Dean's Update
May 1, 2020 - Aron Sousa, MD
The socially distanced and entirely wonderful "Green Team" on rounds at Sparrow. Joining me are (l-r) James Choi, DO, Nora Hernandez, MD, and Rakesh Gami, MD.
Friends,
My two-week stint on the Internal Medicine service is coming to a close on Monday, and I need and want to thank Drs. James Choi, Rakesh Gami, and Bryan Bolen for a great rotation. They are wonderful residents who we are lucky to have in our programs and our community. Rounding is good for my mood, helps me keep my priorities straight, and watching people help others heal gives me hope. Rounding functions a bit like a talisman for me.
We are going to need every bit of patience, perseverance, goodwill, and hope that we can find as we all work our way through the worst economic crisis in a century. As of yesterday, about 25% of Michigan workers have filed for unemployment support. As far as I can tell, that may represent the worst unemployment since the Great Depression, and there is reason to believe this situation will only get worse.
Recessions tend to reduce death rates while unemployment tends to increase an individual’s risk of dying. (You can read an interesting analysis here.) Many of the newly unemployed are our family members, our neighbors, and our friends who are at risk of losing their health insurance and livelihood. Food insecurity is an increasing problem. We need to think about how our economic actions, now and as we address budget shortfalls, have health consequences. We do not all bear health risks equally. It is not lost on me that some of us who drive between campuses a lot for MSU (like I do) have been safer as a result of this crisis. I think I was more at risk driving between campuses than I am doing clinical work.
I am particularly concerned by the circle of disparities impacting African Americans in Michigan. Our own Ken Rosenman and colleagues have shown that Blacks were already disproportionately in overall higher risk occupations compared to other races. They are particularly overrepresented in the personal services, transportation, and social service jobs that increase risks for COVID-19.
The persistent wealth gap and segregation resulting from racism have further contributed to the disproportionate mortality of Blacks in Michigan and the US by increasing risks of poverty. As the economic crisis moves forward, it bears remembering that previous recessions hurt Blacks more than others. It is not hard to imagine that this economic catastrophe will, in the same way, disproportionately impact Blacks and worsen the very circumstances that made them more at risk for COVID-19. It is a morbid, regressive roundelay.
The university is getting closer to understanding how the financial crisis will impact our budgets. There are still some significant unknowns about the future of state funding, the enrollment of students at MSU in the fall, and whether the university will be physically populated this fall. All of those unknowns have a real impact on how bad the budget will be.
Here is what I know. The university expects to address budgetary shortfalls of at least the scale of the 2007-08 Great Recession cuts, and the university is working to spread the budget cuts over three years to help us all adjust and plan. For now, I know that the university will be making cuts, but I do not know how big those cuts will be. As the university is working out the financial options, we are trying to be proactive by preparing for the standard yearly 1% cut plus another 5% cut of recurring general fund. Added to those cuts, we will have to address the downturn in clinical revenue felt by programs across the country. We are just planning, and until we have more information I am just guessing. I genuinely hope this is the worst-case scenario, but no one will know until we have more definitive information.
So far, the principles I outlined two weeks ago still feel appropriate to me:
- We have to preserve our missions of education, diversity, discovery/scholarship, and clinical care.
- We will need to grow in order to emerge from this crisis a strong and healthy college, so any reductions and cuts need to preserve our opportunities for revenue and growth.
- We have to be humane. In the case that we may be required to make cuts that impact people’s careers and livelihoods, we will need to give people time to adjust and make arrangements. Our cuts cannot worsen salary and employment disparities.
Further, the financial work groups I outlined last week have begun to work and they should report to me by the end of next week. I am hopeful. Their early meetings are clearly looking at ways to raise revenue, ways to handle sequestered funds, and how we might make sure our budget cuts are progressive and don’t worsen disparities.
I outlined the health consequences of unemployment and disparities in the paragraphs above because I want us all to think about the social and health impact of layoffs. The size of the financial problem is so large that there will eventually be layoffs in the college. We first will look to retirements and attrition, restructuring, the hiring freeze, and the kind of progressive salary reductions implemented by the president before we move to job cuts. As job cuts become unavoidable, we will work to give people as much lead time as possible so they can adjust and look for other opportunities.
As we face financial challenges, we will continue to adjust to the COVID-19 pandemic as cases continue, including more cases in West Michigan. In many of our units, work will increase as clinical activity returns to more normal levels, research labs start back up in earnest, and our educational programs continue to adapt to the clinical opportunities available to students. So many have accomplished great work in the last few months, and it is painful to complicate the challenges that face us in the coming months with financial burdens. I have great faith in the talent and ingenuity of our people. The work of the last two months proves that we can handle what comes our way – and that gives me great hope.
Serving the people with you,
Aron
Aron Sousa, MD, FACP
Interim Dean