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Benjamin Sachs, MD
Vice President and Dean Tulane University School of Medicine
PUBLISHED: May/June 2011
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Dr. Benjamin Sachs joined Tulane in November 2007 to help the university and city
address significant challenges following Hurricane Katrina. The storm caused
$900 million in damages to Tulane University and Tulane University Hospital, and
one-third of the medical school faculty left. In partnership with a new leadership
team and dedicated faculty that returned after the storm, Dr. Sachs has guided the school
through a major rebirth.
Before joining Tulane University, Sachs was at Harvard University for 29 years. He held several
senior administrative positions at Harvard Medical School (HMS) and the Beth Israel
Deaconess Medical Center (BIDMC), including Department Chair, Obstetrics and Gynecology
at BIDMC-HMS, the Harold H. Rosenfield Professor of Obstetrics, Gynecology, and
Reproductive Biology, and professor at the Harvard School of Public Health. Sachs was elected
President of the BIDMC Physician Organization, an organization of 1,500 physicians, for
three terms.
Born in London, Sachs graduated from St. Mary's Hospital Medical School (now known as
Imperial College London). He received a degree in public health from the University of Toronto
and completed a residency in obstetrics and gynecology and a fellowship in Maternal-Fetal
Medicine at the Brigham & Women's Hospital. In addition, he was a visiting scientist at the
Centers for Disease Control in 1980 and completed the PMD program at the Harvard
Business School in 1987.
Sachs has been involved in international healthcare initiatives including fundraising for and
the development of women's and children's health centers in the Philippines, Armenia, and
Ukraine. A result of his efforts, the center in Dnieperpetrovsk, Ukraine provides free care to
20,000 women and children each year. Sachs is on the boards of a number of community
organizations and in recognition of his work, has been the recipient of a number of community
service awards.
Smith W. Hartley: You recently started doing medical
education at Baton Rouge General. Can you give
us an update on how things are going?
Benjamin Sachs: It’s going extremely well. We just
selected our second class that will be coming up in June
or July. It was competitive. The students had to provide
an essay as to why they thought a rotation of their medical
education should be in Baton Rouge and what
advantage they could take of the Baton Rouge environment
by doing electives with the Governor’s office, the
Secretary of Health, and all the rest of them. Then we
selected a cohort of students. This year we had ten and
now we are going to fifteen and so we’ll slowly ramp up.
SWH: And what is the intention behind the relationship
with Baton Rouge General?
Benjamin Sachs: Long term, Baton Rouge General is
very interested in becoming a teaching hospital. It’s a
teaching hospital today, but to become a full-fledged
teaching hospital where you are involved with medical
students, you’re expanding your residency programs,
GME, you are starting to do clinical research. So we’ve
got a clinical research unit that’s going in now. We are
going to perhaps think about expanding residency programs
with some of the new opportunities coming down
through the federal government—expansion of GME.
And by having medical students coming up there you are
beginning to get the staff used to teaching and thinking
about medicine from more of an academic perspective.
SWH: Do you also hope to keep some of the young
physicians in Louisiana? Is that part of your objective?
Benjamin Sachs: Absolutely. Just to give you some
stats: last year and this year we had over 10,000 applicants
to medical school for 188 spots so that’s about one
in four of every applicant to medical school applied to
Tulane. T-1, the first year class at Tulane is probably the
best class we’ve ever had in terms of their GPA and
MCAT scores. Ever. The largest cohort we have comes
from California, but they come from all over the United
States. In fact I think nearly every state is represented in
the class, so it’s very much of a national school. So if we
can keep these really, really bright kids here, that’s our
future.
SWH: How would you characterize the supply of
physicians in the state? Do we have enough?
Benjamin Sachs: Most of the major organizations
would indicate that we do not have enough physicians,
particularly in primary care. Everybody agrees we don’t
have enough primary care. There are some indications
that overall we have a shortage of physicians because of
the aging of the population and because of new technologies
and new things we can do for patients. So the
demand for medical care is going up.
In my mind, I think we do have a shortage of physicians,
but I think that some of the physician needs will be
replaced by nurse practitioners and physician assistants
and a far more astute use of computers long term. I do
think there is a need for more medical school grads,
more trained physicians. The other thing that’s happened
is that over half of medical graduates in the United States
are women. They want to have families, and rightfully so,
and the workplace was not geared up for that. It’s beginning
to gear up to that so many of these younger women
coming out of medical school want to have jobs where
they are in larger groups so they have time with their
families and they have more of a balanced life. That will
also put some sort of a stress on the workforce, but for
the better. Let me make that very clear, I think these
things are for the better. I think it’s great that we have
more women telling physicians we need more of a balance
in our lives and for physicians that work 36 hours
nonstop it’s probably good that someone says to them,
“You shouldn’t be working 36 hours.” I’m very much in
favor of this.
