Timeline continued from All Heart Jeffery Houpt became dean, serving till 1996. The mandate to enhance the school’s reputation in research was now going full speed ahead. Annual research income during Houpt’s tenure grew to almost $99 million. Emory surgeons performed Georgia’s first kidney-pancreas transplant. The American Cancer Society moved its national headquarters adjacent to Emory’s campus. The Emory Eye Center performed its first vision correction surgery with an excimer laser. The medical school helped establish a new School of Public Health from its masters in community health program which begun in 1975. The school was renamed the Rollins School of Public Health in 1994, for donor O. Wayne Rollins. The Emory University System of Health Care was formed to bring Emory’s clinical components into one unit. The name was later shortened to “Emory Healthcare” This was also the year that Jonas Shulman assumed position of dean of students after his predecessor, Dorothy Brinsfield, retired. Neurologist Mahlon DeLong and colleagues performed their first pallidotomy on a patient, using brain mapping to guide placement of lesions and electrodes. Later, state-of-the-art surgery for Parkinson’s would shift to deep brain stimulation, involving placement of pacemaker-like electrodes to control symptoms of Parkinson’s and other movement disorders. This work would help make Emory known as one of the premier Parkinson’s centers in the world, with more movement disorder specialists than any center in the country. The Emory Heart Center was formed to coordinate Emory’s cardiac services at various locations under one umbrella. The center was spearheaded by Logue Professor Wayne Alexander and Hatcher Professor Robert Guyton and directed by Hurst Professor Doug Morris. This same year, Emory surgeons performed Atlanta’s first lung transplant. The Emory Eye Center was one of the few centers in the country with approval from the Food and Drug Administration to sponsor a study of laser-assisted in situ keratomileusis (LASIK). The Robert W. Woodruff, Joseph B. Whitehead and Lettie Pate Evans foundations created and funded the Robert W. Woodruff Health Sciences Center Fund with grants of Coca-Cola stock totaling $295 million. Income from the fund was dedicated to development of the Health Sciences Center and the Winship Cancer Institute. This same year, Executive Vice President for Health Affairs Michael Johns appointed acting dean Thomas J. Lawley to the deanship. He has presided over unprecedented growth in research space, grants,and collaborative partnerships. Emory doctors performed the world’s first minimally invasive triple “keyhole” off-pump coronary artery bypass surgery, using mini-CABG instruments. This same year, Emory surgeons performed the state’s first split living-related liver transplant, from mother to son. Emory surgeons also successfully split a donated liver into two portions and then transplanted the left lateral segment into a 21-month old girl and the larger portion into a 42-year old woman. Emory doctors implanted the first biventricular pacemaker in Georgia. The NIH designated Emory as one of three Parkinson’s Disease Research Centers of Excellence. also in 1998, Emory doctors performed the world’s first unrelated umbilical cord blood transplant for sickle cell anemia on a 12-year old boy at Egleston Children’s Hospital. This same year, Georgia Tech and Emory created the first joint, two-school Department of Biomedical Engineering in the country. Also this year, Emory clinicians began the use of virtual reality devices to treat debilitating fear of flying and later, post-traumatic stress disorder. Emory doctors implanted Georgia’s first dual-pump ventricular-assist device. This same year, Emory dedicated a four-story, 75,000-square-foot Vaccine Research Center, directed by Rafi Ahmed, a Georgia Research Alliance Eminent Scholar in vaccine research. Emory doctors implanted drug-eluting stents in clogged arteries as part of landmakr studies to see if the devices reduced incidence of restenosis. Also this year, the Whitehead Biomedical Research Building opened, built with funds from the family of foundations whose patriarch, Joseph B. Whitehead, was the first to sell Coca-Cola in bottles. Based on an Emory gene discovery, the FDA approved a protein stimulating bone growth to provide an alternative to painful bone grafts. Emory doctors Chris Larsen and Thomas Pearson performed Georgia’s first islet cell transplant to cure diabetes. The patient, a 42-year old pharmacist, had had diabetes since the age of 8. Also this year, the Winship Cancer Institute (WCI) dedicted a new 280,000-square-foot building, integrating cancer clinicians and cancer researches (sometimes embodied in the same person, like Lily Yang) under the same roof for the benefit of patients. WCI also received a planning grant from the National Cancer Institute, a crucial step towards WCI’s goal of NCI designation as a “comprehensive” cancer center. The seed that Robert Woodruff planted in 1937 with his $50,000 gift for a cancer clinic had now grown into a sturdy tree, its branches reaching for the sky. This same year, continuing a tradition of innovations, Emory clinicians performed the country’s first artificial cornea transplant, the world’s fifth nonsurgical repair of a faulty mitral valve, and Georgia’s first endoscopic, closed-chest, off-pump cardiac bypass. The Department of Biomedical Engineering, only six years in existence, was ranked second in the nation by US News & World Report.                   