Office of the Chancellor

Johns Hopkins Address

It is always a great pleasure for me to return to Johns Hopkins Hospital.  My pediatric surgery and transplant surgery fellowships at this institution were a transformative experience and a turning point in my career.  I came here from Mass General in Boston, where I had spent five years in general surgery, two years in basic science research, and an additional year as chief resident.  Here at Hopkins I was exposed to an extraordinary faculty, including Mass General Hospital surgical alumni Dr. Melville Williams and Dr. John Burke, an exciting new medical environment, and a remarkable culture of excellence.  Dr. Paul Colombani was – and remains – an exceptional mentor to me.  He taught pediatric surgery as teamwork, with a strong family bond.  Given my background and my own love of family, this was something I truly admired and embraced.  He and his team of gifted surgeons enjoyed great food, family get-togethers, and the joys of life, and they made my wife, Graciela, and me feel at home.    

It was here at the Johns Hopkins Hospital that I was introduced to the world of organ transplantation.  I did 12 years of graduate residency/fellowship training, and I was offered a job to be director of pediatric transplants.  But for the very first time in our life together, Graciela said, “I don’t think so.  I think we belong in Texas.  It’s time to go back home.  I want our children to know their cousins and grandparents.”

So we left my outstanding mentors and colleagues, and our wonderful life in Baltimore, and we went back home to Texas.

Before I go any further, let me give you a picture of the University of Texas System. 

  • There are 15 institutions in the UT System – nine academic institutions and six health institutions – and they’re all over the state.
  • All totaled, the UT System has 213,000 students, more than 19,000 faculty members, 69,000 staff members, and a collective budget of nearly $14 billion. 
  • Last year we produced more than 30,000 undergraduate degrees and more than 15,000 graduate and professional degrees.
  • Nearly $1.4 billion was allocated for financial aid awards to students at our academic institutions last year.
  • Chances are, if you see a doctor, nurse, or other health care professional in Texas, you’re meeting a UT graduate. We produce two-thirds of all health-related degrees in the state.
  • Our hospitals and UT health centers serve more than 6 million outpatients and 1.35 million hospital days of treatment every year.
  • The annual research expenditures of UT System institutions add up to $2.54 billion, making us number two in the nation, behind only the University of California System.
  • Among our faculty members System-wide, we have 7 Nobel laureates and 277 members of prestigious national academies.
  • For the second consecutive year, philanthropic support for UT System’s 15 institutions has topped the $1.2 billion mark.    

As an Hispanic child educated in public schools in Laredo, Texas – on the Rio Grande River and the border with Mexico – the odds were overwhelmingly against my addressing you today.  When I was growing up, Laredo was ranked as the poorest city in the United States.  In my wildest dreams as a child, I never imagined I would attend an Ivy League university and become a transplant surgeon and Chancellor of a highly acclaimed public university system.

I left home to earn my undergraduate degree from Yale University before attending The University of Texas Southwestern Medical School in Dallas.  I am a third generation physician.  My grandfather practiced medicine in San Antonio and then Laredo.  And at age 89, my father continues to practice medicine in Laredo.  When I was a boy, he provided me with a tremendous experience in understanding the challenges faced by a medically under-served region along the Texas-Mexico border.  The Border region was, and still is, a region with significant healthcare disparities, many of which are now looming public health issues not only for Texas but for the entire country. 

In shadowing my father as he made house calls, and seeing his love for his practice, I received a firsthand view not only of the beautiful art of medicine, but how this art profoundly touches all classes, from the poorest to the wealthiest without regard to economic status or homeland of origin.  Dad came home with a smile on his face every evening after work, which is why several of his children have chosen medicine as their profession.

My first position after Johns Hopkins was Head of Pediatric Surgery at The University of Texas Health Science Center at San Antonio.  I enjoyed a great clinical practice in San Antonio and developed a very successful pediatric transplant program and a very busy career.  In fact, while at the Health Science Center, I created several “firsts” as a pediatric surgeon, including multi-organ transplants. 

In the year 2000, The University of Texas System Board of Regents conducted a search for a new president of the UT Health Science Center at San Antonio, and my name was thrown in the hat.  However, I wasn’t interested in being an administrator.  I hated long meetings and viewed them as an inefficient use of time.  But my father and my brother drove to San Antonio one day and urged me to go through the process.  My father said, “You don’t want to be disrespectful to the Regents.”  I asked him what my chances were of becoming president, and Dad said “about one in a million.” 

I beat the odds.

