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VOL. 123 | NO. 40 | Wednesday, February 27, 2008

UTHSC's Haik on Lookout for Heir Apparent

SCOTT SHEPARD | Special to The Daily News

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WATCHFUL EYES: Barrett Haik, medical director of the Hamilton Eye Institute, is looking for someone to succeed him in the job while he devotes more time to teaching and treating patients. -- Photo By Scott Shepard

Barrett Haik works 80 to 120 hours a week, and after 13 years in Memphis, he can point to one of the nation's premiere ophthalmology centers, the Hamilton Eye Institute.

Now, at the pinnacle of his career, Haik wants to turn over his empire to others so he can be a mentor and doctor.

Haik is an ophthalmologist and chair of the Department of Ophthalmology at the University of Tennessee Health Science Center. He's also one of the world's leading experts on pediatric eye cancer and chief of eye surgery at St. Jude Children's Research Hospital.

In April Haik becomes president of the Association of University Professors of Ophthalmology (AUPO), an exclusive club of people who lead ophthalmology departments at 120 medical schools in the United States and Canada.

"We're all physicians and are not trained in being leaders of a large institution and a major employer," Haik said. "We have to learn this on the job; even doctors with an MBA don't have the in-the-field experience in running an organization."


A study in cross-training

Haik came to UTHSC in 1995 from Tulane University in New Orleans, tasked with building a first-tier ophthalmology center from the ground up. It's been an on-the-job education in fields ranging from public policy to finance to delicate negotiation: Baptist Memorial Health Care Corp. and Methodist Healthcare set aside their usual competition to
partner in Hamilton's ambulatory surgery center.

The estimated $60 million it's taken to build Hamilton has come entirely from grants and outside fundraising.

Others have built major eye centers, said New Jersey ophthalmologist Marco Zarbin, but Haik brings that along with a broad base of knowledge and experience.

"He's been a leader of so many organizations, which gives him a view of research, clinical care, administration and teaching," said Zarbin, chair of the Institute of Ophthalmology at New Jersey Medical School in Newark, and past-president of AUPO.

Haik's four-year term with the National Eye Advisory Council - part of the National Institutes of Health - and the professional society, the American Academy of Ophthalmology, only add to his new role, Zarbin said.

"This is an important and prestigious position that reflects his pre-eminent position in ophthalmology; I am
confident that his tenure will result in continued advancements in all three missions," said ophthalmologist Bartly J. Mondino, chair of the Department of Ophthalmology and director of the Jules Stein Eye Institute at the David Geffen School of Medicine at the University of California-Los Angeles.


Measures of success

The National Eye Advisory Council provides the final review for most ophthalmology grant applications submitted to NIH, giving Haik an intense education on the future direction of research. But it
also paid dividends for Hamilton Eye Institute.

"I learned how the process worked, so it makes me a better counselor for my faculty," Haik said. "And when you get to review every grant application in the nation, you also get to identify who you want to recruit."

He's built his faculty at UTHSC from four to 34 since 1995 to the point that it's taken on a critical mass. The faculty is so well respected that nearly 400 applicants last year
sought one of just three residency training slots.

That faculty's federal grants rose from $1 million in 2004 to $3.2 million in 2007, while the pool for those grants shrank 20 percent.

Haik has already adopted five new department chairs across North America who hope to replicate their own version of Hamilton in their communities. The challenge today is even greater, he said, as the world of ophthalmology changes.

Once upon a time such departments were expected to carry their own weight, generating enough revenue from clinical care to cover the costs of teaching and research. Eye surgery has followed a downward curve along with many other surgical fields.

"In 1980 a surgeon was reimbursed for cataract surgery at $2,800; today it's $643, with no adjustment for inflation," Haik said. "All of our missions - clinical, research and academics - are money losers."


Competition and support

University eye centers get the most expensive and complicated cases, often with patients who are uninsured. Teaching is a cost hole because faculty members aren't generating any clinical revenue, while research costs continue to rise, for equipment and support staff.

"Without philanthropy and university support, we wouldn't be here at all," Haik said.

Another duty of AUPO is harmonizing the curriculum at 120 different schools of medicine. Only 3 percent of doctors become ophthalmologists, but the other 97 percent need training in understanding the eye, which is an extension of the brain.

The eye provides a transparent view of blood vessels and offers clues to
diagnosing a wide range of ailments. Looking into the eye is considered as essential as listening to the heart, but finding time to teach those techniques is always being squeezed.

"Curriculums have gotten so large with genomic information that as faculty add more, something has to give," Haik said. "It's still only four years, so everyone is jockeying for their position."


A matter of succession

Meanwhile, Haik has identified five top faculty members who could take over as director of Hamilton; headhunters for other universities also have them on the short list, so Haik wants to begin to prepare them for the next phase of their careers. They are Peter Netland, Chris Fleming, Ed Chaum, Natalie Kerr and Robert Enzenauer.

Within a year Haik hopes to have an heir apparent at Hamilton.

"They'll all eventually be chairs of a department somewhere in the country," he said. "I will continue to be the Hamilton Chair at UT, but I miss being a doctor like I used to be. And I want to do more teaching."

He'd also like to hire an operations manager for Hamilton, a business person who can run the physical plant and day-to-day operations. Things that have been on his shoulders the entire time.

"Two years ago when the parking lot needed stripes, I had to take care of it," Haik said. "That's not the best use of a surgeon and teacher."

Along with his breadth of knowledge, Zarbin said, Haik is perfect for the AUPO helm because he's always aware that decisions affect the lives of people in need, and can mean the difference between sight and blindness. That's the sort of attitude AUPO wants at the top.

"Whatever he does, Barrett is always a practicing surgeon," Zarbin said. "He's a real doctor with real patients."

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