John S. Inman Jr., 45M, came into the world upside down, a breech birth, delivered at home in his parents’ bed by their family doctor, who charged $25. It was 1921, before Albany, Georgia, was laid low by the Great Depression, and $25 was a large, but manageable sum for a small-town businessman. Inman’s father never forgot the doctor that saved the life of his son and wife, and this homespun birth story was recounted often during Inman’s childhood. As he grew, Inman dreamed of becoming a doctor, and after graduating from Emory College in 1942, he entered the Emory School of Medicine. “I was blessed,” he says. “The Army paid two years of tuition, and my father paid for one year. When I graduated, I didn’t owe a penny.” Indeed, times have changed. The average education debt today is $135,000 for graduates of private medical schools and $100,000 for public medical school graduates, according to a recent report by the Association of American Medical Colleges (AAMC) on medical school tuition and young physician indebtedness. By contrast, in 1984, private medical school students graduated with an average debt of $27,000 and public medical school students with a $22,000 average debt burden. That means that medical education debt is 4.5 times higher in 2004 than in 1984. The average tuition and fees is 2.7 times higher in private medical schools and 3.8 times higher in public medical schools, according to the report. While many medical students justify the cost of an Emory education because they know it will pay off in the long run, too many others follow the scholarship money to schools with a broader base of alumni involvement and support. Then Emory loses great students who want to come here but can’t afford it. At private schools like Emory, more than a third of graduates now owe more than $150,000. Ten years ago, the average Emory medical student owed about $50,000 by graduation. The problem is simple—tuition has risen, and scholarship money has not kept pace. Although about 75% of medical students at Emory receive some form of financial aid, it’s often a drop in the bucket in light of an annual tuition of approximately $30,000. Meanwhile, physicians’ salaries are stagnant or falling because of inadequate reimbursement, particularly for certain specialties (pediatrics, internal medicine, family practice, obstetrics/gynecology), and rapidly rising malpractice insurance premiums, thereby making it more difficult for recent graduates to shoulder large student loans. School of Medicine Dean Thomas Lawley has made increasing scholarship assistance a fund-raising priority. At every opportunity, he asks alumni to support scholarships, hoping to double the funds available for medical students. Indeed, Lawley himself has pledged $5,000 to the scholarship fund recently established by the Emory School of Medicine Class of 1972, the year he graduated from medical school. “A heavy debt burden means that our students, as soon as they are able, have to go out and make money,” Lawley says. “They can’t go into academic medicine, they can’t do research, and they can’t go into an indigent care situation. That is simply wrong.”       Inman feels grateful he was able to follow his calling–delivering babies in his hometown. He has delivered 10,000 babies during his career, earned enough to send two sons to Emoryboth to Emory College and one to the School of Medicine as well. He says he–continues to have a great career even though he no longer delivers babies. Having no school debt to pay off helped immeasurably, he says, so he spent two years in the Army and four years in residency before coming home to practice obstetrics and gynecology. His father helped set him up in practice in Albany, but after four or five months, he was on his own. “My education at Emory made everything possible for me,” he says. “Emory gave me the best start in terms of medical education and has continued to be important to our family throughout my life.” Inman knew he wanted to leave a legacy at Emory, and when he heard about today’s debt situation, he decided to help. He has contributed a substantial amount of money to support student scholarships by establishing a charitable remainder trust, in which stock will establish endowed scholarships for medical students who train at Emory after he and his wife have died. He hopes his gift will encourage more young people to become physicians to partake of the profession’s rewards and minimize the financial difficulties as graduates enter the practice of medicine. Many medical school admissions officers worry that top graduates who in the past would have chosen medicine may opt for different career paths. The rising tide of debt also unduly influences their choice of specialty. The potential modest future income for primary care physicians has probably already been a major factor in the recent decrease in medical students choosing this specialty. “If we don’t increase our level of scholarship support for students, we’re going to start losing the best and brightest applicants to other medical schools, if not to other professions,” says Joel Felner, associate dean for education at the School of Medicine. “We simply don’t have as much scholarship support to offer as our peer schools like Washington University, Vanderbilt, and Duke.” Tom Duke, 45C, 43M, hopes his recent commitment will offer students from impoverished backgrounds a chance to become physicians and give back to their communities. He himself grew up in the small town of McRae, Georgia, in a family of moderate means. “I would have been hard pressed to pay tuition if I hadn’t been part of the Army Specialized Training Program as a World War II veteran,” he says. “I can understand the needs the students have at this time, and I want to help them, particularly minority students.” To that end, he has committed $2.25 million in trust for an endowed scholarship fund. Duke acknowledges that his days at Emory opened doors to high places for him. During his career, he practiced medicine at Yale and the University of California at San Francisco, and he studied cardiology in Great Britain. After many years of practice in Amarillo, Texas, he has retired. Even though Duke had no debt to worry about after graduation, it was plenty hard to make ends meet. He spent long, grueling summers during his residency as a country doctor in south Georgia, working in a poorly equipped office, driving many miles along dusty roads to see patients in their homes, and often treating patients who couldn’t pay a dime. When reflecting on his long and satisfying medical career, he says that the intangible aspects of medical practice made it all worthwhile. “The practice of medicine is sometimes tiring, sometimes boring, sometimes dramatic, and for the dedicated physician, it is always satisfying,” he writes in a memoir about his summers in south Georgia. “That satisfaction sometimes comes when it is least expected.” Duke hopes medical students today will feel the same way when they retire years from now. And he hopes his gift will encourage young doctors-to-be to hang in there when the financial going gets rough.       