From ER doc to HSC chancellor
Trailblazer in emergency medicine, Paul Roth says it’s about helping people
Editor’s note: After more than four decades at UNM, Health Sciences chief Paul Roth sat down to talk about triumphs, tragedies and disappointments.
As chancellor of the University of New Mexico’s Health Sciences Center, Paul Roth oversees a sprawling system that includes UNM Hospital, four colleges, a medical group, a research mission, nearly 10,000 employees and a $2.2billion budget.
He’s dean of the UNM School of Medicine — only the fourth in the school’s history — and chief executive officer of the UNM Health System.
It’s perhaps an unlikely career path for an ER doctor who went into emergency medicine to help “rescue” people in their most dire circumstances.
And certainly nothing like the one his father envisioned for Roth, who is considered a national trailblazer in emergency medicine and among the first to coin the term “urgent care.”
Roth grew up in New Jersey, where his father published local telephone directories.
“During the summers, I would knock on doors of shops and try to sell ads. My dad’s assumption was that I was going to college — I was the first in the family to do that — so I could go into the business. He already had the sign printed that said ‘Roth and Son Advertising.’
“We used to do these family summer car trips and did one about the time I graduated from high school. Mom and Dad were in front with my two sisters and me in back. It was a typical noisy trip with everybody talking. Then Dad asks me, ‘Paul, what are some of the courses you want to take in your first year in college?’
“And I say, ‘Pop, I want to go into biology. I don’t want to go into business.’ ”
“Suddenly, there was total silence, and no conversation for the rest of the trip, because everybody knew my destiny was to be the ‘Son’ in ‘Roth and Son.’”
Paul got his way. He earned bachelor’s and master’s degrees in biology from Fairleigh Dickinson University before enrolling in the George Washington University School of Medicine, graduating in 1976. He came to New Mexico to enter the family practice residency program at the UNM Medical School.
Roth’s dad eventually got over the loss of his future business partner.
“It took a while for this to sink in,” Roth said, “but as fathers will often do, he accepted it, and became very proud of me when I finally went into medicine.”
Haunting case
Roth no longer teaches classes or sees patients — something he misses.
“The reason I went into medicine was because I wanted to help people, and in their most acute situation having this sense of rescuing them. So I gravitated to emergency medicine. When things went well, it was exhilarating and so gratifying. Unfortunately, it didn’t always go well … and I would find myself having to speak with the family of a gunshot or accident victim, and those were heart-wrenching times.” Any cases that still haunt him? “I specifically remember one that still sends chills up my spine. I was on a night shift in the ER and there was a small child, maybe one year old, who was badly burned. The only part of the child’s skin that wasn’t red and coming off was one heel. We learned later that an upset boyfriend took the baby by the heel and dunked it into scalding water.
“The child (who died) was about the same age as my 1-yearold. It was just terrible. There are moments like that.”
Why New Mexico?
Roth, who also served as acting president at UNM during then-President David Schmidly’s health crisis, ended up in New Mexico because he wanted to go into family medicine.
“At that time they didn’t have training programs in emergency medicine,” and family medicine “was very appealing because I thought of it as being a sort of a Renaissance doctor. You did a little bit of everything.”
“Family medicine was brand new and there were no residency programs on the East Coast. New Mexico’s program was considered one of the top in the country. So I applied here.”
Roth became a professor of emergency medicine at UNM in 1993, was named medical school dean in 1995 and HSC chancellor in 2005. His portfolio includes the colleges of nursing, pharmacy, medicine and population health. University of New Mexico Hospital has the state’s only Level 1 trauma center and there is a new 48-bed, $400 million hospital expansion on the drawing board.
“Hopefully we will be breaking ground by mid-2020. It will take about three years for construction, so we think the doors will open by fall of 2024.”
Disaster team
One of the things Roth is proudest of is the civilian disaster relief team he launched in the 1980s that responded to disasters ranging from Hurricane Hugo to the terror attacks of 9/11.
The team came about because the federal government had decided the country needed a medical response to domestic disasters that didn’t rely on the military. “The feds went to 50 cities that met certain criteria, one of them being a big airport that could land C-130s.”
Albuquerque was one they selected for a presentation.
“We were at City Hall down in their emergency operations center basement. I was there because I was a new division chief in emergency medicine.
“They gave their spiel about this brand new system and asked if anyone would like to lead the effort for New Mexico. There was deadly silence, so I raised my hand and said, ‘I’ll do it,’ thinking this is emergency medicine and this would be the ultimate rescue.”
Over the next couple years, UNM was able to create the first functional medical disaster assistance team.
“You had to be completely selfcontained and able to function for a minimum of 72 hours once you were on the ground.
“When Hugo hit, there were no other teams in the U.S. so we were federalized and deployed and went to St. Croix . ... We had our own uniforms and didn’t want to be viewed as military. No camo. We even had patches with the Zia symbol.
“Over the next 10 to 15 years, we were known nationally. We became the template.”
The disaster teams have since changed dramatically, with the federal government now drawing on expertise from various states rather than calling on individual units.
