Clay Johnston

Clay Johnston, dean of the Dell Medical School, has started from scratch in March to build up the staff and partnerships for the school. Johnston’s greatest challenge thus far has been to focus his energy on key functions of the school, such as initial accreditation.

Photo Credit: Ethan Oblak | Daily Texan Staff

Editor’s Note: This is the last in a series of Q-and-A’s with UT’s deans. Dr. Clay Johnston is dean of the Dell Medical School. He was appointed dean in January 2014. The interview has been edited for clarity. The McCombs School of Business declined our requests for an interview.

The Daily Texan: What sorts of things have happened in the medical school since the Texan last spoke to you? 

Clay Johnston: We’ve been hiring a lot of people. Hiring people is one of the most important things we do. We are almost entirely focused on [hiring] leaders. Now we have three department chairs, with another four to recruit. We had a visit from the accrediting body in February. And that visit went really well. We will hear about accreditation for sure in June. If that goes well, we will start accepting applications for July 2016.  

DT: What kind of relationship do you foresee between the medical school and the rest of UT? 

Johnston: We have started the first program that cuts across schools, called the Design Institute for Health. It’s us and the College of Fine Arts. We will announce another program like this that will include LBJ, McCombs and the Law School within a month. In addition we will start programs that reflect how we hope to find solutions to health problems.  

DT: What has the recruiting process been like so far? 

Johnston: For us, the most logical way to recruit is to recruit the leaders and have the leaders recruit their people. There are some urgent needs we have to fill, so we are recruiting a small number of faculty along the way. In terms of staff, we met those needs right away. We did inherit clinical faculty from UT Southwestern. 

DT: Recently, the University announced a partnership between the medical school and Huston-Tillotson University. Can you tell us about that, and what are the things you look at when it comes to working together with other organizations, such as Seton? 

Johnston: We have a bunch of partnerships, and we will always rely on those. As opposed to our own stuff, we are trying to work as a coordination and creativity engine to move other entities forward. Seton is a key one because they are a primary in-patient partner. The other major partner for us is Central Health, the Travis County health care district. They make sure that poor people get health care and they do that through contracting with different providers. A lot of teaching will happen there. ... Huston-Tillotson is brand new. We are focused on how we deal with mental health disparities in Travis County. Huston-Tillotson is great partner to help us think about that. 

DT: How can the medical school address disparities in health care access? How could it work to alleviate some of the problems? 

Johnston: I see that as one of the critical roles for us. Right now, too much money is being spent on the emergency room and stuff that happens in the hospital, whereas if we shift the dollars and spending more to promoting health, creating a better environment for people, encouraging them to make better choices and identifying conditions early, we could save tons of money and people would be happier and healthier.  

That’s particularly true in neighborhoods where there’s more poverty. What we are interested in is shifting the payer model. Our role is to help these populations to identify the things that could be effective, potentially to coordinate different practitioners that are acquired to create those plans, directing payers toward wiser investment to their dollar. It will be more effective by bringing good ideas and promoting smart policies and the infrastructure. 

DT: How do you plan to help with students’ tuition and also increase diversity? 

Johnston: Our goal is to have no tuition for a third of our students and to keep tuition low for the other two-thirds. We have scholarships for people who plan to go into primary care — it’s probably going to be a forgivable loan program as the way to encourage it. 

The diversity issue is complicated, and it’s going to be a long-term issue for us. It is important, ultimately, to have physicians look like the patients they are treating. Unfortunately, we’re nowhere close to that in the U.S. health care system. We, as a single school, cannot solve that problem, but we are trying to look at the entire pipeline to interest students in medicine as early as middle school. 

DT: What role do you think the Dell Medical School will play in relation to the other medical schools in the UT System? 

Johnston: We have some fabulous [medical] schools in the UT System. They have been honed through years of tradition. We have this opportunity, and responsibility, to be more representative of where the health care system is going. So the other schools are looking to us to succeed and fail because we are definitely taking some of the risks so they can learn from both. 

Clay Johnston spoke at the AT&T Conference Center Friday about building a new health care “ecosystem.” Dr. Johnston is the inaugural dean of the Dell Medical School and will begin his tenure March 1.
Photo Credit: Xintong Guo | Daily Texan Staff

Clay Johnston, dean of the Dell Medical School, called for a health care revolution in a speech Friday at the AT&T Executive Education and Conference Center.

