The Pony Express Age Scenario

Imagine this vision of the future in which the world is characterized by low consumerism, a focus on local markets, traditional delivery of services and slowed technological advances.  All missions of UTMB will be influenced by those characteristics.

In the mission area of research, cross-subsidies will be highly curtailed, requiring that research be supported from extramural, non-state funding sources.  Additional consequences will include limited university-based infrastructure, and a requirement that all time and effort be specifically aligned with "soft money" revenue.  The administration will require that any research at UTMB be directed to one of four areas of research strengths.  This will have a regulatory effect on recruitment, faculty development and retention.  Faculty will establish collaborations with other academic centers and commercial institutions to avail themselves of needed resources and funding.  The administration will facilitate those efforts by forming strategic partnerships.  The UT System will support, encourage and in certain instances require cross-institutional cooperatives to reduce duplication in infrastructure.  There is increasing discussion among the Regents of merging the three UT health institutions in Houston/Galveston. Federal programs will define national research priorities, but the research funded from those sources at academic medical centers (AMCs) will be significantly reduced.  UTMB’s major assets from a commercial aspect are its relatively captive population of patients whose medical data will be important for commercial development of products that are designed for genomically defined patient clusters.  UTMB utilizes this asset to establish itself as an important information resource for specific patient populations (e.g. ethnic, age group, occupation related).

 In the mission area of education, national and worldwide centralization of expertise reduces the need for post-graduate specialty training, leading to elimination of residency and fellowship programs at all but the leading AMCs.  The Board of Regents and the Texas Legislature reorganize the structure of the UT health care components, reducing the number of medical students trained at all five institutions.  UTMB continues to bear the responsibility for indigent and correctional care with reduced state funding, thus limiting the number and scope of patients available to support the teaching mission.  Program closures result in fewer academic departments.  Training in certain areas spans the state with more specialty training occurring through distance learning via connections with Baylor College of Medicine, M.D. Anderson and in a few instances those AMCs designated as national specialty centers.  More emphasis will be placed on training of non-physicians who will act as advanced paramedical personnel.  Training programs in nursing and allied health sciences will be reorganized as well to accommodate those changes.  Graduate schools at all UT health care components will be merged, with pre-candidacy education occurring at one site other than UTMB.  Students will be directed toward laboratories at any location in the System where their chosen area of interest is a strength.  Financial support will involve direct sponsorship by commercial entities who will require post-graduate commitment comparable to that associated with military scholarships.  Research education will include non-service science courses in business administration and intellectual property-related law.

In the area of patient care UTMB will have reduced capacity and specific specialty areas.  The patient base will be largely limited to the immediate geographical environment of Galveston County and Southeast Texas.  Patients will be routed through an internal referral system in order to ensure easy access, cost containment and convenience.  Though self-referral may be an option at extra cost, most patients will forgo that option rather than allowing the system to define their health management.  Specialty services will be available through telemedicine linkages with national AMC specialty sites.  Clinically related research will focus on outcomes rather than experimental procedures and therapies.  Federal subsidies will supplement the state budget according to the defined regional mission assigned to UTMB.