Banking on benevolence

Also:

Extraordinary vision

Docs in debt

At Emory, things have
  gone well with Coke

by Renee Twombly

The Otolaryngology--Head and Neck Surgery Department at Johns Hopkins was resource rich but cash poor. It had fine scientists with good ideas, but not enough capital to do the research needed to make a lasting difference in human health.

So, the department chair, Michael Johns, got up his gumption and asked for his first million dollars. "I was embarrassed," Johns recalls. "But I got over that quickly. I found out that if you don't ask, it won't happen."

He had suddenly understood that wealthy individuals and foundations like to be given the opportunity to donate to worthy causes. They feel good when their beneficence battles disease, eases despair, and advances medical treatment for the coming generations of patients. Says Johns, now director of the Woodruff Health Sciences Center (WHSC) at Emory, "You are not doing a favor to those who have the capacity to give to worthy places, projects, and ideas if you don't ask."

Johns' experience is one that he would like every researcher and clinician at Emory to have. "The Woodruff Health Sciences Center does not have enough money for all the good and brilliant ideas here, for where we want to go and what we want to do," he says.

For anyone who complains that Emory has a bountiful endowment and that faculty shouldn't be expected to ask for more, Johns reminds them that great universities get that way because they continually build for both the future and the benefit of mankind. "Do you think Harvard has problems asking for money?" he asks, referring to the trendsetter.

From his office in the Woodruff Health Sciences Center Administration Building, Johns says, with conviction, "It takes money to produce excellence, and faculty who do not ask will not receive."

Meeting our potential

The typical philanthropy dollar
(for the Woodruff Health Sciences Center)





Donor Source 

foundations - 44¢ 
nonalumni* - 34¢ 
corporations - 18¢ 
alumni - 3¢ 
other - 1¢ 

*mostly grateful patients 



Donor-Directed Use 

restricted* - 87¢ 
hospitals - 4¢ 
scholarships** - 3¢
nonfederal  
research grants - 3¢ 
unrestricted - 2¢ 
facilities - 1¢ 

*includes endowed chairs, endowed 
scholarships, research, equipment, 
and specific programs 

**one-time 


Philanthropy - donations from individuals, corporations, and foundations - provides the financial margin that makes it possible for researchers and clinicians at Emory and at other academic health centers to seek the newest avenues of research and treatment, WHSC administrators say.

For example, major gifts to the Emory School of Medicine last year, mostly from "grateful" patients or their relatives, included $4.5 million to endow the Marcus Chair in Vascular Research and the Marcus Vascular Research Fund. A $20 million gift created the Andrew J. McKelvey Lung Transplantation Center and an endowed chair in lung transplantation medicine, named after his father, Augustus J. McKelvey. Another gift - $17 million from the Charles Evans estate - establishes a Center for Nursing Skills in the Nell Hodgson Woodruff School of Nursing and substantially funds renovations of the Anatomy and Physiology Building into a medical education and research complex.

These research and clinical initiatives would not have occurred without such extra, dedicated funds that come from philanthropy, says pulmonologist Clinton Lawrence, medical director of the McKelvey Lung Transplantation Center.

"Philanthropy allows you incredible flexibility to look into important issues early that may not yet be on the priority list of NIH," Lawrence says. New labs and new professors in the lung transplant center mean that the researchers and clinicians there will be able to seek federally funded research grants, and this effort in turn advances the health care mission of a top-notch academic medical center.

"Philanthropy simply makes the difference between maintaining and going beyond excellence," Johns likes to say. The new lung transplantation center aims not only to improve the ability of medical science to transplant lungs from donor to recipient, it also seeks to provide new treatments for patients who are ineligible for such a transplant and who now have no other options. "We can't make our next great moves without philanthropy," says Johns, who plans to devote a significant portion of his next five years to fund-raising.

The truth is that the health of Emory University, as an entity, significantly depends not only on the tuition that students pay to attend the school, but also on the strength of its medical enterprise, both now and in the future. Revenues from approximately 2 million patient visits a year keep the health center alive while providing general income to the entire university. Historically, this clinical revenue has provided the margin for teaching and research at Emory. Although the federal government funds millions of dollars of basic and clinical research, those dollars are targeted and do not fully cover all the overhead expenses involved in conducting that research.