Johnston said he hoped to build a new health care “ecosystem” by shifting the industry’s focus to developing innovations in education and information processing. He said the health care industry should adopt the Lean Startup model, a plan that emphasizes preventative health care measures.

“We need experts in health care redesign and people who understand population health,” Johnston said “We can be much more influential by coordinating not just with the physician community, but with the broader community to get it to move forward.”

Johnston said the health care system is outdated, with discrepancies between modern technology and the technology used in the health care field. 

“Health care accounts for 18 percent of the U.S. economy, and, yet, it’s powered by technology that’s really 50 years old,” Johnston said.

The McCombs Healthcare Initiative sponsored the event. Edward Anderson, director of the Initiative and professor at the McCombs School of Business, said Johnston’s vision of coordinating health care with the community could lead to a technology boom in Austin similar to that of the 1960s. 

“We have the potential for doing, here in Austin, what was done back in the late ‘60s with high-tech manufacturing,” Johnston said. “It did great things for Austin and put Austin on the map. I think we’ve got a good shot, particularly with this mandate and this team, for making that happen again here in health care.”

Ahmed Riaz, creative director at Frog Design Inc., said Johnston had a positive message that applied to a variety of Austin professionals, including those outside the health care industry.

“He’s in a position to actually change things in the medical world and has a plan to create a system that involves the community,” Riaz said. “It really engaged Austin as a community and the society at large.” 

Johnston, who begins his tenure at the Dell Medical School in March 2014, encouraged future medical students to facilitate health care innovation.

“We want the medical schools here to enable the entire community to start thinking about being partners, envisioning better solutions and moving health forward,” Johnston said. “One of the best places to start that is here on campus.” 

Correction: This story has been edited since its original publication. In his quote about a potential health-care boom in Austin, Johnston referred to a mandate, not a man. Further, he began his tenure in March of last year.

The University hired its first two department chairs for the upcoming Dell Medical School earlier this week.

Kevin Bozic will be the new chair of the medical school’s surgery department, and Amy Young was hired as the new chair of the obstetrics and gynecology department. Bozic said he plans to build his departments in such a way as to help make the Dell Medical School a nationally recognized institution.

“I am very excited about the opportunity,” Bozic said. “Austin has a very vibrant community who embraces innovation and change. I am looking forward into capitalizing the entrepreneurial, innovating spirit and improving the value of health care.”

Bozic said he has held leadership positions at institutions across the nation. He previously worked with Clay Johnston, Dell Medical School dean, at the University of California-San Francisco, where he is a professor and vice chair of the Department of Orthopaedic Surgery. He is also a visiting scholar at Harvard Business School. He graduated from the University of California-San Francisco School of Medicine and the Harvard Combined Orthopaedic Residency Program. 

“A new way of teaching medicine in the new Dell school is to first understand the needs of the patient and organize a system to optimize the help to the patient,” Bozic said. 

According to the University, Young has an experience in initiating and leading programs and collaborative partnerships in obstetrics. Young now works as the chair of the Department of Obstetrics and Gynecology at Louisiana State University Health Sciences Center-New Orleans. She has also served as the District XI chair of the American College of Obstetricians and Gynecologists.

“Improving women’s health is an essential part of the Dell Medical School’s mission,” Young said in a statement. “We can reshape health and health care delivery that improves outcomes for women here and helps catalyze positive change across the country.”

Johnston said the school is founded on a partnership that will help resolve the evolvement of health care.

“This is an exciting time,” Johnston said in a statement. “The decisions we make now will help make Austin a healthier place and a model for the world. The vital, inclusive health ecosystem we want to create is starting to shape.”

Photo Credit: Photo courtesy of the Shivers Cancer Foundation | Daily Texan Staff

The Dell Medical School established a faculty chair to honor Austin physician Dr. Robert Askew, who graduated from UT and completed his residency at UT Medical Branch-Galveston in 1959.

The Shivers Cancer Foundation contributed $1 million to establish the Askew Chair in Oncology. The foundation commemorated the donation Friday, after Askew passed away in July. The gift represents one of the largest contributions associated with the foundation.

According to Clay Johnston, dean of the Dell Medical School, the chair will help the school maintain qualitative standards in treating patients and training doctors.  

