Could a Medical School Catalyze Transformational Health Systems Change? One did in the 1890s

Sofia Ramirez

You know, David, there’s this saying that goes, "If you want to predict the future, create it." And right now, BYU has that chance with the launch of their new medical school.

David Caldwell

Oh, I like that. But wait. Hmm, are they predicting—or defining—the future of healthcare? Because those two paths sound, like, incredibly different.

Sofia Ramirez

Exactly. That’s the crux of it, right? BYU faces what you might call a fork in the road. They can either prepare their students to thrive in the healthcare system we have now—which, let’s be honest, is, well, deeply flawed in so many ways—or they can take the riskier but far more impactful road of developing a medical program that pushes us toward a new paradigm of health and well-being for everyone.

David Caldwell

Okay, so here's my "everyman" question for you. Are they starting from scratch here? A blank slate? Or are they trying to, like, retrofit today’s notoriously messy system into their curriculum?

Sofia Ramirez

Well, BYU does have the opportunity to create something truly new and visionary, but that’s not easy. Health systems worldwide, including in the U.S., have deeply entrenched structures, financial incentives, and cultural norms. Even when you dream big, you're not just fighting against the status quo but also trying to predict where future needs and challenges will arise.

David Caldwell

Right. It sounds kinda like trying to design a plane while it’s flying. Like, you can add better wings or, I dunno, fancier engines, but if the core is flawed, sooner or later you’re hitting turbulence, no matter what.

Sofia Ramirez

Exactly. And that's the challenge for Dr. Mark Ott, the inaugural dean BYU just appointed. His team has to decide: are they essentially training doctors for the healthcare system we currently live with, or are they leading a transformation toward healthier communities, preventative care, equitable access—you know, all the things we wish our system could be but often isn’t?

David Caldwell

Oof. That’s such a big question, though. Like, how do you even decide between fixing what’s broken versus…basically changing what's there? I mean, doesn’t that kind of decision, like, ripple out into everything—teaching methods, the kinds of students they admit, even the partnerships they build?

Sofia Ramirez

It does. And let's not forget, this isn’t just any school—it’s a medical school. It sets expectations for not just doctors but the entire system they’ll work within. I mean, imagine the impact BYU could have if they aim to cultivate doctors who prioritize well-being over profit, who treat patients rather than diseases, who see healthcare as a collective responsibility instead of a commodity.

David Caldwell

Whoa, slow down there, Dr. Ramirez. I’m already picturing a futuristic utopia with floating clinics and AI-powered everything. But seriously, is there any evidence that schools, like BYU’s new program, could actually start pushing the needle on this stuff? It feels like a David versus Goliath fight here. Like, literally, system versus individual.

Sofia Ramirez

It’s not easy, that’s true. But, historically speaking, there are precedents for paradigm shifts like this. Change often comes from those bold outliers who challenge what’s considered normal and possible. And that’s what makes this so fascinating to me—whether BYU will just join the ranks of existing schools, or if they’ll carve out something revolutionary.

Sofia Ramirez

You know, David, this reminds me of a moment in history. Picture this—it’s the late 19th century, and medicine was, well, unrecognizable compared to what we know today. Doctors didn’t follow uniform education paths, hospitals were rudimentary at best, and the healthcare system was, to put it mildly, chaotic and unscientific.

David Caldwell

Oh boy, I’m already picturing smoke, leeches, and—what, like, people handing out questionable tonics on street corners?

Sofia Ramirez

Pretty much. But then, a group of visionaries—not just doctors but women, scientists, donors—came together and said, "What if we could do better? What if we completely reimagined what medical education and healthcare could be?" That’s how Johns Hopkins Medical School was born. And what they created set the gold standard for the future of medicine.

David Caldwell

Whoa, hold on. Women? Back then? I mean, I thought they weren’t even allowed in these kinds of spaces.

Sofia Ramirez

Exactly why it's remarkable. Women like Mary Elizabeth Garrett were instrumental—she was one of the key donors, actually—and her involvement came with conditions. She demanded that Hopkins accept women as medical students on the same terms as men, which was groundbreaking at the time. Talk about disrupting the status quo.

David Caldwell

Wait, what? That’s amazing. So, this wasn’t just about building a medical school. It was almost like social innovation too?

Sofia Ramirez

It absolutely was. They didn’t just rethink medical education—they rethought who should have access to it and who should be shaping it. And because of that, Johns Hopkins went on to become a hub of research, innovation, and leadership that influenced medicine worldwide.