When clinical income is constrained, the university as a whole is affected, say administrators. In an open letter published April 8 in Emory Report, Emory President William Chace responded to complaints that employee benefits were being scaled back by saying that pressures on Emory's budget come from factors that the university is powerless to control and that many of them are due to declining reimbursements for clinical care. Besides "the uneasiness of this country's financial markets," Chace cited the "mess" in which American health care finds itself, the Balanced Budget Amendment, and the federal government's reduction of Medicare payments. The problems "will not go away" easily, even if the economy rights itself, he said. "It is not a matter of riding out a brief storm." An example of this is that even as Emory's hospitals are highly ranked nationally, they have little endowment to carry them through years of declining receipts for medical services they provide.

Anatomy of the endowment



Philanthropy simply makes the difference between maintaining and going beyond excellence.

While the endowment of Emory University as a whole looks healthy due to dramatic growth in the last two decades - a rise from around $400 million to about $4.3 billion last year - those funds are not designed to shore up declining campus revenues, including the balance sheet of the WHSC.

An endowment, by definition, allows the institution to spend only the income generated from the corpus or total of the original donated gift. And that income can be used only for the purposes specified by the donor. When accepting a gift, the university agrees, in principle, never to invade the amount of the corpus, to ensure that the endowment "lives" in perpetuity.

The health sciences center's endowment is valued at about $1.5 billion and is part of the university's $4.3 billion total endowment. And like the university's endowment, much of the monies dedicated to WHSC's endowment are "tied up" and unavailable for general use because they are either in restricted trusts or stocks that don't pay large dividends. Income from such endowments are earmarked into specific accounts that pay for narrowly defined projects.

Monies that established the McKelvey Lung Transplantation Center, for example, can be used only to fund one permanently endowed chair and about five faculty positions, plus associated research and clinical laboratory costs. These funds cannot be used to create, say, a kidney transplantation center or to make up clinical shortfall in, possibly, gynecology and obstetrics. Five of the $20 million is, in essence, in the bank and invested, and only a percentage of funds (usually 4% to 5% of the market value) produced by that investment is available for funding the center each year in the previously described restricted ways. The remaining $15 million coming in over the next five years is similarly restricted.

That scenario applies to the total endowment at both Emory University and at the health sciences center: the total endowment is the sum of all the different endowed gift accounts, most of which are dedicated for a specific project. And although the endowment comprises many different investment accounts, its total market value declined precipitously in 2001 by 10% or about $712 million, and that, in turn, forced delays in some campus construction projects.

Projected endowment income will be relatively flat next year and may decline in the coming years, administrators say. The Emory Board of Trustees uses a formula that determines how much income can be spent from the endowment -- $203 million last year.

It is a fact that Emory's endowment has contributed enormously to Emory's growth in the past decade, Chace says, through gifts that have funded new faculty positions, chaired professorships, scholarships, research support, equipment, and facilities. But he warns, "the endowment has done all it can to help us for now; its force is being employed to the maximum."

Now Emory has to increase revenue from new sources to fund high-priority academic initiatives, and that means new philanthropic efforts, which can help feed the endowment, provide support for new and targeted programs, and, sometimes, provide the discretionary, spendable income that the university's endowment and tuition do not.

To the health sciences center, philanthropic funds help researchers and clinicians quickly and efficiently investigate new medical leads to improve human health.

Cultivating relationships



People give money to make a difference, to support the faculty whose vision and  research they think will make that difference.



While many colleges and universities report that annual giving has declined or remained flat in the past several years, the period between Sept. 1, 2000, and Aug. 31, 2001, was the second-best fund-raising year in Emory's history. The university received 31,854 gifts totaling almost $298 million, much more than its annual average of $100-$125 million, and enough to put it 10th among all American colleges and universities in fund-raising. The big leap was due in part to a large donation, about $150 million from a family foundation that has requested anonymity. The amount collected from alumni that year ($3.4 million) was the largest in the university's history.