“The gift will help ensure that the Dell Medical School has a top-flight physician providing cancer care to Travis County residents and training the next generation of doctors,” Johnston said in a statement.

Johnston also said the chair will be in charge of recruiting top faculty members to help maintain a high standard for the school.

“The Askew Chair in Oncology will also be a model for how we recruit and retain the best faculty members and shape the Dell Medical School into a world-class institution,” Johnston said.

This is the second chair to be established within the school — the first being the Chair for the Department of Medical Education, which Susan Cox currently holds. 

Photo Credit: Griffin Smith | Daily Texan Staff

Clay Johnston, dean of the Dell Medical School, emphasized in a lecture Monday the importance of not accepting the status quo when looking for new solutions in the health care system.

Johnston was hired as the inaugural dean of the Dell Medical School in January. Currently under construction, the school is scheduled to open in fall 2016.

Johnston said medical schools have become multibillion dollar enterprises that see any new business models as threats to their structure.

“They get stuck,” Johnston said. “And promoting health isn’t the priority — but helping the sick.” 

During the lecture in Burdine Hall for a freshmen signature course speaker series, Johnston said, as a researcher focusing on stroke prevention, he was frustrated with the process of executing research studies. He felt the procedure took too long and did not effectively reach
the patients.

“There were few people saying, ‘How do we make research faster? How can we reorganize the structure in order to accelerate studies to reach patients? [It’s] horribly inefficient and everyone is suffering from this,’” Johnston said.

His criticism of the standard method for conducting research studies influenced his concern with other areas in the medical field.

“A new issue comes up,” Johnston said. “Not only is it inefficient, but, with new innovation, it increases the cost of health care. … People are not benefitting from the new technology. The cost of banking and telecommunication has gone way down, so it’s changed the way we live our life, but that’s not true in health. Drugs are not getting cheaper with technology. It’s actually gotten more and more expensive.”

Johnston identified several issues he saw within the health care system and urged students to think critically about those issues, including the requirement to visit the doctor’s office when patients have the flu or that hospital gowns exposing a patient’s rear are still used.

Johnston also evaluated the gap insurance companies create between patients and the value of their care, as well as the “lone cowboy” physician who underplays team and community efforts.

“Just accepting that they should be that way means we’re not looking for solutions,” Johnston said. “It’s not something to be sad about, but it’s an
opportunity for things to be addressed and solutions to be proposed.”

John Daigre, Dell Medical School spokesman, said the presentation was aimed to help students envision themselves in the school and see their work in the medical field go beyond UT.

“It’s about understanding that … creating a medical school of the future … includes a lot of things that people may not recognize,” Daigre said. “It’s all about new models of care — using data and technologies [in a] new way.”

While both the Dell Medical School and the UT-Rio Grande Valley School of Medicine will educate more physicians in Texas, a panel of doctors at The Texas Tribune Festival on Saturday, along with state Sen. Kirk Watson, D-Austin, reiterated the pressing need for more physicians throughout the state.

During the discussion, which was held in Robert A. Welch Hall, Watson said Texas is still below the national average on the number of doctors per 100,000 people.

“The national average is around 240 doctors per 100,000. In Texas it’s 170, and in the Valley it’s 107,” Watson said. “In the area of pediatrics and psychology, we’re below 60 percent of the national average.”

Although the two new medical schools are scheduled to open within the next few years, Tedd Mitchell, president of the Texas Tech University Health Sciences Center, said graduates will still be competing for a limited amount of residency spots in Texas, a number that is not growing as quickly as medical education in the state. Mitchell said if the number of spots does not increase, graduates could be forced to look elsewhere to complete their medical training.

“It’s cheap to go to medical school in Texas, which is a great thing, but the state will be in the habit of educating here and sending them to, heaven-forbid, Oklahoma, or New Mexico or Louisiana,” Mitchell said. “We want them here.”

The doctors on the panel also discussed the need for more primary care doctors in rural areas, positions that don’t offer as many financial incentives as specialty care.

“We need to look at what is drawing people away from rural areas and what is drawing people away from primary care,” said Clay Johnston, the inaugural dean of the Dell Medical School.

Brett Giroir, CEO of the Texas A&M Health Science Center, said the future of medical education would involve more of an interdisciplinary approach.

