Are we willing to rethink our work so we are true to our core purposes and values?

Mark Laret, CEO, UCSF Medical Center, says we need to reimagine how we carry out our work by asking the difficult questions.


As we really face this changing future, it's time for us to look deep inside and ask ourselves some fundamental questions about how we carry out our work. We have to hold close to our heart the core values and core purposes that are the essence of what we do in academic medicine, training the next generation of caregivers, carrying out the important biomedical and population research, caring for populations and individuals.

But how we do it can all change, and I think we have to start asking ourselves, how do we recognize and reward our researchers? Are we recognizing and rewarding the right things? We've had a tendency to focus on the RO1 or the independent scientist at the expense really of team science, or we acknowledge certain kinds of discovery as being more important than the science of integration or application.

In the education community, there are a number of questions. We use a four year time period to finish medical school. What are the skills that you need? Time should be a dependent variable, not the independent variable that determines how long medical school is.

We need to ask ourselves about cross training and residencies and across all the health professions. And then we have a lot of questions about how we deliver health care. We have traditions and structures. We tend to focus on inpatient care, but not as much on the continuum outpatient, skilled nursing, mental health, rehab. We really need to think more broadly about it.

So it's a time of reflection, of asking ourselves, why do we do things the way we do them, and if we did them differently could we do it better and as society is telling us, do it a lot cheaper? The challenge is, of course, that making change is difficult, it's painful. People often feel a sense of loss because they liked the way things are, but I think leaders have to step up and do it. Otherwise, somebody once said, "Lead, follow, or get out of the parade," and this is the time for leaders to step up and really be leaders.