The Peck Era in Medicine

As William A. Peck, MD, concludes his 14-year deanship, Washington University School of Medicine reflects on its transformation.

BY STEVE KOHLER

William A. Peck, MD

Peck is “an incredibly good communicator, articulate and perceptive of others.”

RALPH G. DACEY JR., MD

Big changes over the course of 14 years. Download graphic PDF FORMAT 560 K

“Bill Peck combines excellent science with good business sense.”

ANDREW B. CRAIG III

AN ACADEMIC LEADER IS . . . “educator, wielder of power, pump; he is also officeholder, caretaker, inheritor, consensus seeker, persuader, bottleneck. But he is mostly a mediator.”
CLARK KERR, AMERICAN EDUCATOR

“Bill could have been eminently successful in a dozen walks of life—business, finance, music, and anything that requires skills with people. Luckily, he chose medicine and Washington University.”
WILLIAM H. DANFORTH, MD, CHANCELLOR EMERITUS

William Danforth was talking about William A. Peck, MD. And Clark Kerr, commenting on the work done by leaders of modern academic institutions, easily might have been.

Now in his 14th year in the dual offices of dean of the School of Medicine and executive vice chancellor for medical affairs, Peck has excelled in the tasks Kerr sets for an academic leader. And he has comfortably worn all of the hats—businessman, negotiator, political figure and more—that Danforth imagines for him. In a punishing 14-hour-a-day schedule that seems to some to have fused the school and the man into a complex hybrid, he even has found a way to incorporate his love of music.

“The Peck era in medicine will be regarded as one of unprecedented progress,” says Washington University Chancellor Mark S. Wrighton, PhD. “Dean Peck has been a national and international leader in academic medicine and has contributed to the building of the school in every aspect of its mission: research, education, patient care and public outreach.”

Ralph G. Dacey Jr., MD, head of neurosurgery and a colleague of Peck’s, says, “We all have our various talents, but Bill’s intellectual capacity allows him to function as a scientist and a clinician in a complex business and regulatory environment, cycling back and forth between roles in a way that few can.”

The changes and challenges have ranged so widely that Peck himself says he can’t identify an outstanding success. Instead, as he steps down, he’s most proud that the school is a great institution—in every regard.

Peck sits near family photos arrayed in his office.

In 1988, when first approached about assuming the posts of dean and executive vice chancellor, Peck was at a regularly scheduled pizza lunch/science roundtable with a colleague. “At first, I said, ‘It can’t happen. It’s not on my agenda.’” But then, in an initial stroke of the vision that would come to mark his tenure, he “began to see the opportunities and the needs to satisfy them,” he says. When the offer came from the committee that was reconsidering the medical school’s governance, “there was little to negotiate.”

“Wet behind the ears,” he says he began to “learn as much and as fast as possible,” from outstanding department heads like David M. Kipnis, MD. “I also studied at the feet of great academic administrative leaders: then-Chancellor Danforth and Sam Guze, who was leaving the vice-chancellor’s job. And I learned by example from Ken King (the departing dean). Guze and I had perhaps 14 focused meetings, maybe 20 hours. I’d ask questions and take notes. And I observed Ken King, a master at achieving his goals without people even knowing.”

Managed care was about to disturb the established order, and with it came the concept of competition for contracts with insurers. “We had to decide whether we wanted to compete. It’s a two-edged sword, requiring time, effort and angst, with inevitable tension between academic divisions,” Peck says.

As a result of the decision to compete, the school fostered a clinician track to accommodate physicians focused on patient care and teaching. That change enriched the academic environment and enhanced the school’s competitiveness as a clinical entity. Revamping of clinical business practices included the formation of the Washington University Physicians Network, dedicated to negotiating health care contracts. What is now the nation’s second largest faculty practice plan, named Washington University Physicians, was created to manage the clinical third of the school’s mission. And most recently, much of the treatment delivered by clinicians was relocated to the Center for Advanced Medicine, the Alvin J. Siteman Cancer Center and the Charles F. Knight Emergency and Trauma Center.

