Dr. Michael D. Bailie came to Peoria to assume the leadership of the University of Illinois College Of Medicine at Peoria. A pediatric nephrologists, he joined the college from the University of Connecticut Health Center’s School of Medicine in Farmington, where he was professor and chair of the Department of Pediatrics.
The College of Medicine at Peoria, a regional site of the University of Illinois College of Medicine headquartered in Chicago, traces its heritage to 1882, when the College of Physicians and Surgeons began. In 1913, the College of Physicians and Surgeons was incorporated into the University of Illinois.
The College of Medicine at Peoria, originally known as the Peoria School of Medicine, was temporarily located at the First National Bank building (Commerce Bank building) and then at Bradley University for several years. In 1976, the Peoria School of Medicine moved to its current location just west of Peoria’s central business district. As part of a reorganization, the school was renamed the University of Illinois College of Medicine at Peoria in 1982.
What is the purpose of the University of Illinois College of Medicine at Peoria and what effect has it had on the Peoria community at large?
The overall mission of the University of Illinois College of Medicine at Peoria is similar to that of other universities: teaching, research, and service. Our specific focus is on the education of physicians and biomedical scientists. We support programs in undergraduate, graduate, and continuing medical education. We are also committed to the advancement of our understanding of health and disease through research.
Historically, in the late 60s and early 70s, there were a number of new medical schools formed around the country. There were either formed like us, as a branch of an established medical school, or as a completely new institution. They were frequently placed in communities that previously did not have a medical school. The thinking was that this arrangement would bring healthcare professionals to underserved regions in many states. The addition of these medical schools allowed communities to attract different kinds of physicians. Communities that had limited numbers of medical specialists began to develop specialty programs.
The College of Medicine had a big impact on the expansion of the Peoria medical community between 1970 and the mid 80s. The College has played an important role in attracting physicians who may not have comer here without the benefits associated with a medical school.
The College of Medicine has also directly enhanced the availability of medical care in central Illinois. The College has its own practice plan and operates 10 clinics in the area. Some of our faculty physicians travel to regional hospitals and provide patient care services at those locations. In cooperation with our two major affiliated hospitals, Saint Francis Medical Center and Methodist Medical Center of Illinois, we also offer continuing medical educational programs to regional physicians to help them remain current on clinical issues and treatments. I believe this indirectly contributes to the quality of patient care in central Illinois.
What have been the major accomplishments of the school over the past 25 years?
We have graduated 950 physicians, and 400 of them are scattered around the state of Illinois. One hundred and seventeen of our alumni practice medicine in the Tri-County area, and 105 of our graduates are members of our faculty.
I consider the strong relationship between the College and our major affiliated hospitals to be an important accomplishment. These relationships will continue to grow and expand. The success of many of the residency programs attests to the hospital-medical school relationship. A good example is the surgery residency program. For 10 years, this program struggled to keep its head above water. Three years ago, Dr. Hugh Firor, a pediatric surgeon who had been recruited to the College of Medicine, became the chair of the Department of Surgery, and the program has been on the upswing ever since. It is now a fully accredited residency training program that recruits well.
Another accomplishment has been successful efforts in bringing federal and state grant dollars to the College to support a variety of research and service programs. Some recent successes have included securing federal funds from the Food and Drug Administration to implement a Clinical Pharmacology Fellowship Training Program and funds from the Department of Health and Human Services to establish the Heart of Illinois HIV/AIDS Center. Both of these programs benefit the people they serve and the College of Medicine.
Finally, the College of Medicine is taking a more active role in the community, not only in our relationship with local and area hospitals, but with other organizations such as the primary and secondary schools. We are working on a project regarding immunizations and child health with the Valeska Hinton Early Childhood Development Center. Our medical students provide talks to area grade school children on health-related topics through the Talks to Tykes program. We are also part of the Chamber of Commerce “Adopt A School” program.
In addition, we have been involved with the regional hospitals and other agencies in discussions on community health issues. We are working with the local hospitals on the development of a model program for providing managed care to Medicaid recipients. We are also a part of the Central Illinois Consortium on Higher Education which includes Bradley University, Illinois Central College, and several other Central Illinois colleges and universities. The efforts of this group should improve higher education in this region.
What has been the economic impact of the College of Medicine to the area?
We have a faculty of 92 full-time, 44 part-time, and over 500 volunteer members. Our civil service staff numbers 150, and we have 12 academic professionals. Our medical practice plan now generates over $8 million in billings annually. We spend that money in the community to support faculty, staff, and our educational programs. We also receive $5 million annually from the State of Illinois, which is turning out to be the smallest part of our budget. If all of our educational programs were to disappear tomorrow, we would be talking about the loss of approximately $25 million that currently flows through this community in one way or another. In addition to our state funding, we receive several million dollars a year in grants and contracts. We also provide a substantial amount of in-kind medical services to those individuals in our community who are unable to pay for their medical care.
