Five questions for Richard D. Krugman

Richard D. Krugman, MD, vice chancellor for health affairs and dean of the School of Medicine at the University of Colorado Denver, is a pediatrics professor and a board-certified pediatrician. Krugman is also one of the nation's foremost advocates for the prevention of child abuse and neglect through public awareness and education. A Princeton University graduate, he earned a medical degree at New York University School of Medicine before completing an internship and residency at the medical school he now leads. As the university's first vice chancellor for health affairs, Krugman oversees the Center of Bioethics and Humanities and the Colorado Area Health Education system among other programs. Here, he answers five questions to clue us in on his work, his vision for the Rocky Mountain region's top medical school, and a music career thwarted by a passion for science and writing.

You are dean of the University of Colorado School of Medicine and the university's first vice chancellor for the Office of Health Affairs. What role do you play as vice chancellor and what attracted you to the position?

The truth is I was not attracted to the role - rather, I was made the vice chancellor for health affairs a year after Chancellor Roy Wilson arrived and organized his office to grapple with the complexity of managing the newly consolidated university. I had been dean of the medical school for 17 years prior to that time and was very happy in that job. As vice chancellor for health affairs, my responsibilities are to oversee and manage the clinical relationships among the health professions schools and our affiliated hospitals. There are also a number of programs that serve all the health science schools that are located in the VCHA Office: the Colorado Area Health Education Center Program; the Center on Aging; the Program in Ethics and Humanities; and the Interprofessional Program in Education. A major part of the job is to work with the vice chancellor for research to assure the continued growth and development of all the clinical and research programs on the Anschutz Medical Campus. Finally, with the consolidation of most of the support functions of central administration to the UC Denver Downtown Campus, an important part of the job is to be the ears and voice of the Anschutz Medical Campus so that policies which seem logical or reasonable in the downtown environment are not perpetrated on the Anschutz Medical Campus without a clear understanding of their impact.

Medical schools across the country are grappling with many of the same issues, including a push to recruit more students and faculty of color, train more doctors for rural service, and find ways to fund major initiatives in a tough economic climate. How do you approach these challenges as you strive to preserve the School of Medicine's reputation?

We have had the most success in addressing the state's needs for primary care physicians, especially those who wind up in rural areas. When I began the dean's job in 1990, the legislature was furious with the school for (in their view) not training enough rural and primary care physicians. We implemented a six-part program in 1993 that we have continued for the most part for more than 15 years. It includes a summer camp for rural high school students with our first- and second-year students as counselors; admission preference to rural applicants who have equal qualifications with urban applicants; a longitudinal course throughout the first three years of medical school in which our students spend a half day a week in a primary care physician's office; support for the nine family medicine residencies in the state; and support of continuing medical education through the Area Health Education Centers for those of our graduates practicing in rural areas. We have been less successful - in fact we have been poor - at recruiting underrepresented minority faculty and students. Part of this is related to the absolutely abysmal base funding we get from the state through the university. We are 80th among 80 public schools of medicine in state support. Without more base funding and without adequate endowment or other sources of scholarship funding, we cannot compete with other schools that recruit and support many Colorado medical school applicants.

You are a professor of pediatrics. What is the greatest health issue faced by children around the world today?

Children face enormous health issues all over the world, but I am not sure I can list one "greatest." Children growing up in developing countries have a very different set of challenges (malnutrition and infectious diseases being the most prevalent) than children living in the United States, Europe or in industrialized countries. In the industrialized world, malnutrition among poor children coexists with obesity as a major child health problem. Addiction to tobacco and substance abuse is a major child health issue. So is the environment in which children are raised.  Millions of children live in conflict zones - in cities or countries where there is armed conflict and civil war or in homes where domestic violence, child abuse and/or neglect may be present.

You have spent most of your career educating people about the far-reaching consequences of child abuse and child neglect on children, families, schools and societies. Has Colorado made any progress in this area, and what more can our state do to stop child abuse and neglect?

Colorado and the nation have made a lot of progress addressing the problem of child abuse and neglect. We have the technology to be able to prevent most physical abuse of children, but have not yet applied that knowledge to nationwide programs that can do so. Interestingly, the number of cases of physical and sexual abuse of children has declined by about 40 percent over the last decade (and no one knows why). My own belief is that we need to begin to think of abuse and neglect as a mental health and public health problem rather than as a social and legal problem. If we do, we might actually be able to figure out if genetic dispositions, brain chemistry changes and environmental triggers can cause the problem, and make even further progress in reducing the numbers of cases.

Finally, please tell us something about yourself that few people know about.

My mother had me tracked to become (in her words) "the next Arturo Toscanini." She and I would read music books (the score of piano concertos while playing the recordings on our Victrola). I rode the bus and subway to Juilliard School of Music while living in New York City for seven years between 1950 and 1957. But after I left home for a boarding school in September 1957, my musical career ended and writing and science took over.