Health reporter Nick Stonesifer joined “Beyond the Headlines” to talk about a historic moment in Delaware healthcare – the announcement of who will be running the state’s first medical school.
Nick discusses how he goes beyond the press releases and the press conferences to detail the contours of a major policy announcement, and he gets into the big unanswered questions behind the medical school project. He also details how he builds relationships – online and in-person – with industry leaders and “the person on the street” to develop thorough perspectives in his health care coverage.
The podcast was hosted by Director of Community Engagement David Stradley.
This transcript has been edited for length and clarity.
Nick, you have been living down in the Lewes area for almost a year now. You also have a dog. So I want to start the podcast like this: Let’s say you are hanging out at your favorite oceanside dog park and you strike up a conversation with another dog owner who is complaining about downstate healthcare, and he hasn’t heard all about the medical school saga. How would you catch that person up on what is going on?
I would probably say that things are bad. Things are not going to get better for a little while, but people are trying to fix it.
In regard to the medical school, they are trying to attract more people who will come and learn how to do medicine in Delaware, but time will tell how effective that is.
You would also tell that guy that Philadelphia’s Thomas Jefferson University has been selected to run Delaware’s medical school.
I might say that. Sure.
You actually broke the news that Jefferson had signed a non-binding memorandum of understanding with the State of Delaware even before the request for a proposal had been made public to run this school.
Given all that, how would you rank your surprise meter that Jefferson ended up winning the proposal process?
Not high at all. It was pretty obvious, especially when I got there I recognized people from the Jefferson team and didn’t really see anybody from the main other bidders like PCOM [the Philadelphia College of Osteopathic Medicine].
And when you say “you got there,” you’re talking about the press conference where they announced…
Who was winning. Yes, when they announced who the medical school was on Tuesday – I guess it’ll be last Tuesday by the time this comes out – it was pretty obvious. You could see it coming if you were paying attention to the faces in the crowd. So I was not really that surprised.
And frankly, the [non-binding] agreement, while the state says it has no impact or bearing on the bidding process, you’ve got to go through a lot of work to put together an agreement like that. There was a lot of talk and questions about how this was going to be done, and they already had something in place.
So you were not necessarily surprised that Thomas Jefferson University was selected to run the medical school. What about your surprise that ChristianaCare was not going to be initially involved in this process?
Yeah, that was definitely the big news nugget of the day.
Outside of the fact that there’s a new medical school coming to Delaware, one of Delaware’s principal power players in healthcare was going to be sitting on the sidelines – at least in the intermediary – is a big deal because they had attached their name to a separate bid, through the Philadelphia College of Osteopathic Medicine.
They had put all their eggs into that basket, and it didn’t really go their way. I was surprised to see that they didn’t – I don’t know, maybe 20/20 is hindsight – but [they] didn’t really read the writing on the wall.
A lot is unclear about how Jefferson had structured its agreements with the healthcare systems and if, frankly, ChristianaCare wasn’t pleased with those agreements and tried its luck with PCOM.
One thing that was clear from the announcements is that Jefferson University will not really be running this as a stand-alone operation. The word that everybody kept using – and it showed up in your reporting – to describe this medical school is a “consortium” with over a dozen education and healthcare institutions collaborating on bringing this school to life.
Is a medical school by consortium a typical approach in the field?
I’m no expert on this, but I can tell you what I’ve seen in my own day-to-day life.
A big state school like University of Delaware, if it were a bigger school and was a bigger program like a Penn State, for example – Penn State has its own hospital systems, it has its own healthcare systems, and has its own built-in medical infrastructure to sustain what is needed to run a medical school. Delaware doesn’t really have that.
We have privately-owned hospitals up and down the state. You don’t have anything with Del State [University], you don’t have anything with University of Delaware. So when an outside entity like Thomas Jefferson comes in and it’s saying, “Hey, we’re going to build a branch campus here,” financially within the bounds of this federal grant that we’re using to fund the medical school, it makes more sense to essentially take advantage of the already existing infrastructure to get it done because they can’t build a new hospital.
That would just not be the play.
So the consortium approach is perhaps a more logical approach for Delaware since there isn’t an educational institute that already had a hospital set up with it.
The funds that came from this Rural Health Transformation program from the federal government – you actually couldn’t build a new stand-alone institution through that grant, correct?
There’s some wiggle room for renovations and some capital expenses that can be done through the grant, but they’re pretty muted.
So unless a huge outside philanthropic grant came in with hundreds of millions of dollars and said, “Hey, build a hospital,” that was never going to happen.
The University of Delaware is where this school will be based, but this is not a University of Delaware medical school.
No, they’re trying very hard to make sure that it is not perceived as such.
Jefferson’s going to be running the programs. [UD] essentially, my read of it right now, is going to be a landlord for Jefferson to host these classes. But once [the students are] done with those classes, they’re going to scatter across the state into hospitals like Bayhealth, Beebe, Trinity, a lot of these primary care clinics.