The medical industry is a big business in the Peoria area. Before you came to Peoria, there was a great deal of conflict among the area’s hospitals, a time known as the “hospital wars.” Today there is still very intense competition among hospitals. How does the College of Medicine fit into this whole scenario?
Our role can be touchy at times, but the hospitals have been very good in recognizing that the support of education can be valuable to them as individual institutions and to the community as a whole. The hospitals have had a very strong commitment to education. At the College of Medicine, we recognize our interdependent relationship with the hospitals and our need to support their future vision and development.
Right now, the competitive environment in Peoria is not as nasty as in a lot of other places. I came here from Hartford, Connecticut where a very difficult environment existed, one that wasn’t conducive to supporting education. I think we have a much better environment in this community. I feel comfortable stopping at Methodist to have a conversation, and then walking further up the hill to Saint Francis and having a conversation about the same issue there. I have a fair amount of confidence that we are all on the same track, or at least I understand how to relate to both institutions on common issues. There are people at both institutions who are very supportive of and committed to education, and that’s a big plus. And, while working with competing hospitals, it is critical for us at the College of Medicine to have a broader vision of our role in education, research and service.
What are the key programs for the future of the College of Medicine?
The question we must as ourselves is, “How do we refocus medical education to meet the public’s view of their needs for healthcare in the future?” I hope the College of Medicine will be involved in some of the policy decisions which will provide answers to this question.
“Key” programs in the future will focus attention and debate on issues related to primary care and the concept of the generalist physician. The generalist physician can be defined as an individual who has a perspective as a whole. This may be the whole organization or the whole patient. The generalist deals with undifferentiated problems and acts as the focus for communication in a system.
One arena which will facilitate discussion of primary care issues and the generalist physician is the process we are now undertaking to develop a new undergraduate curriculum. We will have a series of meetings with the faculty and students to get their input on how to restructure our curriculum to meet the needs of the next century. We are already implementing changes in our curriculum beginning with the next class of students who start in August. We have added a new continuity clinical experience. Each student will spend three weeks in the office of a primary care physician in central Illinois. These three weeks will take place throughout the year.
As visitors enter our building, they will see a large sign entitled “Meeting the Future: The Next 25 Years.” We are using this statement as a focus for the debate about the future of our education, research and service programs. It is a starting point, and I hope one which will lead to a faculty consensus on our future direction. Our most important focus needs to be the education of medical students, to begin educating them for the way medicine will be practiced during the next 20 to 50 years, not the way it was 20 years ago.
This community is just coming into the future with regard to how the healthcare delivery system is organized. The quality of the medical community and the sophistication of medical technology in Peoria is already state-of-the-art. Now we will have to catch up to the year 2000 in the way we provide services in a very short period of time.
What specific things do you have in mind?
I’m talking about managed care and health maintenance organizations, shifting from fee for service to other reimbursement mechanisms, less physician control, and more payer and consumer control. When I came here in 1991, there had been one failed HMO in this community. I do not know why that HMO collapsed; perhaps it wasn’t put together well to begin with, but that doesn’t mean HMOs have no value. I believe it’s a matter of experience and having the right people. We now have some very smart people organizing managed care programs here in Peoria. Since the managed care environment in Peoria is still in the developmental stages, it’s going to create growing pains for all healthcare-related institutions.
Technology, both medical technology and electronic technology, has changed and will continue to change the practice of medicine. What are your thoughts on the use and control of new technology?
Technology is important to our educational programs, and we need to develop opportunities for our undergraduate students and residents to have access to communication technologies that will allow them to keep up with the advancements. This means both computer and audiovisual technologies, and it means an investment on the part of the college.
We’re about to renovate our building, and one of the things we’re building is a computer classroom. There is one minor problem. We have the room, but we don’t have the money to stock it. We will have to go out and raise funds in order to buy the computers and set up the educational environment.
I believe new information technologies will continue to be part of the educational process. A student may spend less time in a lecture hall and more time on their own or as part of a group in front of the computer, learning from new resources.
Physicians need to be familiar with information technologies because that’s what will influence their future practice. It will especially be true in rural areas. Physicians in a rural setting will have all kinds of information available to them if they know how to access the information. Learning how to find the information you need and not waste time is an important consideration for physicians.
