Chapter I: Expanding Academic Geriatrics Programs
1. Internal Marketing to Institutional Stakeholders
The challenge: To seek funding to support the growth and development of academic geriatrics programs within a tight federal, state, and philanthropic funding environment
Summary
A common goal across the Hartford Centers of Excellence (CoEs) in Geriatric Medicine and Training is persuading academic leadership that geriatrics is a wise investment. This means you must work on many fronts to garner new support for programs, even where one or more large funding sources are already in place. A mixed portfolio of sources is more stable, and can withstand the loss of individual funders and downtimes. What guides the building of this portfolio should be the program’s strengths, the institution’s mission, and a strategic approach that will allow program directors to make their case well.
Also key is building trust with the institution’s administration, getting to know them, and letting them get to know you and what your program can bring to the dean’s office and the institution. It is important to understand how academic leadership thinks and to use effective strategies to make the case for funding. For example, use a concise yet nuanced message that is backed up with a brief written document including a budget and specifics. The goal is to make it easier for the dean (or chair) to say yes.
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Make yourself indispensible by achieving visible excellence in education. "If you start winning the teaching awards, and become one of the more valuable programs to do the high level teaching, it makes it harder to cut back geriatrics when the time for cutbacks comes." Christine Cassel, MD, American Board of Internal Medicine |
Strategies
Link your program to the institutional mission. Understand what pushes the buttons of your institution. At institutions where the focus is more on research, success will be measured in part by building strength in that arena. At other institutions education is the pivotal point. So, if you are focusing on education in a place that values research more, be sure to present your programs in the most effective way.
"The CoE is not just an isolated faculty development project," observed Brown University’s Richard W. Besdine, MD. He described the CoE’s role as the glue that holds disparate aging-related pieces together, not only in a department of medicine, but also throughout the university. "This cohesion gives identity and substance to the geriatrics program, allowing leadership to find multiple points of leverage for geriatrics within the research, educational, and clinical elements of the institution."
Seek funding based on your program’s strengths. Avoid spending resources pursuing funding for areas where you have minimal expertise or manpower, as they are difficult to sustain.
Create a diversified portfolio. Build program support based on multiple sources of funding by taking advantage of local/regional and institutional opportunities. Don’t just aim for big awards—smaller grants can lead to larger ones. Understand your current support, where it comes from, and how long it lasts. Avoid becoming complacent about money that has been available for a while, as some sources of funding can be variable or dry up. Make sure that no single source of funding represents the majority of an annual budget.
Show a return on investment. Fiscal management is important to administration. Yet few physicians are trained in that area or learn skills, such as “mission-based accounting.” (See Resources below.) Back up requests for program support with numbers, and show a return on the administration’s investment. When preparing an annual report, explain how you have used dollars wisely and what the return is for time spent with junior faculty, for example, in terms of grants, publications, national recognition, or other contributions to the institution.
Build mutually supportive relationships with deans and other administrators. Deans and chairs can support geriatrics in a variety of ways: matching dollars for training, providing seed money for new initiatives, allowing a program to capture more of the "indirect costs" on grants, and supporting new training and research initiatives. In turn, support your deans and administrators by helping them accomplish their goals. For example, line up your mission with theirs, be accountable, and meet or exceed your budget projections.
Match your style of asking to the person. Individual deans vary in how they prefer to be approached for additional resources, so find out how they want the process to unfold. For example, some want a concise description of your proposal linked to the dean’s and other institutional goals, with specific budget and timeline details in writing before a face-to-face meeting. Others may prefer a more informal initial discussion.
Get to know how academic leadership thinks. Pursue opportunities to participate in institutional level activities, such as strategic planning, to gain perspective on the challenges facing high-level administrators and how they make decisions. To expand leadership skills, and learn more about how academic leadership thinks and how to relate to them, many CoE directors recommend external leadership training programs. (See Resources below.)
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Make management a fundamental function. "Management takes real thought and skill. It is important enough to the future of geriatrics that we should be thinking more about how to train people better than we do now." Seth Landefeld, MD, University of California, San Francisco |
Keep your eye on the reporting structure. High-level reporting and administrative structures vary from institution to institution. These differences have implications for how geriatrics programs are managed. In many institutions, a supportive dean can make a major difference within the academic realm, but not necessarily within the clinical area. One trend, the single CEO model for a medical school and its affiliated hospital(s), has the potential to create a more supportive environment for training and academic initiatives at academic medical centers. At one institution, for example, the hospital administration was moved under university management, with a dean overseeing both institutions. As a result, the hospital is becoming more supportive of training in general. As an added benefit to geriatrics, a new palliative care initiative, which the dean had supported all along but which had not been supported by the hospital administration, is now better positioned. At another institution, geriatrics faculty are employees of a hospital or clinical practice, rather than the university or medical school. This reporting structure has been particularly relevant to discussions with clinical administrators about getting faculty time away from clinical responsibilities for the purpose of grant writing.
