The Q&A: J. Gregory Fitz

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

J. Gregory Fitz is dean, provost and executive vice president for academic affairs at the UT Southwestern Medical School. He attended Duke University School of Medicine and he completed his residency in internal medicine at the University of California, San Francisco. He served as chief resident and assistant chief of medicine and director of the Internal Medicine Residency Training Program at USCF. Fitz served as a faculty member at Duke University Medical Center. He later moved to the University of Colorado Health Science Center serving as head of the Division of Gastroenterology and Hepatology and as the Watermand Chair in Liver Research. Fitz joined UT Southwestern in 2003 as the chairman of the Department of Internal Medicine. He became dean in 2009.

Editor's note: This interview has been edited for length and clarity.

Trib+Health: What is the current curriculum’s focus?

J. Gregory Fitz: Most medical school curriculum underwent this change literally a hundred years ago and still looks about the same in many regards. We’ve been engaged in this curriculum reform effort. One of the challenges is that we have a big school, something like 230 students per class, so 1,000 almost over four years, including some combined degree students. The real challenge for us is we are very science-based and we think everybody, no matter what they do when they grow up, whether they are a small-town doctor in Texas or big scientist, really need to be very well grounded in science. That is a core component of the curriculum, past, present and future. The philosophy is really one of focusing on the individual student with all the resources that we have.

Trib+Health: A big issue in the health debate in Texas is a lack of health professionals working in the state. What is UT Southwestern’s plan for keeping graduates in the state?

Fitz: Texas still, despite the population growth and the fact that it is such an attractive place economically and culturally, it is still very under-doctored, compared to most of the country. You finish medical school and go to a residency program, a GME program. Where you do your residency is much more predictive of where you live and have your professional life than where you go to medical school.

From a state standpoint, Texas is really supporting the education of medical students, and paying a lot of money to do it well, but we’ve reached a place where there are more medical students that graduate than there are GME positions for them to enter. So we are a net exporter of medical students to surrounding states and the country. It is a state issue. We are fortunate to have superb residency programs, the biggest in the state and, I would argue, the best. We have about 1,400 GME positions divided among 90 programs. Some of these are literally the biggest in the country, but we really need to continue to focus on the quality.

Trib+Health: What has been the impact of opening the William P. Clements Hospital on the school?

Fitz: Between the students, faculty, nurses, patients we had such a planning approach to this over the preceding four years that there has been a lot of an emotional investment in seeing it open. The opening went beautifully. A characteristic of the very best hospitals in the country is that they are all teaching hospitals. They all have medical students in them. They all have residents in them. And that is part of the recipe for success. As soon as it opened, we took deliberate steps to put both medical students, medical residents — the whole team approach — into the hospital.

Things are going better than we planned. While you never want to have a full hospital because of the connotation, the hospital is already really busy. It has allowed us to do things that we couldn’t do because the design of this hospital is focused not only on things to make patients more comfortable in a more restful environment but also to facilitate teaching. We are able to use technology to bring pathology and radiology right to the bedside. We are learning to use the technology right now. Unfortunately, the students are teaching us how to do it.   

 Trib+Health: What are some of UT Southwestern's latest research strides?

Fitz: This is a very strong research institution. In addition to the medical school, we have a strong graduate school that is basic science in orientation and works hand-in-glove with the clinical operations. The big issues that I think are facing Texas, as well as the country, are starting to gravitate in broad terms around neurosciences. Everything from peak performance to this growing tragedy of neurodegenerative diseases like Alzheimer's and traumatic brain injury. There has been a big initiative launched to focus on the science and the clinical science, not only of normal brain function but also recovery from injury.

We recently opened a new center for neurodegenerative diseases that is very research oriented with a new leader, Mark Diamond, that has come in. We recently started the Hamon Center for Regenerative Medicine. Part of what they are doing is looking at how stem cells in the brain can be stimulated to facilitate recovery from brain injury. We’ve got a very interesting biomedical engineering approach to reprogramming the brain and a new program in traumatic brain injury that is focusing on patients, be they Friday night football players, military veterans or car wreck victims that have trauma seeking to identify what happened and optimize the management. All of these programs end up being very multi-pronged.

We’ve got a big initiative in cancer, biology in cancer treatment. We have a comprehensive cancer center, which coordinates the clinical operational aspects, but the truth is that cancer is going turn out to be many, many different diseases and many mechanisms. We have a number of very large teams devoted to different types of cancer. CPRIT [Cancer Prevention and Research Institute of Texas] has been an enormously important resource for helping us recruit new talent from around the country and also to facilitate the research that is ongoing, so I feel good about that area.

The real challenge for Texas is the broad theme of metabolic diseases: diabetes, obesity and others. That is starting to be of major importance. Not only does it have cardiovascular implications that most people are aware of, it is associated with certain types of cancer and has a significant overlap with brain function. These are themes that interdigitate with each other, but they are the main ones that we are gearing up for in the coming years. We want the right people in the right programs to bring these teams together, because more and more, science and clinical care is a team sport.