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Michael Dunne: I'm Michael Dunne. From its stately, if slightly dated, campus on the Hill to its incredibly modern-looking facility next to the river and the ever-present Sky Tram connecting both, OHSU casts a very impressive image as one enters the city of Portland from the freeway, and beyond the facilities, the institution boasts both the premier medical university and hospital in the state. Today on the show, you'll meet the man in charge of this national facility that calls Oregon home, and hear about his vision to further expand its hospital's reach and also expand its ability to teach the next generation of healthcare professionals. Then, in the last part of the show, we check in with our reporter about the latest budget challenges for Eugene's 4J School District. President Shereef Elnahal, who is the president of OHSU. Doctor, thanks so much for coming in and talking to us.
Dr. Shereef Elnahal: Thanks so much for having me.
Dunne: Yeah. So, you were appointed undersecretary for health at the Department of Veterans Affairs by President Biden, what did that background help prepare you for to run our state's only public medical university?
Dr. Elnahal: It was one of the proudest moments of my career to be asked to serve at the nation's system for veterans' healthcare. And what I can tell you is that a chance to meet so many amazing people, men, women, folks who were deployed to conflicts that ultimately changed their lives. And as a country, we're absolutely obligated to do everything we can to help folks transition back and to live healthy lives. And so that had a chance to run a team of 400,000 people across the United States, more than 100 medical centers, hundreds of clinics, and all sorts of programs that focus on things like preventing veteran suicide and advancing public health. And so, it was a public system, much like OHSU is, and it had a social mission to advance the healthcare and lives of veterans. The mission was not primarily oriented to making money or any sort of institutional focus. It was squarely focused on the health of veterans, and I find that to be very similar at OHSU. We are a state institution. We of course have to make ends meet and make more money than we spend overall, but we are here for the public health of people in Oregon, and that means a statewide mission, including serving folks right here in Eugene.
Dunne: Okay, so I've heard from many healthcare professionals that there's sort of a crisis in in staffing. There's just not enough doctors and nurses and healthcare professionals. I know you have a workforce program. I believe it's called 30-30-30 Initiative. Talk about that and how that might be part of the solution.
Dr. Elnahal: We definitely see shortages in both physicians and the nursing workforce, and across many other disciplines in healthcare. And those shortages are worse in Oregon than the average across the country. In fact, we also don't have enough hospital beds for people in the state, which is actually unusual. Most states have bordering on too many beds, but we're different, and so we have capacity constraints on both people and space and facilities to be able to provide care. So, as the state's premier institution for training the next generation of the healthcare workforce, programs like 30-30-30 really matter. So, the first thing that 30-30-30 asks us to do is to grow the healthcare workforce by 30% in the state, and that means increasing enrollment in our educational programs by 30% by 2030. And we're actually well on our way to achieving that. In fact, ahead of schedule, thanks to the state's assistance. We are also asked to make sure that more than 30% of our class sizes are diverse folks, people from racially and ethnically diverse populations, also indigenous, but also people from rural Oregon, and best equipped to go back and serve those areas. And so we're really proud of the fact that we're already above that 30% threshold. And my job, even when funding and programming for this area of work has been decreased by the federal government to maintain that commitment, and I think we will.
Dunne: Okay, as you're probably aware, we lost a hospital here in Eugene, and there are a lot of challenges in healthcare. And so, I kind of wanted to ask you, you know, when you look out at the healthcare landscape today, both in Oregon and nationally. You know what are some of the biggest challenges and what are some of the potential solutions that are out there?
Dr. Elnahal: Yeah, I know what it's like to see communities lose their hospital. They're often one of the biggest employers in those areas, but more importantly, it's a critical source of healthcare and a matter of life and death often for folks who live in those areas. And so, I know that as health commissioner in New Jersey, I saw hospitals close around the state, and that was a difficult thing to see for all involved. So, I definitely think there's a lot of work to do to make sure that folks here in Eugene get the care they need. There's a hospital that is about, as I understand it, you know, 10-15 miles away, that can serve needs here. But OHSU is also here for folks in Eugene. We have the Clinical Development Research Center for rehabilitative services for children. That's a really important asset here in Eugene. We also make sure that we send clinicians here and ultimately come to the assistance of folks as they need it out of OHSU. We are the main referral point for all sorts of complex care for people here, and we're also a main attraction for students graduating from the University of Oregon who want to pursue an advanced degree in the health sciences. So, we do try to help fill that gap and make sure that we're here for folks.