Whether or not the school moves downstate, if at one point they build a campus and move their campus downstate, is unclear right now. I don’t know if it would move to Del State at any point in the future or anything like that.
Because in theory, these are “rural” health transformation dollars, so they shouldn’t necessarily be based in Delaware’s urban, populous county.
Yes. That’s one way to look at it.
When a major announcement like this happens, I have to imagine that an easy temptation is just to report out the top talking points given at a press conference. In your reporting, how do you try to pierce through the hubbub of the announcement and get something to your audience that is multilayered and nuanced?
Yeah, you definitely are really working to cut through every word they’re saying. You can listen to them on the microphone and hear what they have to say and just let your recorder run and turn your mind off. But usually it’s our job to really dig in deep to what they’re saying in the moment, which takes a lot of mental energy but is beneficial to our coverage in the long term.
You’re looking at power structures to really figure out who’s in, who’s out, and what that really means for whatever initiative. So it’s a lot. And just talking to people and asking questions outside of whatever official statements are being given.
Doing your homework before you get there definitely helps,
This was outside this press conference, correct?
Yes.
So you weren’t necessarily working the room, but you were still working the crowd?
When you go to these events and when you’re a beat reporter, you see a lot of the same faces. Frankly, it’s just in your best interest to go up, say hello to people, ask some questions on or off the record about what’s going on.
You know, you’re “running for mayor” all the time. It works to your benefit to talk to people.
You talk about one of the things you’re assessing when you’re at an event like that is the power structure, the power dynamic. A good example of that is you said earlier that your biggest surprise about all this was that ChristianaCare was not involved in this winning application.
I’m guessing that was not part of the official press conference comments. I’m guessing no one said, “You may notice that ChristianaCare is not involved in this, and let us tell you why.”
No, I mean to the trained ear they had listed out everyone who was going to be in this consortium. And one glaring absence was ChristianaCare.
So I asked about that and things got a little odd. The answer seemed a little prepared that they were welcome at any time to join. They wouldn’t really answer whether or not they had been invited or declined, but we later found out that they had put all their money into the PCOM bid, and it really didn’t go their way.
So you were the lovely reporter who brought that to everyone’s attention at the press conference?
Um, yes. At least that’s the way I remember it, so yes.
I’m sure all the people up at the dais were like, “That Stonesifer, why did he have to bring this up?”
I hope not. I’m not such a bad guy.
I’m guessing there weren’t any representatives from ChristianaCare at this press conference, but you got comments for your article. Was it easy to get ChristianaCare willing to talk about this or not?
They had come out with PCOM, jointly, in defiance of the state’s decision to pick Jefferson. They did the fair sport thing – we respect the state’s decision, but we respectfully disagree as well. We thought we were the better bid.
You know, sometimes when people are frustrated, they’re more likely to come out and discuss what they’re feeling in that moment because they weren’t really there at the time to experience this big coming together.
If you’re chronically online, like me, that meme of Squidward looking out the window at SpongeBob and Patrick running outside – for all the Gen Zs listening – that’s probably how ChristianaCare and PCOM were feeling at that moment.
Being chronically online takes me to the next question I want to ask you about. As we record this, you’re actually finishing up an article that is basically an unanswered questions piece about the medical school. It should be published by the time people listen to this podcast.
One of your sourcing steps for that article was to open up a thread on Reddit – which if anybody doesn’t know is a community message board on the web – and in that message board post you basically said, “Hey, if you have any questions or comments about the medical school, drop them here and I’ll do what I can to report back.”
Why take that step? I’m sure you already had unanswered questions yourself about the medical school. Why reach out to the public in this way?
I think it’s a good journalism exercise when you’re deeply involved in stuff for so long. Some of the very simple questions about where is this going to be, why is it here, what’s this about free education I’m hearing? You know, that gets lost in the weeds for us when we’re really looking at these high-level policy questions.
It’s really about service at the end of the day. This information is supposed to be useful to someone. And that’s what you’re trying to get at.
And frankly, the questions were good questions. Like, I don’t think at any point I’m above the audience that we’re trying to serve. They had great questions that were worth digging deeper into. And you learn something new from other people, too.
There are long back-and-forths in that thread, if you read it. It was definitely helpful to just parse through that, even if some of it is argumentative. A lot of it might be other people helping each other out. We’re trying to facilitate that conversation about the medical school.
I enjoyed looking back over the thread because it’s not like you just put out the question and then people responded. You were engaging. You went back and forth. You were providing information. What do you enjoy about that back and forth, and how is it useful to you as you’re prepping an article?
I mean, I’m not afraid to say I don’t know everything. I’m not a supercomputer, you know? So that is helpful for me when I see questions I don’t know the answer to. I tell somebody, “Hey, I don’t know this. Here’s what I do know that might help you.” And they might have a retort that’s like, “Here’s where to start.”
