Dr. Maria, the recently appointed chairman of the Department of Pediatrics at the Medical College of Georgia, talks about pediatricians as "customers" of the Children's Medical Center, clients he knows he must win over. He also talks about changing the culture of his department so responsibility is spread out more and asking questions is the norm.
After 17 years under Dr. William Kanto, the change in leadership provides an opportunity for Dr. Maria to request more resources, make key hires and do some unprecedented strategic planning.
However, "I am quite mindful of my favorite pediatrics expression: Only babies like to be changed," he said. "So we're going steady but slow in the process."
One tall order ahead is to increase the market share of the Children's Medical Center from the 56-57 percent it has today to 88 percent or better, the volume needed to sustain pediatric neurosurgeons and other good pediatric sub-specialists.
"Community hospitals do play an important role taking care of children," Dr. Maria said. "But when you have a jewel like a children's hospital, especially one with the national standing that we have, there really is no excuse. It really is the best place for children and their parents to be should their child need to be admitted."
He has met with about 20 community pediatricians so far and plans to meet with many more in an extensive outreach effort.
"They are our customers. I told them that," Dr. Maria said. "And they need to be part of this family."
He is also ramping up research efforts within pediatrics, and that could start with his own work. Dr. Maria, who came to MCG from the Medical University of South Carolina, is still collaborating with a partner there on a compound they have had patented.
The compound affects hyaluronan, a naturally occurring substance that helps to line joints and hydrate skin. It is commonly found in cosmetics, he said. It is also found in the nervous system and the brain, where tumors hijack it. Cancer cells use hyaluronan to form a "blanket" they wrap around themselves.
The compound appears to knock off that coating. The anchors the cell was using to hold it on get dragged inside the cell, taking with them many important receptors and cell-surface proteins. Some of those that get dragged in are what Dr. Maria characterizes as the "bilge pumps" on the cancer cell surface.
"They're bilge pumps that pump toxins out of the cell, including chemotherapy drugs that we use to kill them," he said. "So what we do when we give the (compound) is remove the pump off the membrane, so the drug can enter the cell but it can't get out, killing off the cell."
Dr. Maria envisions the compound being given with chemotherapy or radiation as a way of overcoming cancer resistance to those methods "that do some good but still don't get us across the finish line," he said.
He plans to build on research efforts already under way in the department, such as those at the Georgia Prevention Institute, and plans to add at least 10 physician-scientists in key areas to build on strengths. By establishing a Child Health Discovery Institute, he hopes to increase research further and create the first clinical trial unit within the Children's Medical Center.
That is important not just to science but also for the students passing through it. One study Dr. Maria conducted found that medical students put lower professional value on scholarly work than preceding generations.
"Who is going to carry things forward?" he said. "Who is going to move the field forward? What this means is we have to be identifying and nurturing in earlier stages of career development future health professionals that have the burning fire for discovery so that flame is not extinguished as they go through their residency and fellowship training, which it often is today."
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BERNARD L. MARIA
OCCUPATION: Chairman of the Department of Pediatrics; professor of pediatrics, neurology and neurosurgery, Medical College of Georgia; medical director and pediatrician-in-chief, MCG Children's Medical Center; affiliate professor of pediatrics, neurology, and neurosciences, Medical University of South Carolina
EDUCATION: M.D. from Université de Sherbrooke, Quebec, Canada; MBA from University of Florida
FAMILY: Wife, Barbara; son, Alex