despite McCormick’s lobbying, concerns on campus over a similar proposal to combine elements of UMDNJ and Rutgers led the Rutgers Board of Governors to veto a plan that would have led to one state superschool with three independent, regional campuses. That reform plan came from a commission appointed by then Gov. James E. McGreevey and led by former Merck CEO Roy Vagelos, and it has cast a long shadow.

    The Vagelos Commission issued a report in October 2002 that recommended combining Rutgers, NJIT and UMDNJ into one state-wide research university with three autonomous campuses in Newark, New Brunswick/Piscataway, and Camden. The goals were very similar: strengthening Rutgers and UMDNJ, attracting more research funding to New Jersey and building ties with the pharmaceutical and biotech industries.

    Despite passionate support from Gov. McGreevey and members of the legislature, the plan collapsed under its own weight. Political infighting, regional power struggles and a preliminary cost estimate reported to be $1.3 billion over ten years proved a crushing combination. Students and media commentators also lashed out against the working name used in the report — the University of New Jersey, North, Central and South – culminating in what may have been the death knell for the proposal.

    Like many things in New Jersey, the current system of medical education developed in a different way than it had in other states – and in a manner that often sparked controversy. But when the legislature called for the creation of a medical school in 1951, it was seeking to overcome some of the same issues the state now faces — including a lack of primary care physicians and a desire to attract more medical research funds.

    Three years later the first medical program was launched by a private school, Seton Hall University, with ties to Jersey City Medical Center. When funding and governance problems arose a decade later, the state took over the program. In 1967 the school was renamed the New Jersey College of Medicine and Dentistry and moved to Newark as part of a massive urban renewal project that had caused riots when it was announced a few years earlier.

    Meanwhile, in 1966 Rutgers started its own, two-year medical science program called the Rutgers Medical School. But this program had few students and lacked a clinical component, so in 1970 the legislature merged its medical and dentistry college in Newark with the Rutgers’ medical program and create a new, standalone medical and dental school with its own governance. In 1981 the program was renamed the University of Medicine and Dentistry of New Jersey.

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