With the looming competitive threat of two new regional medical schools in the University of Texas System opening north and south of San Antonio, a growing number of business and civic leaders are expressing support for once again exploring a merger of the University of Texas at San Antonio (UTSA) and the University of Texas Health Science Center at San Antonio (UTHSCSA).

Bexar County Judge Nelson Wolff and City Councilman Joe Krier (D9) sent a jointly signed letter on Nov. 9 to UT System Chancellor William McRaven asking him to formally consider the merger and to meet with them to discuss the matter. They hope to meet with McRaven sometime in December.

A 2010 study commissioned to explore a UTSA-UTHSCSA merger ultimately concluded the timing was not right. Publicly, officials cited the administrative challenges and costs of such a merger and reconciling the two different institutional cultures. Privately, medical school officials questioned the academic status of UTSA with its lower graduation rates and academic status.

University of Texas Health Science Center at San Antonio.
The University of Texas Health Science Center at San Antonio campus at mid-day. Credit: Kathryn Boyd-Batstone / San Antonio Report

Since then, UTSA has made considerable progress. Six-year graduation rates, for example, improved from 28.6% to 53% from 2009 to 2013. Admission standards and SAT scores also have risen, as have the number of research grants and total dollars.

There also was the question in 2010 of how to decide who would serve as president of the new university. UTSA President Ricardo Romo and the Health Science Center’s Dr. William Henrich, were both highly regarded. Henrich had recently replaced Dr. Francisco “Cisco” Cigarroa, who was appointed UT System Chancellor in January 2009, the post now held by McRaven.

The letter and a recent op-ed published in the San Antonio Express-News by Wolff and Krier make the case that such a merger would now propel UTSA into Tier One status by dint of the research dollars flowing to UTHSCSA and the number of endowed faculty chairs there.

An excerpt from the letter to McRaven:

“We believe that combining UTSA and UTHSCSA would create a national powerhouse, enhancing Texas’s reputation for academic excellence. A merger would expand the research capacity and academic strength currently enjoyed by the two institutions separately. The combined university would clearly find itself on the state’s list of Tier One institutions. It would also strengthen the Health Science Center’s mission of training doctors and nurses; conducting world-class research; fighting cancer, diabetes, and other diseases; and improving health care throughout South Texas.

“As you know, the UT System appointed a panel in 2009 to evaluate a potential combination of the universities. The panel recommended maintaining the status quo. However, we believe the subsequent development of new medical schools in Austin and the Rio Grande Valley, both part of universities offering undergraduate and graduate tracks, is ample reason to revisit the question of a merger. Indeed, universities across the country – including in California and Texas – have demonstrated the benefits of undergraduate and graduate universities that include medical schools.”

Click here to read the full Wolff-Krier letter to McRaven.

Both officials expressed concern Friday in interviews about the impact that two newly opened medical schools in Austin and the Rio Grande Valley will have on San Antonio’s medical school.

“It gives me great concern that we will be in intense competition with UT-Austin’s Dell Medical School and all its resources, as well as UT-Rio Grande Valley,” Wolff said Friday. “We are going to get hit from both sides, and how we are going to survive and prosper gives me great concern. Most people don’t realize what we are facing. The Dell School, in particular, could attract some of the key people that are here at our medical school.”

Krier said the creation of the two medical schools changes everything in the local equation. A merger, he said, would gird San Antonio’s medical school, which has enjoyed a 50-year regional monopoly and has produced 30,000 graduates, against the Dell Medical School at UT-Austin and  the UT-Rio Grande Valley Medical School, both of which accepted their first class of medical students in the summer 2016.

School of Medicine at University of Texas Health Science Center San Antonio.
School of Medicine at University of Texas Health Science Center San Antonio. Credit: Kathryn Boyd-Batstone / San Antonio Report

“Up until now, it’s been a good idea only for UTSA,” Krier said. “Until now, it was less certain what the benefits would be for UTHSCSA, but the growing flow of research dollars to UTSA, its rising stature under Dr. Romo, and the competitive marketplace changes that.

“I’ve driven through the Dell campus downtown and it is astonishing,” Krier added. “Anyone who thinks our decades of experience operating a medical school means we can sit on our laurels is wrong. The other two schools will be competing in the Legislature for money and with San Antonio for faculty, and the Dell Medical School happens to be in the city that a lot of people think is the coolest place in the country.”

