Oregon Health and Science University's future appears to be bright with opportunity but also subject to numerous and formidable challenges.

How Oregon's only combined medical school, research institution and hospital will deal with the future soon may be made more clear by whom OHSU's board of directors selects as the university's next president.

But the future also will be shaped by what the board decides are the specific goals, roles and responsibilities of OHSU for the next 10 to 15 years.

Three candidates are in the running to replace Peter Kohler, who is retiring after serving 18 years as OHSU's president.

Kohler will be a hard act to follow. On his watch, OHSU became a private-public institution. It also boosted its national stature as a medical school and cutting-edge research center, undertook major clinical and facility expansions on its Marquam Hill campus and the South Waterfront, expanded its services in the suburbs, and greatly increased research investments and private philanthropic donations.

However, there is much more for OHSU to do.

We are not able to judge which candidate - OHSU's own Joseph Robertson Jr., Tulane University's Paul Whelton or the University of Colorado's Jay Gershen - is best. But we do think that the next OHSU president should be selected only after the board clearly decides the priorities of not only OHSU but also the Portland area and the state of Oregon.

We offer the following priorities for OHSU and its next president to address:

• The balancing act between being a private-public institution and how the state of Oregon should be involved. Since going private, state funding for OHSU has been slashed. We think it's time for OHSU to better explain what its private-public status really means and for OHSU to address specific issues and measurable outcomes that will be funded by the state;

• Health care of the indigent and aging. OHSU serves as the poor's first and greatest hope for medical care in time of critical need. This is a losing health and financial proposition for all concerned. It's time for OHSU to lead all of Oregon back to the table to decide how to best provide affordable health care to the poor. Meanwhile, the aging population of baby boomers soon will present a health care burden that represents yet another crisis;

• The dilemma of how to balance being a successful hospital and also a high-achievement research institution and a great medical school. We suggest that OHSU first look to educate qualified Oregonians first - and the rest of the nation a distant second.

• Community, business and state leadership. OHSU is the city of Portland's largest employer. But it needs to be a greater and more proactive communicator and leader about important community issues and outcomes. OHSU must join with business leaders that are struggling to deal with the growing crisis related to health insurance costs and accessibility to health care.

• Mental health? Who in Oregon really cares about the mentally ill? Too few of us. And so, the mentally ill are either overlooked or not assisted. Some become homeless. Others are believed to be criminals and are detained in jail. Still others become a burden for their ill-prepared families or themselves.

A great state requires a great medical school, research institution and hospital.

We consider OHSU to be very, very good at these things. However, the challenges and opportunities that OHSU, the Portland area and all of Oregon face in the future will require OHSU and its next president to commit to be great.

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