It was also a good year across campus, especially on the first floor of the Woodruff Health Sciences Center Administration Building, where the health sciences side of the development effort oversees fund-raising and alumni affairs for the schools of medicine, nursing, and public health as well as the hospitals.

"Development" is both an accurate and euphemistic term for what is accomplished by the staff in these offices -- fund-raising professionals help faculty develop contacts and relationships, which can result in new funds that can make a world of difference.

Those efforts have worked. The health sciences development staff has helped increase new philanthropic giving by almost fivefold in the past five years, from gifts totalling about $15.5 million in 1996-1997 to approximately $72 million in 2000-2001. Including Robert W. Woodruff Foundation gifts, the health sciences center's endowment, as mentioned previously, now stands at $1.5 billion. While that seems like a lot, Harvard Medical School alone reported almost a $2 billion endowment last year, with annual gifts of more than $105 million.

To raise such funds, the WHSC's 18-member development staff has increased the number of "contacts" by more than 250% -- from 959 in 1999 to 2,503 in 2001. Contacts are made when development officers meet face-to-face with prospective donors, either alone or with a faculty member, to initiate cultivation or solicitation of a gift, large or small, to support the donor's interest and match that interest with a clinical or research need.

But the reality is that of all gifts given to the health sciences center last year, more than a third came from so-called grateful patients, who donated their money to support the physicians who treated them or a family member or to nurses who cared for them.

"I have seldom seen a grateful patient gift that didn't support the research or programs of the faculty member who took care of the patient," says Phil Hills, interim senior associate vice president for health sciences development. Donations by grateful patients have increased from $1.8 million in fiscal year 1998 to more than $14 million last fiscal year. Halfway through this year, grateful-patient-giving exceeded $12 million.

That means faculty are key to raising funds, says Hills. "People do not give money to me," he says. "People give money to make a difference, to support the faculty whose vision and research they think will make that difference.

"Everyone in the health sciences center can advance the fund-raising mission," Hills continues. "The role of development is to facilitate relationships between the sources of funds and the faculty so we can work with both the prospective donor and the faculty to secure a gift. The relationships of the scientists, the physicians, the nurses, and the deans are key. We help cultivate those relationships and bring them to the level of the donor making a gift."

Neurology Chair Mahlon DeLong says he's been fund-raising for years, but only in the past several years "have we been able to do it seriously and in a focused way, and that's because we have worked with the development office." The $15 million that has been raised by faculty in his department has led to establishment of a top-notch Parkinson's disease research program and programs in Alzheimer's disease, stroke, and neuromuscular diseases. He now is looking to build up centers to study and treat sleep disorders and epilepsy, among other diseases.

Every member of the neurology faculty "is on the same page with the need for fund-raising," DeLong says. "Those dollars allow us to go in new directions."

Wayne Alexander chairs the Department of Medicine, the largest department in the entire university, and has seen the far-reaching impact of new resources. Most recently, for example, researchers funded by the Marcus Foundation discovered markers for arterial disease that will allow physicians to make diagnoses earlier.

"Philanthropy is extraordinarily important because frequently areas that are new and developing are not supported by government sources," Alexander says. "Philanthropy gives us additional resources to develop new programs on the cutting edge of science and the treatment of patients."

Alexander's wish list for other projects he'd like to see funded is as diverse as his department's dozen divisions. They range from enhancing education programs to developing novel therapies for arthritis and autoimmune diseases and evaluating new concepts about diabetes and lung and gastrointestinal disease.

"Faculty are absolutely the key critical element in fund-raising because they have the most direct personal contacts with grateful patients and family members who have firsthand experience with the impact of disease on their lives," he stresses. "Many times a patient will ask directly, 'how can I help?' and "what are your needs?' If a physician doesn't feel comfortable dealing with a patient directly, he or she should contact someone in development."

The payoff from targeted philanthropic efforts can be enormous, especially when the exceptionally well-to-do are contacted. Most of the philanthropic dollars donated to the health sciences center come from a very small number of "leadership gifts" -- donations of $1 million or more.

