♪ Gavin> Welcome to This Week In South Carolina, I'm Gavin Jackson.

This week we are at the Medical University of South Carolina in Charleston.

Where I spoke with University President Doctor David Cole about the growing medical needs of our state, how MUSC is addressing them, and other challenges.

But first, I started off by asking Doctor Cole about the graduating class of 2025 and the future they are embarking on.

> Great question and just a little bit of context.

Of course, we educate every dimension of health care provider across our six colleges.

So most people focus on the College of Medicine, which we're very proud of.

But every other dimension nurses, College of Health Professions, pharmacy and so forth.

But to answer your question, in the College of Medicine we train the majority of physicians in the state of South Carolina.

And training it doesn't just stop at, medical school, right?

It's a graduate medical education portion of that.

So, our class in general matches well in the state of South Carolina.

Gavin> Mhm.

Dr. Cole> We focus on, educating and training and retaining physicians who can serve the state.

Gavin> And I was going to say, when it comes to their residency, they have a greater chance of sticking around in the state, especially a place like South Carolina, which needs doctors, nurses and everyone in between.

So is the goal to really kind of maybe keep them around and show them that, you know, there's a lot to be had here in the state.

Whether it's, in a variety of different medical fields, and then hope that they stick around to fill some of these voids.

Dr. Cole> We've been, so great question.

And by the way, the statistic which I quote, which is, I think AHEC generated.

The chance of you providing care as a physician in the state of South Carolina fifty-fifty.

If you go to medical school here in South Carolina, any school in South Carolina.

Greater than 75 percent if you go to medical school and you finish your residency training here.

And we've been leaning into that statistic.

So, you know, physician shortage, which is very real.

And by the way, South Carolina is on the short end of the stick of almost health, every health care provider statistic.

You know so, there's a national shortage and we are, have less than, adequate physicians.

Not only a numbers game but also maldistribution.

So, in downtown Charleston, I would say probably not so much.

Many counties are without primary care physicians, OB-GYN, critical you know, needs, so.

So, we've been working to not only provide, MUSC is a comprehensive academic health system can recruit and train medical school students, graduate M.D.

But also have the ability to help shape and develop with partners graduate medical education.

That's residency, that's fellowships to finish the training so the physician can practice.

You know, congratulations, when you get an M.D.

you have two things, two letters and a quarter million dollars worth of debt but you cannot practice.

You know, to be able to practice, you have to finish the entire pipeline.

So unfortunately, the state of South Carolina is generally a net exporter of physicians.

High quality physicians, physicians that get trained in all the medical schools across the state.

And although the match when you finish your M.D.

you match to your residency.

It's a national... match.

But if you just look at the numbers, we have less GME slots than we need.

Therefore we're exporting doctors we need to retain.

Gavin> GME slots?

Dr. Cole> Graduate medical education.

Those are residency and fellowship slots.

Gavin> Whether that's at a hospital around the state, whether that's an MUSC hospital, McCloud- Dr. Cole> Anywhere.

I'm not, I'm speaking through a state lens.

<Sure> You know, so we don't have enough... Two things, we don't have enough... residency positions in the right domains.

So we've been focusing on trying to develop brand new critical needs residency programs in critical needs areas.

Remember that statistic I was talking about, greater than 75 percent chance of staying if you finish your training there.

So, so in our, growth and presence across the state, in our regional medical centers, we partnered with other health entities other health systems to build new primary care residency programs in those communities.

Gavin> Yeah, primary care is a huge factor because a lot of folks, even when they want to go outside of, once they graduate, you know, from what I've been reading and seeing.

Is that, you know, whether it's pediatrics or family medicine, talk about the short end of the stick, a lot of folks don't opt to go to those, those routes.

They want more specialty training so they can, you know, talk about that medical debt, try and cover that back.

So how do you make that more attractive?

I mean, does it have to be something where they get their education costs covered, or do you incentivize in a different way?

How do you get folks into those areas that aren't providing as much income later on in life?

Dr. Cole> You know, again, another great question.

And, I don't have all the answers, but I'll tell you- Gavin> I'm sure.

Dr. Cole> I'll tell you our approach.

So we've been trying... we have been, I won't say tried.

We have been creating a framework, creating the programs, creating the programs in the right places, creating the programs in the right domains.