SWH: What sort of changes do you think we need to
be making in medical schools? Are we not doing
some things we should be doing and teaching some
things we should be teaching?
Benjamin Sachs: Oh I think definitely. I am going to
give you a shopping list in no particular order. What we
teach medical students will be out of date in the next five
to ten years. They have to learn it because they have to
take their boards, but in essence it’s going to be out of
date in another five or ten years. We are accumulating
new ideas, new technologies so rapidly. So the job of a
medical school today is also to teach people how to
learn. Not just what they learn, but how to learn so that
medical students coming out will always be lifelong learners.
So the techniques that some medical schools like
ours are adopting, are team-based learning, problembased
learning, just-in-time learning, which is a technique
taken from the schools of engineering. These are
techniques for medical education that are very, very different
from the old days where you just crammed facts
into their heads and they sat in boring lectures and
watched slide shows. So the first thing is we need to concentrate
much more on how we teach, not so much on
what we teach.
The second thing is I think physicians of the future have
to begin to think about what their role is in the ecology of
the healthcare system. Not just, “I’m going to be a neurosurgeon
and the world revolves around me,” or “I’m going
to be an obstetrician or an oncologist,” but, “I am part of
a team.” Medicine is really a team sport. It is not an individualistic
sport. We used to select physicians in my era
based on their individualism, but today it’s much more
about are you going to be a good team player? Because
you are going to have to coordinate with nurses, pharmacists,
nurse practitioners, other healthcare workers, labs,
technicians. That’s why it’s much more a team-based
sport. We don’t do enough of that.
SWH: Are the medical schools doing anything to
incorporate these sorts of concepts?
Benjamin Sachs: We do team-based learning and simulation-
based learning. We have a simulator and we have
pharmacy students and nursing students who work
alongside the medical students. So we are beginning to
get there.
The third thing is that patient safety and healthcare quality
is never mentioned in medical school. Most medical
schools are not mentioning it and it’s absolutely essential.
Every physician needs to constantly think, “How can I do
this better? How can I do this safer?” Constantly think like
in the car industry in America, that Toyota method, “How
do I constantly make things better? How can I learn from
my mistakes?” So that’s the next thing that we need to do
that we are making mistakes on.
I think the physician of the future has to be very adept at
using electronic medical records, all the IT stuff. Not only
to look for information, but also how to use electronic
medical records. I love the idea of knowbots. Do you
know what a knowbot is? It’s a piece of software that sits
out on the Internet and you program the knowbot. If your
particular area of interest is meningiomas and particular
kinds of meningiomas with certain genetic backgrounds,
the knowbot will overnight scan the whole Internet and
pull all the information here. You wake up in the morning
and on your desktop is all the things collected by the
knowbot. It’s a very sophisticated Google, if you think
about it. It’s a program that is constantly out there sifting
through huge amounts of data. How does a physician
begin to understand that?
Genomics. Clearly the wave of the future. It will change
everything we do in medicine. Everything. It’s a bigger
revolution than the advent of penicillin. The Human
Genome Project finished in 2003. It cost $300 million to
run the first genome on a human being and now it costs
about $1000 and takes four minutes. We don’t understand
what it all means yet, all the information we get, but
it’s beginning to affect how you monitor somebody’s
Coumadin levels, to what kind of tumor they have, to
what’s their response going to be like to different kinds of
therapy? We know that on the shelves are many drugs
that were abandoned because they had a side effect rate
of let’s say one in 10,000, but no pharmaceutical company
could afford to take the risk of a one in 10,000 side
effect. They are very effective drugs and now we’ll begin
to create designer drugs and we’ll know who we shouldn’t
give that medication to and can go back to a huge
number of medications that are already on the shelves.
So we are going to see a really big shift in pharmacology,
diagnostics, management, preventive healthcare.
Children will have their genomics run at birth. We’ll be
able to tell parents how best to try to work with their child
to prevent certain kinds of illnesses. It’s really an incredible
era that we are stepping into. But to teach young
people this in medical school when most of the professors
don’t understand it themselves—that’s the challenge.
How do I get the faculty when I don’t claim to
understand these things? How do I get our faculty, who
obviously are a couple of years younger than me, to truly
get our young people to understand this?
And I think there’s one other component. I don’t think we
are training enough physicians to be managers and that’s
a very important role. I think we’ve left medical management
up to the non-physicians, and there’s a place for
non-physicians, but if you are talking about how to
redesign your operating room to make it more efficient, or
your labor and delivery or your outpatient services,
there’s nobody better than a physician that has some sort
of public health perspective to be able to do that.
I think we are at a time of major change in medical education
worldwide and we’re trying to tackle some of these
problems.
SWH: How then do you set your framework for your
curricula?