“We’re entering a really new era that’s not just about hard science in one field,” Giroir said. “It’s about the combination of multiple disciplines, all to create a sustainable, affordable, accessible health care system that provides the benefits for all across the board. Physicians don’t usually understand that or get the training in that. We are all looking at different ways to train physicians for the next 100 years.”

Johnston echoed Giroir's sentiments.

“Facts aren’t worth as much as they used to be,” Johnston added. “Human memory is very fallible, and a cell phone and Google are much less so. Learning how to find information and synthesize it, and how to use that to problem-solve with patients is another aspect of how medical education is changing.”

Q&A with Dean Clay Johnston

Clay Johnston, dean of the Dell Medical School, has started from scratch in March to build up the staff and partnerships for the school. Johnston’s greatest challenge thus far has been to focus his energy on key functions of the school, such as initial accreditation.

Photo Credit: Ethan Oblak | Daily Texan Staff

Clay Johnston started in March as the dean of the Dell Medical School, which is set to open in fall 2016. Johnston previously served as the associate vice chancellor of research at the University of California, San Francisco, and is a practicing neurologist who specializes in preventing and treating strokes. Some answers in this Q&A have been edited for brevity and clarity. 

The Daily Texan: What have been some of your duties as dean since you started in March?

Clay Johnston: Well we’re starting from scratch, so it’s a little different than the usual dean job. That means bringing in the team, so a lot of hiring. Tuesday, we added our fourth faculty member, but we’ll go from four to 250 in the fall as we accept faculty members that have been part of UT-Southwestern’s team. And then we’ll hire a couple hundred new positions over the next two years, so it’s a lot of team building. We have fabulous partners, but laying the foundations for how we’ll partner is really complicated. So how do we work with Seton [Healthcare Family]? Where do their responsibilities stop and ours start? All of that stuff is what we’re working on now. 

DT: What have been some of your biggest challenges since becoming dean?

Johnston: It’s more of a bandwidth issue. More at this stage — the expectations are so high for us, and they continue to grow, such as this Livestrong gift. It’s a wonderful gift, but also with that comes, 'Okay, what does this mean for cancer care in Austin?' [It’s] something that we would not have taken on this soon. We have so many things to get done that it’s about how we focus our energy without getting too distracted by demands that are placed on us elsewhere. We’ve got to be really careful with limited bandwidth as we grow things out, to make sure we focus on key functions. Accreditation is a good example. We can’t admit medical students until we get preliminary accredited. There’s a lot of work that goes into setting that up. We shouldn’t be distracted by cancer programs unless we’re ready and confident that accreditation is going to come through. We haven’t [run] into any major barriers. Partners have been really welcoming. The UT community is very welcoming. No major challenges at this stage.

DT: When you received the donation from the Livestrong Foundation, they intended for the money to go toward cancer research. What was your original plan for how the new medical school would reinvent health care in Austin?

Johnston: It doesn’t distract us from how we will change health care in Austin, but it does bring cancer as an earlier focus than what we otherwise would have chosen. We know Austin wants high-quality cancer care here in Austin, so that’s a priority for us. Cancer is unbelievably complicated in terms of the number of different practitioners that are involved, the number of health care settings that are involved, and also the way finances flow and the motivations of different groups to keep finances flowing the way they currently are. And so, it’s one of the more challenging areas of medicine, so if we had our choice, we wouldn’t have picked cancer as a early priority, but the community kind of picked it for us.

DT: What are some other things that you plan to focus on besides cancer research?

Johnston: In general, we are sort of driven by the notion that health care isn’t what it should be. Not just for the underserved, but for people with insurance as well. One example of that is how slow and difficult it’s been to have technologies be integrated within the health care industry. So, one example I like is that I can find a restaurant and, right now, know the quality of it and how it’s rated and be able to book a table anytime today. Now, try to do something even close to that with a physician. That’s true throughout the health care system, and it impacts the way that we provide care — the physician-focused care. A lot of the problems we have could be dealt with by technology — on email, on the phone and with pharmacists and practitioners. So, it’s trying to take a step back and to say, ‘What’s the health care plan that we would really want if we could blow up our system, and what pieces need to be in place for us to achieve that?’ And it has to do with creating an ecosystem where the money flows based on our values as people. That’s really challenging to set that up. No other place has really done that well, but if we can achieve that, that would be huge.

