Dr. Martha Ruder balances many significant roles, notably as a family nurse practitioner and coordinator of the associate’s degree nursing program at Gulf Coast State College in Panama City, Florida.

“Nurses are used to being busy,” said Dr. Ruder. 

“I became used to this pace when I was in my nurse practitioner program at Florida State. I was working full time and fulfilling clinical hours, so I quickly fell into the habit of scheduling and carving out blocks of time.”

In 2014, Dr. Ruder graduated from Florida State University with her doctorate of nursing practice; however, her teaching journey was already well underway, sparked by her pursuit of a career in nursing. As a program coordinator and nurse practitioner, Dr. Ruder’s roles are bound together through perseverance, resilience and patience. 

“In the fields of nursing and education, you have to accept that things don’t always turn out the way you plan. Circumstances arise. Things happen, but in these professions, you need to take the time to listen to others, focus on the issues at hand and keep working to facilitate nursing education,” she shared. 

After graduating with a bachelor’s degree from the School of Nursing at the University of Maryland Baltimore in 1979 and obtaining her RN license, 

Dr. Ruder worked in a local hospital’s postpartum unit. There, she stepped into the role of teaching parents what to expect in birthing classes.

“My experience in the postpartum unit really made me realize how much I liked teaching,” said Dr. Ruder.

So, in 1986, after graduating with her master’s degree in nursing education, she began teaching nursing part time as an adjunct in pediatrics and became a full-time instructor in 1996 of maternal-newborn nursing. 

“As a nurse, you become a teacher, too. You teach your patients a lot of things, from what medication to take and how to navigate wellness,” explained Dr. Ruder. “Teaching is a natural extension of nursing.”

In 2007, Dr. Ruder advanced to the role of assistant coordinator at GCSC and rose to coordinator in 2012. Harnessing her extensive experience in teaching and nursing education, Dr. Ruder has been instrumental in strengthening the foundation of emerging medical professionals through comprehensive training, education and resources. As the coordinator of the associate’s degree nursing program, Dr. Ruder has played a key role in the remarkably high pass rates on the National Council Licensure Examination, exceeding the statewide pass rate by a whopping 13% — raising it to 87% at GCSC versus 74% throughout the state. This achievement is a testament to Dr. Ruder’s commitment to excellence in the ever-growing nursing field.

“At Gulf Coast, we focus on remediation,” said Dr. Ruder. “So, if a student isn’t doing well with testing, we look at the information, reteach and retest until they fully understand the material. We have a dedicated person who works with students. We call her the student success mentor, and she works to help students succeed in the program.” 

Recently, in May 2024, Dr. Ruder received word that she and her colleagues secured a $24 million grant for an Interprofessional Education Simulation Training Center from Triumph Gulf Coast, Inc. —  an organization responsible for administering funds from the $1.5 billion awarded to the Sunshine State by BP for compensation after the Deepwater Horizon oil spill in the Gulf of Mexico in 2010. 

“We will be implementing this grant in the fall,” explained Dr. Ruder, “notably an interprofessional simulation building for all health sciences, but nursing will take the lead because nursing is the biggest population in the health science field here.”

Dr. Ruder revealed that GCSC plans to build this program from the ground up, incorporating cutting-edge, immersive simulation technology. This will enable students to wear VG goggles and virtually step into a hospital setting to prepare medication and interpret doctors’ orders. Thanks to this sizable grant, enrollment capacity has surged, thereby enhancing student readiness for clinical practice.

As Dr. Ruder looks toward the future, she sees a significant transition on the horizon. In three years, she plans to step away from her current coordinator position at GCSC and lean into her nurse practitioner role at the Emerald Coast Bay Behavioral Hospital. At this inpatient psychiatric facility, Dr. Ruder provides primary care for patients, demonstrating her unwavering commitment to the field of health. 

“I’m not ready to fully retire,” admitted Dr. Ruder. “I’m so used to working, I can’t imagine just sitting at home. So, this isn’t a full stop for me, just a stop in academia.”

The new $40 million biomedically-based research complex constructed by the Florida Institute for Human and Machine Cognition (IHMC) will be more than a striking addition to the Pensacola skyline.

It will accelerate the pace of discovery that will drive innovations in maximizing the health span for everyone, from elite military operators and veterans to those with neurodegenerative diseases, musculoskeletal problems, and chronic metabolic conditions.

The Healthspan, Resilience, and Performance Research Complex is another step in the evolution of the vision that has been the bedrock of IHMC since its founding by Dr. Ken Ford, the Institute’s chief executive officer.

“Pushing the boundaries of science to maximize the performance and resilience of human beings has long been a foundational tenet at IHMC,” Ford said. “In our health span, resilience and performance research thrust, the vision has always been to work from the molecular level to the whole human. This facility brings that to life.”

Dr. Morley Stone, chief strategic partnership officer, noted that the leading-edge research complex allows IHMC’s interdisciplinary team of researchers to truly realize that vision.

“The healthcare system as it is set up now puts people on a trajectory to decline over decades,” Stone said. “We want to lead the science that drives people to extend the period of a person’s life over which they are high functioning and healthy.”

The unique facility puts Pensacola and Northwest Florida at the center of a human and biological sciences economic ecosystem that did not exist before this $40 million research facility was built. It also serves as a draw for top research talent to the area from all over the world.

“The ability to move from whole human physiology and performance to the molecular level in one facility — there’s nothing else like it in the southeast that I can think of,” Stone said.

“The Healthspan, Resilience, and Performance Research Complex will be an economic and intellectual beacon for the entire Northwest Florida region,” Dr. Marcas Bamman said, the

senior research scientist and director of Healthspan, Resilience, and Performance Research at IHMC.