Dunne: I know that the potential merger with Legacy Health Systems was scuttled, but do you think that there might be another partnership out there? You know, to both expand services, but also as as you talked about, address some of these challenges in healthcare.
Dr. Elnahal: What I'll say is that we will say yes to any conversation around OHSU getting involved in any community, and often what that includes is not a full merger or purchase necessarily, but partnerships on a program-to-program basis. So, for example, when it comes to the services we provide in Southern Oregon, we're a critical resource for systems like Asante Health to help provide, you know, fill gaps in access and just partner on clinical issues. And we stand ready to do that with Peace Health and with any other organization that wants to better serve folks here. But we always look at the best way to structure a partnership to actually meet the purpose of what that partnership is supposed to do, and often that doesn't require a full merger or acquisition.
Dunne: Okay, speaking of expansion, I know I believe you're in front of the legislature asking for support to expand the NICU. Talk about that. Talk about what you need and what that could bring to the state of Oregon?
Dr. Elnahal: Yeah, I'm really glad you asked about that because it is our most important capital priority, meaning the most important next large project for us to build a healthcare facility. And so, we're setting out to build an expansion of Doernbecher Hospital that would really be placed on the last bit of land on Marquam Hill in Portland, and it would be an attachment to the current Children's Hospital. It would include a brand new 60-bed neonatal ICU and mother, baby, and labor and delivery services co-located in that addition. That will be a statewide resource. We have more than 50% of patients coming to OHSU, including to our neonatal ICU, coming from outside the Portland metro area. And so, folks from Eugene, families from this area would benefit from this critical resource. And we are one of only two level four NICUs in the state. We are the only neonatal ICU to do things like dialysis for babies who need it, and even fetal surgery while the baby is in the mother's womb, to provide the most complex and specialized services in that area. So, we view this as a statewide resource. It's also an area that doesn't typically quote unquote make money for health systems. In fact, those often lose money. But because we're expanding in critical areas like cancer, we know that we'll be able to sustain it. And so, part of what we're asking for, in addition to philanthropy and raising our own debt, is bonding on from the state, and that will require support from our legislature and our governor.
Dunne: Okay, bit of a nexus between your previous job at the VA and here in Oregon. I'd love for you to talk to talk about the potential therapies with psilocybin and PTSD because I think that as a state that has legalized it, it's become this sort of new frontier in in a possible treatment that could have amazing results.
Dr. Elnahal: Yeah, I learned about this whole field actually when I was Undersecretary for Health at the VA, and it was actually veterans who told me about the promise of things like psilocybin and MDMA, and finally getting them to a better place in really debilitating conditions like PTSD. And in fact, those vets had to actually travel outside the country and. Those cases to get access to those therapies, Costa Rica, Mexico, and these were folks who served our country and weren't able to access things that could potentially change their lives, and so I actually thought that these kinds of agents should be studied more frequently and more often, and we funded more of these studies from federal resources for the first time in many decades, really since the war on drugs, Oregon is a national leader, as you mentioned, because there is an accessible psilocybin system of care, the drug that is in so-called magic mushrooms, and can be very effective for major depression that's not responsive to traditional therapy and also PTSD. And so, we have scientists with the largest data set in the country on the largest legal and open program for medical psilocybin, showing that there are sustained benefits even from one dose and one course of therapy. So, we're really excited about this, not just because it has huge potential for veterans, which is extremely important, but can also help folks no matter where they come from, who carry these conditions.
Dunne: On this show, I've had the opportunity to talk to many people in academia who have concerns about what they call sort of this enrollment cliff, and we're starting to see this now. And I'm wondering how it might be impacting the student body at OHSU.