Market geriatrics to chairs and peers in other specialties. Strong collegial relationships can open the door for training and research collaborations and even university-wide initiatives that can have a positive impact on geriatrics programs’ growth and development.
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Close-ups Build management and leadership skills. When she first took the reins of the geriatrics program at the University of North Carolina (UNC), Jan Busby-Whitehead, MD, concluded that her program was not leveraging its portfolio well. State funds were 75 percent of total budget; over time she has reduced that to 25 percent. “State money may not always last. In many years we have had large cuts to our state funds. This situation spurred me not to be complacent about this money. You have to grow research and education funds, develop a multi-part mission, and identify multiple sources of external and internal funding (we competed for internal money and got four grants funded, each for about half a million dollars),” she said. Dr. Busby-Whitehead added that small grants can have a snowball effect, and that no source is too small. “When I became an administrator, I was not trained in fiscal management. No one had shown me the metrics of a budget. I received help from the dean’s office, and learned ‘mission based accounting.’ (See Resources below.) In my annual report I have to show how I have used dollars wisely, what the return is, and what I have spent on support for junior faculty to write successful grants. For example, ‘Over the past six years, these junior faculty members have delivered a ten-fold return on investment dollars. They received grants, published their work, and achieved national recognition.’ Never use the ‘we are wonderful’ argument without also showing the importance of the work you are doing, how you are supporting the school’s mission, and how you are meeting the metrics. It is not all about the dollars, but the dollars are important. “It is critical to have strong working relationships with your department chair and dean. You have to build those ties, line up your mission with theirs, and be accountable. Work hard to hold up your end by being fiscally responsible and meeting or exceeding your budget projections,” she said. Dr. Busby-Whitehead recently participated in the strategic planning process for UNC’s academic health center. “The Hartford Geriatrics Leadership Development Program was transformative for my career and for geriatrics at UNC. (See Resources below.) The funding allowed me to attend a two-week course at the Harvard School of Public Health designed for physician executives where I acquired academic leadership and strategic planning skills.” Think like a dean. Robert Golden, MD, is Dean of the School of Medicine and Public Health and Vice Chancellor for Medical Affairs at the University of Wisconsin-Madison. (In 2007 the university received a Hartford CoE grant directed by Sanjay Asthana, MD.) Dr. Golden offered the following advice about leaders seeking resources, with a proviso: “What works for me might not work for other deans and medical schools. If you have seen one dean, you have seen one dean.” Deans’ priorities can vary according to the type of institution. As a dean of a public university, Dr. Golden recommended emphasizing the “overwhelming public need for an expanded workforce in geriatrics due to the demographic trends, an evidence base for best practices, and the far greater need for institutional support in geriatrics than in other—sometimes better compensated—specialties. Acknowledge the realities of the flow of funds, and that geriatrics, like pediatrics, is underpaid and reimbursed at a lower level by the federal government and other third party payors. So focus on existing strengths and opportunities in the academic and public service missions.” Dr. Golden shared how he prefers to be approached with proposals: • Provide the dean with background information prior to the meeting, including a lead letter with the “ask,” (the request) and supporting documentation. • At the meeting, assume the dean did not have time to read everything. So start from scratch and build a case, using real numbers and statistics. Be specific. For example saying, “We have a year or two to submit an application, and it will bring in a lot of money, but we need a little bit of space,” is less convincing than, “I am coming now because we have 12 months before we submit, we need from your office between $100,000 to $300,000 over two years, and will need new office space for five new FTEs. I will share with you why this is an important opportunity.” • Even if you have sent information earlier, bring materials to the meeting that you can leave behind. This way, when the person you’re meeting has time to get back to your idea 48 hours later he will have concrete, specific information close at hand. |
For more on mission-based accounting, how to report the contributions of faculty teaching and research, and the arena of mission-based management of academic medical centers, see resources on the Association of American Medical Colleges (AAMC) web site: http://www.aamc.org/members/msmr/measuringfacultycont.htm
For information about Hartford Foundation’s Geriatrics Leadership Development Program, see the Association for Directors of Geriatric Academic Programs (ADGAP) web site: http://www.americangeriatrics.org/adgap/leadership_dev_program.asp
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