University of Virginia Department of Medicine Thursday, October 23, 2008
DoM is committed to excellence and has targeted 5 core areas in which we measure Clinical Affairs Education Faculty Development Research Administration/Stewardship
Productivity 8 out of 10 divisions posted increased number of RVUs from prior year Total of 168 clinical faculty
Augusta Medical Center • Multi-specialty clinic led by Alan Dalkin, MD • Average of 430 visits per month • 16 providers • Nephrology, Cardiology, Endocrinology, Rheumatology, Pulmonary, Thoracic Surgery
Augusta Medical Center • Expanded efforts in Cardiology with the addition of four faculty members, Drs. Escanellas, Zadrozny, Battle and Luna • In addition, our goal is to provide a greater menu of specialized care in this field including clinical sessions devoted to valvular disease, heart failure, congenital heart conditions, arrythmias and other such areas • Furthermore, we hope to use the practice at AMC as a stepping stone by which we could expand our reach into areas further west such as Lexington, Virginia where care for patients is difficult due to a lack of providers
Challenges and Future Opportunities • Long-term acute care hospital- opening in 2010 at Northridge Site. • Culpeper Regional Hospital- 49% hospital acquisition and need for sub-specialist and hospitalist coverage starting Jan 2009. • UVA Hospital Bed Tower- 72 new beds 2012. • Growth of AMC out-patient clinic and sub-specialty care.
Entrepreneurial Opportunities • Employee Health Clinic. • Complementary health clinic- possible clinic site at Fashion Square Mall. • Multi-specialty clinic at Fontaine – 2011. • New outreach opportunities. • MDVIP • We would welcome novel business plans for new opportunities.
Buchanan Award Winner Women’s Heart Clinic- Club Red Clinic • The University of Virginia’s Women’s Cardiometabolic Prevention Program will be dedicated to providing cutting-edge, comprehensive, effective, and profitable care for women • Co-directed by Anne Hedelt and Amy Tucker, MD (as well as Angela Taylor, MD and Anthony McCall, MD)
Excellence • U.S. News and World Report • Endocrinology # 7 • Digestive Disorders #26 • Cancer #36 • Respiratory Disorders #37 • 35 physicians in the DoM named to the Best Doctors in America (26 named in 2006)
Other novel programs • Combined Nephrology-Rheumatology Lupus Clinic - January 2009 Other joint programs are strongly encouraged
Ambulatory Operations Plan • Sanctioned by the medical center • Under the direction of Marshall Ruffin, MD, Sandy Schenk, MD (surgery) and Mitchell Rosner, MD • Aims to re-define out-patient operations to create a more patient-centered approach
Ambulatory Operations Plan- Goals • (1) The importance of improving access for patients to outpatient clinics. • (2) Empowering clinicians in clinics to have a greater input on clinic operations. • (3) Define clinic governance in a rational manner. The ultimate goal is to create an ambulatory care system that stresses the patient first and involves a more collaborative approach between clinicians and the medical center. KICK-OFF: planning meetings in October 2008 Digestive health clinic work group beginning now
University of Virginia Journal of Medicine Purpose: • To provide residents, fellows, and faculty members the opportunity to publish materials generated from their clinical and research experience • To date three volumes have been published, with the fourth currently in press • With the exception of invited articles, residents are either primary or secondary authors on all articles
Clinical Investigator Track Overview: • The Clinical Investigator Track is designed for individuals interested in a career in academic medicine focused on general internal medicine or one of the internal medicine subspecialties. • In addition to meeting the basic requirements for a three-year training program in internal medicine with a core base of rotations on internal medicine and subspecialty wards and clinics, the program provides the opportunity to earn a Masters Degree in either Medical Informatics or Clinical Investigation from the Department of Public Health Sciences at the University of Virginia School of Medicine. • Ultimately the goal of this program is to develop academic physicians with well-rounded backgrounds in clinical medicine who are uniquely well suited for careers in clinical investigation.