Of the $664 million that has been raised in the past decade, 69% ($456 million) came from just 33 gifts.

There have been 428 "major" gifts ($100,000 to $999,999) to the WHSC in the past 10 years, accounting for $102 million or 15% of the total. More than $43 million or 7% of the total have come from 1,487 "special" gifts ($10,000 to $99,999).

But the most gifts by far (32,271 totaling almost $62 million or 9%) are "annual" gifts of up to $9,999. Generally, the smaller gifts come with fewer strings attached, so they provide a welcome and much needed source of discretionary funds that may help support students or scholars. Comparatively, more than 90% of the larger funds are endowed with extremely specific and restricted uses, as are monies donated from corporations and foundations. "There's very little unrestricted spending money," says Hills.

In most cases, donors have an idea of what they want from Emory, and it is often investigation and treatment of a disease that has levied a personal toll in the donor's family. "People make philanthropic investments for specific things, and they expect accountability of how the money is used. It's very targeted," says Hills. "It's not a handout business, but a hand-up. The donor helps Emory accomplish great research in the area he or she is most interested in.

"Major donors are increasingly more similar to investors who expect tangible returns for their philanthropic support. While the agreements are not contractual, it is critically important that both the donor and the university understand each others' expectations and desires; otherwise, you are faced with unhappy donors who do not provide further support or with funds that simply cannot be used because of impossible requirements," he says.

When a donor's interest doesn't match the institution's goals, discussions often result in an arrangement that pleases both the donor and the recipient at Emory. Gifts can do great and spectacular things, but they can also cost the institution money if inappropriately negotiated and evaluated. A $20,000 gift to, say, study tooth decay in white mice may mean that Emory would have to hire an expert on mouse oral hygiene, when the only thing the money can do is buy the mice and some food to feed them.

The development staff tries to help a donor find a way to make a contribution that achieves the donor's goals and fulfills the needs and priorities of the WHSC. For example, a donor recently wanted to establish an endowed scholarship with a gift of $10,000. A scholarship at such a level would provide so little annual income, less than $500, that it would not sufficiently help the school or give the donor a sense of satisfaction. Instead, the development office discussed with the donor what he wanted to accomplish (naming a fund in honor of his father) and what other assets he might have to endow a scholarship. Through this discussion, it was determined that a small real estate investment made decades ago could be used to fund a full scholarship at $750,000 and help the donor in his retirement planning. That process is typical of how many gifts are negotiated to create a win-win result for the donor and the school.

Operating on grocery store margins



If you don't ask, it won't happen

American philanthropists invest in those things that make sense to them, and at Emory that has led to a $600 million construction boom. For the health sciences center, that has meant seven new buildings and 1.8 million square feet of additional space over the past five years.

One, the $81 million, eight-story Whitehead Biomedical Research Building, is the second largest structure on the Emory campus, smaller only than Emory Hospital. Faculty in three School of Medicine departments-- cell biology, human genetics, and physiology - presented their case to potential donors, including the Whitehead and Woodruff family of foundations (see page 12) that the building was needed to further medical progress. "The building presented an opportunity to do what we are here to do, and that is to create new knowledge in health care," says Thomas Lawley, dean of the School of Medicine.

Philanthropic funds also create endowed chairs that help attract the best and brightest scientists to do the work envisioned in the building, who, in turn, will generate federal research funds, according to Lawley. Philanthropy can also provide funds to help supplement the costs of running those laboratories and programs. "We have a lot and yet not enough to fulfill our ambitions and the ambitions of our faculty."

While philanthropy has always been important to academic medicine, in the past decade fund-raising has become invaluable, says Lawley, who has been dean for the past six years. "Philanthropy has a greater impact now than ever before here in medicine at Emory. The ability of clinical medicine to cross-subsidize teaching and research has essentially disappeared," he says. "Given cutbacks in Medicare, physicians are working harder than ever and being reimbursed less."

