Lee Goldman, Dean No. 23: 11 Years of Leadership and Counting

By Elizabeth Chute

The P&S that greeted Lee Goldman, MD, when he left a department chairmanship at the University of California San Francisco for the medical school dean’s job at Columbia in 2006 had a far different look—literally and figuratively—than today’s P&S. In the 11 years since Dr. Goldman became dean, he has joined with the school’s faculty, alumni, donors, staff, students, and other partners to implement a new medical school curriculum, build the new Vagelos Education Center, increase research funding, grow the faculty practice, improve faculty and student diversity, attract historic levels of philanthropy, and identify ways to enhance the on-campus experience for everyone who studies, works, or visits P&S.

The positive developments align with priorities outlined in the strategic plan for P&S, “2020 Vision,” as pillars of excellence: clinical care, research, education, and campus and community life. The ongoing success of that blueprint for excellence is echoed by faculty and institutional leaders who look back on the Goldman Years of P&S history and applaud the progress made toward the goals set during the strategic planning process.

Steady growth defines the past decade at P&S: increased NIH funding for research, greater recruitment of faculty at all levels, a more diverse and selective student body, improved clinical care with better patient access, and improvements to the campus that make the medical center a welcoming place for all. Although Dr. Goldman emphasizes that everyone shares the credit for success, individuals interviewed about the Goldman tenure cite his single most important early achievement as the one that has enabled the others: stabilization of the financial situation of the entire medical center (of which he serves as executive vice president and chief executive). Senior faculty and department chairs credit Dr. Goldman with innovative leadership that resulted in a fiscal transformation that, in turn, created greater investment and growth in all areas.

The College of Physicians & Surgeons on 23rd Street, circa 1856

One of the key challenges Dr. Goldman faced upon arriving was how to make finances more transparent—recognizing the true costs of doing business and how to obtain the funds to pay them, says Donald Landry, MD, PhD, chair of the Department of Medicine. The dean correctly read the origins of the problems, primarily the lack of incentives for controlling costs and inadequate incentives for raising funds for research with adequate indirect cost coverage. He also placed more responsibility on departments and individual investigators to account for space they occupied, which led to a freeing up of space that could be used to recruit new faculty and generate new research funding. 

P&S Leaders* since 1767

Samuel Bard, 1767-1776, 1791-1804, 1811-1821
Nicholas Romayne, 1807-1811
Wright Post, 1822-1826
John Watts, 1826-1831
John Augustine Smith, 1831-1843
Alexander Stevens, 1843-1855
Thomas Cock, 1855-1858
Edward Delafield, 1858-1875
Alonzo Clark, 1875-1884
John Dalton, 1884-1889
James McLane, 1889-1903
Samuel Lambert, 1904-1919
William Darrach, 1919-1930
Willard Rappleye, 1930-1958
H. Houston Merritt, 1958-1970
Paul Marks, 1970-1973
Donald Tapley, 1973-1984
Henrik H. Bendixen, 1984-1989
Herbert Pardes, 1989-1999
David Hirsh, interim dean for research, 2000-2001
Thomas Q. Morris, interim dean for clinical and educational affairs, 2000-2001
Gerald D. Fischbach, 2001-2006
Lee Goldman, 2006-

* some leaders were deans; others were presidents, particularly of P&S before it merged with Columbia’s medical school

The transformation was remarkable. “Suddenly an institution that did not have a new research building on the drawing board could now generate over 100 thousand square feet of space and that space could be filled,” Dr. Landry says. It placed an added premium on NIH-funded space, which brought in adequate funding and, importantly, provided a strong metric for success.

After achieving financial stability, P&S was able to maintain a margin for growth and investment. “All of this is designed to increase the NIH funding of the institution, which is important for our mission—national leadership for research and innovation—but also it’s part and parcel of our financial stability upon which all of our scientific progress is based,” says Dr. Landry. As Dr. Goldman often says, “The goal is to be indisputably in the top five and arguably the best at everything an academic medical center should do.” A healthy financial situation is a means to that goal, not the goal itself.

Getting the institution on better financial footing was done objectively and without favoritism, says Eric Kandel, MD, University Professor and director of the Kavli Institute for Brain Science. “Dr. Goldman has been very successful. This is a very diversified environment, and he’s restructured it establishing trusting relationships with the various senior faculty.”

Mary D’Alton, MD, chair of the Department of Obstetrics & Gynecology, credits Dr. Goldman with steering a positive course for the medical school with his early reforms and exercising a singular focus on excellence that has a trickle-down effect to the rest of the medical school. “This focus and commitment to excellence over a 10-year period has achieved significant results, and you can see a compounding effect of his many decisions on the overall state of the medical center,” she says.