The science conducted here will be an economic engine, drawing in new funding for federal and industry-sponsored research. Partners in the project have included Space Florida and Triumph Gulf Coast, the nonprofit corporation funded by a legal settlement with British Petroleum following the 2010 Deepwater Horizon oil spill. Funding provided by these agencies helped seed and support the complex.

The Healthspan, Resilience, and Performance Research Complex stands apart among biomedical science hubs due to the collaborative, cross-discipline spirit that has been a hallmark of IHMC since its beginning. Researchers working in the new research complex are an arm’s length away from experts in AI, cognitive psychology, computational modeling, data visualization, exoskeletons, engineering and more.

“It’s an accelerant for the speed of discovery,” Stone said.

The three-story, 40,000-square-foot facility was built by Brasfield & Gorrie and designed by DAG Architects partnered with Atlanta-headquartered Cooper Carry. The complex is designed to fuel the pace of discovery. The first floor is built around human participant testing and intervention, featuring rehabilitation facilities, biomedical sampling tools and performance testing laboratories.

“The first floor focuses on clinical and applied science,” Bamman said. “The third floor contains leading-edge wet laboratories for cellular and molecular science, which enable us to extend and better understand the effects we are having on people on the first floor. We now have the unique capacity—leveraging a range of scientists and technology—to deeply study and improve strategies that enhance the health span, resilience and performance for all.”

“As the biological sciences have become intertwined with information and computer sciences, IHMC is uniquely positioned to accelerate that trend and excel while doing it,” Stone said.

“Every institution doing this work is struggling with how to generate meaning from that information,” Stone said. “Going back to our legacy, being able to tap into artificial intelligence and machine learning capability that was the foundation of IHMC is an invaluable resource for being able to make meaning out of that information that’s generated.”

A regional economic hub, a draw of international experts

The new Healthspan, Resilience, and Performance Research Complex is not just a magnet for talent. It is a magnet for dollars that come into the community that do more than recirculate around the community.

“In this case, we’re bringing in millions of dollars of new research money into the economy that our researchers use to buy houses, eat at restaurants and buy cars. That type of impact is hard to match,” Stone said.

While the population at large will ultimately benefit from what IHMC researchers learn about aging, degenerative and chronic metabolic conditions and what interventions might help ameliorate these, military operators are a specific target audience of the research done at IHMC.

“And frankly,” Stone noted, “it’s just part of the moral obligation that we have to our service members to make sure that not only they leave in the best possible shape they can, but the years after they leave are as productive and high functioning as possible. That’s the moral obligation.”

Thanks to the Healthspan, Resilience, and Performance Research Complex, IHMC is uniquely positioned to fulfill this role.

IHMC is a not-for-profit research institute of the Florida University System where researchers pioneer science and technology aimed at leveraging and extending human capabilities. IHMC researchers and staff collaborate extensively with the government, industry and academia to help develop breakthrough technologies. IHMC research partners have included DARPA, the National Science Foundation, NASA, Army, Navy, Air Force, National Institutes of Health, IBM, Microsoft, Honda, Boeing, Lockheed and many others.

During an interview conducted at his home six months into his retirement, it became clear that John Hogan remains closely attuned to health care trends, market dynamics and the workings of state government.

Those areas commanded his attention throughout his 44 years as the CEO at Capital Health Plan (CHP), a primary care-focused, not-for-profit health maintenance organization (HMO) headquartered in Tallahassee, and for years prior to his arrival in Florida.

Hogan was looking forward to a speaking engagement at the Westminster Oaks retirement community, where he would discuss the latest changes affecting Medicare. And, in conversation, he was as attuned to the future of health care and health insurance as he was to its evolution.

He can’t take his eye off that ball.

“We are always at risk of trying to perfect a system that is not what future demographics are going to need,” Hogan said. “Birth rates and fertility rates in the U.S. are at record lows. We have a growing number of seniors and very senior seniors. Persons aged 85 and above is the most rapidly growing segment of the population in Florida.”

Hogan, who headed south from Georgia in 1978, remembers when less than 10% of the population in Tallahassee was made up of seniors.

“Those days are long gone,” he said. “Statewide, 21% of the population is over 65. My mother-in-law is 103 and a half. Ten years ago, CHP didn’t have a single member over the age of 100; when I retired, we had 20. That trend is going to continue. So, what should the health care delivery system look like 10 or 20 years from now? Are we really thinking about that enough? Chronic illnesses that don’t get cured but are managed for years are expensive.”

Hogan is pleased that the state Legislature has worked toward creating more residencies in Florida, recognizing that physicians tend to remain in the area where they complete their postdoctoral work.    

A Virginia native, Hogan completed undergraduate studies at the University of North Carolina in Chapel Hill — UNC basketball has been an “affliction” for him ever since, he said — and earned a master’s degree in regional planning at the University of Virginia.

While in graduate school, he worked with the School of Health Services Research at the UVA Medical School and was exposed to a “coming thing,” HMOs. Few were located in the eastern and southern U.S. at the time, and Hogan read all that he could about them.

He had, he said, the “HMO bug.”

As Hogan was graduating from UVA in 1976, a group of health care professionals in Tallahassee was deciding not to go forward with an HMO that had tentatively been named the Big Bend Health Plan. The group included Tallahassee Memorial Hospital administrator M.T. Mustian and physician members of the Capital Medical Society.

Would the community lend an HMO enough support to make it viable? Would the medical community embrace the idea?

“They concluded that the time wasn’t right,” Hogan said. “The area was too small. Physicians felt that it posed a competitive threat to the way they preferred to practice.”