David Caldwell

Alright, I’m officially inspired. But, uh, why does this matter for us…you know, more than a century later? What’s the takeaway?

Sofia Ramirez

Good question. There are lessons here for anyone trying to design something transformational. The first one is vision—Hopkins wasn’t just about training doctors; it was about advancing science, public health, and humanity. Everything they did was rooted in purpose.

David Caldwell

Okay, I’m with you.

Sofia Ramirez

Second, collaboration. They brought together people from completely different worlds—academics, philanthropists, practitioners—and cultivated a shared goal. Third, they challenged norms. They didn’t just tweak the system. They broke it apart and rebuilt it with entirely new principles.

David Caldwell

Wow. So they were, like, the ultimate disruptors. Very on-brand for the tech guy over here. What else?

Sofia Ramirez

Fourth, they tied everything to research and evidence. It wasn’t about guesswork or tradition; it was about testing what would actually work. And finally, they thought big. They weren’t afraid to dream of something that seemed impossible. Those five lessons—vision, collaboration, challenging norms, evidence-based design, and bold thinking—are as relevant today as they were in the 1890s.

David Caldwell

Yeah, but how does someone even start applying those lessons today? Like, is that even realistic in our entrenched system?

Sofia Ramirez

Well, that’s the million-dollar question, right? Designing a system from scratch comes with challenges they didn’t have back then, but also opportunities they could have never imagined.

Sofia Ramirez

That’s the challenge, right? And it’s exactly what the founders of Johns Hopkins faced. They weren’t just building a medical school—they were rethinking what an institution could do for society.

David Caldwell

Wait, you mean they weren’t just, like, cranking out doctors to keep up with demand?

Sofia Ramirez

Not at all. They realized that if they wanted to revolutionize medicine, they also needed a premier hospital, which was a pretty novel idea at the time, and post-graduate medical training programs. They weren’t just following what existed—they were following a vision.

David Caldwell

Huh. So it was almost like creating an ecosystem, not just a single solution. It’s kinda like building an app and realizing you also need the whole platform—hardware, software, everything—to make it work, right?

Sofia Ramirez

Exactly. And it’s the same story today. Any new medical school, like BYU’s, has to take into account society’s broader needs—things like health equity, efficiency, and, most importantly, the idea that health is a system, not just a collection of individual parts. And it exists within a larger societal system. And that means we don’t only need visionary physicians. We need teams—nurses, public health experts, administrators—all working together.

David Caldwell

Okay, but let’s be real here. You're saying BYU - or any other new medical school - can’t just focus on making great doctors? They’ve gotta think about everyone else on the healthcare team too?

Sofia Ramirez

Absolutely, well if they want to contribute to transformational change. Medicine today isn’t just about the physician; it’s about creating what we call "systems stewards." These are people—doctors, nurses, health managers—who understand how to navigate and even reshape the larger system. Otherwise, we’re stuck in the same cycle we’ve been in.

David Caldwell

And BYU has what? A nursing school and some other health-related programs already, right?

Sofia Ramirez

Exactly. They’ve got a nursing school, a public health program, health management studies, anthropology, statistics—all of those fields could co-evolve alongside this opportunity. It’s not just putting them under one roof; it’s about fostering collaboration from the ground up to tackle health systems challenges together.

David Caldwell

Alright, but that sounds like, I don’t know, a lot of moving pieces. How do you even get them all moving in the same direction?

Sofia Ramirez

That’s where the shared vision comes in. It’s not enough to just have the right parts; those parts need to align around a purpose that goes beyond convention or profit or prestige. And that’s, perhaps, the most ambitious challenge of all.

Sofia Ramirez

That’s a great question, David. When you’re talking about a system with so many moving parts, it’s a truly bold vision that can align them—bringing people, institutions, and even the entire system together around a shared purpose.

David Caldwell

Alright, but what does "bold" really mean here? Bold like... aspirational goals? Or bold like, hey, let’s flip the whole system upside down?

Sofia Ramirez

Bold in a way that pushes boundaries. It’s not just about surviving in today’s healthcare system. It’s about imagining—no, designing, catalyzing, uh creating—a system that genuinely serves everyone. That’s what BYU has an opportunity to decide—do they want to forge ahead with healthcare’s status quo, or do they challenge themselves to create something new, something truly transformative?

