Historic Agreement: A Q&A with Einstein Executive Dean Edward R. Burns

Editors’ Note: On September 9, 2015, the closing of an agreement between Yeshiva University (YU) and Montefiore Health System will lead to Albert Einstein College of Medicine becoming its own legal entity, with Montefiore having operational and financial responsibility and Yeshiva remaining the academic degree-granting institution until Einstein grants its own degrees. We sat down to speak with Edward R. Burns, M.D., executive dean at Einstein, who shared his thoughts on the agreement and what it will mean for Einstein’s future. Dr. Burns has a unique perspective on the agreement, as he attended Yeshiva University, attained his M.D. degree from Einstein, performed his residency and a fellowship at Montefiore and has worked for many years as a faculty member and top administrator for the College of Medicine.

Albert Einstein College of Medicine and Montefiore have been in a relationship that stretches back more than 50 years. In your view, why is this agreement so important, and more significant than other milestones the two institutions have reached in the past?

It is, by far, the most important of all the agreements signed by Einstein since its founding. To me, the Einstein/Montefiore relationship is analogous to a marriage. And you can’t have a marriage without first going steady and then having a proper engagement. We were dating, if you want to call it that, for about 45 years. Our most recent affiliation agreement, in 2009, could be considered an engagement. Now, finally, we’re getting married. So there’s a quantum difference between what’s happening now and everything that led up to it. We’re becoming a single unit. We’ll share things. We’ll support each other. We’ll sacrifice for each other. That’s the best kind of relationship.

You have a unique vantage point as someone who graduated from YU, attended and graduated from Einstein and did your residency and a fellowship at Montefiore. You now serve as the executive dean at Einstein, where you’ve played an integral part in making this partnership happen. So, in your view, how well do the two organizations fit together?

At first glance, one wouldn’t naturally make a strong connection between a health system and a medical school. Einstein, for the most part, has been a two-mission institution: education and research, with notable superb exceptions in two clinical programs— CERC (the Children’s Evaluation and Rehabilitation Center) and DOSA (the Division of Substance Abuse). Montefiore’s mission, on the other hand, proudly revolves around clinical care and graduate medical education, with some degree of research. So one wouldn’t naturally put us together. But that would represent a superficial approach. You’d have to go back to the founding of these two institutions to fully appreciate that they’re coming from similar origins.

Montefiore was founded by a group of German Jews in the late 1800s who wanted to develop an institution for the poor, the underserved and people with chronic diseases such as cancer. That vision eventually morphed into the modern-day Montefiore Health System. Einstein’s origins in the mid-1950s took a similar approach, just not in terms of patient care. As most people know, admission policies for medical schools from the early 1900s up until midcentury discriminated against Jews. Einstein, however, was founded by Yeshiva and its board on the philosophy that it would be open to everyone—that there’s no such thing as majority versus minority. Everyone is equal: men, women, minorities. It’s analogous, in my way of thinking, to serving the underserved. Einstein’s initial mission was to create doctors to serve everyone. That’s one reason why the missions of Montefiore and Einstein meld together so well.

What does this new partnership mean for you personally, given how many years you’ve been with both institutions?

This is a dream come true. While you’re asking about my personal views, I have to start by giving credit to both Allen Spiegel and Steve Safyer, who lead the two institutions. If not for them, this merger wouldn’t happen. And the same goes for the boards. Roger Einiger and Ruth Gottesman, his predecessor, played leadership roles at Einstein, as did David Tanner, who heads the Montefiore board. Naturally, Richard Joel, the president of Yeshiva University and the YU Board, had to support the joint venture, and did so for the best interests of Einstein’s future. As for my personal view, as someone who grew up in both the Einstein and Montefiore systems, this combination always seemed natural to me. And my dear friend Steve Safyer, who was an Einstein student and went on to an illustrious career at Montefiore, felt the same way. We conspired for years to bring the two institutions closer together. So while it remains my dream come true, the ultimate credit for the merger has to go to the leaders who made it happen.

From a practical perspective, how does this agreement improve both the quality and the volume of translational and clinical research that can be directly applied to patients?

In terms of education, it’s going to be better because we always want to bring things up a notch. The merger will open up new tracks for medical students to pursue. In research, the change will be even more significant. The fact that we are one institution means that we’ll be able to hire outstanding recruits. Montefiore continues to draw top talent, and having a medical school—specifically a research-intensive medical school such as Einstein—will ensure that the types of leaders it hires as department chairs will be of the highest caliber. That’s how this whole amalgamation really benefits both Einstein and Montefiore. There’ll be more interactions, certainly, because both current chairs and new chairs will be devoted to increasing research at Montefiore, within the health system and at Einstein. I’m also looking forward to greater interactions between the clinical and the basic science departments.

You speak about more collaboration among the scientists. As you are well aware, Einstein has a large base of basic scientists. And most of the college’s National Institutes of Health funding is in the basic science area. At Montefiore, the emphasis is on the translational and clinical areas. Given this environment, what do you say to basic scientists about their future?

