Mahalo Nancy Foster

For 16 years, Nancy Foster has served as the Chief Financial Officer and Associate Dean for Administration, Finance, and Operations, significantly improving our school's financial health. Beginning in 2008, she assisted in revamping the school's practice plan and skillfully managed the bleak years of the Great Recession. As she approaches her retirement, Nancy took the time to share her memories from her time in the Dean's Office.

Q: How would you describe the financial landscape at JABSOM when you first started?
A: It was very strong when it came to state financial support. The school’s research operation was pretty robust. We had, at that time, three COBREs. Our tuition allocation was about a third of what it is today, and of course, the MD class size was smaller. So, from an overall school perspective, finances were very stable, and we were progressing forward.

Q: One of the first things you did when you joined in 2008 was to strengthen the Practice Plan. Why was that your first mission?
A: Dr. Hedges and I came from medical schools that were highly subsidized by the Practice Plan clinical revenues, so we knew that we had to figure out how to make the Practice Plan financially sustainable. I was able to outline a financial strategy; however, Dr. Hedges and Dr. Pat Blanchette did all the heavy lifting. Luckily for us at the time, the school received strong state support including Tobacco Master Settlement Agreement monies to help fund operations, and because of that, we were able to help the Practice Plan get back on its feet.

Q: The timing couldn't have been better because having a solid Practice Plan enabled us to ride out the worst of the recession in 2010.
A: By 2010, the Practice Plan was back on track financially. Then the Great Recession hit Hawaiʻi hard financially. The University of Hawaii’s state fund budget was cut by over $100 million. Consequently, the school’s state funds were reduced by $10 million, which was close to half of our state fund budget allocation at that time. Thankfully, the Practice Plan’s clinical revenues were able to fill the school’s $10 million state fund budget gap, subsidizing clinical teaching faculty compensation. If we didn't have a financially stable practice plan at that time, we would have had to lay off many UH JABSOM employees. Bridging uncontrollable or unexpected budget gaps demonstrates why clinical practice plan revenue is critically important in sustaining an academic medical center. A financially viable practice plan becomes even more critical for a community-based academic medical center, which is what JABSOM is, i.e., a medical school without a university hospital. 

Q: Have things gotten easier after deftly navigating through rough waters early on in your time at JABSOM?
A: I think things are different. Recovery from losing the 10 million dollars of state funding took about 4-5 years. We had to look internally for other alternatives because hiring was limited, at least on the UH side. One alternative was working with former Chancellor, Virginia Hinshaw, who allowed us to receive some of the school’s vacant permanent state counts back that were swept in an earlier year. Thanks to Dr. Hinshaw, we were able to place some of our UH temporary faculty into those returned permanent counts. This alternative saved us $2 million a year that we were able to apply towards covering the school’s building operating expenses. 

Q: Another important role you play is with our legislature. What has it been like being a champion for our school, getting them to see our impact on the state?
A: I have to thank Tina Shelton, our former communication director. Tina, as a former news reporter and anchor, had worked covering the state legislature.  She, along with Linda Takayama and Cynthia Nakamura, knew the legislators that Dr. Hedges and I needed to meet every year during the state legislative sessions. These three outstanding women ensured that we were prepared to showcase “what the school was doing for the state along with what the school had accomplished.” Former state senator Jill Tokuda, former state house representative Ryan Yamane, and former Governor Ige heard us. At the time, former Governor Ige oversaw the state's Ways and Means committee. In their role as state legislators, they recognized the value of the medical school and saw how essential physicians are for our state. Consequently, they decided in 2013 that the medical school needed to be separated from Mānoa's state budget line. JABSOM didn't ask for a separate budget line item; however, the state legislature did this action to track how the school’s state funding and positions were being used by the medical school. That legislative budget line change was monumental. It puts us on the radar, separate from the UH Mānoa state position pool. More importantly, the separate budget line allows us to strategize with the legislature as to where they feel any additional awarded support should be targeted. 

Q: Looking back on your 16 years at JABSOM, what sticks out most?
A: The people. I have a group of amazing individuals that I work with at JABSOM, and I've been able to work under great leadership as well. The people here are very dedicated to the overall mission of JABSOM. They give their heart and soul to make sure that we are serving the community in the best way forward. The whole reason I gave up my very secure job in Colorado was to help the people of Hawaiʻi. That was the promise I made to my grandmother before she passed away. So I came back to help, and I think we've done that. Now it's time for the next generation to take over and continue that mission, and the future is very bright, especially as the school moves towards expanding medical education to the neighboring islands.

Q: As you retire from JABSOM, what's next for you?
A: I am moving to the Pacific Northwest. My mother wants to move back. She lived there for 30 years, and we have family there. Even though we're both from Hawaiʻi, she wants to be closer to our immediate family. My husband has been retired since 2021. Even though I'm retiring from UH, I know that I still have things I want to accomplish after earning my masters and doctorate degrees so late in my professional career. Additionally, two of our three sons plan to relocate with us. They feel that the Pacific Northwest, specifically the Seattle area, will have many more opportunities for them. So we're moving as a family to take on new adventures. 

Q: As you depart after 16 years, you leave a wealth of knowledge behind. What words of advice do you give to whoever comes into this role next?
A: A new CFO will know financial strategies like the back of their hand; however, they may not know how things work here in Hawaiʻi if they are coming from the Continent. A new CFO will need to embrace our state's identity and learn and appreciate the culture of Hawaiʻi. I had to learn that when I came back after being on the Continent for 30 years. Additionally, it's essential for the new CFO to learn from and embrace JABSOM’s finance and operations team members’ knowledge and expertise, and to take the time to understand how Hawaiʻi works from a business and relationship perspective. My best advice I can offer to a new CFO is that no one person can be successful in this job on their own. It has to be a team effort.

See more photos from Nancy Foster's Mahalo Event by clicking below: