It’s just after sunset as he settles into his apartment in Zambia’s capital city of Lusaka. He’s already made the rounds with local broadcast media this morning, outlining his plan for reversing the scourge of malaria from the villages on up. Tomorrow he’ll set out for Hopkins’ lab facility many hours away, 50 miles from the nearest paved road. He feels good, like this is all part of what he was born to do. “I’m at peace with the world,” he says.
It’s been six years since the Nobel Prize catapulted Peter Agre from merely lauded wunderkind into roving scientist. He’s 60 now, in perfect form. His mission transcends politics in the most magical way, allowing him to pass through hostile borders and solve elusive human problems. “As a scientist I always feel welcomed,” says Agre. “They treat me as if I’m some kind of conquering hero.”
If Agre carries a halo, of sorts, he knows it was formed and polished over the past 28 years at Johns Hopkins, and he carries the Hopkins banner wherever he goes. When he is invited to present his science to select gatherings—an ever-more-frequent occurrence with his new posting as head of the American Association for the Advancement of Science—Agre opens his slide show with images of iconic Hopkins buildings. The institution’s leadership knows this, too, and the mutual admiration is the stuff of an unbreakable bond.
Seemingly unbreakable. On the heels of his Nobel invitation to Stockholm in 2003, the bond was put through its field trials. Thousands of outside contacts poured in during that first week alone, many of them soon escalating to actual job offers from top-drawer scientific institutions, all hoping to lure a Nobel Laureate who would become the global face for their brand of science. Some of the deals were particularly seductive. A high-stakes tug of war was about to ensue.
|Peter Agre `74 (right), whose aquaporin breakthroughs earned him a Nobel prize in 2003, chats with Chi Dang on the day he recieved the big news. Soon after, the job offers come pouring in
IN THE HALLWAYS OF AMERICA’S best academic medical centers, job offers are casually shared as badges of honor. They are sometimes worn as open secrets to convey a rising stock, or even to prompt negotiation. It’s well-known that the leading university powerhouses compensate their faculty at much lower rates than what great scientists can find elsewhere—especially in the commercial realms—and the most accomplished faculty members here receive upward of three or more serious offers every year. The happiest faculty, of course, like to boast they don’t even pick up the phone when callers come courting. But with Hopkins so perpetually high on the list for talent production, suitors’ enticing propositions remain an ever-present—and potentially escalating—threat. The past year alone has seen the loss of a number of faculty.
Curt Civin, a Hopkins pillar for 30 years, announced he was leaving to head up his own department at the University of Maryland. Breast cancer researcher Nancy Davidson departed for a top post at the University of Pittsburgh. Cardiac researcher Charles Lowenstein prepared to run his own division at the University of Rochester. Neil Powe, a highly published epidemiologist and Hopkins stalwart since 1986 who wrote the book for end-stage renal disease and directed Hopkins’ epidemiology-focused Welch Center for 12 years, accepted a position as head of medical services at UCSF. Ascendant cardiology researcher Hunter Champion, who contributed to a series of findings showing that Viagra could prevent or reverse some effects of cardiomyopathy, announced plans to head up a new heart-lung institute at Pitt.
In the same way that individual faculty members see the offers as helpful to their careers, senior leaders here say the actual departures are, at bottom, Hopkins’ raison. In keeping with the institution’s “Knowledge for the World” ethos, a portion of the best and brightest are supposed to depart East Baltimore, at a steady pace, by design. “We are in the export business,” says Mike Weisfeldt, who as head of Medicine is also charged with helping to maintain the highest quality faculty within Hopkins’ walls in the meantime.
Dean/CEO Edward Miller’s passionate want of great talents is tempered with a pragmatically healthy respect for financial limits. “It is always a challenge to hold top talent,” Miller acknowledges. The task is especially complicated in that—when compared with peer academic medical institutions in the American Association of Medical Colleges—Hopkins faculty salaries fall into the 25th percentile. That figure is hard to change in a non-profit academic environment that faces declining insurance reimbursements and shrinking federal grants, all of which impact the pot for faculty compensation. “We’re never going to be able to chase salary,” Miller says. “But to the extent that we can endow chairs and allow our people to do their best work, we aim to be a magnet for those aspiring to lead in their fields.”
Wherever possible, Miller works to find other ways to sweeten the Hopkins situation for a desirable faculty member he wants to retain. He gladly steps in whenever a department director asks him to, finding face time with on-the-fence stars about 10 to 15 times a year, often to great effect.
As the principal keeper of the budget, CFO Rich Grossi acknowledges extra efforts to retain the “walk-on-water candidates”—those at the level of, say, the late Victor McKusick, a Sol Snyder or a Bert Vogelstein. Grossi, who has now been here for 30 years, takes the long view when assessing the latest wave of departures. He says he has watched faculty grow steadily for the last 10 years, and believes the comings and goings are still within an acceptably healthy range. “We don’t really lose a lot of people.” With faculty now at 2,200, he adds, “the School of Medicine has a very deep bench.”
That may be true, says Vice Dean for Research Chi Dang, who is nonetheless uncomfortable with the status quo. Though he’s on-message with Hopkins’ larger global calling for producing medicine’s leaders, Dang lately thinks we’ve become generous to a fault. “I have become cynical,” he says. “We always pat ourselves on the back when somebody leaves, saying that we’re just populating the world with leaders. I don’t think so. I think we just failed to retain somebody.” As one of Dean Miller’s own cultivated faculty advocates within the executive suites, Dang has become one of the most strident voices for doing more, and doing it sooner, to keep star faculty members close to the Hopkins Dome. Nothing less than the future of Hopkins’ position atop the ziggurat of American academic medicine is at stake, he says.
Miller agrees that improving faculty retention is among the most urgent priorities of the moment, and notes that it’s a process already in the works among the deans. Dang believes it can’t come to fruition soon enough. “If we can become the institution that solves this problem,” he says, “we’ll be much better off than the other places because they won’t be able to steal our people.”
When Hopkins’ leaders dwell on this topic, they often use the terms “push” and “pull,” shorthand for when faculty are pushed from within to move up or out, or pulled away against the institutional will. Both forces are always present in a healthy top-tier institution, but it’s the pull cases that currently concern many Hopkins leaders. Some of these poachings serve as case studies that illuminate the institution’s internal mechanisms and priorities: Selecting a promising new cancer chief compelled other Hopkins leaders-in-waiting to seek out their own top posts elsewhere; the departure of a gynecological figure created a rival women’s center; a group of orthopedics heavyweights also set up shop in another part of town, challenging Hopkins’ place at the center of the region’s medical universe.
THE FORCES THAT PULL at Hopkins faculty are sometimes felt in the executive offices with the opening bids. As Chi Dang recalls with an ironic smile in the case involving Agre, he began to detect what he calls “this sucking sound coming from Duke” almost instantly on the heels of the Nobel announcement. This wasn’t Duke’s first overture for Agre, and both of his daughters had just enrolled at North Carolina colleges. As Dang mulled the basic math, a major Hopkins donor telephoned him, urging him to initiate protective measures to keep Agre in the Hopkins family. The donor suggested a full-court press to get Agre an endowed chair, a time-honored means for retaining major academic figures when their stock is on the upswing.
Dang took the ball and ran, tapping out e-mails to Dean Miller and then-University President Bill Brody. The pair demurred on the endowed chair question—hard to come by at the going rate of $2 million—but Miller launched a series of personal meetings with Agre aimed at finding ways to make the laureate happy with his Hopkins arrangements.
Agre thought Miller said all the right things, and congenially agreed to keep him in the loop as the Duke talks continued.
Alarmed that Duke’s proposal remained in play, Dang upped his campaign. If an endowed chair was not going to happen any time soon, then perhaps a more dramatic gesture would do the trick. “What about a ‘senior vice dean’ position?” Dang asked in the executive suites. “A position where he’s one step above the rest of us?”
Dang says he felt alone in the novel proposal. He sensed nearly all of his fellow senior officers considered Agre’s acquiescence to the Duke offer a fait accompli, as if it were the inevitable outcome of the world’s highest honor being bestowed upon any scientist with a naturally roving soul. Dang had been a longtime friend and confidant to Agre. He knew about Agre’s deep emotional bonds with Hopkins and thought Agre could be turned around. “I feel there’s a time to act,” he says. “It’s not just fanfare stuff. They need to hear, ‘We like you.’”
If that was the case, Agre didn’t hear it loud enough. Duke asked him to visit. “So, of course,” says Dang, “Peter went down.”
The courtship lasted more than a year before a headline announced the news in The Baltimore Sun: “Nobel Laureate Leaves Hopkins for Duke.”
But Duke wasn’t finished. Within a year of Agre’s settling into his new arrangements in North Carolina, Dang got a call. Would he be interested in heading up the rising colossus of Duke’s school of medicine?
“I’ve been asked to look at jobs,” says Dang. “So the question is, ‘Why am I still here?’”
Photo by Chris Hartlove
|"We didn't come here because the food was great and the hours were short." — Stuart Ray
WHY, INDEED, DO SO MANY ATTRACTIVE senior faculty members stay at Hopkins despite more generous offers to work elsewhere? In places with sunnier climates? In cities with lower crime rates? With offers of higher academic rank and the financing and support to create their own dream team departments?
Interviews with more than 50 senior people within the School of Medicine—or recently departed from it—show one remarkable point of consensus. Nearly all of them profess an undying love of Hopkins despite its shortcomings, and they invariably cite the trademark quality of collegiality that’s become embedded in the institutional DNA.
“My 23 years here have been tremendous,” says Neil Powe, just days before leaving for his new post at UCSF. “I love my colleagues.”
“It’s not just that your colleagues here are the very best in their fields,” says molecular biology heavyweight Tom Kelly, who surprised even himself by parting with a distinguished 30-year Hopkins career in 2002 to direct the Sloan-Kettering Institute. “It’s that they also are genuinely interested in your success, not just their own.”
“Hopkins is sort of like an Amish village,” says Peter Agre. “If your barn burns down, the whole village will help you rebuild it the next day.”
Agre says he sensed the communal lure during his time as a medical student here in the early 1970s, when he felt swept up by the generosity of ascendant research figures like Vernon Mountcastle, Helen Taussig, Barry Wood, Dan Nathans, and Victor McKusick, all institutional lifers who were actually changing the scientific landscape far beyond the confines of East Baltimore. Agre found them eager to share their most hard-won bits of knowledge with other would-be future scientists. “The Hopkins call was so penetrating that it was impossible for me to ignore,” he says.
That call is partly born, according to many, through a selfless embrace of hardship. Hopkins alums are not shy of comparing it to the sort of esprit de corps forged in elite military boot camps. The view is particularly evident among veterans of Hopkins’ grueling Osler medical residency—notorious breeding ground of the so-called “Osler marines”—one of medicine’s years-long exercises in self-denial. “The Osler service is legendary for not caring for you,” says infectious diseases expert Stu Ray. “You care for others.”
Ray says the Osler program’s rigors left deep imprints on his career track. “We didn’t come here because the food was great and the hours were short,” he says, adding that the hardships bound him and fellow program alums to a calling larger than themselves.
Urology trailblazer Patrick Walsh says such trials act as an informal selection process that favors medicine’s true believers. Walsh left a medical career amid the comforts of California for what he saw as a life of higher purpose in Baltimore. “Why would someone want to do that?” he asks. “It’s because you want to make a difference. To me, it’s the reason this place attracts and binds.”
Some even argue that the relatively modest salaries here are part of the sorting process. “Nobody comes to Hopkins for the money,” agrees Janice Clements, a vice dean for faculty affairs who has nevertheless recently explored prospects for an across-the-board boost in faculty compensation. “We know this is a problem,” she says, acknowledging that her bid “has been tabled” this year by the broader market trends—even as Dean Miller continues to talk of creating opportunities to retain high-achieving faculty.
Ray, whose 19-year mission here has lately been gaining traction against Hepatitis C, felt the salary squeeze acutely up until about seven years ago—when he suddenly found himself on the receiving end of a tantalizing offer from Vanderbilt. With a serious proposal in hand that would have boosted his salary by half, Ray was forced to weigh the abandonment of a years-long quest to tackle one of the world’s great afflictions, along with all of the colleagues with whom he’d launched such an exquisite series of studies.
