Final Reflections: A Conversation With Clay Johnston

After seven years as inaugural dean of Dell Medical School, Clay Johnston, M.D., Ph.D., will step down on Sept. 1.

Johnston began his tenure in 2014, when he took the helm of the first medical school in nearly 50 years to be built from the ground up at a top-tier research university.

As he concludes his tenure, Johnston shares his thoughts on what he’s proud to have accomplished and what he wishes he had, plus advice for up-and-coming health leaders — and what he’d tell himself if he could go back in time to his first day on the job.

Early Days

What first attracted you to this role?

I saw this as a once-in-a-lifetime opportunity — this convergence of a community that had a vision and was excited about creating a medical school, combined with an outstanding university that was also incredibly excited. We all saw an opportunity to “do” health and health care in a better way. I wanted to lean into that.

What was the biggest challenge at the start?

In the beginning, it was just helping people understand what it meant to have a medical school in Austin — what was possible. There was not a lot of familiarity here with what medical schools traditionally do, much less what we were trying to do differently. I was getting people excited about our potential for innovation and our role as a partner, whether in hospitals or in the community, in the provision of care or in developing new models of care.

Building trust is another challenge that comes to mind. That’s just so critical, particularly when our approach is really about creating collective action; that “vital, inclusive health ecosystem” that we called out early on as our vision means part of our role is to enable those around us. It doesn’t happen without trust. And trust takes time. We continue to earn it, and it will be a forever focus for Dell Med.

Looking Back & Ahead

What are some of the accomplishments you’re most proud of as dean?

I’m proud of a lot of things. Our students. We have fabulous students, and that’s a testament to them as individuals and to how we’re attracting them. The alignment of our mission, our innovative recruitment process and our curriculum has positioned them, and us, for remarkable success. They’re not only performing well by traditional markers like standardized tests and residency placements, but also in terms of their roles outside of hospitals and clinics, in our community and with our partners. I’m also proud of our residents and fellows. We’re now beginning to be just as innovative in how we recruit and train in those programs, and I’m excited to see how that evolves.

In the clinical arena, we’ve made huge progress alongside our partners in elevating quality and increasing value for patients. That is only going to accelerate, even as we remain critical to the COVID-19 response and continue to support really innovative programs in the larger ecosystem that are helping people experiencing homelessness, isolated in their homes, or in need of access to healthy food.

And we’re seeing successes with interdisciplinary research. I think we’re in a good spot now to really take advantage of — and further develop — all kinds of creative collaborations across campus. I’m very proud of the work we’ve been able to do with the support of CPRIT [the Cancer Prevention and Research Institute of Texas] — things that wouldn’t have been possible in Central Texas without our experts. See an example »

These aren’t my wins. They’re a testament to the incredible team here, along with forward-thinking donors who’ve shared our mission and vision.

Is there something you didn’t accomplish during your tenure that you wish you had?

One of our most innovative concepts is connected to how we deliver health care — a model known as an integrated practice unit, where we completely redesign care around patients with a specific condition. Most mature is our Musculoskeletal Institute at UT Health Austin, the clinical practice of Dell Med, and it is a fabulous program. The patient health outcomes are better, the patient experience is better, and the costs are lower. And yet we’re still working on how to make these innovative models financially self-sustainable and scalable. The economics haven’t matured, and that’s a critical barrier to innovation, not just for us, but also for others working to transform the health system.

It’s probably the biggest challenge facing medicine today. We are dependent on revenues from a broken health care system. They push us toward doing more as opposed to doing better. And that then drives many of the decisions we make about how we innovate, where we innovate, where we invest, how we train.

What do you see as the biggest opportunity for Dell Med in the next 5–10 years?

I think one is to become a nexus for health care transformation, particularly as a place for training at all different levels. So, not just undergraduate medical education, but also residencies, fellowships, continuing education for faculty and community physicians. It’s huge.

Words of Wisdom

What’s your advice for up-and-coming health leaders?

We need to be creative and courageous. Small, incremental changes are important, but a rethinking at a deep level is required for us to get to a system that we can love.

For me, the work fundamentally starts with the certainty that health is something that everyone deserves. Then the question of how to achieve that more universally becomes “What’s feasible?” — something you can approach analytically and pragmatically.

Equip yourself with three things: a deep knowledge of what truly are and aren’t barriers, creativity to welcome new ideas and to understand that the existing ways of doing things are not necessarily the best ways, and a readiness to accept risk, sometimes against the advice of others. There will always be people lined up against change. It’s your job to overcome that.

What do you want the community to know about Dell Med?

Dell Med is committed to the community that created it and is focused on making a real impact, particularly for those most in need. The community investment that was foundational for the school is seeing a return in so many ways, and this is just beginning.

Say you could travel back in time and tell the Clay Johnston of 2014 one thing. What would it be?

Just have fun. I’ve loved this job. On the other hand, it could have been more fun if I had taken the opportunity to really celebrate our successes along the way, not always striving to do the next thing, the next thing, the next thing.

Maybe that drive was important to us achieving what we have. But prioritizing joy along the way is worthwhile.