Peck says the secret to being able to manage so many projects of such size is in three parts:
1) Entertain a vision of what is possible, no matter the source. 2) Effect a buy-in by others involved.
3) Rely on talented people whom you know can
turn vision to reality, including department heads and key administrators. For much of his admini-stration’s success, he generously cites the prodigious contributions of others. As examples, he names Lee F. Fetter, for 13 years the school’s associate vice chancellor and associate dean of administration and finance and currently president of St. Louis Children’s Hospital, and James P. Crane, MD, the CEO of the Faculty Practice Plan, as two of those without whom much of the restructuring would not have occurred.

But equally important is step two of the three-part recipe for success, which many say is Peck’s strongest talent. Dacey calls him, “an incredibly good communicator, articulate and perceptive of others.” Lois Hengehold, for 13 years Peck’s assistant, says he is “a wordsmith who can convey vision and bring together brilliant people with their own ideas.” And Danforth says he is “a master explainer, able to make complicated issues understandable to others.”

Among the challenges that began almost immediately for the new dean was the recruitment of department heads to replace leaders who were retiring or moving on. Peck says he always has devoted the greatest attention to the task because, “The secret of our success is good people on the faculty. The departments and divisions are the operating level, and the right department heads and division chiefs are key. They recruit and retain the best faculty members.” Over his 14 years, Peck has named 17 of 20 department heads and created the departments of orthopaedic surgery and radiation oncology.

Hengehold, who has staffed those searches, says, “Dean Peck always strives to take a department to the next level, to always improve. I’ve never heard him say that an issue is resolved or complete.”

Also early in Peck’s tenure, the Liaison Committee on Medical Education, which accredits medical schools, visited, and necessary changes to curriculum became clear: “We had no central oversight of the curriculum, and no planning for curriculum changes. Today, the curriculum bears almost no resemblance to what it was when I began,” Peck says. For much of the advance, he credits S. Bruce Dowton, MD, at the time associate dean and associate vice chancellor for medical education and now dean of the medical school at
the University of New South Wales, and Alison J. Whelan, MD, associate dean for medical student education.

Recruitment of an extraordinary group of academic deans—including W. Edwin Dodson, MD, in medical student admissions; Will R. Ross, MD, in diversity; and Leslie E. Kahl, MD, in student affairs—has enabled the school to attract what Peck calls, “the best students in the world.”

While dealing with the demands of an uncommonly diverse institution, Peck’s commitment to students always has been both resolute and apparent.
S. Andrew Josephson, MD ’01, president of his class from 1997 to 2001, recalls a dean who listened carefully and supported student causes: “Dean Peck is truly a champion for students, and the dedication he has to recruiting great medical students and improving their education is infectious. . . Dr. Peck’s attitude in this area has made Washington University the great institution it is today.”
If internal administration—the dean portion of the job—was part of Peck’s vision, external relations— the vice chancellor component—were no less so. Peck made the school an active part of several communities.

Locally, he picked up the baton created in 1973 when work began to rescue the Central West End (CWE), the school’s own neighborhood, from deterioration. Peck worked to empower Washington University Medical Center and its spin-off redevelopment corporation to further revitalize the CWE via projects such as the Forest Park Hotel and the Buckingham/Yorkleigh housing project. That work drew additional development attention, until critical mass was reached and the CWE was again a community in which to live and work.

More recently, attention has turned to the needier and higher crime Forest Park Southeast neighbor-hood (FPSE) that also abuts the medical center. Peck’s appointment of I. Jerome Flance, MD, gave the project a dynamic leader. With the assistance of Richard Baron, of redevelopment expert McCormack Baron, three years of work have brought “stunning changes,” Peck says. “The
Adams School has been refurbished and houses classes; a community center has been built; there’s
a new baseball field, and a senior assisted-living center recently debuted.”

With an annual total impact of $2.3 billion-plus on the St. Louis economy, Washington University School of Medicine assumed its place in the business community in the person of Bill Peck, who quickly gained the respect of its leaders. Says Andrew B. Craig III, former chairman and CEO of Boatmen’s Bancshares, retired chairman of Nation’s Bank and a partner in Rivervest Venture Partners, “Bill Peck combines excellent science with good business sense. He knows how to set priorities and follow through, and that has earned him the respect of the business community.”

Joined at the table by Fetter; Charles F. Knight, then chairman of the Barnes Hospital board, and Max Poll, then president of Barnes Hospital, Peck renegotiated and advanced the school’s 1964 contract with Barnes Hospital, retaining a bottom-line profit sharing arrangement that is unique in American medicine.

