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Q and A with Dr. Joseph Robertson of OHSU

The incoming university president takes over the institution's top job in September
by: Jim Clark, Dr. Joseph Robertson Jr. is incoming president of Oregon Health & Science University and currrent dean of the university's School of Medicine. In September, Robertson will replace president Peter Kohler, who is retiring after an 18-year tenure.

Oregon Health and Science University's board of directors chose one of their own this month to lead the institution, choosing current medical school dean Dr. Joseph Robertson Jr. after a nine-month national search to become OHSU's next president.

The ophthalmologist and former Casey Eye Institute director will replace Dr. Peter Kohler, who plans to step down in September after 18 years as president.

The Portland Tribune sat down with Robertson recently to talk about keeping good people, the art of using other people's money and the joys of kayaking to work.

Q: I don't want to give you job interview deja vu, but why did you want this job?

A: This is the culmination of having spent almost 27 years at OHSU, and I've experienced so many facets of the organization that this is really my opportunity to leverage those opportunities and have a major influence on the direction that the institution should take.

Q: OHSU belongs to Oregon, and yet, as this city's largest employer, it's such an integral part of Portland. How do you maintain its focus as a statewide institution while serving the local community?

A: Probably the arena where our cooperation with the rest of the state is becoming most apparent is in the educational arena, where we are in the process of setting up inter-institutional education programs. In the nursing school, there are multiple schools involved in nursing education, and in the medical school, the one that I'm most familiar with, we now have students on the Eugene campus doing clinical rotations. And we're putting forth a program that hopefully will be able to place first-year students in Eugene by the fall of 2008.

And our regional medical education program will also engage other institutions and other health systems around the state as well as place more students in rural locations and have greater interactions with our AHAC program - that's Area Health Education Center. So I think that is sort of the prototype for how we can develop a distributive model of education.

Q: Would that effort dilute your market share here in Portland, where there is so much competition among hospitals for insured patients?

A: I don't think there's any risk there at all. I think OHSU is a public entity and a public institution. First and foremost, we must always consider that charge and do what is best for the public. With regard to our regional education program, not only is that good for the state, I think it's the financially responsible thing to do because it takes the resources that are available statewide and leverages them to the best of our collective ability. I believe that if we do the right thing over the long term, ultimately that will be in our best interest.

Q: OHSU is the only medical school in Oregon. Is that something you think will change any time soon?

A: We want the presence of OHSU to be present in multiple communities, but I don't see a new school cropping up out of this program. This program is one that, when it gets to its most basic element, is a program that is accredited through OHSU. It is done cooperatively with these other institutions. If you were to start a new medical school it would require over $100 million in capital investment, another operating budget and it would be a third-tier school for decades. You don't become a prominent school in a short period of time.

Q: What is the view, do you think, of OHSU in Salem, and does that view need to be altered somewhat if the university wants to meet its future financial goals?

A: I think overall the view is very favorable. I think that if you actually look at the public opinion data, the public view about OHSU is very positive. I think we can do a better job of communicating how much impact we are actually having on a programmatic basis - what it means to take students and place them in rural locations in hopes that they will practice there. I think there is probably less than full appreciation for what has been accomplished that has a direct effect on Oregon.

Q: Does that mean sending more lobbyists to Salem?

A: I think it takes more communication. I think it's a two-way communication. We need to be unequivocal in demonstrating that we are listening and trying to do what's in the public interest. Despite the School of Medicine in 2001 losing 40 percent of its base budget, we have, over the course of the next five years, increased the number of students by 20 percent and have laid out a plan to - with only a marginal investment - increase the number of students by 60 percent. I'm not sure that the complexity of that has been fully communicated.

Q: So does that mean spending more time with lawmakers?

A: I think as we partner and reach out to more parts of the state, the people that we interact with will tell our story for us. It's not a matter of us going down there or lobbyists going down there. We need to partner for all the right reasons, but one of the added benefits of that is there are more messengers then that are speaking to their representatives about what's going on for OHSU. The real hope is that we let others speak for us.

Q: Most of what you are proposing sounds not too radically different from what the university has already been doing.

A: I think the change is one of emphasis. It's not radically different, but the focus of the university for the past one to two decades has been on growth. And that's been a very successful and fundamentally necessary strategy. If you're going to be a major player, you have to reach a critical mass.

I look at this almost as a biological analogy - the life cycle of an organization. We had to reach a certain critical mass, but now that we've reached that, we will continue to grow. But it will be a bit more differentiated growth and more focused growth, and the capital structure will be different.

In the past, the capital structure has been rather conventional. You either raise money through a bond, or you get it through philanthropy. We will continue to do that, but through this partnership approach, we hope to couple with others to use joint resources.

Q: Is there a model out there you're basing this approach on?

A: It's based more on my own personal experience. When I was chair of the department of ophthalmology, we developed a very cooperative system where we worked together with other programs to, for all practical purposes, form a joint program. We have to bring programs to people using joint capital, not just OHSU capital. In the past, OHSU has been seen as a citadel. The great thing about the tram is that it reaches out not only to the South Waterfront - that's just the beginning. I really want OHSU to reach out through all the 96,000 square miles of the state of Oregon.

Q: How might potential changes to the current state-mandated $200,000 liability cap for institutions like OHSU affect the university's financial picture?

A: I think the cap needs to be changed. But we do need a cap at the end of the day. Without a cap, OHSU and many other public entities in this state will not be able to perform all the tasks that I think the state and the citizens of the state expect them to. We are balancing the rights and needs of an individual against those of the collective society, and it's not up to OHSU - it's up to society to decide.

Q: You've been dean of the medical school for three years. Are you out of clinical practice entirely?

A: I'm not out. I'm in the operating room every Wednesday morning. I don't see as many patients as I used to, but I've made a concerted effort to stay in the clinical arena.

Q: Will you continue to do that once you're president of the university?

A: This is my plan - I don't want to be held to this five years later, but my plan at this point is to take a three-month sabbatical from my clinical activities to effect the transition. And then re-engage in some manner. I'm going to attempt to stay connected in that way as long as possible.

Q: What's your biggest fear as incoming president?

A: My biggest concern is that we garner insufficient resources to support our faculty in the manner in which they should be supported.

If you look at OHSU, of all the resources that we have, our ultimate resource is the intellectual capabilities of out faculty. And they are incredibly committed. During this period of combined growth and restrained budget it has been a time of relatively scare resources for our faculty. And our faculty have been very successful.

And as the institution's recognition has increased, and as individual faculty members' national recognition has increased, they are subject to offers from elsewhere. And people will try and pick them off. They want to stay. They're committed to OHSU. But I'm concerned that, absent an investment of resources, we could lose some of our faculty.

Q: Is OHSU doing stem cell research?

A: It is.

Q: Would you like to see the doors to that type of research opened wider that they currently are?

A: I would say that there are restrictions on stem cell research at the time being across the nation that do limit the applications that will be developed.

Q: And is that something you would live to see change in the coming years?

A: We want to do everything we can within the decision that's made by society.

Q: You live in a houseboat in the Willamette River. Does that mean you'll be taking the tram to work?

A: I have a kayak on my front deck. My dream is to paddle across and ride the tram. That would be cool.