Increasing the Research Profile

A clear sign of growth for P&S is its NIH research profile, with NIH grants to P&S increasing 44 percent in the past seven years, a time in which the NIH budget has increased only 5.8 percent. “It is a clear indication that the research enterprise is moving and it is moving across a wide range of departments,” says Dr. Goldman. “The faculty have performed very admirably and it is very rewarding to me—and I think to all of Columbia University—to see this vibrancy in the research mission.”

The research growth is led by awards and gifts for precision medicine, a focus of the research vision for P&S and a priority adopted by Columbia University President Lee Bollinger as a multicampus collaboration, led by Tom Maniatis, PhD, chair of the Department of Biochemistry & Molecular Biophysics. 

A clear sign of growth is in the research portfolio: NIH grants to P&S have increased 44 percent in the past seven years, during a time in which the NIH budget increased only 5.8 percent.

In partnership with NewYork-Presbyterian Hospital, P&S recruited David Goldstein, PhD, to head the new Institute for Genomic Medicine, further investing in and advancing the research vision of precision medicine. Led by Dr. Goldstein, the Institute received one of the first NIH grants to participate in a new national precision medicine program. “We’ve already made great strides in precision medicine to make it a full university priority with great support from NewYork-Presbyterian and the NIH,” says Dr. Goldman.

Research at all levels is critical to improvements in clinical care and patient outcomes. A recent example in obstetrics would be research conducted here that shows promise to reduce neonatal respiratory problems, says Dr. D’Alton. “Dean Goldman is a champion of our research initiatives,” she says, “and while, of course, we incorporate research from other academic medical centers, it is incredibly rewarding when it is developed internally and often has a more immediate impact on our clinical care.”

Recruitment is also key, and faculty chairs credit Dr. Goldman with supporting their goals of attracting the right people to reach strategic goals. Says Craig Smith, MD, chair of the Department of Surgery: “When I’ve told him, ‘This is a person we must have to reach this goal,’ he could easily have said, ‘You’ve already overspent the check.’ Instead, he’s been more than willing to step up and go somewhat beyond that to hire the right people.”

One of several new facilities built during the Goldman years is ColumbiaDoctors Midtown, which opened in January 2013 on West 51st Street. Physicians, nurse practitioners, and dentists see patients in a three-story space that includes 125 exam rooms, 30-plus procedure rooms, and other facilities that cover 125,000 square feet. The location offers lab services, an imaging suite, and physical, occupational, and sports therapy facilities. The midtown facility is part of a substantial expansion of the faculty practice organization over the past decade.

In the past five to seven years, P&S has recruited at all levels—from junior and senior faculty to department chairs—at a rate of 9.5 percent per year. An annual departure rate of 3 percent to 4 percent results in a net increase of 5 percent to 6 percent a year. “That growth has really helped fuel the success of our missions,” says Dr. Goldman, adding that it sends an important message internally and outside the institution that outstanding clinicians, researchers, and educators are joining the faculty.

P. Roy Vagelos, MD, chair of the CUMC Board of Advisors, describes the effect of recruiting outstanding faculty and its impact on attracting other faculty and students. “Faculty continue to grow in numbers and the quality is superb. Good recruits lead to good recruits, on both the basic research and clinical side,” he says.

Student applications have continued to rise over the past decade: now approximately 8,000 annual applicants with an acceptance rate of 4 percent. “The quality of the students is superb,” says Dr. Vagelos, a 1954 graduate of P&S. “We compete with very few schools for the level of students we’re bringing in. We select students who are capable of being the best of the physicians who will practice medicine and the best of physicians who will do research.”

Along with the growing number of applicants and increased selectivity, the student body has become more diverse in the past decade, outperforming peer institutions. Between 20 percent and 25 percent of the student body is consistently made up of underrepresented minorities, with half men and half women—critical to serving a community and patient population that is increasingly diverse. “We serve a diverse population, and I think it is imperative that our faculty, staff, and students similarly reflect the diversity of that patient population,” says Dr. D’Alton. “I think it’s something we always need to work on and be mindful of.”


Expanding Clinical Care

A second key priority for P&S under Dr. Goldman’s leadership is clinical care, with improved patient care and better access for patients. The effort goes to the heart of the institution’s mission: “Clinical care is the reason academic medical centers exist in the first place. I think what’s really been striking here is the way we’ve been able to grow,” says Dr. Goldman.

The flourishing FPO, or faculty practice organization, known as ColumbiaDoctors, has grown substantially during the past decade. A stronger FPO not only has a beneficial effect on patient care and access, but it also aids physicians, offering the protection of a larger organization and help with operational issues, such as joint contracting with third-party payers, negotiating better rates from insurers, and bringing down malpractice costs.