He would have headed his own program at Vanderbilt, but he’d also be lofted into an administrative role too far removed from the laboratory bench work where he’d left so much unfinished business. His job in Nashville would be to replicate the Hopkins program. In the course of an agonizing half-year process in which he and his wife looked at homes in Nashville and gauged the costs of uprooting their two young children from the county public schools they loved, Ray looked around at all that he and his five close colleagues had accomplished and asked himself a very basic question. “Why start over?”
“I don’t feel like my colleagues here are competitors,” he says. “I like the fact that when I wake up in the morning, I’m mulling science all the time.”
Not that he didn’t exploit the Vanderbilt option. Ray openly shared the news via comfortable relationships with senior colleagues Dave Thomas, John Bartlett, and Mike Weisfeldt. Heck, years earlier Ray had shared a 700-square-foot lab space with Thomas, now his division chief. They’d later pulled long hours together for five years in a windowless lab, which was eventually “renovated” with a fresh coat of paint and new towel dispensers. He’d paid his dues in spades, and decided to use the Vanderbilt offer to accelerate his hopes for a few small adjustments.
His seniors listened, as Weisfeldt seemingly waved a magic wand that ushered in meaningful changes. Now Ray is delighted to show a visitor through rows of premium new lab benches in the Rangos Building, where his own private office showcases footings of the looming new biotech park further west on Madison. Ray will be up for a full professorship at the age of 45, and he gets to keep tending his pet projects, his babies, until they learn to walk.
There have been similar success stories involving other Hopkins stalwarts, most of whom were also core members of ongoing research programs that vested them with an undeniable emotional allegiance. All of the reversals were supported by Miller, who empowers each of his deans and directors to make their own best judgments and then assists whenever asked.
Weisfeldt successfully reversed a near-poaching of cardio-radiologist Joao Lima by Harvard-Brigham, at one point stopping Lima in the Hospital hallways to say he’d secured direct talks with Miller. “Ed’s involvement meant a lot to me,” says Lima. “It meant the institution cared.” At another point, Harvard came after pediatrics chief George Dover, prompting Dang to enlist the support of Miller and Grossi in a counteroffer. “We can’t let George go,” said Dang. “We’d have to start over.” Dang also detected and reversed an attempted poaching of neuro-degenerative diseases expert Ted Dawson by the University of Texas Southwestern, holding on to Dawson, two key associates, and their $16 million grant. Dan Ford, vice dean for clinical research, reversed an attempted poaching by a major California institution of prominent HIV pharmacology researcher Charles Flexner. Janice Clements is proud of the recent retention of pediatric gastroenterology expert Maria Oliva Hemker against four successive overtures from top-ranked institutions in the Northeast and Midwest. In that case, multiple parties intervened, including Miller, Grossi, Dang, department chair George Dover and Hospital President Ron Peterson.
Curiously, not all of the nearly poached targets believe Hopkins should ever routinely acquiesce to negotiations. Though Stu Ray used Vanderbilt’s offer to positive effect, he sides with Hopkins’ fiscal conservatives regarding salary talks. “I sympathize with the costs of retaining people,” he says. “You don’t negotiate with terrorists because that only encourages more kidnappings.”
DECLINING TO NEGOTIATE has its own costs.Though it’s conventional wisdom that replacing departed stars almost always costs more than finding ways to keep them, leaders here acknowledge cases where they’ve stood pat in response to outside offers for myriad reasons. Some of those cases are political, some personal, some even purposeful, as in those where a star’s science may have been strong but his or her leadership skills found wanting.
|There are also the no-fault cases, the "good losses," as Miller calls them, where accepting offers from outside the school was actually the smartest move some stars could make.
But there are also the no-fault cases, the “good losses,” as Miller calls them, where accepting offers from outside the School of Medicine was actually the smartest move some stars could make. Miller cites departures like those of former vice dean Catherine DeAngelis for a powerful post atop the Journal of the American Medical Association, or former radiology heavyweight Elias Zerhouni to head up the National Institutes of Health, or former vice dean Michael Klag to lead the Bloomberg School of Public Health. “I think I lost them for the right reasons,” he says plainly.