My family and colleagues were very happy for me, but I was nervous.  I had the same feeling I had when I walked into Yale my freshman year.  “This is going to be very hard.”  I thought maybe I should take a business class that covered Robert’s Rules of Order.  But the Regents said, “No time like the present.  You start on Monday.”

Because I didn’t know very much about administration, I immediately surrounded myself with the smartest people I could find.  I told them I had a vision but not an agenda.  I empowered my staff to show leadership, accept responsibility, and get things done.  In turn, they became more open and involved with helping me create a new strategic plan.

After nine successful and joyful years as president, I decided to go back to pediatric surgery.  This caught everyone by surprise, as I had really enjoyed a nine-year honeymoon in administration.  During my tenure as president, the UT Health Science Center at San Antonio experienced a surge of growth and success:

  • Our budget increased from $351 million to $668 million.
  • Our endowment grew from $293 million to $411 million.
  • Our research expenditures went from $84 million to $210 million.
  • The number of employees almost doubled, from 3,300 to 6,000.
  • Our total number of graduates increased from 17,000 to nearly 26,000.
  • The amount of the Center’s square footage expanded from 2.4 million square feet to 3.5 million square feet.
  • Our members inducted into the prestigious Institute of Medicine increased from 1 to 5.
  • Our awards from the National Institutes of Health more than doubled, from $51 million to $107 million. 

I was enormously proud of the Health Science Center’s growth and collective accomplishments.  We had grown significantly stronger as an institution and surpassed a great many of our goals, so I was ready to return to surgery.  But then a new Chairman of the Board of Regents, Scott Caven, called and said he wanted me to interview for the open position of Chancellor of The University of Texas System. 

I was reluctant to take that step.  I drove to Laredo and talked to my father again.  I told him that many people had warned me that the job was too political.  They said I wouldn’t be happy.  I spent an hour talking to Dad and told him I wanted to return to surgery.  He listened carefully and said okay, and I was about to leave town when I ran into my brother Ricky.  He asked how the conversation went and I said, “Dad supports my decision to return to surgery.”  And Ricky asked, “Did he give you a hug?”  I said no, he didn’t.  Ricky said, “Then you better go interview for that job.”

So I said “No, I’m not interested” twice, and both times I ended up with the job.  This is the Francisco Cigarroa formula for successful leadership.  Just say no.

It’s one thing to become a leader; it’s another thing to actually lead. Today I use the same techniques I used when I created a successful team of transplant surgeons.  Work together, share the decision-making, and strive for continual improvement.  I hold myself and the team accountable when things don’t go as expected.  I treat everyone with respect.  And I listen. 

The field of pediatric transplant surgeons who run major public university systems is a very narrow one.  I am probably in a world of my own.  I accepted the chancellorship with the stipulation that I could continue to take surgical calls one weekend every month to perform transplants and save lives.   

Surgery is my passion.  Running a university system is a privilege and a profound responsibility.  I am comfortable in both worlds because I firmly believe that higher education saves lives, as well.  

Serving as Chancellor of The University of Texas System has been challenging work, and as the first Hispanic chancellor in the history of the UT System, I am aware that I am not only making history, I am shaping it.  Let me tell you a few things about the development of higher education in my home state of Texas – and how the flagship University of Texas at Austin and University of Texas System institutions have played a major role in the history of that development.

The Texas Constitution of 1876 specified that the legislature was to establish and provide for the maintenance and support of a “university of the first class” to be located by vote of the people.  In 1881, Texas voters chose Austin for the site of the main university and Galveston for the location of the medical school. 

Another major outcome of the Texas Constitution of 1876 was the establishment of the Permanent University Fund.  We usually refer to it by its acronym – PUF.  It is a public endowment that provides financial support to institutions in the University of Texas and Texas A&M University systems.  Today, more than 20 Texas institutions benefit from this endowment. 

The PUF is a thing of beauty, with an impressive diversity of revenue sources from two million acres of land in West Texas that legislators set aside in the 19th century for higher education. 

The principal of the fund includes all proceeds from oil, gas, sulfur, and water royalties, all gains on investments, all rentals on mineral leases, hunting leases, grazing leases, vineyards, wind power, and all amounts received from the sale of those university lands.

I have an affinity for a physician and educator named Ashbel Smith, who was the president of The University of Texas’s first Board of Regents.  Because of his remarkable leadership, he is known as the Father of The University of Texas and the Father of Texas Medicine.  During Galveston’s epidemic of yellow fever in 1839, he treated the sick, published reports about the disease in the Galveston News, and wrote the first treatise on yellow fever in Texas.  As a result of the leadership of Ashbel Smith and his colleagues in medicine, Galveston has been a center of medical education since before the Civil War, especially in the area of infectious diseases.