“Today it is hard for any doctor, especially an individual doctor in private practice, to keep his or her head above water, especially in the broader primary care specialties,” says Dr. Smith. The FPO has been important for maintaining the financial viability of all practices and for improving patient access. “This can’t be done by a smaller group or practice.”

Expansion also has brought Columbia doctors closer to more patients. New practices in the northern suburbs and development of midtown and other new facilities in New York City have contributed to overall growth on the clinical side that has averaged close to 10 percent for the past several years.

A focus of the P&S research vision is precision medicine, a priority adopted by Columbia University President Lee Bollinger as a multicampus collaboration. The Columbia Precision Medicine Initiative utilizes the intellectual resources of Columbia faculty in medicine, science, and technology to leverage this revolution in health care. With support from Columbia and NewYork-Presbyterian Hospital, P&S has invested in the Institute for Genomic Medicine, which has received one of the first NIH grants to participate in a new national precision medicine program.

Progress in clinical care has developed naturally through a strong and collegial working relationship with NewYork-Presbyterian. “The foundation for our progress in clinical care has been our close working relationship with the hospital,” says Dr. Landry. “The investment from the hospital in extraordinary physicians with exceptional capabilities, leaders in clinical innovation, often clinical investigators, has caused startling changes everywhere we look throughout the medical center.” He notes, as examples from within Medicine, interventional cardiology, the comprehensive array of organ transplantation services, the many domains of medical oncology, interventional GI endoscopy, and ICUs. “Our growth exemplifies the vision of the dean and the NYP CEO—that we must provide care at a minimum level of excellence across everything we do, with a significant number of areas where we are extraordinary. And that is actually about where we are today.”

Patients, doctors, and the community all benefit. Working with the hospital, P&S has further strengthened “already great” programs in organ transplantation, pediatric neonatal and intensive care, cardiology, cardiac surgery, and spine surgery, “just to name a few that attract people from all over the country, all over the world,” says Dr. Goldman. The “Best Hospitals” ranking of NewYork-Presbyterian as No. 1 in New York City and No. 6 among American hospitals is a source of shared pride, and the six specialties in which the hospital ranks in the top five—cardiology/heart surgery, diabetes/endocrinology, nephrology, neurology/neurosurgery, psychiatry, and rheumatology—are all areas in which Columbia doctors are among the tops in their fields.


Education: On the Leading Edge

Efforts to achieve a third strategic goal for P&S—strengthen the curriculum for medical students—have drawn positive reviews from throughout the medical school community. The goal was to have educational programs define what every medical student should know, then give each student the flexibility to pursue specific areas of interest. The practical implementation of that resulted in shortening the preclinical curriculum to 16 months from two years and requiring a scholarly project—all with the aim of focusing the medical students on inquiry in a more substantive way.

The school reduced sharply the number of lectures and put students together in small groups so they could work together to solve problems. It also made a large commitment to simulation to help students improve physician-patient encounters and learn skills needed in the ICU, operating rooms, and other venues.

An advantage of the education reforms undertaken by P&S is that students are allowed time for scholarly projects that are broadly conceived, allowing them to pursue individual interests at a rigorous level. Curriculum reform is not unique to P&S, as other medical schools have followed Columbia’s lead to shorten the preclinical portion of the curriculum to expand opportunities for clinical electives and scholarly inquiry. P&S needed to undertake the reforms, says Dr. Landry: “If we sat back and didn’t make education a priority we might have risked tarnishing a jewel of the institution.”

The Roy and Diana Vagelos Education Center, which opened in 2016, was constructed entirely through private donations, symbolizing the school’s philanthropy successes of recent years.

The new Roy and Diana Vagelos Education Center at P&S, which opened in August, encourages the kind of learning reflected in the curricular reforms, providing spaces for simulation, open lounges for study, and state-of-the-art anatomy classrooms. The building has earned multiple awards for its design. The New York Times named the building to its list of “The Best Architecture of New York in 2016,” saying: “It’s what medical schools generally aren’t: playful, welcoming, warm. And when the sun sets, the center becomes a beacon in the neighborhood.” The building is not only an architectural masterpiece, says Dr. Goldman, but, from a practical perspective, is also “a great place to study, to learn, to relax. We’ve seen every nook and cranny of the building used the way the architect designed it. That’s been very rewarding. The building would not have been possible without the generosity and vision of Roy and Diana Vagelos. We remain very grateful to the many donors, including the Cheryl and Philip Milstein Family, the Helen and Clyde Wu’56 Family, and the Mary and Michael Jaharis Family, who were instrumental in bringing the building to fruition for the benefit of future generations of students at P&S.”

