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Feature
Resources, Responsibility and Resonance
Dr. William Liljemark becomes Interim Dean of the School of Dentistry
On June 1, 2003, Dr. William Liljemark was appointed Interim Dean of the University of Minnesota School of Dentistry. A month into his new assignment, Northwest Dentistry spoke with him about the course the School will take over the next year and the resources at its disposal.
The Editors
NWD: You are the interim dean of the School of Dentistry. Please describe that assignment. How do you see your role? Is there a timeline?
Dr. Liljemark: When I was thinking about putting my name in for the position, a friend of mine who was Associate Dean in the School of Public Health told me that ñinterimî is not the same as ñactingî dean. I am the dean. IÍm not just someone who holds things together until the new dean arrives. While the assignment from Dr. Frank Cerra, Senior Vice President of Health Sciences, addressed multiple issues, one of its main elements was to smooth the transition for the next dean by making sure operations are going well, and that momentum on our current goals and agendas is maintained. I am going to work along the lines of the strategic vision and plans the School has developed.
My role is to facilitate discussions and decision-making that address budget challenges, curriculum and organizational changes and decentralizing management and decision-making within the School. We will need faculty on board for all these things, so there are major changes happening. It would be very difficult for all concerned for the new dean to arrive and find the place disorganized. Hopefully I can keep things going in the right direction.
As for a timeline, it was set initially at six to nine months, but I believe it will probably be a year.
NWD: Give us some personal background: bio, strengths, personal philosophy, influences. Why do you think they chose you?
Dr. Liljemark: IÍm sort of an old Minnesota person. I grew up in South Minneapolis, went to public high school and to the University of Minnesota for my undergraduate degree. My parents didnÍt have a lot of money, so I was a commuter. Then I ended up in dental school. I had a research experience with summer fellowships here and found I really liked research. The U had a D.D.S./Ph.D. program funded by the National Institutes of Health (NIH), and I received my dental degree and doctorate in microbiology. I went to Harvard and Forsyth Dental Center, where I spent three years in research and teaching. I found out Boston is an expensive place to live, and they werenÍt paying me very much, so I started looking for a full-time job elsewhere. I looked at some very good schools all around the country, but Minnesota made me a better offer.
Once here in the School, I spent most of my time doing research, and I was very successful at it. I accumulated a lot of grants from the NIH and other sources, and ended up receiving a Merit Award from NIH, which is a big honor. I was very proud of that.
IÍve also had a lot of University experience, particularly with the Graduate School. I was Chair of committees dealing with faculty nominations, coursework and programs for the health scienes.
Of course, IÍve also had a lot of jobs here at the School, and I think that is another reason Dr. Cerra decided to appoint me. When they restructured the School into four departments when Dr. Richard Elzay was dean, I became Chair of the the Department of Diagnostic and Surgical Sciences for about nine years. After that, I went back to my research lab for awhile and then decided to retire from the U and spend a few days a week practicing. However, Dr. Speidel retired from the Division of Orthodontics, and there was a lot of encouragment from within and without for me to take that job. I agreed, and I think weÍve done a pretty nice job. When Dean Polverini resigned this spring, it wasnÍt until some people in the Restorative Department and elsewhere encouraged me to consider that position that I began to think about it. I said they could put in my name if they wanted to „ and the rest is history. I wasnÍt exactly campaigning for the job, but I told people I would do my best job if Dr. Cerra and the School wanted me to do it. And here we are.
As for influences, IÍd say they were a myriad of associations through professional networks, local to international.
NWD: Talk about the School right now. What amount of your time is spent responding and reacting?