No one knows that better than John Henry, who has been guiding Emory Hospitals in various administrative capacities since 1963. While costs have always been a concern, hospitals are so besieged these days that "there are not enough dollars in the clinical enterprise to make it all work," Henry says. Of most concern to him are the increasing costs of malpractice insurance, sophisticated devices, medicines, declining reimbursements for care, and the squeeze produced by federal, state, and local regulators.

Two of the hospitals he runs, Emory Crawford Long and Emory University Hospital, are much less profitable than they were even several years ago, and a third hospital, Wesley Woods Geriatric Hospital, has never been profitable. That means the clinical enterprise can contribute less to teaching and research at the health sciences center. "Emory has gone from being a clinical mecca to being on the brink of a great research institution, but research does not fully pay its way," Henry says.

"If money isn't coming from the hospitals and clinics to fund research - and it won't in the future - the difference has got to come from philanthropy." Henry is hoping philanthropy will also help shore up endowments at the hospitals and assist in developing new clinical programs.

Mike Johns says that Emory's clinical revenue is approaching that of grocery stores, which often operate on a 1% margin. "We are not a food chain, not a Kroger or a Publix," he says. "We need a much bigger annual margin to meet our mission, at least 4%, but we are not there yet. We are just barely in the black."

Breaking barriers



Our job is to provide the compelling story, the idea that we can turn wealth to the public good.

The School of Medicine, which has an endowment of more than $880 million (making up more than half of the health sciences' overall $1.5 billion endowment) is currently looking for philanthropic funds to provide scholarship money that will help attract top medical students. The best students go to schools that offer top scholarships, Lawley says. Because Emory's School of Medicine cannot offer as many scholarships as it would like, student debt is soaring -- a third of the Class of 2001 finished with debts of more than $100,000.

Cost also is the main barrier to students being able to fully participate in and benefit from programs in the Nell Hodgson Woodruff School of Nursing, says Dean Marla Salmon. The school wants to increase its $23 million endowment to attract more students to nursing - and thus bolster the severely depleted ranks of nurses nationwide - and to provide more opportunities for nurses. The school's new Lillian Carter Center for International Nursing focuses on scholarship, research, and exchange for nurses worldwide and is the academic center for an international nursing joint degree (MSN/MPH) with the School of Public Health. The nursing school's long-standing national leadership in nurse midwifery has expanded to create a new family nurse midwife program for emerging health care needs and has partnered with other specialties to create the Women's Health Practitioner Program. The clinical research focus is fully developed in the doctoral program.

"Scholarship support for all these programs is our most pressing fund-raising need," Salmon says. "The best and the brightest want to study in this atmosphere but can't always do so because of the great debt they accumulate. To continue to graduate future national and international leaders from Emory's nursing school, we must double our endowment to provide significant support for our students."

The 12-year-old Rollins School of Public Health owes a significant portion of its current $19 million endowment to the largesse of the Rollins family, whose business specializes in pest control and home security systems. But Dean James Curran is seeking additional philanthropic support to help recruit and retain top faculty as well as support students. It can be a hard row to hoe, he says. "We don't have grateful patients, and we are too young to have significant financial support from alumni. But we have a compelling mission -- the health of the world."

From his health sciences center-wide perspective, Michael Johns rapidly ticks off new initiatives he would like to see, including ones in bioinformatics and neuroscience, a home for medical students and medical education, and a new Clinic A building, to name a few. A center-wide planning process is now under way to help identify crucial philanthropic needs -- the kind of action that usually precedes a major capital campaign.

Gary Hauk, vice president and secretary of the university, said in a recent issue of Emory Report that a capital campaign with a goal of raising at least $1 billion will likely be launched in four to five years. Those funds will help Emory move further up in the ranks of the nation's great universities, he says.

"To become one of the top 10 universities will require a great deal of resources that are not currently available through our endowment, our research dollars, or the potential for growth in tuition," he said. "We simply must ask our friends and strangers for more money."

Looking to the boomers


There is little doubt among administrators that enough money exists "out there" to meet the needs of an Emory, a Harvard, the American Cancer Society, and all the other worthy organizations and institutions that seek it.

"Over the next 10-30 years, there will be the greatest wealth transfer the United States has ever seen," Lawley says.