I would be encouraging, in part because there’s a misconception about what translational science is. Translational science is just a fancy name for lab-based science that relates to health and human disease. But that’s what Einstein has been doing since 1955. We have always placed a heavy emphasis on translational research. That’s not a new thing. Many of our so-called basic scientists work in the areas of cancer, diabetes and heart disease. We use basic science or lab-based science to explore questions that relate to human health and disease, and that’s called translational science. So the current faculty should not be concerned about our joining Montefiore because we already promote what they’ve been doing. Future faculty will buy into that same vision. Moreover, clinical research is an area of opportunity for us. And while we now have a CTSA (Clinical Translational Science Award) in partnership with Montefiore, we perform and have always performed clinical research. I think the melding of Montefiore and Einstein is going to give us an unparalleled opportunity to expand in this area. What we hope to do is hire new clinical faculty who are interested in clinical research. They will apply for and receive grants just as our basic scientists do. So it’s not a zero-sum situation—it’s additive.

We’ve heard a lot about Einstein’s operating deficit. How do we grow in stature under these financial pressures?

Even before the merger, we’ve been successfully dealing with our deficit, reducing it substantially. Remember that deficit reduction can come not only from cuts, but also from savings and increased philanthropy. The merger is going to represent an additional opportunity because it will reduce our spending by taking advantage of economies of scale. Take, for example, human resources, IT and housekeeping. These will now all be shared services with Montefiore and the overall cost of such services under the health system will be considerably less. This will reduce the deficit, allowing for an eventual expansion of our research and educational opportunities. That’s because once we get our deficit under control, we’ll be able to expand—and Montefiore is very interested in expanding Einstein’s research mission, and making the entire enterprise greater than the sum of its parts. So Montefiore will expand, and has committed to expanding, the research enterprise. With such investments, Einstein should grow mightily.

In becoming more efficient and reducing deficits, will Einstein’s quality and innovation suffer?

To use a scientific analogy, quality and innovation are part of Einstein’s DNA. No one says that deficit reduction is easy. When it involves people, we look very, very carefully at any reduction in faculty and staff, not only for the personal effects it has on people’s lives, but also for how it will affect the entire scientific enterprise. And we haven’t done anything like across-the-board cuts, as have been done in many places. We’ve taken what is termed a surgical approach to trimming our budget and are very careful to do so in a way that doesn’t impact quality. In terms of the overall enterprise, we are certain that it will be much stronger after this deficit reduction takes place.

Specifically how do you see this agreement benefiting the existing faculty, staff, new recruits and our more than 1,000 students and postdocs?

There’s no one-size-fits-all answer to that. It’s different for each group. The students will benefit from expanded clinical activities. Montefiore, as you know, continues to undergo expansion. That’s going to open up more clinical sites for our students. Faculty will benefit from the peace of mind that greater financial stability brings. Furthermore, since expansion is ultimately contemplated, that will mean the recruitment of additional talented faculty, and that, combined with the fact that Einstein is a very collegial environment, should increase the amount of research and the number of grants awarded.

I fully understand that some Einstein staff have expressed worry and concern about autonomy in the future. But the structure that’s contemplated is that Albert Einstein College of Medicine will exist as a separate entity with its own board alongside that of the Montefiore Health System. It’s truly a merger and acquisition of an independent unit. And that independent unit will continue to operate under the same leadership that it does now. So what I say to the staff is that the people you know well now are going be the same people you’ll continue to know and who will supervise you in the future. Furthermore, Montefiore’s leadership is both benevolent and supportive.

Ultimately, our merger with Montefiore is going to be good for grad students and postdocs because we have not recruited large numbers of new faculty over the last several years, due to fiscal constraints. Once we get into a new mode, we’ll begin recruiting new faculty, creating greater opportunities for graduate students and postdocs.

There are dozens of academic medical centers across the U.S. What’s going to set the Einstein/Montefiore partnership apart as offering something unique?

If you closely examine the partnerships between medical schools and hospital systems, very often they work at cross purposes. Although they represent a type of marriage, many of them are not peaceful ones. What’s great about the Einstein and Montefiore partnership is that, for the most part, we see eye to eye on everything. We have common goals and shared values. It’s not as if we were introduced to each other yesterday, fell in love and are hoping for the best. We’ve been together since 1963. That’s a really long time to know each other. And if we’re going into this marriage after such a long engagement, then we know it’s a good match.

If you could project out based on what you know now, what is this partnership going to look like in five years? Ten years?

There have been new rankings of medical schools published in Academic Medicine that have comprehensively looked at the quality of the medical schools, not just in relation to what the MCAT scores of their admitted classes are, but based on the quality of the doctors who graduate and what happened to them post-graduation. In the first such national ranking this year using this approach, Einstein ranked number 13 among all medical schools in the United States. We’re very proud of that. When you think about Stanford and Harvard and Johns Hopkins, for us to be among the top 15 medical schools in the United States—that’s an excellent place to start. Furthermore, Montefiore is an outstanding hospital. It’s among the top ten largest medical centers in the United States. In New York, it’s number two. It has the second-largest residency program in the United States. That’s also a great starting place. So both the medical school and Montefiore are starting their new relationship from positions of power, authority, responsibility, excellence and respect. Where are we going to be in five years? Bigger, better and more renowned. Where are we going to be in ten years? Even bigger, even better and even more renowned.

In closing, is there anything that you’d like to add about the future of our institutions as one?

The best is yet to come.