The Builder: How Tom Lawley crafted a national presence for Emory's medical school
By Sylvia Wrobel
1. Dean Tom Lawley
2. In the dermatology lab where he studied microvascular endothelial cells
3. With Jack Shulman, former executive associate dean for medical education, and Claudia Adkison, former executive associate dean
4. Medical students cut the ribbon to open the new medical education building in 2007.
5. With then Woodruff Health Sciences Center CEO Mike Johns at the medical education building's topping out ceremony
6. Demolition day of the old building
7. Throwing out the first pitch at a Braves game in 1998
8. In 1997, the Emory-Children's Center opened. Lawley postponed his own medical education building in favor of the pediatric building. Faculty had been working in WWII-era trailers.
9. With Emory President James Wagner (l.) and former Suntrust Bank CEO Jimmy Williams, for whom the medical education building is named.
10. Playing baseball at the NIH
11. (l to r) The Lawleys' son Tom works in development at Georgia Tech; his wife, Lesley, is an Emory pediatric dermatologist; Lawley and his wife, Chris; daughter Meg, who is now an Emory ob/gyn resident, and her husband, David Goldsmith, who is now an Emory psychiatry resident. Another son, John (not shown), works in Emory's research compliance department.
12. With wife Chris in 1996
Tom Lawley is stepping down this fall after a 16-year run as dean of the medical school. Along the way he crafted a national presence for a once regional school.
His legacy includes a five-fold rise in research funding; a new curriculum; a doubling of faculty size; six new departments; more than 1 million square feet of new clinical, teaching, and research space; and an uncommon spirit of collegiality. At Emory, chairs actually like each other.
Before becoming dean, Tom Lawley had already shown his talents as chair of dermatology for eight years. When he arrived on the scene in 1988, the department was in bad straits. There were only three faculty, and research funding had tanked. It had nowhere to go but up. Lawley smoothly guided its rise. By the time he left the chairmanship, the department had grown into the country's third highest in National Institutes of Health funding and employed 18 faculty.
The dean of the medical school had noticed. He told Lawley that a successful chair sooner or later would want to become a dean, so why not work alongside him for a while to learn the game from the inside? Lawley laughed. "Why would I want to do that? You have the worst job in the world." But ever loyal, he took on additional responsibilities as executive associate dean and then, after the dean left for another school, as interim dean.
"At that time, the medical school was a sleeping giant," Lawley says. "It was just beginning to wake up to how good it could be, to realize it had the potential and the resources to become a national leader."
Michael Johns, then the new executive vice president for health affairs, believed Lawley was the man who could take the school there. Lawley had a strong NIH research pedigree, was a respected clinician, had proven his ability to attract and retain faculty who liked and trusted him, and bested a series of top-notch national candidates who auditioned for the role.
Looking back, Johns, who just retired as Emory's chancellor, says Lawley's ability to develop strong, trusting professional relationships and his integrity—the first word colleagues use to describe him—proved indispensable in the years ahead, as did his fabled calm temperament. In a time of change, when he was about to launch a blueprint for research, or even more so in time of turmoil, as the school would face with changes in its clinical practice and the near-demise of Grady Memorial Hospital, Lawley maintained his quiet confidence, conveying his belief that steady, sustained effort would pull the school through any problem.
Embracing the unknown
As a kid, Lawley's ambition was to play second base in the major leagues. Then he became fascinated by the grace and skill with which a teammate's physician father tended to players' lacerations and other injuries. By the time he was a medical student at SUNY-Buffalo, Lawley had his life all planned out. He would marry his college sweetheart, Christine, finish his residency at Yale, and set up a general dermatology practice in his hometown of Buffalo. Being a doctor already seemed a giant leap for the son of a detective and social services caseworker, the first generation in his family to go to college. In medical school, Lawley had been so unworldly that he initially declined an invitation to join Alpha Omega Alpha, assuming it was a social fraternity for which he had no time.
"If someone had told me I would become a researcher, I would have said they were crazy," he says. "I did research as a medical student, and I didn't like it." During his residency, first at Yale, as planned, then back at Buffalo, where he returned after his father's unexpected death, he saw a disconnect when he looked at many of the faculty who were "nice, normal people inexplicably dedicated to research." Yet when SUNY-Buffalo allowed Lawley to complete the last year of his residency in the dermatology branch at the National Cancer Institute (NCI), he discovered he was wild about research, when the questions were his own. Over the next 13 years, he developed a national reputation as a researcher in immunologically mediated skin disease. He also treated patients, a practice he continued throughout his career at Emory.
When he took the Emory dermatology chair, his NCI colleagues were dubious. They saw a quagmire, but Lawley saw an opportunity to build a program from scratch. The Emory chairs of medicine, pathology, radiology, and surgery were so eager for him to come that they offered him some of their own funding and research space. The ink on his contract had barely dried when Lawley began recruiting, starting with NCI colleagues Wright Caughman, now Emory's executive vice president for health affairs, and Robert Swerlick, now chair of dermatology and chief of dermatology services for Emory Healthcare.
