Here are some of the questions of concern posed to me by faculty, staff and students:
- Is my job secure?
- Will my job expectations change?
- Will my salary go down?
- Will my benefits decrease?
- Will I now become a state (or hospital) employee?
- Will my ability to provide the best care to patients be sacrificed to support the academic mission?
- Will my ability to provide the best educational experience for trainees or carry out my research be sacrificed to support the clinical activities of the hospital?
- Is this a hospital takeover of the clinical faculty?
- Is this a university takeover of the hospital?
- What will be the role of the clinical departments and other leaders going forward?
The dates of these questions: November 2013 – January 2014.
I was also the dean of the College of Medicine in 2013. In fact, I co-led the small committee that came forward with the recommendations for the structure and governance that merged the then UNMC faculty practice plan (UNMC-P) with the hospital (TNMC) to form the “Clinical Enterprise” that was subsequently branded as Nebraska Medicine.
2014 was a time of much anxiety and fear among faculty, staff and students of all the entities impacted by this integration – UNMC-P, TNMC and UNMC. Whenever there is change, it is human nature to assume the worst.
However, as Nebraska Medicine was codified and operationalized over the subsequent two years, not only did the above concerns not come to pass but over the subsequent 10 years the opposite happened. A period of rapid expansion in all missions ensued.
- No clinical faculty experienced salary decreases, with many who were previously undercompensated seeing increases to market levels.
- UNMC College of Medicine full-time faculty numbers went from around 600 to 1200, with support for clinical care, research and educational activities all increasing.
- Extramural research funding more than doubled
- Residency and fellowship positions increased by more than 50%
- The size of the medical school class increased 15% and a new regional campus will open in Kearney later this year.
- Numerous new clinical programs were created, and new Nebraska Medicine sites of care were established throughout metro Omaha and the state.
- New state-of-the-art facilities were created to carry out the missions of UNMC and Nebraska Medicine.
- The integrated nature of the new organization allowed a much quicker response to the COVID pandemic than would have been possible under the prior system.
Why was this the case? Was it because of the ownership, governance structure and associated documents of the new entity and the organizational chart? No, it was due to the commitment of all individuals involved – faculty, staff, trainees and senior leaders – to shared goals and missions. Organizational success in my experience is less about the boxes in the org chart and much more about the people who are filling those boxes and their values.
There seems to be uniform agreement among the leaders of the University of Nebraska, UNMC and Nebraska Medicine that Nebraska Medicine is performing well. Furthermore, its continued success, both in terms of mission and financial vitality, are critical to the future success of not only Nebraska Medicine but the academic missions of the university. There is no rationale that would argue for a major change in the way we take care of patients at Nebraska Medicine.
It is somewhat ironic that in 2026 there is so much desire to maintain a structure and work environment over which there was so much anxiety and concern a little more than a decade ago. Again, major change is hard.
So, to return to the questions of 2013-14 that are now being repeated today regarding the plan for sole university membership in Nebraska Medicine: I expect no changes in employment, salary, benefits, daily operational activities, or commitment to our missions going forward. Most of you will likely see little to no change in what you do on a day-to-day basis.
My recommendation is, to the extent possible, to put aside the above concerns and continue to focus on the mission and providing the outstanding care that you do every day.
Keep in mind that the process of creating governance documents and then other necessary agreements for a transition such as the one proposed takes a lot of time. Nebraska Medicine functioned in its new form for over two years before the governance documents were finally completed in 2016. So, this may take a while.
I believe the future of Nebraska Medicine and UNMC is bright. As dean, I work regularly with leadership of the University of Nebraska and Nebraska Medicine. I have confidence that those involved in working though this transition have the best interests of the college and our patients at heart and will arrive at a mutually beneficial way to move forward that will not only maintain what we have achieved over the past 12 years since the formation of Nebraska Medicine, but will create opportunities for even greater success to the benefit of our patients and the citizens of Nebraska.