David Caldwell

Okay, but to be fair, doesn’t that sound kinda... overwhelming? Like, they’re gonna take on a system this, uh, massive? It feels like trying to push a mountain uphill.

Sofia Ramirez

It’s a monumental task, but history is full of examples of this kind of bold thinking. It’s the same kind of mindset that fueled Johns Hopkins back in the day—challenging norms, breaking away from tradition, and designing a system to advance humanity, not just follow conventions.

David Caldwell

Right. So is BYU’s medical school just going to say, "Let’s turn every graduating doctor into superheroes," or…?

Sofia Ramirez

That might be one interpretation. But it’s more about equipping them to think systemically—about health equity, prevention, and whole-person care. The vision isn’t just for the students or faculty; it’s for the impact on patients’ lives, on fostering healthier communities.

David Caldwell

Huh. So it’s bigger than just the school—it’s a whole... philosophy?

Sofia Ramirez

Exactly. Which is why the central question remains—what kind of future are they building? Is it one that addresses our existing system of rescue care, profit-driven models, and prestige? Or can they pave a new path toward something we’ve always wanted but haven’t fully achieved—a healthier society for all?

David Caldwell

And what’s stopping them? Like, why not just leap at this bright, shiny new paradigm and go all-in?

Sofia Ramirez

Because the reality is, bold visions disrupt. They challenge comfort zones, legacy players, and entrenched interests. And they require more than just ideas—they demand commitment, collaboration, and usually, a good dose of risk-taking. But when those pieces come together... that’s when progress happens.

David Caldwell

Alright, you’ve got me curious now. What’s next? What do they need to actually make this vision happen?

Sofia Ramirez

Well, David, one of the key elements to making this vision happen is the people—it often starts with those who aren’t exactly “by the book,” the ones willing to question norms and push forward with fresh perspectives.

David Caldwell

Alright, you’ve got me intrigued. Are we talking mad scientists? Rebels? Who’s making the cut here?

Sofia Ramirez

A bit of both, actually. Take Johns Hopkins Medical School’s founders. When they set out to create their vision, they didn’t just recruit people with impressive résumés. They went beyond the established norms of their time. They looked to Europe, not just Harvard, for inspiration. They wanted progressive, innovative thinkers—people like William Welch, William Halstead, William Osler, and Howard Kelly.

David Caldwell

Alright, I know those names probably mean something... to somebody. But what made them so special?

Sofia Ramirez

Each of them brought something unique to the table—not just brilliance, but a willingness to challenge the status quo. Welch was a pioneer in medical research, Osler revolutionized bedside teaching, Halstead pushed the boundaries of surgical techniques, and Kelly was known for innovation in gynecology. But they were also very human—eccentric, rebellious, and sometimes downright controversial. And they were young. In a way, they weren’t afraid to ruffle feathers.

David Caldwell

Okay, but let’s be honest—how often does being rebellious actually work? I mean, we’re celebrating these folks now, but I’m betting they weren’t exactly winning popularity contests back then.

Sofia Ramirez

Oh, they were definitely pushing boundaries, and that came with resistance. But that’s kind of the point. Change doesn’t come from people who fit neatly into the system; it comes from those who ask, "Why does it have to be this way?" That’s what makes their story so powerful—they weren’t there to uphold the status quo. They were there to break it and create something better.

David Caldwell

Alright, so let’s bring this back to BYU. They’ve got Dr. Mark Ott as their inaugural dean. Is he, I don’t know, the next Osler or Welch?

Sofia Ramirez

That’s the big question, isn’t it? Dr. Ott is clearly brilliant and accomplished—he wouldn’t be in this position otherwise. But what really matters for transformational change is whether he and his colleagues are willing to challenge conventions, to step outside the norms and build something new. Innovation doesn’t thrive in complacency; it thrives in bold, visionary leadership. And only time will tell if that’s what we’ll see here.

David Caldwell

So... we’re waiting to see if he’s ready to shake things up? I mean, no pressure or anything, right?

Sofia Ramirez

Exactly. Because ultimately, it’s not just about him; it’s about the kind of people he chooses to surround himself with and the culture they create. New institutions need more than just names—they need innovators, disruptors, and collaborators who are driven by a shared vision, not the status quo.

David Caldwell

Alright, that’s a lot of responsibility. But hey, sometimes it’s the unexpected people who end up stepping up the most, right?

Sofia Ramirez

David, thinking about Dr. Ott and the kinds of leaders we were just discussing, doesn’t it seem like every major leap forward—whether in healthcare, education, or any field—always hinges on someone stepping up in ways no one quite expects?