I admire Ashbel Smith because he was a steadfast supporter of education at all levels, but especially higher education and medical training.  At the ceremony to lay the cornerstone for the Old Main building on what would become The University of Texas campus, Ashbel Smith said prophetically, “Smite the rocks with the rod of knowledge and fountains of unstinted wealth will gush forth.”  He was a grand orator, and it was a well-phrased metaphor.  But Dr. Smith had no idea that 40 years later, in 1923, oil would be discovered on university land in West Texas when the Santa Rita oil well gushed forth fountains of wealth.

The two million acres of West Texas desert and prairie lands that the state legislature gave to the people of Texas – as an investment for their public university – became the miracle of The University of Texas endowment.  As an interesting footnote to this story, the Board of Regents was considering selling some of that land when a geologist named Johan Udden, serving as director of the University’s Bureau of Economic Geology, convinced them that oil and gas might lie beneath those dry and dusty acres.  Without geologist Johan Udden, The University of Texas System would not be what it is today

Striking oil was an astonishing moment in the history of higher education in Texas.  By 1925, the Permanent University Fund was growing by more than $2,000 a day.  Today, new technology has increased production on those lands, and our investments have had extraordinary success.  At the end of January (this year), the PUF was valued at $15.73 billion.    

There is nothing like the Permanent University Fund in the entire nation.  Texas is unique – and incredibly blessed – to receive significant financial benefits from the land itself.  In a very real sense, West Texas lands and the PUF have helped the University of Texas MD Anderson Cancer Center find new treatments for cancer.  The PUF has built centers for the arts and culture, supported surgeons and their lifesaving artificial hearts, and so much more.  These funds support critically important research, outstanding patient care, and labs and teaching facilities. 

Today, 135 years after the PUF was created, The University of Texas System has 15 institutions that are educating and training a new generation of students and doing world-class research that is improving the quality of life in our state and far beyond. 

The University of Texas System has much to celebrate.  Our institutions are strong and world class, following their own trajectories toward excellence.  But quality is a moving target.  And so three years ago, the UT System underwent a self-examination of the way our institutions were performing and how we could improve them. 

Since the summer of 2011, the UT System has introduced several initiatives that are changing the environment in higher education.  We have become a model not only for Texas, but for the entire nation.  To give you three examples:

  • The Framework for Advancing Excellence was our systematic effort to address a number of challenges in higher education and position UT institutions among the best.  There are nine major focal areas in the Framework, and I am happy to report that nearly 100 percent of our initiatives are now under full implementation.  The focal points are:
    • Undergraduate student access and success:  We are striving to increase the number of degrees conferred, to improve four-year graduation rates, to reduce the financial impact of higher education on students and their families, and to increase blended and online learning.
    • Faculty/administrator/staff excellence:  We are attracting and retaining the very best faculty and staff through awards, the creation of prestigious academies, and other incentive-based strategies.
    • Research:  We are promoting research, advancing technology commercialization, building partnerships with private companies, and supporting our emerging research universities.
    • Productivity and efficiency:  We are implementing cost-containment strategies, looking for ways to share services and to better utilize our spaces.
    • Strategic Information Technology Infrastructure Investments:  We are expanding our computational power and data storage, and expanding the metrics in our performance and productivity dashboard.
    • Enhance philanthropic success:  We are implementing fundraising plans in all of our institutions and rewarding successful strategies.
    •  PhD programs:  We are mentoring and advising doctoral students, including career advising, to shorten their time to completion of their degrees.
    • The health of Texas:  We are advancing medical research in Austin and other metropolitan areas, improving patient safety and quality, and using technology to strengthen healthcare education, research, and delivery.
    • Expanding Educational and Health Opportunities in South Texas:  We are building a new university and medical school in the Rio Grande Valley.
  • The UT Board of Regents invested $50 million to support the Institute for Transformative Learning, which is working with our academic and health institutions to establish UT System as a global leader in blended and online learning.  This academic year, UT Austin is offering nine MOOCs – Massive Open Online Courses – and the UT MOOCs are reaching 175,000 students worldwide.
  • We are honored to be the first public university system in edX – a not-for-profit consortium that offers online interactive learning.  EdX was founded by Harvard and MIT, and they have since added UC Berkeley and other institutions.  We are using the edX platform in a variety of technology-enhanced instructions.     
  • Our initiative called TIME – an acronym for Transformation in Medical Education – has launched pilot programs that partner six undergraduate institutions with four medical schools to offer a student-centered, clinically focused curriculum that is one to two years shorter than the traditional eight years required to earn an undergraduate and medical degree.  This program streamlines a medical curriculum that hasn’t been updated in 100 years, produces doctors in a shorter and more efficient timeframe, and lowers the total cost of a medical education, thereby reducing student debt.  
  • The Task Force on Engineering Education for Texas in the 21st Century has examined the current state of engineering degree programs in Texas, after the Texas Workforce Commission projected that the state will need 9,000 new engineers and computer specialists every year for the next decade – far below the numbers currently being graduated.  One of the task force’s recommendations is to graduate at least 50 percent more engineering and computer science students per year for the next ten years.  Each UT academic institution has developed a preliminary plan for this expansion.     
  • The University of Texas Clinical Safety and Effectiveness program offers a five-month course on clinical safety for faculty and staff at our six health institutions.  The Board of Regents allocated $8 million to support CS&E in integrating quality and safety concepts into the way our medical and health professionals do their work every day.  The program awards grants to institutions, supports a fellowship program to recognize healthcare providers who demonstrate expertise, and hosts an annual conference to share best practices and  develop ideas to drive System-wide initiatives that improve quality and safety.
  • The University of Texas System Academy of Master Teachers recognizes outstanding educators at our nine academic campuses.  The Academy fosters excellence in teaching and creates opportunities for continuous learning and scholarship at our universities. The Academy also supports innovation in teaching, including blended and online learning and the use of technology in the classroom.