Residency Recruitment • So far this year, we have 1,434 applications for 33 slots our program for the 2009-10 academic year. 443 applicants have been invited to interview, and 358 have been scheduled. We hold recruitment on Mondays and Thursdays, November through January • The 2008-9 Class of Categorical Interns represent the following Medical Schools: Brody at Eastern Carolina University Eastern Virginia Medical School George Washington University Medical College of Virginia Temple University Texas A&M University of Alabama University of Florida University of Georgia University of Iowa University of Kentucky University of Maryland University of Miami University of Newcastle, Australia University of Pennsylvania University of Rochester University of South Alabama University of Tennessee University of Virginia Wake Forest Wayne State West Virginia University
Residency Match to Fellowship • Of the 2009 graduating class of 30 residents and 4 Chiefs, 22 matched in Fellowships (Cardiology, Endocrinology, Gastroenterology, Hematology/Oncology, and Infectious Diseases) at the following institutions: Oschner Thomas Jefferson University of Alabama Birmingham University of Chicago University of Michigan University of North Carolina University of Virginia UT Southwestern Wake Forest Baylor Boston University Cleveland Clinic H. Lee Moffitt Cancer Center Johns Hopkins Louisville Mayo Clinic MUSC NIH Northwestern Note: Of the remaining residents 3 have secured positions in primary care, and the remainder have applied for Fellowship for 2010 and will be pursing positions as hospitalist or in locum tenens in the interim
Education • UME: • Budget cuts to UME (1M per year) • Request for changes to clerkship structure • Basic science to careers course
Budget cuts to UME • Please send a list of all UME teaching that you do to help us be sure that faculty are getting credit and compensation for their educational efforts. Send to Amy Tucker.
Third Year IM Clerkship • The 3rd year is expanding to 12 months from 10 in anticipation of increased class size, adding 8 wks to the third year. • We proposed that the Curriculum Committee use four weeks of the extra time to restore the IM clerkship to 12 weeks--8 weeks inpatient, 4 weeks ambulatory, but were denied • Curriculum committee has added 2 wks of geriatrics, 2 wks of acute care medicine (ER plus Anesthesia), and 4 wks of surgery selectives
Proposed Clerkship Modification Reasons that we had requested our changes: 40% of UVa students do not spend any of their 3rd year Medicine clerkship at UVa, but surveys indicate that exposure to UVa HS and faculty is one of the most valuable aspects of the clerkship for those who are on site. Third year students do not get exposure to Medicine subspecialties, narrowing the diagnoses to which they are exposed—as participants in care and in MS morning report. Surveys among former students now in Internal Medicine residency or practice indicate that subspecialty experiences were among the most valuable and contributed most toward selection of IM as a career. Number of letters written for IM or IM/Peds residencies is dropping.
Proposal for Consideration • Rearrangement of the time students are required to spend on IM. • Combine the 4 wks of subspecialty selectives now required in the 4th year with the 4 wks of General Medicine into an 8 week Inpatient Medicine experience in the third year. • Move the 4 wks of AIM into the 4th year.
Advantages to the Revised Structure Third year students would be at UVA for no less than half of their inpatient experience • Improved equivalency across the clerkship because all students get our conferences, including student morning report, housestaff, and faculty for at least half of their time. • Inpatient clerkship grading may be fairer, because there will not be the weight of a single AIM preceptor (as 1/3 of the clerkship grade this has a significant impact, and the preceptors vary in their styles). • Total amount of AIM time remains unaltered, maintaining a robust ambulatory experience. • AIM grading may be fairer--students will all go into AIM with core clerkships completed leveling the field. Some AIM preceptors see fewer students and may have a harder time sorting out performance differences that are a function of experience. New third year students can slow an office practice and frustrate patients and staff, while a seasoned fourth year may be helpful.