But the idea would surface again in Tallahassee, and this time, Hogan would be in the mix.

Post UVA, Hogan worked for regional health systems agencies in Brunswick and then Albany, Georgia. The jobs aligned with his master’s degree but not with what he truly wanted to do.

Versus planning and development, his greater interest was in bringing about market alternatives to the traditional fee-for-service approach to health care. He wanted to discover whether prepaid health plans could work from the standpoints of quality and affordability of care.

When Hogan arrived in Tallahassee in 1978, Capital Health Plan, as yet unnamed, was in development. Maybe this time, the idea would win. The capital city had a vast number of state employees and, if state government were open to an HMO, that might be enough to get one started on a path to sustainability.

At the time, Hogan said, the federal government viewed membership of at least 25,000 as an HMO viability threshold. The Tallahassee metro area numbered only about 250,000 people. Was it reasonable to think that a start-up HMO could attract 10% of the population as members?

“We argued that it was not the aggregate number of people that mattered, but who made up the population,” Hogan said. “You have a lot of university folks here, you have a lot of state employees, you have supportive employers in city and county governments and school districts. We felt that we could get to 25,000.”

It did, in 2¹⁄₂ months.

Today, CHP has 135,000 members in a nine-county area: Calhoun, Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor and Wakulla.

“The key thing in secondary markets — and I don’t care if you are starting a health plan or a restaurant — is to do an outstanding job with the initial risk takers who give you a chance to show them that you are a good value to them as consumers,” Hogan said.

He said CHP’s first medical director, Dr. Bud Huber, stressed the importance of treating early adopters with courtesy and respect, delivering quality clinical care and generating good word-of-mouth.

The early adopters hung around, and 40-plus years later, “CHP has never had a disenrollment rate of more than 2% in a year, and usually it’s around 1%,” Hogan said. In 2023, the National Committee for Quality Assurance awarded CHP a perfect five-star rating for “member rating of the plan” and “satisfaction with care.”

Hogan believes there is a strong correlation between such satisfaction and local accountability. The plans and providers who are going to do best, he said, are those that assume accountability for the quality of care and service — and for financial operations.

“Despite the development of telehealth and the fact that the person reading your X-ray may be in India, the vast majority of health care is still a personal, locally delivered service,” Hogan said. “But for most people who have national or statewide or regional or major carrier health plans, bills are processed in Atlanta or Oklahoma City or another faraway place, so when there’s a problem that comes up with service delivery, a claim or anything else, you’re usually calling a 1-800 number.”

There are downsides to the corporatization of health care, Hogan said, acknowledging that CHP employs physicians, but it has become nigh unto impossible for doctors to sustain solo or small-group practices.

“Things have gotten too big,” he said. “The government pays for x percent of a practice. Big health plans pay for x percent. And you don’t have any leverage in negotiating with these folks. You need to be part of something larger.”

In all of this, Hogan said, there are two fundamental and fundamentally different approaches to health care: one that relies on drumming up business and the other that calculates risks, lives within a budget and emphasizes health maintenance.

Optimally, a service delivery system will achieve better health for the population, better health care and sustainable affordability — so-called triple-aim outcomes. Approaching that goal will require continuing programs of refinement and experimentation.

Hogan, at this point, will leave that trial and error to others. He has been succeeded at CHP by Sabin Bass, who had served as the plan’s executive vice president and chief financial officer.

A basketball player as a younger man, Hogan switched to golf, an activity that creeping arthritis has interfered with. At 6 feet, 6 inches tall, he’s got the wingspan for pickleball. Maybe he will give that a try, he said.

For sure, he will keep his eye on the health care ball. ▪

Many people consider jumping out of a perfectly good airplane for the sheer thrill of the experience. Far fewer actually do so, for various reasons, fear of heights being chief among them.

For the 14,000 men and women who graduate from the U.S. Army Airborne School every year, standing in line to jump out of an aircraft becomes a mindset and a skill. In three weeks, the basic parachuting lessons taught at the Fort Benning, Georgia, school enable students to overcome fears, complete jumps from aircraft flying at altitudes over 1,200 feet and stand proudly in line for graduation and bragging rights.

While intensive training builds muscle memory that helps make proper, safe landings a regular occurrence, awkward jumps resulting in trauma to the body do occur. In fact, a significant number of students and paratroopers operating in the field suffer mild brain trauma like concussions and mild traumatic brain injury (mTBI).

“A substantial number of students, approximately 25%, suffer from mild traumatic brain injury,” said Dr. Ken Ford, founder and CEO of the Institute for Human and Machine Cognition (IHMC) in Pensacola.

The U.S. Army, aware of IHMC’s expertise in pioneering technologies and leading studies aimed at leveraging and extending human capabilities, asked IHMC to study students at the school experiencing mTBI and hopefully find an approach to reducing long-term effects.

The study is an example of the kind of project that will be accomplished more effectively in a new $40 million IHMC research complex that is due to open this spring. It will be the fourth building on IHMC’s Pensacola campus, and it will support and accelerate healthspan, resilience and performance research. The new building will house state-of-the-art labs and equipment expected to benefit and attract researchers.

IHMC, a not-for-profit research institute of the Florida University System, receives funding from a wide range of government and private sources. Research partners include NASA; the U.S. Navy, Army and Air Force; Raytheon; IBM; Boeing; and Microsoft.

The paratrooper research was conducted at Fort Benning and the main IHMC campus in Pensacola. It was one of many human performance projects in which IHMC’s faculty and staff collaborated with industry, academic and government research partners to develop science and technology to extend human performance and resilience.