He also stepped out onto the larger stage, taking leadership roles in national organizations to represent the school in public affairs. “The world at large and even many in academic medicine didn’t recognize us,” he says. Peck’s efforts, a concerted media relations push, and attention to the U.S. News & World Report rankings have changed that.

At the particularly influential Association of American Medical Colleges (AAMC), Peck served first on the Council of Deans, then as the council’s chair, and finally as chairman of the entire association. “Bill Peck brought a measured tone to our debates and was able to guide discussions so that diverse opinions were heard and crafted into a consensus. This is not always easy to do on our Executive Council, comprising as it does deans, hospital directors, faculty, students and residents,” says Jordan J. Cohen, MD, president of the AAMC, in yet another recognition of Peck’s abilities as a consummate consensus-builder. Today, Peck is vice-chairman of Research! America, reflecting his continuing interest in biomedical research.

Another interest—alumni relations—has taken Peck to meet with alumni around the country and the world. “They love their school,” he says, “but they hadn’t been spoken to lately, and they were stunned to learn all that was going on.” In large measure because of Peck’s interest and involvement, alumni interest has grown so that there are now 5,000 alumni donors, compared to fewer than 3,000 when Peck began. The interest in the school that he has fostered has resulted in 67 endowed professorships.

Though he rarely speaks of it, the energy and broad involvement that now define him were not always Bill Peck’s to enjoy. At the age of seven, having suffered a spate of child- hood diseases before
being diagnosed with osteomyelitis—a chronic inflammation of the bone—he weighed just 25 pounds. At the time, the mortality rate for the condition was 80 percent. Effective treatment didn’t come until Peck was 16.

The son of a physician, Bernard C. Peck, MD, who kept an office in the family home, Peck’s early years revolved around medicine and music. Social life centered on his father’s colleagues, and Peck’s health meant that he spent many long stints in the hospital. He’s certain now that those experiences aimed him in the direction of medicine, perhaps even to the extent that his research interests in bone metabolism spring from his childhood condition.

They also forged his strong sense of family: An elegant portrait of his father hangs so that it is over Peck’s right shoulder when he is at his desk. The sideboard in his office holds more than a dozen photographs of his wife, Pat, children and grand-children. He attributes much to Pat’s great support and understanding.

Early talk of a career in music faded when, he says, “it became clear as a teenager that I would not be one of the world’s great pianists.” Nonetheless, he continues to play the piano at a near-professional level and has issued a CD of his music, “Listen to the Beat.” He often performs at social functions and at fund raisers.

And excellence—that notion of being one of the world’s best that nixed the music career—is still Peck’s determining factor, his raison d’etre. Dacey says it’s at the center of Peck’s character: “Some people just do; they’re compelled to achieve, to perform in a superior way.”

Speaking to the subject, Peck says that the school under its new dean and executive vice chancellor, Larry J. Shapiro, MD, is poised to be successful into the future and to take the next step toward still greater excellence, despite many uncertainties. “It won’t be easy. But then the pursuit of excellence is a strange journey. You never really arrive; you never are all that you can become.”

 

Peck to focus on shaping health policy, moving biotechnology forward It’s not so much retirement as it is a change of focus for William A. Peck, MD. Leaving the School of Medicine posts of dean and executive vice chancellor for medical affairs, he will become founding director of the Center for Health Policy at Washington University in St. Louis. Building on Peck’s deep experience and close associations in business, government and health care, the new Center for Health Policy will foster studies to influence federal, state and local policy regarding health care. Peck says he will concentrate on the nature and quality of the health care work force, improving policy that governs care delivery and cost effectiveness. “Our brilliant faculty should have the opportunity to explore these important issues,” he says. Chancellor Wrighton calls the work, “an extremely significant undertaking of importance to us and to the nation.” As part of Peck’s legacy, friends and admirers have created the Peck Scholars in Medicine, an endowment to assist medical students with the rising cost of their educations. “The majority of students leave medical school indebted, and their ability to repay is curtailed by the declining incomes of many doctors’ practices,” he says. Peck also plans time to follow his interests in securing venture capital for biotechnology start-ups and in fulfilling his obligations as a director of several corporations. He will maintain his faculty appointment as the Alan A. and Edith L. Wolff Distinguished Professor in the Department of Medicine. He makes no mention of golf or beach resort time.