So, I'll brag on our teams for a moment, in Florence and in Catawba and our Lancaster hospitals in the last, three years, from concept to accreditation approval to matching successfully now, two years in a row, a primary care program in Florence.

And this year in Catawba, is pretty remarkable because, again, if we can recruit physicians into that, those training programs, there's a significant likelihood that they will stay in those programs.

So that's, I'll call it "phase one."

And by the way, when those programs are mature, we'll have probably 120 new training slots in critical needs areas in critical domains across the state that didn't exist before.

Gavin> And that's part of the way of fixing this problem we're talking about here.

Dr. Cole> So we've been able to by the way, and we've been very grateful.

We've, many ways the state legislature on this topic has been incredibly helpful.

So... last year we had a discussion with legislative leadership and requested what we call the "Critical Needs Physician Program."

And basically that's recurring dollars that will if you're a MUSC medical student, if you match in your residency in a high needs area in a rural, underserved space, half your student debt is forgiven.

<Mhm> And then the other half will be forgiven when you practice for four years in that community.

So we're trying to get aligned incentives.

We're trying to say, hey, you know, we're trying to remove barriers, you know, and get people to reconsider, reinvest as physicians and providers in communities.

One of my basic thoughts has always been, whether it's physicians or nurses or technicians, you know, if you have a heart for health care in terms of that, being your practice, you should have the opportunity to be, trained and part of that community and deliver care for those you do care for.

Gavin> And with that program, is that, it's in its infancy at this point.

Have we seen any results yet?

Or is it just starting?

Dr. Cole> This was the first year.

<Okay> Yeah.

So, I'll have to track down the statistics, but I know there is a lot of very excited medical students that matched.

I think part of it was actually getting, by time we got approval, we, a lot of commitments had already been made in terms of thought process.

We're going to continue to get upstream as much as we can.

Another program the year prior to that, another scholarship program, actually, we called it "S.C. First Scholarships."

And we asked for and actually received one time dollars, 3 million from the state and we said we'd match it, which we did, philanthropically.

And we put that into an endowment.

And the concept behind that is, scholarship is, that if you're first in your generation as a South Carolinian, to get into a graduate school in health care at MUSC, you're eligible for this full-ride scholarship.

We gave out eight last year.

Gavin> So just more ways to incentivize too.

Dr. Cole, when we're talking about the need for primary care and pediatrics.

Do you think that telehealth has made up that difference?

Do you think that's what's kind of maybe eaten into a lot of that or urgent care facilities?

I mean, we look at stats like, the Association of American Medical College project that a shortage of 20,200 to 40,400 primary care doctors will exist by 2036.

That's a gap there.

We even see there's a shortage of some 3000 physicians for South Carolina alone.

So... talk about telehealth and urgent care, but we still need those, those core folks there.

Those primary care doctors.

Dr. Cole> My thoughts.

So... health care workforce, every dimension of health care provider, physicians, nurses, techs are in shortage.

As we speak.

And will be in some level in crisis as we move into the future.

This didn't occur in a day.

I think we all have our own dimension or ownership of what that looks like, both as a nation and state and providers and schools and so forth and so forth.

So we're not going to dig ourselves out of it in a moment.

My thoughts are that we have three, dimensions we can lean into.

One for us, MUSC, we educate every dimension of health care provider.

We need to educate the heck out of every quality student that we can.

Maximize our programs, identify where those needs are.

That's one.

Two, we need to partner creatively with others, other enterprises, other institutions.

For example, technical schools across the state, in our regional divisions, we are partnering with those technical colleges to identify techs that we can provide guaranteed employment.

You know, figure out how we can provide, the educational faculty, if you will, to do this.

Help, get the pipeline aware that there's great jobs, you know, in health care, if that's the domain in which you want to be.

And I think the third one, which kind of gets to what your original question was, this is more longitudinal.

We really need to reimagine and start to deploy different care models, you know.

And how health care is being provided, I think is ultimately going to be our best answer of how we could become more effective, maintain high quality, provide care where patients live.

Gavin> Okay.

Dr. Cole> And somewhere in all that is telehealth.

So telehealth is, is a great sort of lever.

It allows you to be more effective and efficient, if you will, reducing distance.

