Dr. Ray Greenberg, the outgoing president of the Medical University of South Carolina, is busy packing up his office, giving books away to colleagues and saying good-byes.
After nearly 14 years at the helm of MUSC, Greenberg leaves Charleston for Austin, Texas, early next month to start a job as the executive vice chancellor for health affairs at The University of Texas System.
He recently sat down with The Post and Courier to share a few final thoughts. His responses have been edited for length.
Q. What made this opportunity at the University of Texas seem like the right one?
A. It’s several things. One is that rather than running a single institution, the job is really about overseeing a whole system of institutions that have statewide impact — individually and collectively. And when you say, ‘The University of Texas system,’ people may not realize it’s MD Anderson, it’s Texas Southwestern, which is a top 25 medical school in Dallas, three institutions that are pretty similar in size to MUSC in Galveston, Houston and San Antonio. So it’s large scale.
Secondly, Texas is 25 million people. It’s one of the largest states, five times the size of South Carolina. If you make a difference there, you make it on a large scale, a big impact.
Texas has resources. The schools that are in Austin, in San Antonio, Houston and Galveston are all roughly similar in size and scale to MUSC. We’re a little bit bigger than them in terms of research funding and I think in all instances clinical enterprise, but nevertheless, they’re pretty similar to us. They get three times the amount of money that we get from the state as their regular appropriation. Plus, the state of Texas has royalties that come to them through oil and gas, above and beyond the core operating budget, they have a very large amount of money that they can invest in capital projects and other non-operating kinds of expenses.
So to be in a situation where there are resources to invest in building real quality is very attractive.
Q. It’s no secret that MUSC has been struggling financially. Are the challenges here any worse than similar institutions?
A. The hospital side has clearly gone through some challenges. I think the good news is we’ve finished the year very strong and partly because the volume has been record volumes. The normal peak volume period in typical hospitals is during the flu season, during the winter months. It tends to trail off in the spring and early summer.
Because in the hospital so much of your costs are fixed costs, the more volume you can drive through the system, the better you can perform financially. If you go back to, say, Thanksgiving last year – that’s when I lost the most sleep about was how little cash there was on hand.
So much of the improved financial status achieved to date, there’s some of it that’s come through the things we’re doing to improve efficiency and so forth, but a lot of it, there’s some one-time money and part of it really is just volume driven.
Q. Is that luck?
A. Well, I don’t think it’s luck. What I can tell you after however many years I’ve been doing this, trying to understand and predict hospital volume is — the best statistician in the world could not figure it out.
It would be a terrible thing to say we want more sick people in the hospitals. Obviously, we want to keep people out of hospitals but if you’re running a hospital and it’s going to cost you a certain amount to run the operation, it’s better to be full than to be empty. We traditionally run very full compared to the average hospital, but it’s been even more so in the last few months.
Q. What is going to be the toughest challenge, in your opinion, for your successor?
A. It’s hard to get beyond finances because I think health care in general and higher education — you sort of have the perfect storm of every revenue source that we’ve depended on for years to build these big, successful enterprises, they’re all under stress right now.
The biggest engine historically of funding has been the clinical enterprise (the hospital). We use that to effectively underwrite the education and research missions. When you get into a situation where there’s not extra revenue coming out of the clinical enterprise, then that becomes a bit of a challenge.
On the research front, the biggest funder of biomedical research is the federal government. Now under sequester, the NIH (National Institutes of Health) budget is down a little and I think even the rosiest projections would say, well, maybe if we could get it to be flat, that would be a victory in a sense.
The educational enterprise, there are two principal sources of funding for that. One is the state. We don’t have to talk about the state funding situation; I think that’s well known. I just told you, a single point of reference, comparative institutions in Texas get three times the amount of money that we get. So for us, we get $54 million and those institutions get around $160 million.
Making up a $100 million, even if you’re talking about a $2 billion enterprise, is a big challenge, from a management point of view. That’s a particular problem in South Carolina.
The other source of revenue for the education mission is tuition. Because of the cuts in state funding, we’ve got to increase tuition. Our tuition here is certainly well above, for most of our programs, the national average in their respective disciplines. It’s not stopping students from wanting to come here. Last year, we had record numbers of applicants for every program, but it does mean that they’re finishing with a lot of debt.
So, what does that leave? It leaves philanthropy, and philanthropy has grown tremendously here.
Part of that has to do with the growth of the retirement population, particularly in coastal South Carolina — Kiawah and downtown Charleston just have, in the time that I’ve been here, have been a game changer really in the number of people who have resources and are generous and many of them are grateful patients who want to help support the program that benefited them personally. So I think philanthropy will be a very important piece going forward, but we’re going to have challenges on all the other fronts.
Q. Do you think your medical background and your health administration background better served you in this role or is it more of a political job?
A. That’s a great question and I’m not sure those are the only two models of what one could look for in the next president.
If you look at the trajectory of the medical university, it really started during Jim’s (Edwards) leadership, during his tenure as president. You know, he was president 17 and a half years; I’m almost 14, so it’s more than 30 years since either he or I have been president. You go back to a very different era pre-Jim Edwards.
I think one of the real questions when I was elected — the board knew me well because I’d been here for five years — but there were probably questions about how I would do in the political arena and how I would do in fundraising because Jim was seen as the most effective fundraiser we had ever had here.
I wasn’t from South Carolina. I didn’t have the network of friends and contacts like Jim. I think if you talk to legislators today, I can’t imagine we could have a better relationship with the General Assembly than we have right now. Whether someone came out of a political background or not, we have a wonderful relationship with the General Assembly.
In terms of private fundraising, the last year Jim was here, we raised either $16 million or $17 million. I think the record we raised in the last two or three years was around $80 million. This is gifts and pledges, this isn’t cash. This year we’re around $75 million. So we’re raising four times the amount of money that Dr. Edwards raised, but the important point of that is that it’s not about the person.
The reality is the product you’re selling, you’re basically a salesperson, and the product you’re selling is what people invest in. It’s not the salesperson. I think there’s a mistake in thinking that Jim Edwards or Ray Greenberg raised this money. We just happen to be the person there who was representing the institution and could communicate. I think certainly the common denominator is you have to be a good communicator.
Q. What was one of highlights of your time in this office?
A. There are a lot of highlights and it’s very hard to single out one thing. It sort of then feels like you’re devaluing things that were accomplished.
I’ll give you an honest answer that I can give you today that I couldn’t give you when we talked immediately after the announcement because now I’ve had about three weeks and probably 2,000 people have contacted me. It was over 1,000 in the first two days.
What means the most to me personally at this point is — and this is going to sound corny and it’s not going to sound like it’s any great revelation — it’s the personal things.
It’s the student who wrote to me who was a student in our Master of Health Administration program, who, at the time, was struggling to get an internship so I helped open the door. He’s off doing something else now, but, to him, that was one of the most important things of his professional career and, for me, it was a phone call to help someone that I thought needed help.
The number of people who have contacted me who have needed to get into the health care system, needed to see somebody and saw somebody and they believe their life was saved, that is not a small number of people. I didn’t do the saving, I just helped connect them.