The inevitable pain that will accompany the changes, he assured the 170 people at the program in the Sheraton Inn, will be worth the eventual gain.

"I think if we can get through the next two to three years, the people of this community will look back at the changes and will be very, very proud," Bernardino said.

"If we can accomplish even half of our goals, we will have significantly improved the quality of care in this community."

Bernardino, whose topic was "How an Academic Health Center Copes in a Chaotic Environment," took office as vice president for health affairs on April 1. He came to UB from Atlanta, where he was director of managed care with the Emory University System of Health Care, Inc., and professor of radiology at Emory University School of Medicine.

Bernardino said he has set out to achieve three goals for the UB medical school: sort out the graduate-medical-education puzzle with affiliated hospitals to increase benefits to the public and improve residency programs; increase development and research revenue, and stabilize clinical revenue.

UB and its teaching hospitals, he added, are in the process of signing affiliation agreements, the heart of which deal with residency training-graduate medical education-and ownership of the reimbursements from insurance providers that fund the training. As the provider of residents to hospitals and source of a major revenue stream, UB must play a larger role with the hospitals than in the past, Bernardino contended.

"We need to be general partners in the future, not a limited partner," he said.

Bernardino said that some area hospitals will close because Western New York has far too many beds for the population, and that the closings will have a sizable economic effect. The imperative during these changes will be to maintain quality of care, he stressed.

"UB should serve as a conscience," he said. In terms of quality of care, he added, "UB physicians should strive to achieve maximal outcomes in the 60-75 percent of patients, rather than the 50 percent national norm."

In an effort to increase revenue from research and development sources, Bernardino said the UB medical school in the future will focus its clinical and basic research on four national centers of excellence. Two obvious areas, he said, are pediatrics and cancer; the remaining two are still open for discussion.

Noting that stabilizing clinical revenue has been his major focus, Bernardino said that government intervention will be an ever-larger force as increasing numbers of patients are covered by Medicare and Medicaid. Greater government involvement, he added, will bring closer scrutiny, in the form of audits of the medical school's practice plan.

The practice plan is the mechanism by which university-affiliated physicians, under contract with the university, agree to return a certain portion of their clinical practice revenues to the university to support essential, but non-revenue-producing aspects of the medical school, such as basic-science education. In the past, each clinical department maintained its own practice plan.

"In this environment, we can't operate a practice plan in a decentralized manner with decentralized authority," Bernardino stated.

Underscoring the need to introduce sound business management, he added: "We need a corporate mentality rather than a cottage-industry mentality. We must emphasize the group needs rather than individual needs."

Bernardino said that in the current chaotic health-care environment, the medical school needs to constantly question conventional wisdom and determine its own path to a new level of stability and excellence.

"I have no question about our surviving," he said. "I have no question about our thriving."