Helping to provide access when you couldn't maybe have even, accessed a, you know, health care facility and so forth.

You know, we have new layers, advanced practice providers.

We have to really do, I think, a very thoughtful job of how do we enable people to work at the top of their, you know, education and to make that as the most effective and efficient for the patients.

And, and another dimension, I'd have to say, you know, the expectations of patients, you know, we have to meet expectations.

But at the same time, you know, it can't be that we're... patients are "I'm only going to see my one primary care doctor in seven counties, you know, on a Tuesday."

Gavin> And then we also talk about what's going on here on campus.

You all have a new medical, a College of Medicine building coming online, 2027.

<Mhm> And that should probably help retain, recruit some folks into the school.

Dr. Cole> So, yes, that's going to be, by the way, the first dedicated College of Medicine building in almost hundred years.

Gavin> How many?

Dr. Cole> A hundred, at MUSC.

So we're excited about that.

But with those new facilities we will be able to continue to recruit high quality students and look to expanding our class base numbers, significantly as we head in the future.

I think at least 50 percent in the next foreseeable future, as much as we can to meet the need.

Gavin> And then that Roper property will come online in 2029.

What, is that going to be just... Are there any plans for that building yet?

What's the future of that building?

Dr. Cole> So first of all, anything I can do to help Roper build their hospital quicker, I'll do.

(laughter) But, so we have a purchase agreement.

So once they're able to, and I say that in jest, but I actually truly support their decision making.

Anything we can do as partners, we will.

So, my knowledge is probably by 2029 will be the first time we'll have access to that property.

Once they build another facility and move out.

If you will, Roper is the hole in our donut on our campus.

We have a lot of needs as we try to build into the future.

So we've not, specifically defined, but I'm certain that it'll be somewhere between, you know, supporting our academic mission and somewhere along the lines of some form of acute care facility, research or innovation.

I'm being a little bit vague, but we don't know.

Gavin> I know it's still early, and I'm sure there's something big on the horizon.

But that being said, Dr. Cole, I want to ask you just about research money MUSC brought in more than 300 million in research funds in the fiscal year 2023, which led the state overall in research funding.

It also leads the state in federal and NIH funding.

So what is the status of that federal funding?

How concerned are folks on campus about the future of that money?

Dr. Cole> Great question.

So, and by the way, last year we were 360 million.

Significant growth continues.

There's a lot of unknowns, many dimensions coming out of the federal government right now.

So one dimension specifically is NIH.

What's their longitudinal funding going to be or near-term funding?

Indirects, which is a... in the world of an NIH grant, you have direct funding which covers the salary and supplies to do the work.

And the indirects basically are what's required to pay for the electricity and the infrastructure to do the rest of the, you know, have a functioning lab.

So the indirects were being cut significantly and fairly, acutely.

For us it would be about a 40 million dollar hit.

So I think our basic thoughts or principles are along this line, don't overreact.

You know, we're trying to inform the appropriate officials to say, "Look, this is what the impact can or will be."

Ignoring any MUSC specific concept here.

You know, when you think of research, I think of knowledge-based economy.

And a knowledge-based economy and innovation, to me, is a key element of what South Carolina and the nation doesn't want to sort of lose are literally cutting edge on.

So to me, the argument is how do we become more efficient, more effective?

But, don't, you know, don't cut our legs out from underneath us in terms of what we want to do.

My... always being prepared, you know, we have plans or possibility, for possibilities.

So if we need to together as an enterprise, we're not going to let the researchers, you know, say, "Hey, good luck with that."

You know, we're committed to the tripartite mission because we know and we see the impact that it has for those that we serve.

So be prepared.

Don't overreact, be engaged.

And, we'll see how this moves out.

It is sort of like asking somebody, saying, "Well, exactly what is the impact of the tariffs?"

I'm not sure, yet.

I mean, there's a lot of moving parts, right?

It's even unclear exactly, I think, China tariffs changed dramatically yesterday.

Right?

So we're trying not to overreact, but we're also trying not to be naive.

Gavin> But have you had to intervene yet and fill in some funding that has dried up at this point?

Dr. Cole> There have been some, student, support grants that have... there's two dimensions here.

