May 27th, 2004
Well, I have held off sending this announcement for quite a while, thinking that something might change. But, as of yesterday, things are essentially 100% solid.
I have found a very interesting opportunity in Kansas City, at the University of Missouri (UMKC). The medical school there is quite novel, taking students out of high school into a 6 year program. I have my doubts about the maturity of 18 year old medical students. But the quality of the product seems to be pretty high. Anyhow, the differences there extend beyond just the age of the students – after 2 years of coursework, the program pairs the students in their 3-6 years with a mentor/preceptor/teacher which they call a “Docent”. Each docent has between 8 and 12 students, who are with the same docent for their last 4 years of medical school. They attend on the wards with the docent, see patients with the docent. In fact, the medical school building is literally built up from the foundation with the docent system in mind --- the students in each docent team have 12 small offices clustered around a central meeting area. To the side is one larger office for the docent. Each team has its own support secretary.
The system is fundamentally designed with the concept that medical students learn via a personal relationship with one key mentor. Particularly, the outpatient experience is quite novel there. I will never see patients “by myself”. Every clinic session is with 4-6 students seeing patients with the docent. Obviously, younger students are very inexperienced and require more than just supervision. But over the course of 4 years, they build relationships with individual patients and a great deal of continuity. I will also precept 2 residents clinics, which are of the more traditional format. All of the docents are internists, and most of them are general internists.
Truman caters to a very underserved population. 30% have no insurance at all, the rest are a mix of Medicaid and Medicare. It receives public funding from the state and Kansas City. In Missouri hospitals and doctors routinely are allowed to opt out of caring for even Medicaid patients – so in contrast to Massachusetts, where the Medicaid population is somewhat distributed among various hospitals, Missouri has concentrated them into one institution. I don’t necessarily like that. But it is a challenge that I am not afraid of, and I think I am as well suited to care for these folks as anyone. Like any public institution delivering care to poor patients, they have significant financial constraints, and bureaucracy abounds too. In contrast to many teaching institutions, they do receive significant salary support for the docents, directly from the medical school. And the department head actually answers to the dean.
Finally, I will have a small part of my job description dedicated to helping Truman work with Cerner on improvements to their information systems. What that exactly means remains less clear, but at last it is a formal part of my position officially dedicated to medical information systems, an area that I never was able to formally enter at BIDMC.
Leaving Behind BIDMC:
I would like to be honest. I would have probably returned to Beth Israel Deaconess and the wonderful patients, colleagues and staff there. I did not leave 2 years ago with the intent to never return. As it stands however, BIDMC is not hiring and there was no apparent ability to create a position for me so that I could return. I would appreciate some degree of honestly when ex-patients ask if Dr. Hermanns is returning. Dr. Hermanns did not “decide to go elsewhere”. Perhaps it is best that patients be told that “Because of the move to the Shapiro building, we did not have space for Dr. Hermanns and he was unable to rejoin us”. They can decide for themselves what that exactly means. I would like to express my greatest appreciation for the years I shared with all of you. Moreover, this may not at all be the final chapter for BIDMC and me. We greatly enjoyed our years in Massachusetts and the Kansas City position is by no means perfect. Rich Parker asked me if I would like to remain in communication about openings at BIDMC, when and if they occur. I most certainly do.
As you know, we have spent the last 2 years on a traditional farm in western Kansas. We had our compliment of cats, dogs, chickens, a horse, and cows in the pasture. It has been a wonderful experience for my children to get to know my heritage and their grandparents and extended families. But I am not really in love with medicine here in western Kansas, nor the dry dusty climate. Hopefully Kansas City (roughly TWICE as much rain) will suit me better in terms of climate. Though we did not set out to find another “farm” in Kansas City, we ended up finding a place north of the city in Parkville (20 minute commute to work) that has 10 acres of pasture and woods. We will have horses (but no chickens!), and lots of space we could never have had in Massachusetts. The public school system there is quite acceptable, in comparison to Kansas City and Boston. We will be minutes away from the airport, allowing easy travel to see our family in Europe and friends all over the country. Should any of you end up traveling in the Kansas City area, please do let me know and I will do my best to roll out some mid-west hospitality!!
Staying in Touch:
Our website remains a way to always get a glimpse of what we are doing. Its not well maintained or fancy, but it gets pictures and a newsletter from my wife at least monthly. www.hermannsonline.com
My email is and will remain david at the above web address.
Finally, it is OK to forward this email to whomever you see fit and might have been forgotten.
David Hermanns MD