When Daniel C. Tosteson '44 steps down from his post as dean of the Medical School (HMS) this June, he will leave his successor expanded research facilities, a recently remodeled campus and a new emphasis on individualized learning.

But Tosteson's replacement, neurologist Joseph B. Martin, inherits his position in an era of dramatically restructured health care systems and of reduced federal research funding.

Martin, now chancellor of the University of California at San Francisco, will need to maintain the Medical School's current level of academic excellence while finding increasingly scarce funding for research.

In addition, Martin, who is universally respected for his research achievements and his personal integrity, will have to carve out a place for himself within an administration increasingly centralized around President Neil L. Rudenstine.

The Race for Funding

When Martin arrives on campus, his first responsibility will be to protect medical research and education.

"I believe he correctly identifies the principle challenge is ensuring that the resources for medical research and education remain available at the needed levels," says Albert Carnesale, the University's provost, who participated in the search.

Because of the decline in funding for scientific and medical research and the resulting intense competition for money, Martin will have to fight hard to maintain Harvard's preeminence among medical schools.

Currently, the school pulls in more than $400 million in federal research grants each year. Its endowment now exceeds $840 million, up from the $138 million mark of 19 years ago when Tosteson began his deanship.

As part of the wider University capital campaign, now halfway finished, HMS has raised $160 million.

Unlike many medical schools, where administrators have been forced to shut down research facilities due to severe budget cuts and funding shortages, this year Harvard opened the Institutes of Medicine, a new research program designed to encourage collaboration among faculty members from affiliated hospitals.

But despite the current rosy financial picture, Martin will not be free of financial pressures.

"Sources of support for medical education, which in the past were reviewed as a legitimate part of the cost of health care, are now being seen as a competitive disadvantage," Carnesale says. "In particular, it is now difficult for physicians and health care institutions to charge higher prices if their activities and their institutions support medical research and education."

Carnesale said he is confident that Martin will rise to the challenge of finding money for research and teaching.

"Chancellor Martin is very familiar with this set of problems and believes that they can be addressed constructively only through cooperative means," Carnesale says.

Preparation

Managed-care health systems and hospital mergers are common in Massachusetts, and Harvard's affiliated teaching hospitals reflect those trends. Brigham and Women's Hospital merged with Mass. General in 1993 to form Partners Heath Care, and Mount Auburn and Deaconess hospitals recently merged as well.

Martin's experience on both coasts may have helped to prepare him for the conditions of health care in Massachusetts.

During his time at Harvard, where he chaired HMS's neurology department and served as acting head of Mass. General, he gained familiarity with the school's administrative structure.

After leaving Boston, Martin served as dean of the UCSF school of Medicine from 1989 to 1993. While there, he helped run UCSF's first capital campaign, which concluded in July of 1996. The campaign pulled in more than $550 million for the university.

He also gained experience with managed care, currently prevalent in California.

Administrative Changes

As a member of the increasingly centralized administration, Martin will also have to acclimate to a bureaucratic structure different from the one he left.

In his five years at Harvard, Rudenstine has attempted to rally the deans of the different schools around interfaculty initiatives and other collaborative processes. HMS has been a key player in many of those programs.

Martin will be expected to step in and continue those collaborations without detracting from the HMS's own programs. This could put further pressures on the new dean to find extra resources despite a shrinking supply of research funding.

However, the provost stresses the benefits of cooperation among different sections of the University.

"Martin is one of the first "to recognize that addressing the challenges facing health care requires collaborations among people," Carnesale says.

The Student Perspective

HMS students, who will be among the first to feel the impact of Martin's leadership, laud his reputation. He is known at medical schools across the country as one of the authors of a major medical textbook, Harrison's Principles of Internal Medicine.

But some students wonder what sort of dean Martin will be, and particularly whether he will maintain HMS's revolutionary approach to medical instruction.

In 1985, Tosteson and other HMS faculty members pioneered a medical education program called the New Pathway which steered students away from rote memorization. Instead, medical students now spend more time discussing cases in small groups with faculty members.

New Pathway, regarded as Tosteson's crowning achievement, has won acclaim among medical students, who worry that the expensive program might suffer under Martin.

"I hope that he keeps things the way they're going right now in terms of the New Pathway," says Sanjay Shetty '96, a first-year medical student. "[It's] the big thing that distinguishes Harvard."

Steven W. Hetts '96, a first-year medical student and a former Winthrop House resident, says he is also interested in hearing Martin's position on affirmative action in medical school admissions.

Unlike many chancellors within the UC system, Martin did not resign when the system's governing board voted to abolish the program within the state universities.

Hetts, a San Francisco native who used to work at UCSF, says he isn't worried about the Medical School's research funding.

"HMS is in the enviable position of getting lots of research money," he says. "It boggles my mind. Other institutions are thinking of shutting down labs, and Harvard just finished the Institutes of Medicine, and the Dana Farber Cancer Center is constructing a new research building."

In order to serve HMS best, Hetts says, Martin should concentrate on getting funding for younger doctors, at the level of associate professor and below