Dr. Liljemark: When the School was first restructured, I was part of a group who wanted a more decentralized management and decision-making system, an approach that was later incorporated into the compact the School developed with the Academic Health Center after the terms of Deans Elzay and Till were completed. Dr. Polverini had been encouraging and implementing that process. I think the main reason I was chosen as interim dean is that my own approach to management is consistent with this vision. I like it because I believe that more departmental control over their own destinies, resources and education is better than a top-down management structure. IÍm a pretty good listener; my style is to let people do what they know how to do rather than telling them what to do. People here are very intelligent, and most of them have lots of experience. They know how to take care of their own affairs. We have a tremendous faculty and one of the best dental schools in the country, so there is no reason each department cannot maintain and facilitate its own goals within the goals of the whole school and have the administration perform more of a strategic planning, support, oversight and integrating function rather than deciding on every hire and small change. I donÍt care for that philosophy or that work environment. I liked the direction the School had been going and wanted to keep it that way.
NWD: What is there to build on? How proactive can an interim dean be?
Dr. Liljemark: I wouldnÍt have taken the job if I didnÍt think this was a
wonderful place and that we have a strong foundation upon which to build and that I could be proactive. We have extremely good facilities, great community support andtop notch students. [laughs] I probably wouldnÍt have been able to get into this school! The facilities have just gone through major remodeling „ weÍve updated equipment in the majority of the clinics „ and a development goal is to improve the pre-clinical areas, including integrating some of the things Ralph DeLong is doing with the virtual patient.
A major strength is our research environment. WeÍre ranked number one out of 19 dental schools in the amount of funding awarded by the National Institute of Dental and Craniofacial Research (NIDCR) in fiscal year 2002. This has to be one of the top five to 10 dental schools in the country. And while there are always opportunities for improvement, we have no inherent weaknesses. Of course, the way we do business, work and teach is something that will always be in a flux, but thatÍs just the nature of
dealing with a rapidly changing profession. We always need to look at ways
to be better, like fine tuning the curriculum to eliminate redundancies in lecture rooms, incorporating new technologies and materials, facilitating effective teaching in the clinics and maintaining and recruiting the best part-time faculty.
Faculty, of course, is crucial to this school. From my experience in the orthodontics area, students want to work harder and treat more patients because they want to learn. I believe that is the case in most of the clinics. But if students see more patients, they need more supervision. And if there is a crisis in dental education, it is in the nationwide shortage of dental faculty. The discrepancy between salaries in private practice and faculty positions
is significant. Competition for good faculty is fierce, and recruitment is very hands-on: phone calls, meetings, networking etc. You almost have to recruit good people away from other schools. ThatÍs the reality. Our strength is that people come and look at us because they know weÍre a good school. We can attract the people we want. We have to keep that advantage.
NWD: Would you elaborate on the research commitment?
Dr. Liljemark: Research is an important part of our mission and an important part of the mission of the Academic Health Center and of the University of Minnesota. We have funding from lots of sources, including both national and international support, and good relationships with industry. For example, we have research relationships with Unilever, Colgate, 3M and others. Our Biomaterials Center is in its third cycle of funding from 3M. NIDCR is obviously strong.but there are numerous other foundations. NIDCRÍs focus now is neuroscience, and we have tremendous faculty in that area. There are biomaterials, periodontic research, bone research and genomics. We have a tremendous research faculty here, and it is not by accident. I was proud to be a part of that plan. But now that I am an active part of the clinics and their people and facilities, I am proud to be a part of that, too.
NWD: Where does the state budget fit in?
Dr. Liljemark: State support as a percentage of budget has been shrinking for the last six years. This biennium the University took a huge hit. The School of Dentistry shared in that hit, and it was a hit our Strategic Plan and Compact didnÍt anticipate. Maintaining a full-service, high-quality facility under those circumstances is difficult, but I view it as an opportunity to take charge of our own destiny. One thing I want to instill in the faculty is that it is imperative in this world today that we do that „ and we can, because we have the horses to do it. We need to be creative in our solutions and look at how we do everything, from restructuring our curriculum to developing new partnerships, chasing down more grant support, being more entrepreneurial and being more efficient. We are looking at big-time budget challenges, but we can handle them. IÍm very confident we can do that.
NWD: Is state money the major outside influence?