Dr. Elnahal: We're lucky enough to have really robust enrollment and OHSU's programs, we want to make sure that folks graduating from our schools have ready access to jobs on the other end or further training like fellowships and residencies, and we're really successful at placing our students in these programs. Well over 95% of students in each of our programs, gets to the next step successfully. We have extremely high board passage rates, and we are meeting our enrollment every year. And so, enrollment certainly is an issue with undergraduate programs across Oregon. We maintain robust interest, and in fact, have been expanding the class sizes and potential partnerships with other schools because of that. We know on the other end of these programs is a really suitable livelihood, but also a really fulfilling career. The health professions can be some of the most rewarding careers you can have, and I really encourage students out of University of Oregon or anybody else listening who might be considering OHSU to do so.
Dunne: How have you been able to manage what I imagine is a challenging relationship with the federal government, especially with regard to funding for research and whatnot, how has that been going?
Dr. Elnahal: Yeah, it's easier said than done, I would say. You know, we are finding areas of potential partnership with this administration on certain things, like psychedelic therapy, which is a priority, but certain policies have been really hard, like cuts to the Medicaid program out of HR one, the so-called big beautiful bill. We're going to see more than 200,000 Oregonians fall off of Medicaid coverage. Those are patients we will still need to see, and we will see, but they will not be able to access services as readily as when they had a stable insurance plan, and so they'll show up more often in our emergency rooms and more often in our hospital beds without that critical preventative and primary care. There's also many proposals that are concerning from a scientific perspective. So, we brought in more than 550 million dollars in extramural grants from the NIH and from industry last year, and that's squarely because our scientists continue to knock it out of the park, but many other institutions are seeing reductions. That was an all-time record for us, and so if we start to see proposals like political appointees reviewing grants or canceling grants or deciding what the research priorities are, instead of the scientists and the scientific community doing that, I think we will really see a decrement in our competitiveness across the world when it comes to biomedical science. So, these are just two examples of things we're really concerned about.
Dunne: Okay, you're relatively new, but I wanted to give you the opportunity to talk about your vision, both you know the near term and the longer-term vision for what you want OHSU to be,
Dr. Elnahal: We would really love for OHSU to not only be an organization that is more successful at commercializing the incredible inventions and innovations, new drugs, new technology that can help people get to a better place with their health, but also hopefully be a catalyst with partnerships with other institutions to make Oregon itself the heart of health innovation in the United States, we have a really fast-growing and successful life sciences industry. We have partners like Genentech that just made a $750 million investment in the state with exciting new infrastructure that they plan to build, and I also hope to make sure that more of our scientists work with their new and innovative techniques and inventions. See a chance to see that work spin off into new companies, attract an investor base here, like venture capital, and really make this a place for innovation in the health sciences. I do. Think that the University of Oregon and other universities in the state can be critical partners in that, and in fact, states like North Carolina have made their public universities the source of their innovation economies. I do believe we can build an innovation economy on health here, and I'm excited to do it with any party who's willing to work with us.
Dunne: Okay, Doctor. My last question for you is: Fair or not, much of the state may think of OHSU as Portland's entity, and I wanted to give you the opportunity to talk about both the outreach as well as the infrastructure that exists that maybe people aren't as aware of as they should be.
Dr. Elnahal: Well, certainly our flagship is in Portland. Our hospital, our children's hospital, we have partnerships at two other hospitals in that area. But we are also meaningfully invested in care outside of the Portland metro area. So, one statistic is that about half of the patients that come to our main campus are from outside the Portland metro area. We are the single quaternary referral base for anybody who needs any kind of complex care, whether it's cancer services, neurosurgery, or really complex primary care for patients who need it. We are also increasingly in more communities physically, so we have nursing campuses in La Grande, Ashland, and Klamath Falls, we have joint programming with universities like OIT out in Klamath Falls, like the DPT program that is graduating folks every year, and we are also increasingly through telehealth and through clinics in many areas, including Central Oregon, providing care directly in areas outside of Portland. And so, we have a really important statewide mission that is actually in the law that helps us define what we can do as a state entity, and that commitment is meaningful, especially in rural health. We have what's called a rural health-based practice network that is training and ultimately allowing clinicians to live and work successfully in rural areas, and it's a really important goal for me to make sure we continue to expand and be available to any Oregonian.