David Caldwell

Alright, I’m intrigued. Are we talking secret superheroes here or just regular folks who somehow end up surprising everyone?

Sofia Ramirez

A little of both, honestly. Take Mary Elizabeth Garrett, for example. She wasn’t a doctor, wasn’t even formally part of the medical field. But in the late 19th century, she became one of the biggest reasons Johns Hopkins Medical School even exists as it does today.

David Caldwell

Wait, how does that even happen? I mean, let’s be real—how does someone completely outside the medical world pull off something like that?

Sofia Ramirez

Well, Garrett was a philanthropist and deeply committed to advancing the role of women in society. When Hopkins was struggling to fund the medical school, she stepped in, not just with her financial support—they desperately needed that—but with conditions. Her money came with a set of demands that were, frankly, revolutionary for the time.

David Caldwell

Conditions? Like… take it or leave it?

Sofia Ramirez

Exactly. She insisted that women be admitted on equal terms with men—a non-negotiable demand. And the amazing thing is, it worked. Hopkins became one of the first major institutions to truly open its doors to women in medicine, and Garrett’s influence didn’t stop there. She helped set a higher standard for medical education as a whole. She wasn’t a traditional leader in the field, but her vision—and her willingness to act—shaped the future.

David Caldwell

Wow. So she wasn’t even in medicine, but she changed the game for everyone in it. That’s… huge. Do you think stories like hers happen today?

Sofia Ramirez

I believe they do, but here’s the thing—it’s not always where or how you expect. Champions like Garrett emerge in surprising ways, often because they see a bigger picture no one else is looking at, and they’re willing to challenge the norms everyone else takes for granted.

David Caldwell

Okay, so bring this back to BYU. Are we waiting for the next Mary Elizabeth Garrett to show up out of nowhere?

Sofia Ramirez

In a way, yes. But it’s also about creating the kind of environment where those champions—be they donors, community leaders, or even political allies—can see the vision and step in. It takes clear purpose, bold ideas, and, frankly, a willingness to take risks to inspire that kind of support.

David Caldwell

Right. So it’s not just about asking for money or waiting for someone to swoop in dramatically. It’s about showing them something worth believing in.

Sofia Ramirez

And that’s where the bold vision we talked about comes back into play. Champions don’t just show up—they need to see a path where their actions can make a real difference. The question is, will BYU’s vision be compelling enough to attract those kinds of transformative allies?

Sofia Ramirez

David, to your point about BYU’s vision, think back to Johns Hopkins—a vision like theirs not only reshaped medical education but triggered a ripple effect across the field. That kind of bold institutional groundwork is exactly what allows champions to step up and drive systems change, even today.

David Caldwell

Alright, I’m listening. But when you say "leverage points," are we talking about, like, subtle influence or full-on wrecking-ball change?

Sofia Ramirez

It depends on the vision driving them. Take Hopkins again—they didn’t just build a medical school; they redefined the relationship between science and medicine. They legitimized hospitals, helped establish nursing as a respected profession, and popularized residency training as the gold standard. It wasn’t just one tweak—they fundamentally shifted how healthcare was taught and practiced.

David Caldwell

Whoa, wait. So you’re saying they basically rewired everything? Medicine, hospitals, even nursing? That’s... a lot.

Sofia Ramirez

Exactly. They created a new ecosystem, right? And by tying everything to biomedical research, they laid the groundwork for the United States to become a global leader in medicine. Now ask yourself, in today’s landscape, what kind of institution could catalyze that level of transformation?

David Caldwell

Hmm. So you’re saying we've got opportunities, but what does that actually look like? Are we talking about reinventing medical schools from the ground up here?

Sofia Ramirez

Possibly. One idea I've been thinking about is requiring all premedical students to major in something like "health systems transformation." Imagine a whole new academic track combining economics, public health, even social change. It could prepare future doctors to be not just clinicians but stewards of a better system.

David Caldwell

Okay, that sounds ambitious. But is anyone even set up to make something like that happen?

Sofia Ramirez

Some places are starting to experiment, but we’re far from where we could be. Take, for example, proposals like creating an institute for health systems transformation at a place like BYU—an interdisciplinary hub that gathers expertise from public health, nursing, even business, to prepare leaders for future challenges.

David Caldwell

Alright, interdisciplinary sounds exciting and all, but how do you actually pull that off? I mean, it’s not like these departments just magically start working together.