As much as the UT System and the Board of Regents have accomplished over the past three years – and those accomplishments are substantial – there is much ahead of us to strive for and complete. 

One of the most exciting new developments in Austin is the establishment of the Dell Medical School at UT Austin.  It will be the first medical school at a major Tier One (AAU) public research institution in the last 50 years.  It will transform healthcare in Central Texas.  In fact, with the addition of a medical school, UT Austin has the potential to become the top public research institution in the nation, making Austin one of the great national centers for biomedical research.  And coupled with UT System initiatives to support technology innovation and entrepreneurship, Austin will be one step closer to becoming a major technology hub like Route 128 in Boston, the North Carolina Research Triangle, and Silicon Valley.

We have recently selected a new dean for the Dell Medical School – Dr. Clay Johnston. Dr. Johnston is a physician and professor of neurology and epidemiology who comes to us from the University of California, San Francisco, where he is currently associate vice chancellor of research at one of the top ranked academic medical centers in the nation. 

We are also moving forward with Project South Texas, including our plans to create a new university and medical school in the Rio Grande Valley.  That is the south-most region of Texas that forms a sort of “V” between the Rio Grande River and the Gulf of Mexico.  It is an area where the population is rapidly increasing, but where current opportunities for upward mobility are limited.  Consider these facts:

  • According to the Texas State Data Center at The University of Texas at San Antonio, the current population of the Valley is 1.26 million – and by 2020, the population is projected to grow another 1.5 million people.
  • The Valley is 90 percent Hispanic, compared to 38 percent in Texas overall.
  • The dropout rate among high schools students in the Valley is 7.2 percent, compared to 2.4 percent in Texas overall.
  • Among adults older than 25 years of age, only 15 percent of students in the Valley have college degrees, compared to 26 percent in Texas overall.
  • The median household income in the Rio Grande Valley is about $28,000 per year, while for Texas it is more than $50,000 per year.
  • According to the most recent data (2012), the unemployment rate is as high as 15 percent in Starr County, and 11 percent on average for the Valley, compared to 6.7 percent in Texas statewide.
  • In the Valley, 40 percent of “families with children” live below the poverty line, as compared to 16.8 percent in Texas and 13.5 percent nationwide.
  • In the Valley, there are a half-million children, and 47 percent of them live in poverty, compared to 27 percent statewide.
  • The Valley has 107 physicians per 100,000 residents, compared to 195 physicians per 100,000 residents in Texas and a national average of 220 physicians per 100,000 residents.  The Valley has about half as many doctors as it should have by national standards.
  • There are systemic health factors afflicting Valley residents, including a disproportionate rate of chronic and infectious diseases: 
    • For example, the tuberculosis disease rates in the Valley are twice the rate in Texas overall and nearly 3 times the national rate. 
    • The major populated metropolitan area of the Rio Grande Valley is the most obese in the country.
    • Nearly 10 percent of adults in Texas have been diagnosed with diabetes, but the rate of diabetes in the Valley is higher, between 12-15 percent.
    • The Comparative Effectiveness Research on Cancer in Texas (CERCIT) Project reports that cancer has surpassed heart disease to become the leading cause of death for Hispanics in Texas.  The report indicates that this is also the case in the Valley. 
  • 38 percent of the Valley’s population does not have health insurance, compared to 24 percent in Texas statewide and 15 percent in the nation.