There's in the hesitancy of readjustment, funding of grants that normally the rhythm of the NIH, it gets delayed, that can cause gaps.

You know, so in the situations where we have a grant that, you know, got an outstanding score, you know, by all rights, it can and will be funded.

But the mechanism has been slowed.

We're definitely going to gap fund that, right?

<Okay> So we've tried to be thoughtful about what that looks like.

If there are students that are on campus that we've made commitments to and some other funding is not available because, you know, again, the mechanisms of funding or timing of funding, any of those things, we'll support the students, you know, to make sure that they're, we're doing the right thing for them.

But... in general, we've been I think, there's another dimension too which is confidence.

I think you intimated anxiety provoking, yes.

You know, so we've been... you know, basically saying, "Listen, we're strong enterprise.

Our mission is purposeful.

The impact that we have is meaningful, and we're stronger together.

And we will deal with this together."

And, and be prepared for whatever that is.

So, I think it is part of it is appropriate confidence without naively, you know, saying we're "Chicken Little."

And we're trying to do both.

Gavin> Do you think the average South Carolinian, the average American, doesn't quite understand maybe what the point of research is and this amount of money that you need to do this research to get these breakthroughs.

I mean, we're in this innovation district too that I want you to speak about in terms of what that does and in terms of helping grow and advance research and also breakthroughs in the medical industry.

Dr. Cole> I think you're right on target.

I think we have a challenge.

It's almost a language barrier.

We do a poor job of explaining this complex stuff that we're doing and not putting in to simple terms where somebody can actually see the impact.

You know, NIH funding specifically is the vast majority is biomedical research.

Biomedical research is what's created a generation, actually, 100 years of miracles in U.S. medicine.

Right?

And so, I think we need to do a better job of understanding and discussing in a manner that people understand what the impact is.

You know, I always sort of joke that, that if... you know, somebody randomly thinks about MUSC, they usually have two thoughts.

One is, I hope I don't get sick because that means I'm probably pretty sick.

Right?

Coming to MUSC for complex care downtown.

And the other thought is, I'm not sure what research is, but good luck.

And we need to do a better job of explaining what the impact and how those two intersect and what that means in people's lives.

<Mhm> So yeah, I think some of this is on us, you know, in terms of how we tell that story in a more understandable and meaningful manner for those that we serve.

It's hard to continually ask a lot and say, "Well, we'll get back to you."

Gavin> We'll get the money.

Everyone sees the numbers, but they don't see the what comes of it, too.

But to that end, when we're talking about misunderstandings or folks maybe not knowing as much as you would like them to know.

There's also rampant misinformation out there, too.

I mean, we just went from the measles being pretty much eradicated, in the United States to a thousand cases, this past year, which is the highest in five years.

It sounds like.

We haven't had an outbreak in South Carolina yet, but, how prolific, in your opinion, is medical misinformation right now?

And how do you think we got to this point?

Dr. Cole> Yeah, great... Another great question.

It's pretty rampant.

But I would just say I wouldn't even use the pre-term medical misinformation.

It just happens to be the medicine is part of that.

You know, when you think about something like measles, it causes my heart to ache, to think that we are allowing this to occur in our nation where we know exactly what we can and should do.

You know, in many ways, if you look back 50, 80, 100 years... those childhood diseases, polio, measles, I mean, it created a situation where every family in America, death was part of your life, and you might lose a child at any moment.

And, and those vaccines created that to be a new reality, which is not the case.

So it's almost like we have a generational amnesia.

You know, where people have no knowledge base.

It's like, "Hey, it's always been great."

No, it hasn't, you know, and somehow, again, it's an education piece.

<Yeah> Gavin> You think Covid, I mean, was just... just really kind of kicked it up a lot, too?

And then, you know, when they saw everyone was talking about using masks or doing this and that.

And then no one really saw the benefits, even though we did know that we didn't see these massive surges until we all just kind of abandoned everything.

But do you think that played into it?

Do you think social media, where everyone goes to TikTok before going to one of your students who's been educated and say, "Oh, I think, I think I know what's going on because I saw it on TikTok" versus a trained medical professional.

Dr. Cole> All of the above.

Social media... You know... it's ironic to me, just my thought that I think as a society, despite the name social media, we're more isolated than ever.

