Doctor helping Hopkins to heal

Checkup: Three years after a leadership is rift, the institution is refocused. But medical `czar' Edward Miller knows challenges lie ahead.

August 09, 1999|By Jonathan Bor and M. William Salganik | Jonathan Bor and M. William Salganik,SUN STAFF

In the amphitheater of the great teaching hospital, a 6-foot-5 executive with silver hair and a serious suit was talking renewal: a new cancer center in the fall, a research building by 2003, a new enterprise in Singapore.

When the father of a girl with leukemia denounced the pediatrics center as cramped and decrepit, Dr. Edward D. Miller was ready with yet another plan for the Johns Hopkins Medical Institutions: a $150 million Children's Center, with all the latest amenities.

"We have an insatiable appetite for things new," Miller told those gathered at his monthly town meeting.

Three years into his tenure, Hopkins seems revitalized. When Miller took over, its top leaders were warring. The medical school and hospital appeared paralyzed, unsure how to survive the managed-care revolution.

Hopkins has done better than survive. While other elite medical centers are losing money, Hopkins maintains a steady flow of patients and operates in the black. It runs a prosperous outpatient center at Greenspring Station and plans a similar venture in White Marsh. It expanded its reach by buying Howard County General Hospital, and has embarked on a building program in East Baltimore of surprising size and scope.

Many doctors are quick to point to more subtle changes. "The place is less distracted," said Dr. Paul McHugh, chief of psychiatry. "It's being managed by people who keep things pretty quiet. They get on with their tasks."

Still, Hopkins faces challenges. In an era when insurers are paying less for each patient, doctors are being asked to focus more on the bottom line -- to increase their caseloads, for instance, so revenues can stay as high as ever.

For many, this means less time in the lab and, consequently, less time for the slow grind of research that has yielded the breakthroughs of the past. Doctors fear that the same medical center that introduced anesthesia to surgery, grew the first cell cultures, solved blue-baby syndrome and unraveled the genetics of colon cancer will lose its intellectual edge.

"The thing that keeps me awake at night is how to maintain the core mission of Hopkins and survive in a business that is as challenging as any," said Dr. William Brody, president of the Johns Hopkins University. "I feel it, and the faculty feel it."

The sentiment is not lost on Miller, an anesthesiologist who still spends a morning a week in the operating room but devotes most of his time to navigating the tough economics of health care.

"Everybody in the country would say this is the serious problem that the academic centers are facing," he said.

Consolidated control

Miller was appointed to the position of medical "czar" nearly three years ago when the trustees ended a century-old system in which the medical school dean and hospital president shared and often jockeyed for control. The old system had sparked rivalries before, but nothing like the warfare that erupted between the last two men to hold the jobs: Dr. Michael Johns, the dean, and Dr. James Block, the hospital president.

Many observers felt the two were set up for battle by a system in which neither had sole authority. But they also seemed to genuinely dislike each other: Block, often seen as secretive and territorial, accused Johns of hogging the limelight before Hillary Rodhan Clinton's committee on health care reform. Johns, whose wit could border on sarcasm, complained that Block was scheming to have him fired.

In 1996, Johns left for Atlanta to become the chancellor of Emory University's medical school and hospital system. Soon after, Block resigned, too, when the Hopkins trustees moved to create a similar position of authority. It was a position, Block recognized, that required academic credentials he lacked.

In Miller, the trustees saw a calm, steady leader with a knack for consensus building. It didn't hurt that he looked the part, towering above nearly everyone. As anesthesia chairman and later as the interim medical czar, he had kept an open door, waited in line at the cafeteria and asked staffers about their children or sick parents. He had a hearty laugh and a gentle air, but didn't shy from decisions.

Miller, 56, said the job of running a sprawling medical center was about as far from his original plan as he could imagine. He was content practicing anesthesiology and rising through the ranks of academic medicine, but never saw himself running an organization with 15,000 employees at its central campus alone.

A graduate of the University of Rochester School of Medicine, Miller trained in surgery but switched directions when he discovered he didn't get the same thrill from cutting and sewing that others did. In anesthesiology, he was fascinated by the effects of medications on vital functions such as breathing and heart rate. And he liked the idea of being the protector, the person upon whom patients depended for their every breath.

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