As these statistics show, in the Rio Grande Valley there is an increasing need for doctors and health professionals, nutritionists, teachers, and a myriad of other professions that will improve basic services, educate children, and grow the economy in that region of Texas.

For several years, our Board of Regents has been striving to plant a bigger University of Texas flag in the Rio Grande Valley – to address many of the challenges I have mentioned and to transform the Valley through greater involvement in education, teacher training, medical training, biomedical research, and healthcare.  As the centerpiece of our commitment, the Regents have allocated $200 million to fund a new university and medical school that will span the entire Rio Grande Valley, with a presence in each of the major metropolitan areas of Brownsville, Edinburg, Harlingen, and McAllen, immediately making the new university one of the two largest Hispanic-serving institutions in the nation.

What became an idea only 17 months ago has now been approved and funded by the UT System Board of Regents, passed by the Texas Legislature, and signed into law.

The university has a new name, approved overwhelmingly by the people of South Texas and the Rio Grande Valley.  Our new university will be called The University of Texas Rio Grande Valley:  UT-RGV.

Two weeks ago we named the founding dean of the UT-RGV medical school.  He is Dr. Francisco Fernandez, professor and chairman of psychiatry and neurosciences at the University of South Florida College of Medicine in Tampa. 

We are very excited to welcome Dean Clay Johnston at UT Austin and Dean Francisco Fernandez at UT RGV into the University of Texas family.  A search has also been under way to hire the first president of UT RGV, and we will announce our selection in the coming weeks.

What I didn’t mention earlier, when I was describing the beauty of the Permanent University Fund, is that 13 of our 15 institutions are eligible for the PUF, but not UT Brownsville and UT Pan American – the two predominantly Hispanic universities in the Rio Grande Valley.  However, the new UT RGV will be eligible for PUF funding, which will provide greater support for this under-served region of our state and make it possible for students to study in the Valley, do research there, receive medical training there, and save lives there for decades to come. 

Daniel Burnham, one of America’s premier architects at the beginning of the 20th century, once said, “Make no little plans. They have no magic to stir men’s blood and probably will not themselves be realized.”

At UT System, “Make no little plans” could be our guiding principle.  The stereotype of Texans is that we are given to exaggeration, but it is no exaggeration to say that the aspirations of The University of Texas System are big and bold.  Every day at our nine academic institutions and six health institutions, we are implementing innovations that create a stronger learning environment, improve the undergraduate experience, contribute world class research, render public service, and provide nationally acclaimed medical training and patient treatment.  We are saving lives and shaping lives.  We are transforming the world in which we live. 

It has been my great privilege to serve as chancellor of The University of Texas System for the past five years – and to join the Regents and thousands of faculty members, administrators, legislators, alumni, students, and their families in our collective pursuit of excellence in higher education.  I have accomplished all I set out to do and much more.  It is time for this reluctant administrator to return to transplant surgery – and to teaching the next generation of surgeons what was taught to me here at Johns Hopkins Hospital by Dr. Paul Colombani and his esteemed colleagues.  And so I am returning to The University of Texas Health Science Center at San Antonio to serve as Head of Transplant Surgery, to teach and train medical students, and to save one life at a time.  I can finally look Paul Colombani in the eyes again and tell him his training of me as a pediatric and transplant surgeon was worth it, as I will again be a full time surgeon.

I’m looking forward to refocusing my brain activity to learn more about the wonderful things occurring in medicine.  I’m looking forward to utilizing the talents that I have to take care of patients again.  I’ve got to learn a whole new environment and really delve into medicine again and get quickly caught up.  And it’s going to be fantastic to teach students and residents again.

In short, I’m looking forward to this next great adventure of my life.       

Thank you again, Paul, for giving me this opportunity to visit old friends and make new ones here at Johns Hopkins.  It was an honor to address all of you today.  As fellow physicians and others dedicated to the beautiful art of medicine, you have my greatest respect and admiration.