Benjamin Sachs: Most medical schools have food
fights over the curriculum. “I want six weeks to teach my
course. If you don’t give me six weeks I am leaving.” So
when I came I said, “Guys what we teach is not important.
I’m going to challenge you to think about how you
teach. It won’t matter if you have six weeks. You’ll be
evaluated by how aggressive you are in terms of how you
teach.”
SWH: With regard to curricula, how do you characterize
the continuing medical education in this country?
Is there improvement?
Benjamin Sachs: No. It’s awful. What’s happening in
the Common Market faster than it’s happening in the
United States is the whole issue of re-credentialing. We
require CMEs to try to keep physicians up to date. And
don’t forget these are physicians who came out of the old
world where they were taught “what” instead of “how.”
What’s happening abroad is for re-credentialing a surgeon
they would have to do online courses, show that
they understood the material, they would have to take
tests, but then they would have to go into a simulator, like
a pilot goes into a simulator. I want to know that the 60-
year-old surgeon has the manual dexterity to be able to
adapt when there’s a patient waiting in the operating
room. I would want to know that somebody who is twenty
years out of medical school knows how to use the
equipment. How many times, even at the best teaching
hospitals, have I walked into an operating room and seen
a surgeon asking the technician how to turn on a piece of
equipment or asking the company rep in the operating
room how to use a piece of equipment? I think it would
be preferable if we had simulation-based training so
these physicians have to perform first in a simulated environment
and then take it to the operating room. I think
that will change CME. CME will be designed much more
towards credentialing or re-credentialing the physicians
for hospital privileges or retaining their license. It will be
based on cognitive skills as well as physical or manual
dexterity.
SWH: How important would you say are public
health, epidemiology, nutrition, as they relate to medical
education?
Benjamin Sachs: Vital. Tulane has the largest MD/MPH
class in recent years. You can get your MPH at the same
time you get your MD degree. We have about 65 kids
every single year doing that. So we believe in it. We walk
the talk, so to speak. It’s those MD/MPH kids who we’re
offering the chance to come up to Baton Rouge to get
practical experience in public health.
SWH: What do you see as the future of Medical
education at Tulane Medical School?
Benjamin Sachs: In 2005, after the storm, there were
serious discussions about moving Tulane out of state.
Moving the medical school out of state. The medical students
were at Baylor and nobody knew whether it could
come back. One-third of the faculty had been laid off.
When I came to Tulane in November of 2007 there were
huge financial losses, research destroyed, literally flooded.
Everything really was destroyed by the storm and still
not recovered. But I realized that with the men and
women that came back after the storm we could build
something different. I’m going to answer your question a
little tangentially, but this year we just finished we had the
best year for research in the history of Tulane ever.
Incredible. We have more applicants to medical school
than ever. Our entry class is the strongest class ever in
terms of MCATs and GPA. Far above anything we’ve ever
known. Through our network of neighborhood health centers
we’re really reforming healthcare delivery in New
Orleans. To watch all of this is just incredible. It’s the
energy and the courage of the faculty that came back after the
storm. All I had to do was wave at people and smile and give
them a little bit of confidence and they just took off. That’s
really who takes the credit for all of these things.
So where we go from here is much more of the same.
Accelerate further the healthcare delivery reform in New
Orleans. We are moving towards bringing the School of
Science and Engineering, the Primate Center, the School of
Public Health and Tropical Medicine, and the med school
closer together for research. I want the physical scientists
working alongside the biological scientists. I want physicists,
chemists, and mathematicians to ask the same questions
from their perspective as the biologists. We are building a Bio-
X complex. We’ve got a $43 million dollar renovation going on
as I speak. We raised the money and these Bio-X complexes
are like no other research facility you’ve ever been into.
Because it allows physicists and chemists and mathematicians
and engineers to work alongside biologists who ask the
same questions. That will be our strength. We’ve got a great
Primate Center in Covington; it’s the biggest primate center in
the United States. It’s got a bio-defense lab; we just invested
$40 million into that. They are doing infectious disease
research that is incredible. The School of Public Health and
Tropical Medicine really has an international perspective on
top of everything. So from a scientific point of view we’re
going down this road very aggressively. From a public health
point of view, we are doing that as well. And we have some
plans for some other major initiatives. We’re not sitting still.
SWH: Are you enjoying New Orleans?
Benjamin Sachs: It’s great. I’ve had three years. You know
I spent 29 years at Harvard and if I would say to a Harvard
faculty member, “Why don’t we think about doing this or that?”
They would look at me and they would say, “I’m from Harvard.
Why should I change? The world comes to me.” We make a
suggestion in New Orleans at Tulane and it’s, “Let’s do it yesterday.
Let’s try it. It may not work, but let’s give it a try.” It’s so
refreshing. And people in New Orleans have been really
incredible to me—every part of the community has welcomed
me from one end to the other. It’s great.
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