Roth’s last deployment was to New York after 9/11. He was team commander.
“We had hopes of rescue and healing,” he said. “And only found death.”
Controversy
Roth has also found himself at the center of various controversies and disappointments. Among them:
Health Sciences faculty and others revolted when UNM regents in 2016 pushed through a plan to bring HSC — and Roth — more directly under control of the board of regents and the UNM president. It eliminated community members on what was then a separate HSC board that also included regents.
Dozens lined up to speak in opposition to the plan that was pushed through quickly by appointees of then-Gov. Susana Martinez.
Roth at the time was critical of the regents’ refusal to postpone the vote, saying he was disappointed the Health Sciences Center community “didn’t have the time or opportunity to provide input into the policy changes.”
He also said he was grateful to then-President Bob Frank for “clarifying” that he could continue as CEO at Health Sciences.
In retrospect, Roth says the governance change has “worked out fine.”
“We are still operating in that structure as changed back in 2016 but it’s much more positive and very productive.”
Roth, who referred to current UNM President Garnett Stokes as a “breath of fresh air,” said that, at the end of the day, “it’s how people relate to one another.”
Roth and UNM have also been the targets of anti-abortion groups, particularly when Republicans in Congress took UNM Health Sciences to task in 2016 for alleged violations of laws governing fetal research. The state attorney general later found no violations.
UNM was among the schools investigated by a House Select Investigative Panel, which focused on fetal tissue procurement and abortion practices nationally.
New Mexico was in the crosshairs because Albuquerque has one of the few private abortion providers in the country offering late-term abortions. The controversy over the relationship between UNM and late-term abortion provider Curtis Boyd resulted in Roth’s ending Boyd’s UNM faculty privileges.
Was it a mistake to have Boyd as an adjunct faculty member?
“I did unwind it. I always have to be very careful that I don’t insert my personal views into policy or strategy of the university, but ultimately came to the conclusion that the benefits associated with having learners being taught procedures at Boyd’s clinic did not outweigh the reaction from the community.”
In 2018, the university permanently banned one of its faculty members from conducting fetal research following two internal investigations.
The House congressional committee investigation ended with no punitive action taken against UNM. But, Roth said, it was “one of the most difficult times, not so much because I had a particular philosophy but it was realizing our faculty were being castigated in a way that exposed them to a lot of risk personally — and the fact that I knew we were doing everything ethically.”
The UNM School of Medicine recently learned it will lose its neurosurgery residency program next summer, costing the school eight resident physicians now in the program. That’s a blow to a state that has a hard time filling doctor shortages, especially in specialty fields.
While UNM offered plenty of training opportunity in emergency cases, its inability to build out sufficient community-based neurosurgical services hurt the school, as did faculty turnover, reducing mentorship opportunities, according to school officials.
They hope the selection of Dr. Meic Schmidt, currently chair of neurosurgery at New York Medical College, as new chief of neurosurgery will strengthen UNM’s program. “With his superb surgical and management skills, he is uniquely suited to lead our program,” Roth says.
Meanwhile, Roth continues to grapple with the ongoing opioid crisis that has ended thousands of lives a year nationally, and hundreds in New Mexico.
National drug companies are now being sued in New Mexico and across the country for advertising, promoting and incentivizing physicians to prescribe opioids, but Roth adds that the medical profession isn’t blameless.
“We didn’t have systems in place to track things like doctor shopping to get prescriptions, and there wasn’t a lot of understanding by clinicians about how addictive these drugs really were.”
Family time
Roth and his wife, Erin, have three children. Rachel, 24, Jordan, 22, and Benjamin. 17. Rachel graduated from UNM with a degree in psychology and is “dedicating her life to counseling and family therapy.” Jordan is an artist and wants to go into the film industry. Benjamin is still in high school.
Roth treasures private family time.
Looking fit and sporting an Apple watch, Roth has done tai chi most mornings for the past 50 years, and includes elliptical and light weights in his exercise routine. He admits having an affinity for a good T-bone steak.
“Biologically there is no reason that if we lived the right life we couldn’t live to be 100 despite our genes.”
He also likes working around the house, such as fixing an old lawn mower that just wouldn’t work.
Thanks to lessons he learned on YouTube, it now “runs like a charm.”
Recalling the rescues
Roth earns $675,000 a year under his current contract, which runs through next June.
As he reflects on more than four decades at UNM, he still sounds like an ER doc who finds rewards in rescuing people.
“I still remember this case where the receptionist came up to me and said there was an older lady in the lobby who was kind of slumped in her chair and not moving. It turns out she had just seen her primary care doctor and was waiting for a family member to pick her up.
“So I’m thinking maybe she fell asleep and I walk out to check her. There’s no pulse. She’s not breathing. She had had a sudden heart attack and actually died.
“So I scoop her up in my arms and run into the ER. We resuscitated her and she was admitted to the hospital and was treated.
“About two weeks later I was on duty when her daughter shows up in the ER with a plate of cookies to thank me for saving her mom’s life.”
“It’s cases like that,” he said, “that are so exhilarating.”