Dr. Liljemark: State dollars accounted for 26 percent of our income in 2002, so thatÍs significant. And tuition accounted for another 13 percent of our income. But we do have other very good outside support. We are trying to do a lot of things with outreach. Our Hibbing Clinic has been successful on many fronts. We have affiliation agreements to treat UCare patients enrolled in public programs and with the University to provide
care for graduate students. Medica and the public-private partnerships like the one we have with Patterson Dental Supply Inc. and some 20 companies support our Center for Contemporary Dentistry. Of course, Dr. Cerra and the AHC have been very supportive, too. My experience so far has been very positive in a pretty tough environment.
NWD: What about time demands?
Dr. Liljemark: I spend most of my time planning. IÍve been at the School a long time. I know almost everybody here. IÍve been talking to a lot of people, finding out where they are with their programs and clinics, discuss how to improve the efficiency of the teaching to get a better experience for the students. This is a planning effort. They are educating me about how they do business. If faculty take ownership of what theyÍre doing and are successful with it, they are going to be a lot prouder of it than if someone comes along and says, ñWe have to do it this way.î Sure, there will be parameters, and all efforts must tie in to our education, research and service mission. But these people are bright and realistic and experienced, and they will figure it out.
Maybe I have a false sense of confidence in this whole process, but I think it is going to be fine. DonÍt get me wrong „ it wonÍt be easy. The process is to encourage the people who know their own systems to examine what they have and ask the critical questions. For example: How do we continue to provide services to public program patients within a challenging economic environment? We are the stateÍs number one provider of dental services to that population, yet our state support is evaporating while the service expectation remains. We must meet those expectations creatively and efficiently. Because we want to serve citizens of this state. Not only do we address an unmet need, but the cases we see are challenging. Our patients have complex oral health needs, which translate into good learning experiences for our students. So we have to find new ways to do things.
NWD: What are some built-in opportunities you may have? What is the SchoolÍs contribution to the University as a whole?
Dr. Liljemark: Both the University and the School have a three-part mission: education, research and service. And we make significant contributions in all three areas. We have a tremendous opportunity to enhance the educational experience for our dental residents thanks to General Medical Education (GME) funding for our specialty programs.
Our graduate specialty programs are being fashioned as medical residencies, and we have relationships with Regions and Fairview Hospitals to receive GME funding for our residents. But that funding is in jeopardy, the result of a decision in Washington to re-interpret the rules by which hospitals obtain direct GME payments for residentsÍ training in non-hospital settings. If approved, this change can really hurt dental programs around the country. But with the American Dental Educators Association (ADEA), the ADA, our AHC people and other educational leaders, thereÍs a lot of focused effort to advocate that the proposed rule be rescinded. We have our fingers crossed on that one.
As for other contributions, weÍve already talked about our research program. But our outreach/service programs are also valuable and visible contributions to the mission of the School and the University. In many communities, our portable and fixed-site dental clinics are the face of the University in Greater Minnesota. Add to that the fact that we are the only dental school in the state and the only dental school in the northern tier of states between Wisconsin and the Pacific Northwest. We educate more than 75 percent of the stateÍs dentists, plus provide continuing dental education to 4,000-5,000 practicing professionals each year. ThatÍs a whole lot of ñcontributions.î And it is my perception that the School of Dentistry right now is viewed as an integral part of the Academic Health Center. We have
been a producer for many, many years. Being number one in the country for NIDCR funding is remarkable. But that too has to be maintained.
NWD: Define success. What would help?
Dr. Liljemark: For me, success would be maintaining the momentum on current initiatives, providing a smooth transition for the new dean, de-centralizing management and decision-making and solidifying a system that is headed as much as possible toward self-sufficiency. And that is critical. IÍm very uncomfortable about the high tuition students pay for dental school. The University had to increase tuition and the SchoolÍs had to do the same. And itÍs been done in response to decreased state support. But we cannot continue to raise tuition, so we need to become moreself-sufficient.