Education at P&S continues to evolve in other ways as well. New departments—the Department of Neuroscience, the Department of Systems Biology, and the newest, the Department of Emergency Medicine—have been approved. A commitment has been made to propose another new department—likely to be called Medical Humanities and Bioethics—that will complement existing efforts across the university.


Enhancing the Campus and Community 

P&S also has made significant progress toward creating more of a campus environment for students and the surrounding neighborhood, despite the dense urban setting of the medical center. For many longtime residents and faculty members, the changes are nothing short of dramatic. 

Many of the medical center buildings are almost 100 years old, so upgrading the physical plant has included new buildings, renovation of hundreds of thousands of square feet of space, and improvements in elevators, stairwells, bathrooms, and corridors.

New plantings on Haven Avenue, the addition of a Barnes & Noble store and café, open spaces for congregating, and renovation of the two lower levels of Hammer into a Teaching and Learning Center have given students a sense of a more traditional campus, says Dr. Kandel. The dean’s idea of a campus was visionary in a way that was different from those who preceded him. “There are people who were here for a long time, very good deans, but they didn’t think in these terms at all,” he says. “Dr. Goldman had the idea of a campus as a place where you could sit down and have a cup of coffee, some place where there wouldn’t be cars. He’s slowly but surely working it out. It’s very pleasant to have a campus here.” Plans for closing Haven Avenue to traffic to provide a pedestrian plaza with tables and chairs are moving through government approvals, but the medical center’s one-day closings of the avenue for special events during the past few years have given the medical center community and the neighborhood a glimpse of a new kind of campus.

With many of the medical center’s buildings dating to the 1920s, the physical plant has needed updating, one of Dr. Goldman’s major goals. He is proud of putting in place plans that have renovated hundreds of thousands of square feet of space, along with fixing elevators, stairwells, bathrooms, and corridors, making things look better even in buildings nearing the age of 100.

Dr. Goldman’s aggressive program to replace, augment, and improve the facilities, says Dr. Vagelos, included adding the latest technology for teaching and identifying multiple spaces for group instruction. Another new initiative will be to “blow out” the fortress-like exterior wall of the Alumni Auditorium to create additional areas for students to socialize, connect their computers, or work in small groups.


Future Priorities—and a Bold Goal

Gift Launches Campaign to Make P&S Debt-Free for Students

The 250th anniversary steering committee identified a fund-raising goal for this anniversary year: raising enough money to make P&S debt-free for students with financial need. The chair of the committee, P. Roy Vagelos’54, and his wife, Diana, have made a $25 million gift to launch the scholarship campaign, the P&S 250th Anniversary Scholarship Challenge for Endowed Financial Aid. Their gift will be used to match contributions for endowed scholarships starting at $50,000 to incentivize alumni and other friends of P&S to join this effort.

This is the first phase in the school’s effort to raise $150 million to $200 million in endowed scholarship support. Achieving this goal will enable P&S students who need financial aid to receive scholarships instead of loans or scholarships augmented by loans. Reducing debt will allow graduates to consider career options in fields such as primary care, research, and community service.

More information about the campaign is available on the anniversary website, http://ps.columbia.edu/250.

No discussion of the past—even of the past decade, just a mere 4 percent of the medical school’s 250-year history—is complete without looking toward the future. While innovations in clinical care, research, and education and investment in the campus and neighborhood are sure to continue, P&S, together with a committee planning the 250th anniversary, has identified as its top goal something that will truly set P&S apart from its peers: eliminating medical student debt.

The cost of medical education has an effect on choices medical students make when they consider their careers, says Dr. Vagelos, who chairs the anniversary steering committee. Endowment funds should ease those decisions. “That’s a dream of many of the faculty and alumni.”

Plans also call for continuing to build stronger relationships with the local community. One idea on the table is an office of service learning that would help faculty and students formalize work with the community. Dr. Goldman also intends to enhance existing programs, including those that encourage high school students to pursue science careers and underrepresented minority college students to consider careers in health care fields, including research. 

The progress made in the past decade has given P&S a clear sense of optimism about the future and the likelihood of continuing to connect strategies with goals. Noting that many at P&S could go elsewhere to teach, study, and work if they wished, Dr. Goldman emphasizes that one of his key roles is to offer opportunities that help people to thrive. “I believe the role of the dean is to create an environment that allows people to be successful. It’s about how people who really do things at a world-class level every day want to be here, can thrive here, and can say this is the best place for them and their careers. We need to create, sustain, and enhance an environment that makes them not just want to be here, but also proud to be here.”