Ford took on the challenge with principal investigator Dr. Morley Stone, who is IHMC’s chief strategic partnership officer, and a large research team. Funded by the Department of Defense, their blind study’s focus was to understand how a ketone ester supplement might reduce the long-term effects of mild mTBI.

“We hope the intervention of a supplement like ketone ester will reduce the level of damage experienced after a blow to the head,” Ford said.

Ketones are chemicals naturally produced in the liver. A ketone ester benefits the human body in many ways including curbing carbohydrate cravings, increasing endurance, improving muscle recovery and enhancing cognitive function. Ford observed that studies have shown that elevated ketone levels induce an increase in a protein called brain-derived neurotropic factor (BDNF), which supports existing neurons and helps grow new ones.   

Dr. Gwen Bryan, a research scientist and lead for IHMC’s powered exoskeleton research team, said the new research complex will be advantageous for many reasons.

“It fits right in between robotics and human performance,” Bryan said. “The robotic side is the hardware and the software that we use to develop suits that are trying to help humans. And, we need to know how they are affecting us.” She explained that her work includes physiological assessments to ensure that exoskeletons are functioning as intended.

To date, Bryan’s research area was a hodgepodge of biomechanics equipment set up in a robotics room — not a good human subject experimental area.

The space was distracting for participants who were measured and tested, taped up with sensors and asked to move and bend while wearing an exoskeleton. There was no privacy. To determine that the suit was performing as intended, Bryan used motion capture cameras, measured muscle activity and applied metabolic sensors to participants.

“The new building will be awesome,” she said. “I can bring my devices together in one dedicated area. This will be helpful and offer privacy to our participants while we validate the exoskeleton.”

Positive thoughts bring positive results. On the Pensacola campus, plenty of positive thoughts spin and churn as scientists and leaders including Ford and Bryan push beyond norms, prod and measure, scan, test and analyze.

The new building will foster new rounds of creative solutions that will enable people to enjoy life and function with higher performance.

The fuselage door is open, and IHMC is taking the jump.

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While a first-year medical student at the University of Florida, Deborah Morris visited her grandfather in a room he shared with another patient in a nursing home.

He was in his 80s, a retired military man. Tough, he had beaten esophageal cancer, but his heart, finally, was dying.

He had ping-ponged between a hospital and the nursing home for some time, and now he was in a bed at the end of a hall, as far removed from the nurse’s station as it could be. When his daughter arrived, he was gasping for breath and pleading for help.

“As a medical student, I said to myself, ‘We have got to do better than this,’” Morris recalled. “It was so far from OK. Really, it was that experience that drove me to pursue a career in hospice and palliative medicine.”

Morris moved to Tallahassee from Virginia about three years ago and worked for a time in palliative care at Tallahassee Memorial HealthCare (TMH). In February, she became the medical director at Big Bend Hospice (BBH).

In relocating, Morris said, she and her husband Tod, a TMH oncologist, sought a community that is “committed to caring for everyone.” In Tallahassee, they are convinced they found such a place. Morris points to community support for an in-hospital hospice unit at TMH as evidence for that belief.

As of this writing, the First Commerce Center for Compassionate Care (FCCCC) at TMH, which will be operated by BBH, was expected to receive its first patients in mid-November. The approximately $6 million project will provide eight acute care beds reserved for patients nearing the end of life.

Typically, those patients will be transferred from TMH to BBH and will have become so vulnerable and fragile as to be unlikely to survive even a two-mile ambulance ride from the hospital to BBH’s 12-bed Hospice House.

For terminally ill patients too sick to be transported, the only option had been to remain in a sterile, noisy hospital room.

“They need an environment that is appropriate for end-of-life care,” Morris stressed. “TMH is a great hospital with great doctors and nurses, but the hospital space, itself, is not a hospice space. A favorite nurse of mine when I was in hospice training said, ‘We labor coming into the world, and we labor going out.’”

First Commerce Center for Compassionate Care rooms — the credit union was awarded naming rights given its $1 million contribution to the project — were designed as places where patients, family members and caregivers can comfortably gather. They have the feel of a room in a home.

Wiring is hidden. The patient bed has a headboard. The couch folds out into a guest bed. The rooms are conducive to efforts to meet spiritual, psychological and family needs. One of the rooms can readily be converted for use in pediatric cases.

In October 2019, Lee Hinkle and Rheb Harbison, then the board chairs at TMH and BBH, respectively, met to discuss how the two organizations might benefit by a closer relationship. Their meeting led to one between TMH CEO and president Mark O’Bryant and BBH CEO and administrator Bill Wertman. The two chiefs have been doing lunch ever since.

“Our first meetings were the genesis of the inpatient hospice unit at TMH,” Wertman said. “The discussion continued for the better part of two years concerning what it might look like. It’s a win-win. We benefit by having our acute care nurses in the hospital, and the arrangement helps TMH reduce the mortality rate within the hospital. Hospitals can be scrutinized very heavily for that.”

Like Morris, Wertman was profoundly affected by the passing of a relative, his mother, who died two years ago at age 89. For the last 15 years of her life, Wertman served as her caregiver. 

“Let’s face it, there is a very specific reason that people need our services,” Wertman said. “It’s not until then that they find out what the true benefit of hospice is. You are grieving, and you are dealing with the sadness of what’s coming and still trying to be strong for your family and, in my case, for my mom.”

Wertman said that even given his years of service as a hospice CEO — he joined BBH in 2015, initially as human resources director — “I learned a great deal about hospice when I was vulnerable and I needed their help.”