It’s very easy for me to sit down at my computer and start exploring the Internet. Sometimes I discover that a significant amount of time has elapsed and all I’ve done is wander around in the system. If you are physician in a busy practice, you don’t have the luxury of exploring the Internet – only medical school deans have time to play around on their computers. For a practicing physician, it is important to be focused and rapidly access the information you need.
On the other side of the coin, there are huge advancements in medicine and healthcare in this country, and a lot of it is due to medical technology. The problem is technological healthcare costs a lot of money. That is part of what is driving a lot of the changes in healthcare delivery. There are questions about overused resources. It’s a very complicated issue which will continue to get more complicated because if the continuing advancements in medical technology. From an educational point of view, it will be increasingly important to educate medical students about the appropriate uses of high-tech tools. Our responsibility will be to help students understand how to limit high-tech interventions by thinking first, and then utilizing those options when necessary.
Has the issue of medical ethics over the years taken a back seat to the hands-on training of medical technology and skills? How does this piece of the puzzle fit in with rising healthcare costs?
I don’t believe medical ethics has taken a back seat to the clinical training of medical students and residents. For example, when our medical students and residents work with attending physicians, especially in a hospital setting, they learn a lot about the ethics of medicine by observing how a mentor physician handles individual patient cases. At the College of Medicine, we’ve had a formal ethics program in place for several years. I do feel a medical ethics component needs to be integrated throughout the whole educational experience. As we begin to examine and revise our undergraduate curriculum, the issue will be addressed.
This issue of ethics and healthcare costs is complicated and will require a great deal of debate. One of the most difficult issues will be the potential limitation or rationing of healthcare services. We already have some rationing based on ability to pay. I don’t have a good answer to this problem, but I know we must be acutely aware that as we work to control costs, we may do harm. There are some tough decisions to make.
The old-fashioned doctor of fifty years ago has certainly evolved. Today a doctor has to be a businessperson and, increasingly, a politician as well. What are your thoughts on this changing role?
What the physicians of a century ago has available to them was certainly a lot different than today. The big issue for me is, how will the physician of the future integrate into a much broader concept of health and healthcare.
My first boss, Bill Weil, who was chair of the Department of Pediatrics and Human Development at Michigan State University, made this statement one day when I was attending a faculty meeting. He said, “Doctors don’t save lives.” We all looked strangely at him, because we were sure we were saving lives left and right.
“Well, you think about it,” he said. “If you think of longevity in the world and look at the mortality rates from various diseases, and try to figure out how they are related to the practice of medicine, you will reach my conclusion.”
For example, the incidence of tuberculosis and the death rate from TB was falling long before there were anti-TB drugs. As people moved out of overcrowded conditions and many other public health approaches were implemented, the outcome for those infected with TB improved. This improvement was not an issue of medicine, per se, but of public health. The man who invented the toilet and the people who put in the sewage systems saved a lot more lives than doctors. This line of thinking presents health as a very broad-based community concept.
In my opinion, the changing role of physicians means doctors will be better educated and more involved on the business side of their practice, and they will have to become more involved in political and social issues. This community has been very fortunate. There are many community activists among its physicians, nurses and other healthcare professionals. The Heartland Clinic is a great example. At the medical school, we are taking all these areas into consideration as we review our undergraduate curriculum.
Then there’s the whole issue of non-physician healthcare providers. We recently have had a lot of discussion about nurse midwives in this community, and non-physicians prescribing drugs. Is the increasing use of non-physician providers going to be good or bad for the health of individuals and the community? I don’t believe it’s appropriate to assume that giving a particular healthcare professional more responsibility or authority in direct patient care is going to produce a bad outcome. These issues need to be addressed through outcomes research so documented results can be used to examine if the ways we practice medicine are appropriate and cost effective. In relation to this, we need to educate physicians to work in teams with other healthcare professionals.
How do we address the issues of cost and coverage? What kind of healthcare reform measures do you favor?
We do spend a lot of money on healthcare in this nation. We spend more money that any other country in the world I know about, either per capita or in total. We also need to ask the question, are we really the healthiest people around? I’m not convinced we are. In terms of cost, I think we can provide excellent care for all our citizens and still hold costs down. My view is, whatever we do, we must preserve high quality healthcare for all people, including those at the fringes of our society. This includes three groups: the older population, children, and people in the middle who have no health insurance even though most of them are working and trying to be self-sufficient. We need to look at those 37 to 40 million people who are uninsured at various times. I think for a trillon dollars, we should be able to provide them coverage. We need to think about rearranging our healthcare dollars. I happen to believe there is plenty of money in the healthcare system. The problem is how we use it. As a nation, it will be a difficult process to reach a consensus, given our size and diversity.