DT: What will the application process for medical students be like?

Johnston: We can’t start recruiting students until we have preliminary accreditation, which we do not have today. Those applications went in, and they’ll come visit us in the spring, so hopefully by next summer we’ll have approval to recruit. How we’re thinking about it is, UT-Austin is a really special place. We’re put in great position here at the Dell Medical School being able to work within UT-Austin and the great community of Austin, and we are bringing together really creative people excited about this opportunity in a way that’s only possible because of the foundation the community set for us here. So, that means we’re getting fabulous teachers, and we’re going to have a really cutting-edge curriculum. We do recognize that medical education is really expensive, and we need to have diverse people from a variety of socioeconomic backgrounds, and we also need to make it so that the financial burden on students isn’t so great that students feel obligated to go into more lucrative areas of medicine — like procedure-based areas — because we desperately need primary care doctors, and they currently don’t get paid as much. So, given all of that, we also know that we’ve got to keep tuition low and also provide targeted support for students. We’ve already raised a fair amount of money to do that, so we’ll have a number of different scholarships for our students, and as we’ve looked at our tuition, we’re hoping to keep it quite low, and we’re evaluating how to best do that right now.

DT: How do you think the Dell Medical School will select from UT applicants?

Johnston: I would say we’re going to be neither negatively nor positively biased. Definitely not negatively biased. We know that there are fabulous students and a ton of pre-med students here at UT. For us, the key is the fit. I suspect that we’ll get a lot of students from UT because there are so many great students here. We do get some pressure from politicians to think about how we really are here in part to train physicians that will work here in Austin primarily — but also more broadly in Texas — and so, we will get more of them if we continue to take Texans and think about them as being critical to our programs.

DT: Are you going to continue practicing neurology while being dean?

Johnston: I am going to try. Looking at my schedule recently, it may not be so easy. I love the practice of medicine. It keeps me grounded. Over the last three months, I have not seen a patient. I miss caring for people, so I’m going to do the best I can to get that back into my schedule. The president and the provost don’t pay me to see patients. With the skill sets and position that I have, it could be seen as a distraction from getting the job done. On the other hand, being on the ground and understanding what medicine is like today is important for making the right decisions. I’m not sure on how to create that balance, but I’m ready to get back into the hospital.

DT: What are you most looking forward to in opening the medical school?

Johnston: I’m most looking forward to welcoming that first set of students. Just 50 students in that first year. That’s truly going to be a monumental point.

The UT System offices on July 11, 2013. 

The Daily Texan file photo | William Crites-Krumm 

Photo Credit: William Crites-Krumm | Daily Texan Staff

On Monday, the Austin American-Statesman reported that Gov. Rick Perry’s choice for UT System chancellor, Kyle Janek, was being considered by the UT System Board of Regents. Janek, who is currently Health and Human Services executive commissioner, would take the place of Chancellor Francisco Cigarroa, who announced his resignation in early February. Janek’s current position as executive commissioner entails managing the state’s Medicaid rolls, integrating technology into health care and maintaining the Health and Human Services Commission. It’s not academia, but for the position of chancellor, it just might be the right kind of experience. 

As a doctor and expert in the field of health management, Janek, if chosen, could help guide the Dell Medical School through its early years. Though the forthcoming medical school has a more-than-able dean in the recently chosen Dr. Clay Johnston, having a doctor in the System’s leadership could prove to be beneficial to the medical school as it finds its place in the massive System network. 

On the other hand, while Janek has the basic qualifications, he’s done nothing remarkable to deserve the position of chancellor. His tenure as a Texas senator was nothing if not mediocre.

Janek’s legislative record seems innocuous enough. He authored bills on things such as asbestos claims and reductions in mandatory appraisal increases for property tax. Janek’s time under the dome shows his ability to craft measures to appease Republican Party leaders, but did nothing to mark him out as the sort of person fit to lead a massive university system.

And while Janek’s undistinguished time in the Senate doesn’t throw up any red flags, his performance as executive commissioner of the human services commission has been more concerning. 

As commissioner, Janek refused to believe census data showing that more than a quarter of Texans don’t have health insurance. Accordingly, he did little to stop the problem of under-insurance in the state.