BBH, which operates with a certificate of need issued by the state, serves 6,500-square-mile Area 2B comprising Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor and Wakulla counties. It employs 279 people and is the third-largest health care provider in its service area behind TMH and HCA Florida Capital Hospital.

On Aug. 10, its patient census stood at 435, including its palliative care program.

To staff up the new unit, BBH was engaged in August in what Morris called a “huge recruiting push” aimed at hiring nurses, providers and care aides. The search, she said, was focused particularly on prospective employees who enjoy acute care.

“We’ve had a lot of interest from nurses who have worked in hospital settings in critical care,” Morris said. “Many have been hearing reports about this unit for years, and they are very excited.”

Their interest level has been mirrored by community support for the project.

“First Commerce was amazing for us,” Wertman said. “Here you have a credit union that you wouldn’t think of as supporting a health care effort in a hospital, but one of their directors who was familiar with what we’re doing went to bat for us and their board overwhelmingly approved the donation.”

As of August, a capital campaign that was launched in late 2022 had sailed past the $4 million mark.

“That shows the level of compassion in the community for hospice, and it also speaks volumes to Dena’s abilities and her connections; she has made this happen.”

About BBH Foundation president Dena Strickland, Wertman said, “Many people love her and respect her, and when she asks, they give.”

Meanwhile, Wertman is encouraged that the TMH-BHH collaboration suggests possibilities for “a continuum of care that is not so fragmented and disjointed, but more aligned and more accessible.”

At those Wertman-O’Bryant lunches, important chatter takes place between bites.

“I think in the near future, we will see a new kind of health care delivery in our area that will be pretty much unparalleled elsewhere in the country. There aren’t a lot of projects like it, and this one has a lot of momentum right now.”

When Dr. Alma Littles was in second grade, her teacher told the bright, young girl she would make a good doctor someday.

“I didn’t know what that meant,” said Littles, the youngest of 12 children growing up in Quincy. “I don’t think I had ever seen a doctor.”

That young girl did indeed grow up to be a family physician, treating residents of her hometown, an area where doctors were scarce.

Littles’ career as a physician, educator and health leader blossomed, and in February 2023, she was named the interim dean of the Florida State University College of Medicine, a school Littles helped create, with a mission that reflects her own life story.

“We were developing physicians who would practice personal and patient-centered care, focusing on populations of need, the underserved, geriatric patients,” Littles said.
“I called it my personal, professional mission.”

The FSU College of Medicine was created in 2000 by the Florida Legislature to take an unconventional approach with an unwavering commitment: The new medical school was to use community-based clinical training to educate its students, create a technology-rich environment and address primary care health needs of Florida’s citizens, especially the elderly, rural, minorities and underserved.

The model: Medical students would spend their first two years at the central FSU campus in Tallahassee. In their third and fourth years, instead of studying in an academic medical center, students would complete their clinical rotations at one of FSU’s regional settings in Daytona Beach, Fort Pierce, Orlando, Pensacola, Sarasota or Tallahassee (separate from the main campus).

The college also has rural training sites in Marianna and Immokalee. The clinical training program extends into hospitals, skilled nursing facilities, managed-care organizations, private clinics and other outpatient settings, according to the medical school’s website. Students work one-on-one with local health care providers. Ideally, they will return to these places, or others like them, to practice.

“It wasn’t the traditional medical education model,” said Littles, previously the medical college’s senior associate dean for medical education and academic affairs for nearly 20 years.

Has this untraditional method worked? For starters, consider the numbers from the FSU College of Medicine’s 2022 Annual Report.

“Through 2021, more than half of the college’s M.D. alumni matched in one of these primary-care specialties: internal medicine, family medicine, pediatrics or obstetrics-gynecology.”

“Most alumni now practicing in Florida are in primary care, and a good percentage of those are in rural or other underserved settings, where recruiting new physicians can be a challenge.”

Figures from the Association of American Medical Colleges, which examines how the FSU College of Medicine compares to all other U.S. medical schools (155 accredited schools), show FSU is in the 95th percentile for practicing in underserved areas, 85th for training in family medicine, 83rd for practicing in state and 86th percentile for practicing in primary care.

At the outset, the college faced plenty of hurdles. The medical establishment said there were enough doctors. Local advocates knew that wasn’t the case.

The FSU College of Medicine was the first new medical school in the U.S. for roughly 20 years.

Medical groups later changed their outlook. In its 2022 study, the American Medical Association reported that the U.S. faces a projected shortage of between 37,800 and 124,000 physicians within 12 years — many of those (between 17,800 and 48,000) are primary care physicians.

“FSU was a pioneer,” said Dr. Dean Watson, vice president and chief integration officer for Tallahassee Memorial HealthCare. “Once FSU went through the process, numerous medical schools followed.”

Watson was present for those early discussions about the college. “There were six or eight of us sitting in trailers creating this, and now you’ve got hundreds of very bright people involved,” Watson said. “The college has elevated health care across the board.

“FSU has also brought in great faculty members that are focused on providing high-quality care for the underserved,” Watson said. “It’s a win-win.

“We view each other as true partners,” he said.

This partnership received a boost from the Florida legislature in 2022. FSU and TMH have joined forces to build the FSU Health Tallahassee Center, which will offer advanced medical training and research opportunities.

The building, funded by a $125 million appropriation from lawmakers, will be located on the TMH campus, providing educational, medical and research laboratory space, drawing on talent from TMH clinicians and faculty from the FSU College of Medicine and College of Nursing.

It’s the latest step for the FSU medical school, which has launched outpatient care and facilities in struggling communities.

FSU PrimaryHealth is based in southwest Tallahassee, a place where students work with physicians on a hands-on basis in a real-world setting.