As far as healthcare reform is concerned, I think we are moving in the right direction with managed care. Having said that, there are a lot of pitfalls. In our eagerness to reduce costs, we need to concentrate on maintaining quality. I believe it is possible to increase the quality of care and do it at less cost. However, getting there will be difficult. It means changing habits for the physician, the payer of healthcare services and the consumer. The physician will have to learn new ways of practice; limiting the overuse of technology is a good example. The payer will have to be well educated about the cost, quality, and outcomes of care. And consumers will need to take more responsibility for their own health. The usual things we talk about are smoking, diet, and exercise. We also need to think about other measures that are really healthcare related – seatbelts in cars and helmets for bicycle and motorcycle riders.
You obviously have to deal with many government bodies? What level of confidence do you have in governmental programs that deal with medicine?
I feel we haven’t done all that badly up until now. While the Medicare program hasn’t been perfect, it does take care of a lot of older adults who would have trouble affording healthcare, otherwise. I am concerned about the future funding of Medicare. In the year 2002, when Medicare is scheduled to go broke, guess who becomes eligible for it that year! I feel we owe it to our senior citizens to resolve this problem, and resolve it soon.
I feel the same way about Medicaid, as a concept. Somebody needs to provide healthcare for those who can’t, for one reason or another, provide it for themselves. The majority of people who are uninsured are employed; Medicaid recipients are the very young and the elderly people who have run our of their own resources.
Do you receive a significant amount of government funding for the College of Medicine?
Yes, we receive money from the state and federal government for our programs. We have grants for research, grants to teach, and grants to provide services, such as the Heart of Illinois HIV/AIDS Center. The state component for education is about 28% of our budget and grants account for about 5%.
Do you feel malpractice reform is strongly needed in this country? Does the malpractice environment really drive up the cost of healthcare?
A lot of people think so. I just don’t know the answer to that, but there’s a big push for tort reform. Malpractice insurance premiums are certainly very high; if you’re spending $60,000 or more for malpractice premiums, you’re going to have to recover that cost upfront, which will impact the cost of healthcare.
The two big questions in my mind are: Do current malpractice laws provide an opening for people to pursuer frivolous suits, and how much does defensive medicine by physicians drive up healthcare costs?
I think there are frivolous suits, and laws need to be changed to discourage them. However, people who are injured ought to have access to legitimate recourse through the courts. As for the second question, defensive medicine does cost us something. I know of no data that tells us how much defensive medicine really costs. There are many educated guesses, and it is a difficult question to answer.
I have a friend in Canada who said to me several years ago “Americans view their healthcare system as if death were an option.” We need to keep in mind that medicine has limits. We have such good healthcare for the majority of the population that we may take it for granted and forget about the limits.
What role does research play both at the College and in the entire Peoria community?
In general, research is one of the reasons we have had great advances and opportunities in our healthcare system. A majority of the basic and clinical research in this country has been funded by the federal government. The variety of research being carried out in Peoria has several effects. Research adds to the stature of the College of Medicine and the community as a whole. It brings jobs, it improves the educational and the scholarly environment, and improves the quality of life when it leads to new discoveries.
Medically related research is an active career component of many physicians in this community. The College of Medicine carries out both basic biological research and clinical research. There are two recent additions in Peoria that will enhance our ability to do state-of-the-art clinical research. The Health Advance Institute, a new business here in Peoria, develops opportunities for physicians to carry out clinical research. The Clinical Pharmacology Training Program at the College of Medicine, a program funded by the Food and Drug Administration, will train physicians to carry out clinical studies with new drugs and to improve the use of drugs. Both of these programs have the potential to enhance the health of this region of the state.
What do you see as the future role of the College of Medicine?
In the future, the College of Medicine must become a more integral part of improving health in central Illinois. I hope our vision for medical education will be directed toward the training of the generalist physician who will have the knowledge and skills to practice medicine in what I believe will be a different healthcare environment of the future. This means beginning to think about our curriculum and how it will accomplish this educational mission.
We need to talk about what the next 25 years is going to bring in healthcare delivery and how our educational, research, and service programs will fit. The faculty, which includes most of the physicians in this community, need to enter into a dialogue and reach some consensus. Then we can work with the hospitals and other community institutions to find the approaches and resources that will allow us to be successful. Obtaining the resources we need will not be easy. I don’t know what the federal government is going to do with the funding of Medicare, that largest support for residency education. There is a very good chance the educational support from Medicare will be cut. The state has already cut out funding for education through the Medicaid program. We are going to continue to be dependent upon our relationships with the community. The College of Medicine is initiating a fund-raising campaign next year; this will be one way for us to improve and modernize our educational programs. I believe the community recognizes the value of have a medical school and a branch of the University of Illinois here, and will be supportive of our efforts. IBI