As the clinical revenues that have traditionally supported medical education have fallen off due to the pressures of decreased reimbursement through Medicare, Medicaid, and managed care, tuition costs have risen along with the cost of educating physicians and practicing medicine in general. Further complicating matters, medical schools must adhere to small class sizes to meet AAMC accreditation requirements, as well as to teach subject matter effectively. Emory is accredited for no more than 114 medical students per incoming class. That leaves medical schools without the income generating solutions of increasing class size that law and business schools have. Although Emory’s endowment has done well in the past 20 years, much of the income it generates is earmarked for restricted uses. The famed Woodruff Scholarships, which offer full tuition and a stipend to a select group of medical students, are awarded to only four or five medical students in each class. Although other scholarships are available, most cover only a small portion of tuition. The average medical student at Emory receives significantly less scholarship money than students at comparable medical schools. With student debt spiraling upward and no end in sight, Emory officials worry that potential students may follow the money to another medical school.           Margaret Mermin, 77M, knows the financial sacrifices of attending Emory School of Medicine are worth it in the end. Attending medical school and completing her residency at Grady while putting her own children through private school left her hard-pressed to pay tuition. Student loans and remortgaging her house paid her way. But her education has given her the career she was meant to have, and she believes it is important to continue supporting the school, running one of the first alumni scholarship campaigns in the early 1990s. She urges her fellow Emory alumni to support scholarships, because the alternative is unacceptable. “I fear that only the children of the richest and poorest parents will get to go to medical school in the future because tuition is now so high,” she says. “That would be terrible for our society. Also, we don’t want our Emory graduates to choose specialties with an eye to paying back loans instead of following their true interests and serving the community. That’s not what Emory is about.” One of the most enthusiastic couples to graduate from the School of Medicine, Anne Elizabeth Hendrick Gaston and J. Harper Gaston IV, both 55M, couldn’t agree more. Both are individual recipients of the Medical Alumni Association Award of Honor and the Emory Medal and are dedicated volunteers. For the past 10 years, they have sponsored the Gaston Service Award Scholarships. Recipients must be accomplished scholars and have a track record of community service in high school, college, and medical school. Recent recipients have developed service organizations within the medical school, founded a statewide coalition of health professional students, coordinated volunteers for clinics for the homeless, taught and mentored children, and participated in volunteer health services activities throughout the world. Serving others is the heart of medical practice, says Harper Gaston. “It’s a different world now in medicine, and although the financial rewards are not be what they used to be, service in and of itself is the greatest reward that our profession can offer us. It is the heart of medicine. I hope our scholarships will encourage young people to say yes to volunteerism.” The Gastons decided that scholarships within the medical school would be the best way for them to make a modest payback for what they have received. “We both have had incredible careers and attribute much of that to our experiences at Emory.” The Gastons have given their time and energy to the medical school for more than 50 years. They served as co-chairs of the National Council of Medicine and are current members of the school’s Advisory Council. Throughout their careers, both have devoted at least half a day a week to education and other volunteer activities. Harper Gaston was an adviser for several years to the Emory University System of Healthcare Board of Directors and a member of the Emory Board of Visitors. In addition to being a leader in the Kaiser Permanente Medical Care program, he was involved in the California Heart Association for almost 20 years, including serving as president. Anne Gaston was a founding member and president of the Association of Emory Alumni (AEA), and she served as an elected member of the Emory’s Board of Trustees. She was the first female president of an Emory medical school class and one of only two women in her class. Devoted to improving health care for children both as a neonatologist and pediatrician in northern California, she volunteered weekly throughout her career, teaching medical students and residents at the University of California–San Francisco, where she became professor of pediatrics in 1979. “We believe that community involvement broadens all of us and allows us to continue to grow and to contribute to the common good,” she says. “The common good—that’s what being a doctor is all about.” To make a gift to Emory School of Medicine, contact Phil Hills, senior associate vice president for health sciences development and alumni affairs, at 404-727-7511, or phills@emory.edu. Or make a gift online at https://www.alumniconnections.com/donate/emory/medical.html Valerie Gregg is a freelance writer in Atlanta and a former staff member of the Woodruff Health Sciences Publications office.           Emory School of Medicine's need for more scholarship funds is not a new problem, as evidenced by this memory from alumnus Eugene Stead, dean and Department of Medicine chairman at Emory as well as a great leader in medical education (see A Marriage Made in Atlanta timeline) "I have always been grateful for Emory, my alma mater. This small, struggling college had the audacity to attach to itself a failing proprietary medical school. At the time I entered, it was on and off the probation list. It was 1928 and the Great Depression had already begun in the South. The only question anyone asked when I applied for admission was, "Son, can you borrow the money for tuition?" I said that the Atlanta Rotary Club would lend me the money. Each year I cheerfully send Emory a check. No Emory medical school, no Dr. Eugene Stead." -From The Quest for Excellence: The History of the Department of Medicine at Emory University School of Medicine, 1834-1986, by J. Willis Hurst
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