Still, some departures have long-term consequences. Leaders here describe cases where major researchers have forged paths that came to distinguish the perceived strengths of Hopkins Medicine, areas of excellence that can draw ambitious younger physician-scientists to also steer their careers here. But when a magnetic figure in, say, oncology or radiology, suddenly departs, the midcareer professionals who came for them sometimes feel abandoned—and vulnerable to a hostile takeover.
Because Hopkins likes to “grow its own” leaders instead of seeking talents elsewhere, it is especially the concerns of these “rising stars” that Dean Miller asked Vice Dean Janice Clements and Assistant Dean Lisa Heiser to address in a series of moves over the past year. At a leadership retreat in November, Heiser presented the early results of a 67-question exit survey that 30 recently departed faculty members took the time to fill out. One prevailing complaint often cited by younger faculty was that they felt orphaned within their own departments. Many cited disappointing relationships with department directors and other senior faculty, the very people whose job it was to guide them in advancing their careers. “People are knocking themselves out here,” says Heiser, and it’s especially hard for younger faculty to thrive in a research culture that can rely too much on an “eat-what-you-kill” approach with certain scientific programs.
The more senior-level faculty members surveyed expressed frustrations with a lack of room for advancement. They wanted leadership opportunities, and felt the most expedient way to advance was to find other institutions with openings.
At bottom, says Heiser, the turnover and the complaints must be addressed to reverse the tide. Despite the relatively small number who participated in her survey, Heiser found the senior leaders attentive to her presentations and supportive of her recommendations. Miller took up the cause in a January facultywide open meeting in Turner Auditorium, which generated robust participation.
Heiser followed with the February publication of her 25-page final report, which included key recommendations for policy changes [see sidebar] that Miller has embraced. “Janice and Lisa are doing a great job,” he said in a January interview.
But what about when Hopkins’ “farm system” can’t answer sudden needs in leadership? As one worried senior faculty member asked in the wake of a series of key senior departures, “Can we import as well as we export?”
Though Dang is a big proponent of cultivating from within, he reports that in the rare events when Hopkins must look outside, its courtship skills can compete with the best of them. He cites one ongoing case in which he’s been attempting to woo a star stem cell researcher from a West Coast institution. “We went all out,” he says.
AT THE URGING OF A RESPECTED COLLEAGUE, Dang in June 2007 accepted an invitation to at least visit Duke and hear them out. He and his wife liked what they saw. They were seriously thinking about it until their college-bound daughter spoke up. “If you guys move here I will not come visit you.”
That protest carried real weight (family and kid/school factors were frequently cited by Hopkins faculty as primary career considerations in recent interviews) but another detail also gave Dang pause. He’d stayed in close contact with his friend Agre, who’d kept his home in Baltimore and still maintained a Hopkins office with at least a titular professorship. Agre commuted between Baltimore and Durham, and during their visits Dang began to detect cracks in his friend’s happiness factor with his situation at Duke. Dang was also aware that the top brass at the Bloomberg School of Public Health had been quietly courting Agre even before he left for Duke, a courtship that seemed to be warming.
On one of Agre’s rare workweek visits to Baltimore in December of 2006, Dang saw an opportunity to accelerate the process. “Y’know,” he told Agre, “today is the dean’s annual Christmas luncheon. Wouldn’t it be fun just to drop by?”
At the board room gathering feted by a small jazz group and plates generously laden with chilled shrimp, Dang homed in on Ed Miller among the hundred or so guests and tapped him on the shoulder. Dean Miller wheeled around and didn’t miss a beat. “Agre! I knew you’d be back!” The two quickly broke into the sort of easy small talk distinctive to old friends. If there had been any cooling over the previous exchanges, Dang was satisfied that a thawing was now in place. Agre felt reaffirmed about his lifetime place in the Hopkins family.
In the meantime, the tribal elders at Public Health had come to believe their growing Malaria Institute needed a more powerful global reach. It was going to need its own walk-on-water scientific emissary, someone whose name and credentials would allow them to fluidly pass hostile borders with the greatest of ease. There would be bonus points if the candidate was Hopkins-bred, made in the mold of a Victor McKusick.
When Bloomberg Dean Michael Klag—who’d recently been “poached” from the School of Medicine to replace the departing Al Sommer—asked Agre to meet with him at the Towson Diner on the afternoon of December 26 for some conversation, it felt just like two lifelong friends in blue jeans sharing coffee.