“They’re located about a block away,” said Shannon Davis, principal of Sabal Palm Elementary School, which is a Title One school. “This is one of the most poverty-stricken areas in the state. They’re in a prime area to serve families who are in great need of physical care.”

Sabal is Tallahassee’s only community partnership school, where four core providers offer services under a 25-year contract. “FSU is our health care provider partner,” Davis said.

One case involved a sickly boy raised by a grandmother struggling to get him medical services. Sabal Palm connected the child with FSU PrimaryHealth.

“He’s now there on a regular basis, and he’s happier and healthier,” Davis said. “All of a sudden, he has resources open to him that were not available to him in the past. Now, we’re seeing a different child.

“There are many other stories like that,” she said.

The college partners with more than 170 health care organizations statewide.

“You can look at the work that has been done for children and maternal health in Gadsden County through the College of Medicine,” said Dr. Temple Robinson, chief executive officer of the Bond Community Center. “Look at the establishment of the FSU PrimaryHealth Center in Leon County. The College of Medicine’s footprint is all over the state of Florida.

“Our relationship with the College of Medicine is seamless because we have a common mission, and that is to provide health care to underserved populations, elderly, rural and minority populations,” she said. “That goes hand in glove with the College of Medicine’s mission.”

It’s a different model that “produces excellent students,” said Dr. Rudolf Hehn, who recently retired as the Thomasville/Archbold Hospital site coordinator for the FSU College of Medicine’s Tallahassee Campus. “The college has done an outstanding job of fulfilling its mission.

“The primary emphasis is to work with physicians in an actual community instead of working out of a hospital that might have 1,000 beds and treat diseases that are very complicated, unusual or unique,” said Hehn, a member of FSU’s Alumni Hall of Fame.

To fulfill its mission, picking the right, empathetic students is essential, Littles said.

The FSU College of Medicine receives more than 7,000 applications a year for 120 slots in each class. Sixty students are selected each year for the Physicians Assistant program. “They obviously have to have the academic credentials,” Littles said. “We have to look beyond that.”

The college looks for students who have demonstrated an interest in “focusing on the unique needs of patients from all walks of life,” she said.

Many students are also from varied backgrounds.

FSU College of Medicine is in the 97th percentile for graduates who are black or African-American, 90th percentile for faculty who are women and 91st percentile for graduates who are Hispanic, Latino or Spanish, according to the AMA figures in the university’s annual report.

Dr. Christie Alexander was among the 30 students in the College of Medicine’s first graduating class in 2005. She was also the first alumni to become a full-time faculty member.

Alexander called herself an unofficial poster child for the school.

“I come from a nontraditional background,” she said. “I was 28, older than most students coming into medical school, with life experience under my belt. I’m a woman, and I come from a Puerto Rican family.”

Alexander, who later became president of the Florida Academy of Family Physicians, said students “were very much mission-driven” in a college envisioned as a game changer.

Alexander is still immersed in primary care, but she has recently left FSU. On a road trip, she discovered that the tiny town of Marfa, Texas, needed a physician. She’s decided to stay.

“Everybody, in a sense, is underserved here,” she said.

The college fosters such devotion, said Dr. Alexandra Mannix, a 2014 graduate of the College of Medicine.

“It provides a foundation and passion for education and leadership and advocacy,” said Mannix, the assistant program director of the UF Health-Jacksonville Emergency Medicine Residency Program.

Most of all, the college is seen as a source for those who might otherwise be forgotten. “When we need to do something, we’re going to knock on their door and say, ‘Please help,’” said Davis, of Sabal Palm. “And they always do.”

During the height of the COVID-19 pandemic, the news was flush with reports covering the important clinical trials for vaccines and treatments, bringing hopeful news of a way out on the horizon. To date, over 9,000 clinical trials related to the pandemic have been conducted, each contributing to the global health science community’s understanding of how to best combat the disease.

The process for getting health care treatments and pharmaceuticals to market is a lengthy and, appropriately, stringent process. Even with the FDA’s recent Fast Track designation aimed at accelerating approval timelines when there is an urgent medical need, only two drugs were approved for use in treating COVID-19 in 2022. On average, clinical drug trials have a success rate of around 10%.

CEO Jeremy Wyatt, a longtime Northwest Florida resident, heads ActiGraph, a Pensacola company seeking to improve the approval process, both in terms of speed and in ensuring that the science behind testing is more robust.

Wyatt holds an undergraduate degree in electrical engineering and an MBA in business administration. He has been with ActiGraph since its founding in 2004, working in hardware development before being promoted to CEO in 2020. He is passionate about “building technologies that can solve problems,” a vision that aligns with ActiGraph’s mission to use technology as a bridge between clinical research and better patient outcomes.

ActiGraph is both a hardware and software developer in connection with items including its wearables.

The ActiGraph LEAP product resembles a contemporary watch, but is in fact used to detect changes in the movements of people who are afflicted with Parkinson’s disease, a neurological disorder.

The LEAP, which was scheduled to enter production in October, collects raw data through various sensors like a PPG (for recording heart rate) or a skin contact temperature sensor. The LEAP also includes an accelerometer and a gyroscope that allows for measuring “not just movement and steps, but also gait and balance.”

Data collected by the ActiGraph LEAP and similar wearables is sent to the CentrePoint platform. The platform enables data collection, monitoring and processing, all for the purpose of supporting research. ActiGraph wearables collect raw data, enabling future-proofing for the platform and the implementation of new algorithms as they are discovered by the scientific community.

“ActiGraph’s mission is pioneering the digital transformation of clinical research,” Wyatt said. “That’s our mission. To do that is not a business endeavor. It is a scientific endeavor.”