You know, so there's a lot of impacts, including sort of a devaluation or an awareness or understanding of what is actually true or not.

It's hard for everybody with all this, easy opportunity to put out sort of your own version of truth.

It's just, it's just hard.

So Covid, it's... it's interesting because Covid was bad enough that it warranted a lot of attention, but by the way, if you look at the history of pandemics, 1918... 1918 was much more rapid and dire.

You know, so it attacked young people.

And within 24 hours, you could be "I'm fine, and I'm dead," within 24 hours.

That catches people's attention.

Covid had a lot of grayness and vagueness to it, right?

There are some people that got really ill and others are "I'm sniffles," you know, and then and then you interject social media into all that, and you got the, you know, anecdotal story about this and that and so forth.

And by the way, the vaccine of Covid is not perfect.

Yes, you can get another version of Covid, but if you looked, it's hard to describe what didn't happen.

<Sure> When it doesn't happen.

<Exactly> You know, so... all those things play together.

I think from a health care, you know, view... the unfortunate reality is that eroded confidence in health care.

It eroded the confidence in terms of science.

I think it eroded confidence in terms of the, what we considered to be sort of common truths.

And, you know, it's always the American way to question.

We're independent, you know, we do our things.

I fully respect that, you know, but... there's got to be a balance here somewhere.

I think that, you know, at the ground a lot... you know, I'm a surgeon.

I take care of patients.

I'm in the operating room, weekly.

And I will tell you from a patient perspective, when somebody has a new diagnosis and they need care, what they want is somebody who's caring and knows what they're talking about and what they say they do.

That's my biased perspective.

And I don't think that truth has changed.

You know, and by the way, maybe the ones who don't believe I never see at my doorstep, you know.

But I think that we need to continue to do the good work and we need to build and continue to rebuild whatever confidence is required because the mission is too important.

Gavin> And Doctor Cole very well said there to that.

And do you think that students, need to learn more about how to handle misinformation among patients, in a way that maybe helps them see the light, that it's not exactly what they're saying it is on TikTok, but actually this is X, Y, and Z instead.

Dr. Cole> You know, it's a brave new world, you know... with our students, one sort of thought... for me it's, it's always a privilege to intersect with that generation, that new generation, because the talent, the passion, enthusiasm they bring to the table makes me optimistic for the future.

Having said that, they live in a much more complicated world than I grew up in.

They just do it's far more dangerous.

You know so, having that discernment and ability to sort of rise above the noise in a manner that's meaningful, to, you know, not get defensive but combat, it's a different skill set that I honestly think we're struggling to sort of educate the future with, well.

By the way, add AI.

You want to blur the future reality, add AI.

There's huge upside, but there's potential significant ongoing risks for our society, in medicine.

All of the above.

I'm a huge proponent of artificial intelligence.

Because I believe in the basic ability of man to do the right thing, and I believe that we can do the right thing.

And specifically in health care, we desperately need transformation of how we perform our work and function.

And AI won't save us, but it's a tool that'll help with transformation.

In the middle of all that is... the new generation.

So, you know as well as I do, that I'm... the younger generation has a much easier understanding.

They grew up with computers, iPads, iPhones- <The internet> the internet of things, all those sort of things.

I'll share, I thought it was a funny story, my son is a... went to medical school here, and he was catching grief from his mother as a second year because she found out he was skipping class.

So, he was catching the wrath of mom.

And he finally said, "Mom, all the, all the lectures are recorded.

I can listen to it at 2X speed.

Why would I waste eight hours in class when I can listen to it in four?"

And I'm thinking, good point.

(laughter) Right?

You know, but it's just a frameshift, it's like...

So my generation, that's how we, knew that it was your responsibility.

I think things have continued to shift.

So how we educate, how we interface with our...

I believe on one hand, we're all humans and the human touch and caring is always going to be essential.

But, the tools that we have to somehow deliver on that are going to be much more, they're going to be... something that's hard to currently imagine in the future.

Gavin> I was going to say, what keeps you up at night?

What gives you hope?

But I think you already answered both those questions.

It's a little bit of both.

So, Doctor David Cole, we'll leave it there.

Thank you so much.

Dr. Cole> Yeah.

For South Carolina ETV, I'm Gavin Jackson.

Be well, South Carolina.

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