One thing weÍre working on is to reposition the SchoolÍs revenue profile. The University has an internal revenue-sharing system to cover central overhead costs, and the formula is based on the amount of gross revenue generated. But of course our revenues are offset by clinic overhead, which is an expense most other income-producing units do not content with. So, weÍre negotiating to maintain a greater share of our revenues. Obviously more state support would be welcomed. And IÍd consider increased alumni, donor, foundation, grant and development support to be other indicators of success. But bottom line, we are going to have to take the position that these are our problems to solve and do our best from that standpoint. If I was going to be the next dean, I would make it one of my highest priorities.
NWD: WhatÍs going to change? What has to?
Dr. Liljemark: The process of de-centralization, departments managing their own affairs and working out of their own budgets, is going to continue. It started three or four years ago. ThatÍs a gradual but major change. Crisis situations like the state budget can be an opportunity to be creative and to work together to work smarter, more efficiently and at less expense. We have to make real decisions about serious matters. For example: We increased the number of patients in the ortho clinic, so thereÍs more work. But thereÍs no grumbling because the students know the learning curve is steep when they graduate, and that part of the learning curve involves an ability to use time efficiently and manage patients. At the same time, itÍs good for the School. We see more patients, earn more clinical revenue, take control of your own destiny. I donÍt see that element as a negative in an educational system. And we have an enormous pool of patients.
NWD: Talk about how students are taught today and the factors that impact dental education and its administration, including interdisciplinary ones.
Dr. Liljemark: Things like finances, availability of faculty and organizational management affect the way students are taught. The interdisciplinary focus is clearly taking place in the research area. Our department chair in Oral Sciences isnÍt a dentist. He holds adjunct appointments in psychiatry and neuroscience. Another well-known researcher in Preventive Sciences is from neuroscience. We participate in the Rural Health School, an education program where students from a variety of health disciplines immerse themselves in interdisciplinary practice. And our students take classes with medical students. Emerging disciplines are going to affect dental practice. So education needs to become more interdisciplinary. But itÍs not just about what dental students can learn; itÍs about what dentistry can teach. This was an Academic Health Center strategic vision many years ago, and Frank Cerra supports that integration. I think we are doing a lot, but we can do more in the didactic education and basic sciences. Because dentistry and medicine drift apart in our case base, basic sciences is the best place to immerse dental students.
Our students are well-equipped to be at this point in the evolution of our profession. They are the best and the brightest. Their average GPA is just astounding, over 3.5. We just have to challenge them to the max and give them the best education we can because they can take it. They need to be challenged. The array of talents they bring is amazing, for the people they serve, for the entire dental community. But again, we have to maintain an environment that will continue to attract and keep them.
NWD: How would you characterize the SchoolÍs position, and yours, at this moment?
Dr. Liljemark: We are trying to maintain the momentum begun under Dean Polverini. Hopefully we can make the transitions in a very short time, but itÍs complicated, moreso than I thought when I was dealing with a division where I knew all the players. For example: making changes in the entire undergraduate curriculum that includes comprehensive care clinics and the schedules of juniors and seniors plus faculty is an enormous undertaking. You make one small change, and the ripple effect changes everything from course content to faculty schedules etc. In a relatively small graduate program, changes donÍt have the domino effect they do in such big programs, so changes there have to happen slower. Anticipating those domino effects isnÍt easy. From my own experience in the orthodontic department, I know that thereÍs a complexity that is unique to our own department. Knowing that every other department has the same is exactly why I am depending on the departments to help in the decision-making process.
The heart and soul of the planning we are doing is to improve the quality of undergraduate dental education. Everything that takes place in this school is important, but educating dentists is the most important thing that we do by far. So we need to provide the best education possible for our students. I want them to walk out of here confident that they know what to do when they get into practice. And we need to give them the experience here that will build that confidence and skill. I strongly believe this need is very real and we will do our best to make fulfilling it a reality.
Copyright 2003. Minnesota Dental Association.
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