Economic models back him up. The New York Times reported in April that researchers predict between $40 trillion to $136 trillion will "migrate between generations over the next 50 years," depending on economic growth rates. And a big chunk of that will end up in charitable endeavors, the Times said. By 2052, $19.2 trillion to $50.2 trillion will be spent on philanthropy. Out of that, as much as $6.7 trillion will go to charity over the next 16 years.

"The baby boom generation really does want to give back," Lawley says. "Our job is to provide the compelling story, the idea that we can turn that wealth to the public good."

Also:

Extraordinary vision

Docs in debt

At Emory, things have
  gone well with Coke

Johns says the best way to provide those narratives is for physicians to speak with patients who seek out opportunities to help, as well as to talk with people not in their care who approach them about giving. Faculty must begin to think about potential grateful patients and other beneficial relationships, to work with the development office in planning fund-raising strategies, and "become comfortable with the notion that, nowadays, asking for funds is a good tool for advancing medical knowledge."

"Physicians are in the best position to do this," agrees Lawrence, whose long-term close relationship with Andrew McKelvey resulted in the $20 million lung transplantation center. "You are asking for a gift for a larger purpose than your own work, and that makes talking about the need for this money much more comfortable," he says. "I take the team approach. This money helps out lab scientists who can bring results to the clinicians, who can then apply advances to patient care."

Lawrence also offers his fellow physician fund-raisers a piece of advice. "It is better to think big. People who are self-made are not attuned to the mundane."

"If people understand how important our mission is, they volunteer their willingness to help," Delong says. "Dealing with disease is a cause that is vital to everyone's well-being."

For more information on making gifts to the schools of medicine, nursing, or public health or to the hospitals and the clinic, contact the Health Sciences Development Office at 404-727-5711.


Renee Twombly is a freelance writer.
 

 



Vision" has taken on many meanings in Bernard Waterman's life. He made his fortune by running and then selling entertainment for the eyes -- a television station. But recently, his own sight began to fail, and he now relies on groundbreaking medical treatments to keep what remains intact. Finally, he has the foresight to know that even greater medical advances in restoration of vision may come if he shares his media fortune with top-notch researchers.

Waterman, who suffers from macular degeneration, was referred to the Emory Eye Center by physicians at the Mayo Clinic because of Emory's research into the leading cause of blindness in Americans over the age of 50. After Emory ophthalmologist Tom Aaberg, Jr., explained the etiology of the disease as well as its limited treatment potential, Waterman enrolled in a clinical trial of transpupillary thermal treatment (TTT) to seal leaky blood vessels that destroy vision in the center of the retina.

Multiple treatments stabilized his loss of vision, but just for a short time. In the meantime, Waterman was doing his homework, learning all he could about the Woodruff Health Sciences Center. "As a layperson, I have a great interest in medicine, especially genetics," says the Sanibel Island, Florida, resident, who has supported genetic research at Mayo. "I know now that Emory is not just about the eyes, but the human being," he adds, reflecting his appreciation of both the depth and breadth of research at Emory as well as the gracious reception his questions have received.

But it is the preservation of vision that most interests Waterman. "I already have friends who are blind," he says. "The population is aging and living longer, and I am concerned about the vision of millions of people."

About a year ago, his Emory doctor, Aaberg, Jr, moved to Michigan into a practice focused on treating children with ocular tumors. He transferred Waterman's care to his father, Thomas Aaberg, Sr., director of the Emory Eye Center. Aaberg Sr. used photodynamic therapy, a "cold laser" procedure that had just received FDA approval, to stop further progression of Waterman's macular degeneration. His condition has since remained stable.

Through his association with the Aabergs, Waterman asked what he could do to help Emory help other patients with macular degeneration.

"He provided us with several pieces of state-of-the-art equipment we could not otherwise afford and which now allows us to offer more precise treatment," says Aaberg Sr. One machine constructs an optical cross-section of the retina and can detect structural changes even before they result in visual deficits. Besides underwriting ongoing refinements for such ocular coherent tomography, Waterman has funded a second device, a digital fluorescein angiography camera, which records circulation in the retina as well as the underneath layers to highlight abnormalities and help diagnose the cause of a patient's eye disease.