Wyatt stressed the importance of transparency in his company’s data collection work, noting ActiGraph’s customers are half “pharmaceutical research” and half “academic customers.” Both need accurate and detailed data; the former for FDA approval of new drug treatments, the latter for facilitating better research to facilitate medical research and public policy.

Wyatt, citing Geoffrey Moore’s work, Crossing the Chasm, noted the existence of different market categories ranging from early adopters to laggards. Typically, this distribution would be akin to a bell curve. In the pharmaceutical and medical research world, however, “there’s a lot of risk aversion” contributing to delays in getting approvals and completing research.

To date, ActiGraph has been used in more than 22,000 peer-reviewed scientific publications and in over 250 clinical drug trials. Among the institutions that have used ActiGraph for scientific studies are Harvard, Stanford and University College London. Organizations that have worked with ActiGraph include the Centers for Disease Control, the National Institute of Health and the M.D. Anderson Cancer Center.

In an NIH study, an ActiGraph device was used to track the “physical activity and sleep in 13,000 Americans.” This information gained influenced follow-up research and policy decisions by the FDA.

Overseas, the wearables were used in the Raine Study in Australia, which measured correlations between certain demographics and the relative percentages of physical activity versus sedentary time. Closer to home, ActiGraph was used in the University of South Florida’s TEDDY study, which examined the movement and sleep of children with a risk of developing Type 1 diabetes.

The technology has not only been used to study humans but to study animals as well.

ActiGraph wearables, as Wyatt recounted, “were used to study the behavior and mating patterns of the white rhinos at Disney.” He mentioned that the San Diego Zoo has used their products for similar purposes.

Wyatt is proud of the work his 107-employee company has done; the workforce is divided into several groups.

The product team builds the CentrePoint platform so that it scales and interfaces with every ActiGraph wearable. A data management team helps “customers get their data on time.” The science team works on making the data collected by ActiGraph devices robust and digestible. A quality and regulatory team checks for operation in “accordance with ISO 13485 standards.” Said to be the largest division, the operations team ensures that “a clinical trial is delivered on schedule, ensuring that our logistics work right.”

More than anything, Wyatt is proud of how his company treats its employees.

“Our goal is to make you a better human when you’re here,” he said.

Another point of pride for Wyatt is ActiGraph’s presence in Pensacola. “Not one dollar (in revenue) comes from Pensacola, and that’s a very good thing for Pensacola.”

He went on to say that, though the city is not necessarily regarded as a technology or innovation hub, he is “proud we can do this in Pensacola and that we represent the city on a global stage.”

Wyatt is grateful for the local Industry Resilience and Diversification Fund group at the University of West Florida. It has supported his company in getting funding to build its facilities in Pensacola.

Assume that a heat dome has parked itself over Tallahassee and surrounding areas. High temperatures have exceeded 100 degrees for a week. The demand for power has become so great that outages are becoming a problem. Hospitals are overflowing with cases of heat stroke and heat exhaustion. Hallways are being staged as makeshift emergency rooms. People without shelter are dying on the streets.

How would you address that crisis?

The scenario was run by Tina Vidal-Duart and Carlos Duart, Miami-born entrepreneurs who moved to Tallahassee as a result of the COVID-19 pandemic. Together, they oversee the CDR Companies.

Notably, Vidal-Duart is the CEO at CDR/Health, a health care services contractor whose strengths include meeting community needs during crises or following natural disasters.

CDR/Health emerged as a go-to player during the pandemic in several states. Vidal-Duart served as the CEO of Florida’s COVID-19 Infectious Disease Field Hospital System. After the hospitals were demobilized, she was instrumental in helping CDR/Health’s COVID-19 test site logistics team deploy a call center; develop software that facilitated the patient experience from registration through result delivery; and launch a proprietary vaccination data management system.

Carlos Duart is the president/CEO at CDR/Maguire Engineering, a heavy infrastructure firm whose work is confined to large state and federal projects such as interstate highway construction and reconstruction. He also advises the management team at CDR/Emergency Management, a disaster-response company that has helped communities recover from hurricanes, tornadoes, floods and fires. Like CDR/Health, it was involved with several states in combating COVID-19.

If a community were overtaken by locusts, CDR/EM likely could develop an action plan. But what of the Tallahassee heat-dome scenario?

Vidal-Duart and Duart fielded the question immediately and with specifics.

“I would take all those empty Kroger buildings in SouthWood and bring in the one thousand hospital beds that we have in warehouses in various parts of the state and open an alternative care site to relieve the pressure on hospitals,” Vidal-Duart said.

“We would probably deploy a couple of hundred staff just like we did after Hurricane Ian,” she continued. “We would bring in supplies for treating heat stroke and heat exhaustion — ice, blankets and IV bags to hydrate people. We would devote one of the buildings to a shelter for homeless people or people without power. During Hurricane Ian, we built a shelter in an old Publix in Fort Myers where the AC units had been stolen from the roof. We brought in generators and very large portable AC units.”

“On the emergency management side, it’s basically the same idea,” Duart said. “We would set up cooling centers in tents or buildings. We would need chairs, beds, generators, food, staff, possibly IVs. It’s all about supply chains and logistics and the ability to move people and supplies quicker than anybody else.”

Both Duart and Vidal-Duart earned bachelor’s and master’s degrees from Florida International University. In February, they contributed $1.2 million to the school to establish endowed scholarships in the FIU Honors College. Vidal-Duart’s advanced degree (2004) is in international business; Duart’s is in taxation (1999). He is also a CPA. The couple began dating after they were introduced to one another by mutual friends at an FIU football game. They quickly discovered they had something in common: Both were going through divorces.