Dunne: He is Dr. Shereef Elnahal, the president of OHSU. Doctor, thank you so much for coming in and talking to us.
Dr. Elnahal: Thank you.
Dunne: Now let's check in with our reporter about another big budget cut looming for Eugene's 4J. Ellie Graham, reporter for us here at KLCC. Ellie, it's great to talk to you. How are you?
Ellie Graham: Doing well, and yourself?
Dunne: I'm good. I'm good. I think we're doing better, maybe than the number-crunchers at Eugene 4J. Why don't you talk about your story about really the complicated budget season ahead for Eugene 4j School District?
Graham: Yeah, absolutely. So last week, Wednesday, October 21, there was a resolution that came about during a work session, and what that looks like is 4J is projecting a structural budget deficit of between $30 to $35.5 million. That's for the 27-28 school year. But yeah, the board authorized the district to begin planning for a more sustainable budget, and it does look like it may include the possibility of staff reductions, but no specific cuts have been finalized at this time.
Dunne: Okay, and then remind our audience they had to do this last year, or for the for the for the previous school year as well, didn't they?
Graham: Yes, indeed. So, the district, so yeah, so last year, the district had, you know, had to make cuts then, and then this year it comes about again, and there's, you know, several melting pressures financially. It looks like enrolment declining is a recurring theme. It appears, as we all know, that affects funding, and then operating costs and special education costs continue to put pressure on that budget. The one thing that did come up that you know that was referenced was the temporary federal relief money, which expired, was something that they were you know leaning on and did provide some remedy, and then that brought to the surface how it's got to be a sustainable fix and not these one-time reliefs.
Dunne: Okay, okay. You talked about in your piece. You talked about that you know last year $30 million shortfall that they had to eliminate 260 jobs. I know you said they didn't have any numbers, but it sounds like that's pretty much where this has to go, right? I mean, it's got to be staff reductions?
Graham: Well, they've implied that they haven't gave a fixed or a definite. You know, this is where it's going to go. Superintendent Miriam Mickelson did say that she opened the stage, I guess, by saying she can't guarantee that staff reductions won't occur, or she said that it won't that it will be unaffected. Without saying the you know this is exactly what we're doing. They're just authorizing the planning process with the vision that somewhere within that there's going to be some staff reductions.
Dunne: Okay, did the superintendent lay out a vision for how they plan to navigate these economic problems, and certainly with the but with the enrollment shortfall that a lot of schools are seeing. Did she lay out how they hope to you know come out the other end of this in a in a better position.
Graham: Yeah, so they have knowledge lessons learned from last year's budget process, basically learning that the one-time fixes don't work, which I mentioned before. But they are now being diligent in terms of tracking and updating the board.
Dunne: So, Ellie, what other things sort of came out from your reporting? What are some things that the district is going to do, especially with regard to you know community engagement and whatnot?
Graham: Absolutely, the district sounds like they want to involve the voice of families, and so they are planning some listening sessions and surveys with the budget expected to go through the approval process in May or June, and so those data like all part of the plan and timeline. Not a guarantee that every decision has already been made, but they are going to be approaching it in two phases, is what I gathered. So in December they're going to look at areas such as high school bell schedules, leadership positions, and district departments, and then in February following that, the focus is expected to shift more towards building level staffing, class sizes, and then those enrollment adjustments.
Dunne: Guess we'll just have to see what happens. Ellie Graham, who covers education and other things for us here at KLCC, Ellie. Thank you so much for your reporting.
Graham: Thanks, Michael.
Dunne: That's the show for today. All episodes of Oregon On The Record are available as a podcast at klcc.org. Tomorrow on the show, you'll meet the new CEO of PeaceHealth Oregon and hear how she plans to restore trust that was lost during her predecessor's time, and how she wants to expand services into all parts of the region. I'm Michael Dunne, host of Oregon On The Record. Thanks for listening.