Which it was, in that Agre and Klag had been hired by McKusick himself years earlier and toiled together as assistant professors. Now they sat across a table from each other, both marked with their share of hard-won gray hair.
After laying out some of his hopes and dreams for his school’s Malaria Institute, Klag, in so many words, finally popped the question. “You know, Peter,” he said, “this is the sort of position that could really allow you to address underserved populations around the world.”
Agre had been thinking about this very slow-moving offer for months. He was, indeed, deeply restless, enough so that he was even indulging efforts in his home state of Minnesota to draft him as a candidate for the U.S. Senate. But deep down he was still all scientist, and the Bloomberg idea felt like a chance to come home. “This sounds really important for me,” he said. “I think I’ll try to come back.”
Within the coming year, Agre had begun to settle into new office space in the School of Public Health’s main building on the southeast corner of Monument and Wolfe, surrounded on three sides by time-worn buildings central to the Johns Hopkins School of Medicine that set his great career in motion. During one of those early visits back home, he came upon a familiar guard at an entry-way to the main hospital. “Dr. Agre,” the man said, “It’s good to see you back.”
Pre-empting the Burn of the “Churn”
New report outlines key steps for holding on to top faculty.
While Vice Dean Janice Clements exalts in Hopkins’ formidable track record for building medicine’s leaders, she’s also committed to stemming the tide of premature departures among the core faculty here. After a recent study of the issue, Clements has arrived at a primary conclusion regarding the keepers. “We could do more to keep people from looking around,” she says. “We need to listen to them more, before they develop split allegiances.”
According to a report generated by Assistant Dean Lisa Heiser at Clements’ request, finding the right tools for that mission is a complex task.
Here’s the picture: In fiscal 2008, 93 of the School of Medicine’s 2,015 faculty exited. This constitutes an attrition rate of 4.6 percent, which is on par with that of most other American medical colleges. (Of that 93 at Hopkins, 12 were asked to leave.)
The American Association of Medical Colleges says such “churn” is costly. Turnover typically costs each institution about $100,000 to $300,000 per position, averaging about $3 million per college of the 24 institutions recently surveyed by the AAMC. (Hopkins has not yet done accounting on this, though the leadership broadly agrees turnover is costly.)
“There’s a higher return on investment when faculty retention is high,” says William Mallon, who presided over a recent study of faculty retention as the AAMC’s director of organizational learning and research. But Mallon cites a hidden cost that can apply when key departures play out in a pattern. “There’s a psychological churn factor,” he says, “that makes other faculty ask, ‘What’s going on?’”
As part of the Hopkins study, Heiser secured 30 exit surveys from among the 93 departing faculty in 2008. Most were instructors and assistant professors, but two associate professors and three full professors also weighed in.
Heiser’s 25-page final report, delivered in February, concluded that complaints about work-life balance issues continue to dominate for many of the younger faculty who move on, closely followed by non-competitive salaries. Departing senior faculty members more often cited a dearth of professional growth opportunities, leadership slots, and chances to have impact in new ways and to be recognized for it.
In response, Heiser’s group developed two key recommendations aimed at addressing the issues. The first initiative would enact a series of work-life upgrades—suggestions range from providing more flex-time options to offering part-time tenure tracks with benefits—along with salary adjustments and the identification of new pathways for growth. The second would work on the front end by developing better criteria for selection and recruitment, supplemented by more clearly spelling out expectations departments hold for their new faculty.
Heiser’s report goes far beyond the broad strokes, spelling out details that would improve the protocols to “identify faculty who might be or come to be at risk” of leaving prematurely for another institution. The tools would include methods for improving feedback about performance, along with provisions for better mentoring.
Heiser intends to unveil more details of the upgrade plans in various School of Medicine media venues. “We know our faculty are struggling with Hopkins’ tripartite mission,” says Heiser, “where they’ve got to see patients, conduct research, and educate trainees—while generating revenue in an extremely challenging fiscal environment, being a good citizen, and attempting to have a satisfying personal and family life. We’re hoping to find ways to make it easier for them to do all of those things.” —RF