"Hospitals, medical centers, and medical schools are under tremendous financial pressure and often cannot fund new developments in technology and treatment," says Waterman of his donation of hundreds of thousands of dollars worth of equipment. "This was a way I could contribute that would be immediately useful."

Such generosity is critical to Emory's battle against macular degeneration, says Aaberg. "Philanthropic giving simply makes the difference between an ophthalmology department that provides service to patients and one that makes a long-term difference in their care," says Aaberg, who started fund-raising when he arrived at Emory 15 years ago -- making the Eye Center the first department to do so at the health sciences center. During his tenure, the Eye Center has raised more than $25 million.

That money has allowed Aaberg not only to start new programs and purchase needed equipment, but provide "support insurance" to faculty so that they can continue to conduct research when grant monies are tight. The center's faculty have grown from five to 26, and its prestige and federal research funding has increased from a negligible level to a rank within the country's top 15 ophthalmology departments.

Most of the discussions about philanthropic donations start with the patient, Aaberg says. "They understand how terrible it is to lose their vision. And they know that if there is no research, there is no hope."

 

Extraordinary vision



Philanthropist Bernard Waterman has
contributed new equipment that allows
the Emory Eye Center to provide more
precise treatment for macular
degeneration.


When pediatrician Keith Seibert considers his financial situation, he imagines a dark cloud hanging over his head, following his every move. By the time he graduated from the Emory School of Medicine in 1999, he had borrowed $150,000 to pay his way through medical school. His debt payments were deferred while a resident, but on the day his residency ended this spring, the looming cloud began to rain.

"My payments are $1,500 per month -- completely unaffordable on anything less than a gross annual income of $80,000 to $90,000 per year," he says. "That fact limits my career options at a crucial point in my career. Because of it, I cannot do a subspecialty fellowship now, despite the fact that there is a national subspecialty shortage. I had to take a job in private practice rather than academics or public health because of my debt. I really had very little choice in the matter."

And that is a tragedy, says cardiologist Joel Felner, associate dean for clinical education at the School of Medicine.

"Debts are even affecting the specialties our students are choosing, which is a horrible situation, and it contributes to declining numbers of graduates going into academic medicine and clinical research. 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. We simply don't have as much scholarship support to offer as our peer schools like Washington University, Vanderbilt, and Duke."

Indeed, Seibert's debt is not an anomaly. Nationwide, the average medical student now graduates with about $100,000 in debt. At private schools, more than a third of graduates owe more than $150,000. At Emory, the problem results from rising tuition and a shortage of scholarship money. Although about 75% of medical students at Emory receive some form of financial aid, it's often a drop in the bucket when students face an annual tuition of $30,000.

That's why School of Medicine Dean Thomas Lawley has made increasing scholarship assistance a fund-raising priority. At every opportunity, he's been asking alumni to support scholarship funds, hoping to double the funds available for medical student scholarships.

"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."

Many young doctors like Seibert are surprised and disappointed to find themselves in severe financial straits as they embark on a life of doctoring.

"My main reason for choosing medicine as a career was for personal fulfillment, contributing to society, and getting a sense of lasting value from my job," he says. "My colleagues and I spent at least seven years after college, training about 120 hours a week. We now find that our educational debts will make it difficult to achieve the basic financial goals that most professionals share. Once we entered the work force, we expected to be able to buy a home, save money for our kids' college education, and maybe take a vacation once a year. Many of us won't be able to do those things for a very long time."

 

Docs in debt
by Valerie Gregg  
We're going to start losing the best and brightest applicants to other medical schools, if not to other professions.


Everywhere on the Emory medical campus are the signs of prosperity produced by the public's appetite for a particular soft drink.

Indeed, for Emory, things have gone much better due to the generosity of three families - Candler, Woodruff, and Whitehead - responsible for the phenomenal success of The Coca-Cola Company.