It’s just conversational in that way. So, it’s definitely good for people who may have had questions about this. If you’re a news consumer and you see a bunch of stories about the medical school – not a lot of people have access to reporters. Reporters are frankly very busy and don’t have too much time to make themselves accessible. So whenever and wherever we can be of service, that’s really the goal.
I thought it was cool because I’m the director of community engagement. Part of my job is to get the reporters out in the community and engaging with the public. We do that in a lot of in-person ways with listening sessions in libraries or pop-up newsrooms in coffee shops.
But I thought this was a cool place where you just took the initiative yourself and basically set up your own digital pop-up newsroom there and allowed the public to engage, to get information from you, but also open up your own blind spots and go, “Oh, that is a question that I don’t know the answer to.”
It’s mutually beneficial. Everybody benefits, and that’s the goal.
So of those unanswered questions that you were being grilled about on Reddit and that made it into your article, which are the ones that you are most interested in getting to the bottom of in your next reporting steps?
I really just want to see signed agreements. I want to see budgets. I want to see commitments made by healthcare and education institutions. But those aren’t really publicly available right now, so that requires some digging on my end.
A good question that, frankly, I hadn’t really thought of until Reddit was what happens to the already existing medical program known as DIMER (Delaware Institute of Medical Education and Research), which places Delawareans into Jefferson or PCOM classes once a year, or annually they hold reserve seats for Delawareans.
People are wondering if it would become obsolete, now that we have a huge funnel of medical students coming into Delaware. What’s 30 seats meant to do?
We are parsing through the differences [between] the two programs. One is really meant to give Delawareans specifically a chance to go to medical school, and the other one the goal is to bring people here. That’s what state officials are saying, at least.
On the opposite side of the spectrum from that Reddit chain, which was engaging with a more normal public, you also played a major part in organizing Spotlight Delaware’s recent Health Care Summit that happened in late April before Jefferson University was announced as running this medical school.
The future of the medical school was really a through line in many of the conversations at that summit. The audience for that summit was very much industry leaders rather than these everyday folk that you were engaging with on Reddit. How does organizing something like the Health Care Summit aid your reporting on the medical school?
These are the people making decisions about what’s going to happen with the medical school. These are physicians who are on the front line of the specialty shortage. So there’s definitely a lot to learn and a lot of high-level stuff that we are going to try and distill down and really make it palatable, really show the impacts of these shortages in Delaware.
So it definitely helps out. It’s definitely good to be in a room with a bunch of people that know what’s going on and make connections.
Reporting is hard work. You put in the time at the press conferences, the time editing your articles, the time making contacts. But there’s got to be some pleasure there for reporters as well. What’s been enjoyable to you about reporting on the medical school?
I think it’s a very historic time. This is the first medical school and really getting to be on the front lines of that reporting has been pretty exciting. This house is going to be built at the foundation, so to speak, and whatever we learn about at the start of these agreements…
You know, when people are asking 30 years down the line, “Why is this this way? What the heck happened?” We want to get to that before 30 years down the line if we find there are these huge glaring problems with what this medical school was supposed to do. If there were these huge structural problems at the start, we can shed light on those.
At Spotlight Delaware, we try to make really clear what the impact of public policy decisions is on the lives of Delawareans. So let’s end on this and just ask you, how would a medical school tangibly impact the life of a Delawarean?
Yeah. I think in the short term, it’s not going to.
It’s definitely not right away going to make a huge impact. But either way, you know, there’s going to be this first class of 40 students. That’s going to be 40 students that are spread across the state learning medicine in doctors’ offices, doing their clinical rotations and stuff like that – really just adding bodies to what is going on.
And then there’s the other camp that is like, this is a long way out. We’re training a few specific types of doctors, and as Delaware gets older, its healthcare needs get more specific. Specialty care is really where we’re seeing some of the largest gaps and this medical school, at least right now, won’t address those immediately.
It will benefit, but, you know, 20 years down the line. If there are people who trained here, they did their residency here and they stayed here, that’s a lot of physicians that are here. There might be a lot of specialty people who maybe went to do their medical degree here, but then went and did their training somewhere else and came back.
So who knows? I think in an ideal world, the state is hoping that people will see how lovely Delaware is and stay here forever. But that’s really to be seen. That’s to be determined.
The grand vision for the normal populace is because of this medical school, there’ll be more medical professionals in Delaware to serve you.
That’s their goal. Time will tell.
So 30 years from now when Spotlight Delaware is still kicking and hires a new reporter from Penn State, they can move to Lewes and have good quality healthcare.
Well, if that’s the case, the timeline is all out of whack, so…
Thank you, Nick, so much for your work helping Delawareans understand just what the medical school means for them. There’s more to come.
Thanks for having me.