Sofia Ramirez

It takes deliberate planning. You build connections—like linking with like minded organizations. The One Health Utah Collaborative, public-private partnership focused on transforming Utah's healthcare system to improve affordability, equity, and health outcomes by fostering collaboration among stakeholders and driving innovative solutions. And Get Health Utah, a nonprofit working to improve healthy eating, active living, and mental wellbeing in Utah. There are many more people and organizations working for improvement. The key will be to align the vision and incentives enough to reach a tipping point, a critical mass that can shift the system altogether.

David Caldwell

Community engagement? So this isn’t just high-level theory—you’re talking about embedding these institutions in the places they serve?

Sofia Ramirez

Exactly. It’s about recognizing that institutions like BYU’s medical school don’t exist in a vacuum. For them to truly transform the system, they need to connect directly with the communities they aim to impact. That’s where the real ripple effect starts.

Sofia Ramirez

And then there's competency based education. We inherited from the Johns Hopkins era professional licensing, specialty board certification, and other educational and training requirements that are out of date. For example, if an outstanding nurse practitioner has been seeing patients largely independently for 20 years, and she wants to be a family practice doctor, currently she would need to go through 7 years of education and training. That makes no sense.

David Caldwell

Alright, I’m with you. But it sounds like designing these institutions is just the first step. What’s next? What does it take to make that kind of long-lasting impact?

Sofia Ramirez

Good question, David. Designing these institutions is crucial, but the real key to long-lasting impact lies in how they implement those designs and remain adaptive. Take BYU’s new school, for example—if they make strong, intentional moves now, they could redefine healthcare for decades.

David Caldwell

Decades, huh? That sounds like a pretty big deal. But, uh, how exactly does one medical school ripple out like that? I mean, where do those big, lasting effects actually come from?

Sofia Ramirez

Great question. It comes down to influence. Institutions like this don’t just produce one kind of outcome, like doctors—they create a culture, set standards, and inspire others to follow suit. Think about Johns Hopkins—it changed how we think about medicine, education, even public health, and its impact is still unfolding more than a century later.

David Caldwell

Okay, so you're saying it’s like—planting a tree? The roots might be small now, but eventually, it reshapes the whole landscape around it?

Sofia Ramirez

Exactly. But those roots have to be deliberately planted. It’s about embedding principles like equity, prevention, and whole-person care into the foundation of the institution. And more than that, it’s ensuring those principles endure by influencing others—students, colleagues, policymakers, even entire communities.

David Caldwell

Yeah, but how do you make sure it sticks? Like, what stops bold decisions today from, I don’t know, getting watered down or forgotten in five, ten years?

Sofia Ramirez

Consistency and follow-through. Institutions need strong leadership willing to hold the line on their vision, even when it’s uncomfortable. They need systems that track outcomes and adjust strategies, so they’re always walking the talk. And, just as important, they need to inspire the people they touch—not just students and staff but donors and partners—to stay invested in that vision.

David Caldwell

So, it’s not just about having flashy ideas. It’s about creating a kind of legacy, something that keeps the ball rolling even after the first leaders are gone?

Sofia Ramirez

That’s exactly it. Legacies like Hopkins weren’t built overnight. They were built through a relentless commitment to a better future—a refusal to settle for the way things were. And here’s the really inspiring part: institutions like BYU’s new school have that opportunity right now. They’re in a position to ask, "What do we want medicine—and the health system broadly—to look like for future generations?"

David Caldwell

Alright, I gotta say, the stakes feel pretty high here. Like, no pressure, but BYU or any new medical school might be setting the tone for, what, the next century of healthcare?

Sofia Ramirez

Potentially, yes. But here’s the optimistic part—we’ve seen it before, and we know it’s possible. By focusing on values that prioritize well-being, equity, and collaboration, they can drive changes that outlive us—all of us.

David Caldwell

Alright, Dr. Ramirez, you’ve officially inspired me. I’m sold on the idea that transformation can start in the smallest places. Any final thoughts for all of us listening in?

Sofia Ramirez

I’d just say this: sometimes the biggest impacts come from the smallest beginnings. And whether we’re talking about medical schools or our own communities, the question worth asking is the same—what kind of future are we willing to fight for?

David Caldwell

And on that note… well, that’s all for today! As always, Sofia, it’s been such a pleasure. And to our listeners, thanks for tuning in—we’ll catch you next time on "It’s Time."