Early in her career, Vidal-Duart specialized in acquiring and turning around financially distressed rural hospitals for a business she helped create at age 22. All of the hospitals, located in Kentucky, Louisiana and Georgia, were in bankruptcy or had announced plans to close when Vidal-Duart got involved. Most were owned by a hospital service district and governed by calcified bureaucracies.

“In small communities, you have people who have been working at the same place for a really long time,” Vidal-Duart said. “Unfortunately, that is not always the best way to run a hospital. Some hospitals hadn’t updated their chargemasters (a schedule of services and fees) for years. They weren’t setting expectations for patient lengths of stay and admissions from the ER department. They may have failed to negotiate supply contracts. Or, the reputation of a hospital in the community may have been poor.”

Vidal-Duart, then, worked to make the hospitals more efficient and profitable, at times adding services and bringing in additional doctors.

“At hospitals owned by service districts, profit is sometimes looked at as a bad thing,” she said. “What people fail to realize is that profit enables facilities to stay open, it allows for reinvestment and makes raises and bonuses possible. It takes time to change that mentality — to the benefit of the employees and the community.”

As a CPA, Duart worked for Price-Waterhouse for three years and later became the controller at an engineering firm owned by his then father-in-law.

“I have always had a business mindset,” he said. “I started reading the Wall Street Journal when I was 11. Numbers are my thing. If you can competently and efficiently run a business and motivate its employees, you can do amazing things, and it’s not all about money.”

Duart is the son of Cuban immigrants. Vidal-Duart’s father emigrated to the United States from Cuba at age 3. Her mother was born in California to a Mexican-American father and an American mother.

They grew up in modest households and learned the value of hard work while very young. As a girl, Vidal-Duart contributed to the household income by mowing lawns and cleaning houses.

At age 4, Duart began picking Surinam cherries with members of his family. Three gallons were good for five bucks. At age 15, he was introduced to engineering. Standing at intersections with clipboard in hand, he counted cars. (Having misheard Duart when he told her about that experience, Vidal-Duart believed for years that he got his start counting cards.)

At the engineering firm, Duart the controller aspired to a bigger role in the business. The owner scoffed at the idea.

“He told me that I was an accountant and that I would never be able to manage things,” Duart recalled. “He said I wasn’t even capable of managing the office. But I became president and CEO of the company. When people tell me I can’t do something, it lights me up.”

In 2009, Duart purchased the Maguire Group, a 70-year-old, Rhode Island-based engineering firm with 200 employees.

“That was a big move for me as there was no safety net; the deal was funded by me,” Duart said. “And not everything was smooth sailing. In 2012, we went through a Chapter 11 restructuring due to significant liabilities that were undisclosed when I bought the business. But we survived, paid all our vendors 100 cents on the dollar, and even won two national awards related to the restructuring.”

Meanwhile, Duart had hired his future wife as a consultant who would rework the business’s approach to project management.

When COVID-19 took hold in Florida, the state reached out to CDR, given Duart’s and Vidal-Duart’s experience in emergency management.

“Once we understood what the needs were, I started calling all my contacts, and Carlos started calling people he knew in health care and we were able to secure additional lab capacity and medical supplies that the state was having a hard time getting,” Vidal-Duart said.

CDR’s COVID work expanded as the pandemic worsened. Vidal-Duart, as a former hospital CEO, helped educate state Department of Health employees on how to establish and run field hospitals. Finally, the state asked her if she could open them.

“We did, and then we opened hundreds of mass testing sites for the state,” Vidal-Duart said. “That led to vaccinations. We were the first to provide monoclonal antibodies on a mass scale, and we’re still the largest provider in the country.”

For Duart and Vidal-Duart, COVID-19 would become personal. Duart contracted the virus during Father’s Day weekend in 2020 and was admitted to Baptist Hospital in Miami. The antiviral medication remdesivir was administered, but it didn’t help. Duart said he had been scheduled to receive a ventilator when he started to improve in response to convalescent plasma.

“Carlos almost died, and I sat there thinking, ‘I am going to be a single mom,’” Vidal-Duart said.

So it was that she was greatly moved by a woman who had been tested for COVID and desperately needed her test results. Her husband had COVID, and doctors have given him 24 hours to live. She would not be permitted to see him unless she presented a negative test result.

“Carlos was sick at the time, and I remember thinking that this could be me in a couple of days,” Vidal-Duart said. “I called the lab and said I needed to have the woman’s results within eight hours. They told me they had thousands of tests to go through to find them, and I told them I didn’t care. They did it, and she was able to see her husband before he died.”

Duart and Vidal-Duart said they worked 20-hour days in Tallahassee during the pandemic and managed to see their two small children in Miami for only a couple of hours on Sundays. Eventually, they decided to make Tallahassee their new home.

They developed a building off Mahan Road that houses offices along with a medical spa, a primary care clinic and a testing lab, all part of their family of companies.    

“We lead by example,” Vidal-Duart said of her and her husband’s management style. “There is nothing that we call on others to do that we would not do ourselves, even if that means responding to patient emails and giving them test results at 3 in the morning.

“We are willing to work side by side with our team. We feel like a family. There is a camaraderie and bonds that have been built that only come about when you come through a disaster or an emergency.”

Duart said of the company culture at CDR/Maguire Engineering that “we are engaged in a team effort, everyone has a role to play and we don’t pass the buck. If something needs to be done, we’re gonna get it done.”

That approach can differ from that of government. Asked if he could markedly streamline a state or federal agency if given 90 days to do so, Duart had another ready answer.

“A hundred percent.”