The original Emory University Hospital was opened on the Druid Hills campus in 1922 after Asa Griggs Candler donated $1.25 million to build it. Candler was a young pharmacist who, in 1891, paid $2,300 for a fledgling Atlanta company that sold a sweet fizzy drink that hit the spot with countless consumers.

That enterprise, The Coca-Cola Company, became such a success that Candler helped establish a new university in Atlanta from the roots of Emory College, a small Methodist school chartered in 1836 in Oxford, Georgia. Candler bequeathed $1 million to the new university in 1914 in his famous "Million Dollar Letter," laying out the mantra to which, religious tone aside, all future Emory benefactors and fund-raisers adhere in spirit:

I fully appreciate that One Million Dollars is insufficient to establish and maintain the university, which is needed and intended by the church. Indeed no amount of money alone is adequate for such a purpose. The faith, the love, the zeal, and the prayers of good people must supply the force to do that which money without these cannot accomplish. But I trust all these precious things will be given, together with many other gifts, great and small, from people of large means and from people of small means, so that in due time the great institution which is proposed may be fully equipped for the blessing of men and the glory of God.

Asa Candler continued his support of the new university, giving Emory a total of $8 million during his lifetime.

Coca-Cola's success depended not only on Candler but also on Joseph Brown Whitehead, a Chattanooga lawyer who liked Coke and thought it should be more readily available. In the late 1890s, the drink was sold only across a soda fountain, where the syrup was mixed with carbonated water. Whitehead had the idea that Coca-Cola could be bottled and thus be available anywhere "within an arm's reach." In 1899, he and partner Benjamin Thomas approached Candler, who gave them the bottling rights, reportedly for one dollar.

When Whitehead died in 1906 at age 41, his wife, Lettie Pate Whitehead, then 34, took over the family Coca-Cola bottling business. Generous by nature, she became an active philanthropist. She remarried Col. Arthur Kelly Evans in 1913. Lettie Pate Whitehead Evans gave generously to Emory. Her two sons, Joseph Jr. and Conkey Pate Whitehead, died young, and their wills established foundations to honor their parents. Among their many gifts were the Joseph Brown Whitehead Chair in Surgery and the Conkey Pate Whitehead Surgical Pavilion, which virtually doubled the size of Emory University Hospital.

In 1919, the Candler family sold The Coca-Cola Company to a group headed by businessman Ernest Woodruff. His son, Robert Winship Woodruff, who attended Oxford College for a short time, became president of the company in 1923 and presided over its success until he died in 1985.

Robert Woodruff's first gift to Emory benefited the School of Medicine in 1937, when he donated $50,000 for the Robert Winship Clinic for Neoplastic Diseases, now known as the Winship Cancer Institute.

Then, in 1979 Woodruff and his brother George decided to give the $105 million in assets of the Ernest and Emily Woodruff Foundation to Emory University, which, at the time, was the largest gift to a single educational institution in the nation's history. Since then, the endowment established by the gift has funded Woodruff professors, Woodruff scholars, special academic programs, salaries for new faculty, faculty research, and facilities. In the 1990s, the Robert W. Woodruff Foundation created the Woodruff Health Sciences Center Fund, a $500 million endowment that supports new programs and facilities at the center.

The Woodruff and Whitehead foundations have supported countless medical initiatives. Their gifts rank among the largest ever made to programs for patient care, teaching, and research. They have been a vital part of the transformation of Emory University into a major teaching and research institution and one of the nation's leading centers for patient care.

At Emory, things have gone well with Coke



Emory benefactors Robert Woodruff
and Lettie Whitehead Evans




Joseph Whitehead first proposed
putting Coke in bottles.




The Whitehead Biomedical
Research Building




The Woodruff family of foundations
has supported scholarship,
research, and care at Emory.




The Woodruff Health Sciences
Center Administration Building


In this Issue


From the Director  /  Letters

Banking on benevolence

Healing the bottom line

Moving forward  /  Noteworthy

On point: Tell Congress what's at stake

Stopping the AIDS cycle

 


Copyright © Emory University, 2002. All Rights Reserved.
Send comments to the Editors.
Web version by Jaime Henriquez.