Finding triumph in a ‘worst job'
The best part of being dean, says Lawley, was recruiting chairs who shared his belief in the school and in doing the right thing for the school, however painful for the individual or department. Claudia Adkison, former executive associate dean, says that more than once she watched Lawley pass over a chair candidate widely assumed to be the No. 1 catch in the country because he felt the person lacked the collegial character he wanted among his leadership.
For much of its history, the medical school had focused mainly on patient care and teaching. Research had taken a backseat. When Lawley took over, that had begun to change. The school won research funding faster than more established medical schools, although, Lawley admits, it was starting nearer the bottom. To make up for lost time, it needed a critical mass of researchers and research space. Lawley launched the school's first research strategic plan in a decade. Six years later, the school had 80% more investigators, half a million gross square feet of new research space, and new programs and services to support research.
During Lawley's deanship, the school began the largest construction boom since the university moved from Oxford, Georgia, to Atlanta in 1915. One million square feet of new space was added. Research funding shot up five times over, to more than $427 million last year. The school now ranks 15th in NIH funding.
Lawley seized an opportunity few deans get: to oversee the design of a new building and new curriculum simultaneously. The 162,000-square-foot James B. Williams Medical Education Building, which opened in 2007, quadrupled teaching space and made possible a 15% increase in class size.
The new curriculum, which also debuted in 2007, exposes students to patients early and often from their first semester; teaches basic science in the context of its relevance to health and disease; provides more time in small group classes and outpatient settings, where most doctor-patient interactions occur; and includes a minimum five months of "discovery" at Emory, CDC, NIH, or other research settings and a mentoring system in which faculty and students remain in the same small group together from year 1 through graduation.
Overall, students give positive feedback on the new curriculum. They are hitting new levels of residency matches, and some are graduating with first-author publications, says Bill Eley, executive associate dean for medical education. Last year almost a fifth of the class did not graduate "on time," much to the faculty's delight, having opted to complete an MPH or pursue additional research.
Not everything about being dean was fun though. Inevitable problems arose: a student or faculty member who crossed an ethical line, faculty or staff disagreements with some decision or direction. But, "Tom balances competing interests with dignity and respect, even when personalities are strong and the noise level rises," says Ray Dingledine, executive associate dean for research.
Noise was particularly high during the restructuring of The Emory Clinic in the mid-1990s, from a private, for-profit partnership to a nonprofit faculty practice, a time filled with overflowing meetings, strongly held opinions, and considerable angst.
Johns, who oversaw the restructuring, credits Lawley with infusing the process with a calm confidence, gaining support of the chairs and section heads. "If someone brings Tom a problem, they leave his office understanding his position and respecting how he arrived at it," he says. They also know, adds Eley, that "they always have access to him, that what is said behind closed doors stays there, and that once he promises something, it comes to pass if humanly possible." Adkison says she watched Lawley fight battles for chairs and faculty that they had no idea were even going on.
The crisis that cost Lawley the most sleep revolved around Grady, the large public hospital where about one-fourth of Emory medical school faculty, 360 residents, and many medical students spend part or all of their time. Over the years, Lawley watched in dismay as his faculty at Grady struggled with aging equipment, lack of basic supplies, and administrative disorder. Grady's multimillion-dollar deficit climbed, and state and county support shrank. Vendors waited months for payment, and Emory was always last in line. Ten times Lawley entered discussions with the hospital CEO, only to begin again when that CEO was replaced. Had Emory called in the debt, he says, the hospital would have gone under.
What Lawley, Bill Casarella (executive associate dean for clinical affairs at Grady), and the faculty did was sound the alarm, starting with elected officials and others. Former Georgia Pacific Chair Pete Correll first saw Grady's dire condition on an ER tour arranged by the medical school. Shocked, he started mobilizing. The Atlanta Chamber of Commerce created a task force of 17 business leaders, chaired by Correll and real estate developer Michael Russell. Its rescue plan included a new governance structure. Named to the new Grady Health System Board, Lawley provided a better understanding of Grady's importance—and Emory's contributions to the hospital. In the end, the Woodruff Foundation pledged $200 million to the effort to rebuild Grady, fueling enthusiasm from other donors, and Emory forgave part of the $60-plus million Grady owed the school. The following year, Grady's finances began to improve.
"The medical school is in a good place now," says Lawley, "and there are other things I want to do professionally and personally." He plans to take a year's sabbatical and travel with Chris to New Zealand and Africa and back to Ireland, a favorite destination of theirs. He will read some of those books Chris keeps recommending. He and several other health sciences center administrators took up quail hunting, and he found he liked it. His hunting dog has died, but his shotguns are at the ready. He enjoys making pasta, risotto, and other dishes he calls "experiments" on the weekends and hopes to take cooking lessons in Italy.
And, to no one's surprise, he will work. As a faculty member, he'll spend more time with patients, teach more, write about issues like student debt and health care reform. Speaking at his last graduation ceremony as dean this past May, he urged students to recognize and be open to the opportunities that will present themselves throughout their careers. "If I had not done that," he said, "I would have missed so much. I started by wanting nothing more than to help make patients healthier. I ended up finding new ways to do it." EM