Basic Science for Careers Course • 2 hour sessions with basic scientist and clinical faculty member together or clinician investigator presenting translational applications of basic science • Each session to be provided twice, in two consecutive weeks, each of which involves ½ of the third year class • Tentative dates March 2-5 and 10-13, 2009 • DOM is providing 12 sessions
Education 2007 2008 The Michael Rein Teaching Award Michael Rein (ID) Brian Wispelway (ID) AjeetVinayak (PCC) Andrew Wolf (GM) John Densmore (H/O) Michell Rosner (Nephrology) Robert Carey (Endo) Gene Corbett (GM) John Dent (CV) Rebecca Dillingham (ID) Molly Hughes (ID) Michel Kahaleh (GI Steven Koenig (PCC) Steve Lommatzsch (GM) Anthony McCall (Endo) Mo Nadkarni (GM) Peggy Plews-Ogan (GM) Michael Rein (ID) Mitch Rosner (Nephrology) Vanessa Shami (GI) Ajeet Vinayak (PCC) John Voss (GM) Mark Williams (GM) Brian Wispelwey (ID) Andy Wolf (GM)
Faculty Total Number: Clinician Investigators: 46 Clinician Educators: 44 Academic Investigators: 19 Academic Educators: 0 Clinical Faculty: 76 Research Faculty: 45
Faculty Development Activities • Clinical-Investigator pathway for residents (2/year) – Providing a pipeline to clinical investigative careers. • Support of Faculty to obtaining advanced degrees (MS in Clinical Research ) • Support of K12 program (2 DoM Awardees)
Faculty Development Activities Promotion and Tenure pre-review – Improved success rates with P&T. Career Development seminar for Fellows. Development of mentorship review templates for each academic track. Informal mentoring. Development of mentorship awards.
Dr. Barbara Mann (2008) Comments from mentees: Dr. Barbara Mann has influenced a generation of physician-scientists. She has influenced trainees at all levels and is widely regarded for her advice and counseling. Those that she has mentored have gone on to success at all levels of academic medicine and each one looked back to their interactions with Dr. Mann as a formative experience. Her scientific knowledge as well as her knowledge of grant mechanisms and ability to participate in career development have made her a valuable mentor.
New space-4th floor Jordan Hall Demolition to begin Dec 08. Completion estimated Oct 09. Five laboratories with offices. Additional desk and shared equipment space. Centrally located. Conference room available now.
Research Awards 2007 Harini Bagavant (Rheumatology) Eric Houpt (ID) Brian Wamhoff (CV) Judith Woodfolk (Allergy) Shyr-Te Ju Award established 2008 Margaret Plews-Ogan (GM) Girija Ramakrishnan (ID) Shyr-Te Ju Award Yan Ge (CIIR)
DOM Financial Challenges • FACTS • Department of Medicine Posted a 1.3 M operating deficit last year (FY08). • Our HSF Revenue so far this year is well below the budget that was prepared. As of September, charges are already $1.2 M behind budget and collections are $550K behind budget. • We are currently $648K deficit in HSF operations. • SOM Dean’s tax was increased. The impact is approximately $304K more than it was last year. • HSF has proposed changes in Medicaid reimbursement to physicians (This represents approximately $200K loss in revenue). • State budget cuts for the SOM are anticipated to be $3M; it is too soon to quantify impact to the DoM but may be as high as $600K. • Indigent care payment will not be as high this year because in the prior two years we have been receiving settlements from other years (approx $250K less funds). • SoM has announced a $1 M reduction to Department of Medicine UME funds. Timeline has not yet been determined for the reduction. • The fastest and least painful solution is to ensure that we provide the best clinical care we can and that we get all the revenue we can for providing that care. To do this we all need to work together. This is part of the path back to financial stability. Below are suggestions and estimates of the impact of things we can begin to do now. • http://spweb.eservices.virginia.edu/sites/dom/DMEC/default.aspx • Log-on username and eservices password
New Faculty • Brian Annex, M.D. Division Chief, Cardiology • Jaime Escannellas, M.D. Cardiology • Charles Farber, M.D. Public Health • Max A. Luna, M.D. Cardiology • John Zadrozny, M.D. Cardiology • Laurie R. Archbald-Pannone, M.D. General Medicine • Joshua S. Barclay, M.D. General Medicine • David Y. Ling, M.D. General Medicine • Douglas S. Keith, M.D. Nephrology • George M. Verghese, M.D. Pulmonary • Max M. Wedder, M.D. Pulmonary