Donald E. Wilson, the only black dean of a non-minority medical school in the country, has spent much of his first year at the University of Maryland at Baltimore dealing with the state budget cuts.
Dr. Wilson came to Baltimore from New York where he was chief of medicine at the State University of New York Health Sciences Center in Brooklyn. A native of Massachusetts, he graduated from Harvard University and Tufts University medical school, specializing in gastroenterology.
Q: How much of a difference do you think it makes that Maryland's medical school has the only black dean?
A: I don't know if it makes any difference. I know people made some correct assumptions before I came here. I have more interest in increasing the number of minorities in the med school than other people might have. I have more interest in health-care research that involves minorities than other people might have.
You might say that's biased, but I think it's reality. It's survival. I don't see how this country is going to survive unless it begins to deal with its minorities. When you look at all the expertise and services that will be required by the year 2000, 2010, you realize that if you don't start dealing with this now, you're going to be woefully, inadequately prepared to compete on a global basis. You're already seeing it.
Q: Do you feel any particular pressure as the only black in your position?
A: I think it's sad that it was 1991 before I became the first dean. And now that I left my previous job, there are no black chairmen of medicine at this time. That's sad.
For about five years, there was pressure on me to become a dean, but I resisted it because I wasn't interested in the job. One reason I wasn't interested is that there is a lot of pressure being the only black person who is a dean.
I thought that this med school, at the time, offered the ideal situation. It was in the right area, part of its community; it offered a lot in terms of prestige and accomplishments; and the state was financially healthy. As it turns out, two out of three ain't bad.
Q: What is the financial situation?
A: Well, I was just away on vacation and during that time I learned that we are faced with another state budget cut. That's all I've had since I've been here. The first one occurred about two weeks after I accepted the position and it's been the modus operandi ever since.
We are the state medical school, but what a lot of people don't realize is that the portion of our direct budget that comes from the state is down to around 10 percent. Most of our budget is generated by research funding and professional faculty.
One of the things that's been good about the school is the dramatic increase in research funding in the last five years. When we provide the resources and the space that allows bright faculty to go out and compete for funding, they get it. We've done very well with that.
But we've about run out of space. Luckily, we've got a new building going up -- we should break ground in about two months -- but that will be about two years before that's completed. We expect to see a significant increase in research funding once we get people into that space.
Q: Do you have any particular accomplishments or disappointments of your first year?
A: One of the things I wanted to do was to get the school to take a fresh look at itself, and we're doing that, looking at our vision, where we want to be 10 years from now. Strategic planning is especially important in tough financial times, and we're doing that.
And I think we should take a fresh look at the curriculum. It changes every year, but there hasn't been a significant change for over two decades. We're one of a number of medical schools that over the past five years have looked at what medicine is like in the 1990s -- it's not what it was like when I got out of med school in the '60s -- and how it's going to be different in the year 2000.
The new curriculum we are talking about uses more of a problem-solving approach. A med student has to spend more time with computers, has to learn how to continue to learn, to use new data to solve problems. They can't learn out of a textbook anymore because by the time they get out of medical school, half of what they learned is wrong, or if it's not wrong, it's no longer relevant.
That type of curriculum requires more faculty time as we go from large classrooms to smaller groups. It requires more space, more equipment. And all of that requires more funds. So it will take longer than I had hoped. There will be some changes in 1993 and we will continue to make changes until we get it done, but the timetable depends on the recession.
Q: What is your vision of training doctors for the next century?
A: The physician has to be more than just a skilled health-care provider. Health is not just the absence of disease, it's how well you are, so the doctor has to be able to deal with everything from nutrition to psychological problems. A global approach to providing care is something people are looking for.
So I'm looking for opportunities for our students to take care of people, not just treat diseases. I want to get them involved with in-patient ambulatory care so they are spending some time dealing with relatively well people.
When I went to med school, probably 60 percent of the patients in a hospital were not that sick. Let's say you'd develop a pain in your belly, you go to a doctor and he puts you in the hospital to run some tests. You walk in fairly healthy, there's no push to get you out of there, and the student or resident has some time to chat with you when you are relatively healthy, to learn about your family, your aspirations, to learn some old people medicine.
But you can't do that now. Patients aren't allowed to go into a hospital for diagnostic work. So our students are dealing with people who are very ill and, therefore, do not behave the way they do when they are not ill. The patients come in, get a procedure done and then get out.
Students don't have an opportunity to see a symptom appear, LTC develop over a period of months, to follow up, to see what happens to patients after they go home. That's one reason now that students don't see primary care as being that attractive. In an ambulatory care setting, students will see more relatively well patients. That's a change we can make.
Q: I understand it was some old people medicine that got you interested in the profession.
A: I think I was 8 years old. I was sick and a doctor came, gave me an injection and I got better. This was 50 years ago in Worcester, Mass. I would have probably gotten better if he hadn't come, but I was impressed with the idea that somebody could do something and make me feel better.
That got me interested in becoming a doctor. My father wasn't particularly interested in it: I was the first one in my family to get a college degree. What he made clear to me was that if you want to succeed as a minority, you have to put yourself in a position where you can succeed on your own without looking to someone else to appreciate or promote you. As a doctor or a lawyer, you could be responsible for yourself and succeed based on your own talents.