Though it’s no surprise a Republican has skewed perceptions of health care, it’s still worthy of criticism. Janek’s views may mirror those of older Texans, but what if he were to continue to ignore the more progressive views of younger Texans as chancellor? The University would not benefit from an out-of-touch older man pushing vestigial norms on today’s students. 

We should also be wary of anything Perry pushes for in the System. He has shown on several occasions his disregard for the University’s interests in favor of pursuing his own warped ideas for what higher education should look like. Perry might not see Janek as the best man for the job so much as he sees him as the best man to achieve his agenda.

Though Perry’s endorsement carries clout with the regents, all appointed by him, it’s no guarantee. Perry’s last endorsement fell on deaf ears as the board ultimately went with Cigarroa instead of his proposed candidate. Janek isn’t the worst choice, but he leaves a lot to be desired. Hopefully the regents can come up with a more compelling candidate to move UT forward.

Breland is a Plan II senior from Houston.

Photo Credit: Shelby Tauber | Daily Texan Staff

After a nine-month search by a committee including educators, health professionals and students, the University introduced Clay Johnston as the inaugural dean of the Dell Medical School on Tuesday morning.

Johnston, who studied at Amherst University, Harvard University and the University of California–Berkeley, is currently the associate vice chancellor of research and director of the Clinical and Translational Science Institute at the University of California–San Francisco School of Medicine. He will begin serving as dean March 1. 

The Dell Medical School, which went into planning in 2012 and was named last year, is in the final states of design and is expected to receive its first class of students in 2016. President William Powers, Jr. said Johnston was selected in part because of his forward-thinking vision for the school.

“We had a dozen fantastic people from around the country,” Powers said. “This really garnered a great deal of interest from some very high level people. [Johnston] is innovative and open and wants to help design a medical school in a new way. He is very interested in new forms of health care delivery, and he has worked and proven himself in the institute that he heads up — in his ability to work with many stakeholders in a complex situation.”

Johnston said he will try to use his role as dean to advance the way medical schools approach health care, which he believes should be more patient-centric.

“I think medical health care is really at an important juncture right now,” Johnston said. “My vision is to create a medical school that really represents where health care should be going, not where it’s been. That’s the beauty of starting from the ground up and then being able to take a look at how health care is working, how medical centers are working and design them for the next century.”

Unlike the six existing medical institutions within the UT System, which each have their own president, Powers said Dell Medical School will be a unit of the University.

Johnston, who plans to continue treating patients as dean, said all individuals involved in the Dell Medical School project have different expectations for his performance. He said he will be expected to deliver excellent care to patients, create multidisciplinary programs intended to advocate research and turn the school and research hospital into modes for economic development in the community. Johnston said one of the first challenges he faces will be prioritizing these objectives.

“The school is going to do all of those things, but when?” Johnston said. “You can’t do all of those things from day one or year one or even year five. So the biggest challenge is prioritizing amongst these critical goals and making excellent progress in all of these areas but managing the expectations so that people understand that it is impossible to grow this thing, even in five years, to the vision that all of us have for it.”

Robert Messing, vice provost for biomedical sciences and chairman of the search committee, once worked alongside Johnston in the neurology department at UC–San Francisco. Messing said he recommended Johnston and one other individual early in the search process for the dean.

“We were faculty members in the same department, which had more than 120 faculty members and spanned four affiliated hospitals,” Messing said. “Our relationship has always been more professional than personal, and those professional interactions definitely helped me recognize him as a strong candidate. I’ve always been incredibly impressed by him whenever our paths have crossed.”

According to Messing, the search committee unanimously recommended Johnston for the dean position because of his work at UC–San Francisco.

“At UCSF, he’s been the leader of one of the largest Clinical Translation Science Institutes funded by National Institutes of Health, which takes research innovations and translates them to patient care,” Messing said. “And he directs the UCSF Center for Healthcare Value which leverages research and clinical practice to reduce costs, increase value and enable innovation.”

Seton Healthcare Family, which runs several hospitals in Austin, committed $295 million to build a teaching hospital for students enrolled at Dell Medical School last year. UT also has a partnership with Travis County Central Health, a county organization which works to give health care access to Austin’s poor. Last year, Travis County voters approved a property tax increase to support the new medical school and teaching hospital.