The advent of new medical schools in Austin and the Rio Grande Valley and the eventual transition in leadership at both campuses makes merger talks a more logical step now, according to Wolff and Krier. Romo, 73, announced in September his plans to step down in August 2017 after 18 years as UTSA’s president.

Dr. Henrich, 70, a kidney specialist, has no plans to retire. He took an extended medical leave in 2012 to be treated for myelodysplastic syndrome, a blood and bone marrow disorder, but was later able to return to his full duties.

Several civic and business leaders who asked not be quoted because of the sensitivity of any merger talks, said Cigarroa, 59, a nationally recognized liver and kidney transplant surgeon who is the head of pediatric transplants at the Health Science Center, would be an ideal candidate to lead any merged university. Cigarroa served as UTHSCSA president from 2000-2009 and as UT System chancellor from 2009-2014.

A single UT university in San Antonio combining UTSA’s engineering, cybersecurity, and biosciences research with the Health Science Center’s medical, dental, nursing schools, and its research programs, would create a comprehensive university able to attract top students, faculty members, and more research grants, Wolff and Krier said Friday.

“UTSA is a different university than it was 10 years ago, and no one should look at them as secondary partners today,” Wolff said. “Their research programs, biosciences program, cybersecurity program, and the grants they are winning – it all adds up to a very impressive trajectory.”

The proposal to reconsider the merger comes as Henrich continues to work on another major deal within the UT System.

The Health Sciences Center also is home to the Cancer Therapy and Research Center (CTRC), which holds a coveted National Cancer Institute Center designation. Officials at UTHSCSA and the UT-MD Anderson Center in Houston recently signed an affiliation agreement, and now have 17 different teams working together to design the future center’s operations and guidelines here.

University of Texas Health Science Center at San Antonio.
University of Texas Health Science Center at San Antonio. Credit: Kathryn Boyd-Batstone / San Antonio Report

Henrich said reports that the project could cost $70-80 million “are accurate,” and that infrastructure improvements alone to the CTRC campus will cost $35 million. Expansion of the center’s professional staff, administrative, and facility support also will add significant expense over the first 6-7 years of operations, he said.

“We have to find the money and I am cautiously optimistic that we will raise that sum of money,” Henrich said. “We are on our way with the $17 million from the San Antonio Cancer Center, $12 million from the PUF (Permanent University Fund), and we have a lot of philanthropy in the works.”

The 2017 City Bond also is expected to provide a $5-6 million contribution to the project.

Henrich said candidates for the director’s position will be interviewed in early 2017 at which time a firm timeline for opening MD Anderson-San Antonio, or whatever the new center is named, will have to be made.

“Many of us think there is an opportunity to take another look at the merger now,” Krier said. “It’s not written in heaven that it has to be done, but with the retirement of Ricardo Romo and the eventual retirement of Dr. Henrich, who I doubt will be there for another 10 years, it seems like an opportune time.

“I had conversations with both of them before the op-ed was published because I didn’t want them surprised,” Krier added. “Dr. Romo’s official view is that whatever (the) UT System want(s) to look at is fine. It’s a decision above his pay grade. Dr. Henrich, not surprisingly, expressed a number of reservations.”

Henrich said Friday he is not necessarily opposed to the merger proposal, but does question its timing given the findings of the 2010 study. He also said he intends to stay in his position through the completion of the affiliation with MD Anderson.

“I think the question is going to be: How much have things changed since then, and how often should we look at this?” Henrich said. “At the time of the 2010 study there were significant expenses associated with the merger and other reasons not to move forward.

“I don’t know if this is a decision for presidents of institutions, it’s a decision for the chancellor,” Henrich added. “My position is that I am open to following the dictates of the chancellor. I certainly understand the logic behind Joe and Nelson’s position.”

Henrich said the Health Science Center’s established reputation would serve it well against the two new medical schools. It will take years for both to develop into complete medical schools, he said.

“It’s always a concern that we are in a competitive market, but it’s a national market and we are always in competition to recruit the best and brightest to San Antonio, and once they are here, to retain them,” Henrich said. “I certainly respect that they have high ambitions for the school in Austin. One advantage we have is that we are an established medical school with a high-level track record.”

More than a dozen business and civic leaders interviewed for this study expressed support for the merger talks, although none would comment on the record given the sensitivity of the matter. None of the individuals interviewed oppose the idea, although several said there are those who think the merger is impractical and will never happen.

Romo was traveling and unavailable for comment.

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Robert Rivard

Robert Rivard, co-founder of the San Antonio Report, is now a freelance journalist.