Year 3. January 29. Where have we been and where are we going?
It was my great honor and pleasure to deliver last week's Grand Rounds on the State of the Department of Medicine. First, I want to say that all our accomplishments are due to the unparalleled strength of our community -- including you. Each person in the department of medicine (DoM) is integral to our success, and though I serve as the face of the community, our achievements are collective.
This year, we have many achievements to be proud of, and areas for improvement. I must say, it was difficult to cover it all in just one hour! So instead of aiming to cover every detail, I focused on the key highlights, aligned with our department's newly minted strategic plan. Below is a summary of highlights from my presentation: You can access the full recording of the presentation here.
Strategic Plan Implementation
As a department of our size, it's crucial to have common goals to work towards and common language to align our goals. To that end, in 2023, we drafted an impactful and ambitious strategic plan for the department. Our overall vision statement is: Lead in Innovation. Transform Care. Advance Health For All. This statement effectively captures our vision as a department and is underpinned by our seven core values: Leadership, Equity, Accountability, Discovery, Excellence, Respect, and Service.
Underpinning our 7 core values are four mission pillars that represent the DoM’s core missions, each with an overarching goal:
- Research: Accelerate the growth and impact of our research and discoveries.
- Education: Develop leaders who will drive the future of medicine and health sciences.
- Patient care: Provide the highest quality patient-centered, innovative, integrated healthcare for all.
- Community Engagement and Investment: As a public university, advance health and improve outcomes for our diverse communities.
Each pillar is as important as the other, and their success is interdependent.
Across these four mission pillars we have a foundational goal to build community within the DoM, grounded in our vision and core values. This goal will be at the center of all that we do and accomplish.
Then across all goals, mission, pillars, and values are our five cross-cutting priorities: 1) People, 2) Justice, Equity, Diversity, Inclusion (JEDI), 3) Infrastructure, 4) Collaborations & Partnerships, and 5) Innovation.
Strategic plans can be nice visuals or platitudes that you can put on your walls, or they can be a catalyst for impact. We are in the business of impact through strategic implementation. We've put together implementation teams across the four pillars listed above, headed by an oversight team that will ensure that cross-cutting themes are being sufficiently infused across each of the pillars, and will be in deep collaboration with the strategy implementation leadership teams.
We are already seeing the fruits of our labor across a range of our strategic plan's goals. One of those areas is faculty. Faculty, alongside trainees, and staff, are the heartbeat of the DoM. We currently have 1,828 faculty, making us perhaps one of the largest departments of medicine in the country.
The majority of faculty are in the health sciences series, followed by the senate series, then adjunct series, then volunteer. In terms of growth, we had a net growth over the past year of 84 faculty, factoring in 149 new faculty and 65 departing faculty.
Division Chief Search Updates
This faculty growth is only on track to continue, including in terms of leadership. We are currently working on filling three division chief positions in cardiology, geriatrics, and pulmonology, respectively. All of these searches are progressing well.
Of course, our department can't run on blood, sweat, tears, and compassion alone! We need a healthy financial profile to sustain our work. Thankfully, in no small part due to your tireless efforts, and steady oversight by our financial team, we are in a very strong place on this front, with a total of 1.7 billion dollars in revenue in the 2023 fiscal year.
The largest source of revenue in our department came from our clinical work, followed by contracts and grants. However, each area of revenue is crucial to our financial health.
So, where does this money go? Mostly, to support the salaries of the nearly 5,000 members of our DoM community.
Our financial performance continued to enable our department to maintain healthy reserves that place us in a position to begin strategic investments in our future, while ensuring that we can continue to support our missions if unexpected crises that impact our revenue arise, for example what was experienced during the height of the COVID-19 pandemic.
The health system is undergoing a process of financial integration that will align revenues across the UCLA Health to enable broader investments across the entire enterprise. This is a work in progress. The department will continue to experience levels of support for all of our missions consistent with current practice.
Our clinical work has been an important driver of our financial success. Importantly, our faculty and providers provided exceptional care while sustaining record levels of patient volume in our ambulatory and inpatient services.
The clinical pillar of our strategic plan seeks to provide the highest quality patient-centered, innovative, integrated healthcare for all. To meet this goal, we are prioritizing three strategic objectives in our first implementation phase:
- Increase access to high quality patient-friendly inpatient and ambulatory care
- Strengthen clinical infrastructure and operational efficiencies
- Cultivate an environment in the clinical setting that supports provider and staff wellbeing and retention
So, what's our baseline for these objectives? We continued to grow clinically, with 2.3 million clinical encounters over the past year, up by about 75,000 from 2022 and over 250,000 from 2021.
Our RVU growth is also up to nearly 4.6 million, higher than both 2022 and 2021.
In terms of our inpatient services, our hospitalists supervised 31,587 admissions last year compared to 28,921 in 2022 and logged 228,748 inpatient encounters compared to approximately 218,000 patients the year prior. As a reminder, our hospitalists are everywhere -- across 14 locations -- and there's been significant growth across nearly all those settings.
While we continue to make great strides towards reaching our goals, as a system we need to continue to grow to meet clinical demands and ensure that we remain a regional and national destination program. The health system set a goal to increase new patient visits by 5% or more in FY24 and achieve 1 million unique patients by FY28.Why 5% growth? While we know that more patients means use of more resources, we know that we are up for the challenge, and that this growth will sustain our financial viability, maintain our competitiveness in the market place, and position us to achieve our population health strategy, improving our ability to provide equitable care and access to a wider patient population, while supporting our academic missions.
For many of our clinics our schedule utilization exceeds 100% indicating that we are running beyond our physical capacity in some areas. While we will continue to recruit new faculty and continue to identify additional facilities, we also need to optimally manage our existing resources. As such, there are several initiatives that are underway within the department and across the health system to optimize and increase patient’s access to our services:
Within the DoM, specific initiatives are being planned and implemented through five workgroups: APP integration, supporting scope of PCP, after-hours care, telehealth standardization, and short-term/gap year hiring. We've already increased our new patient visits by 10% over the last six months of FY23, meaning our efforts are already paying off, even as we continue to implement new initiatives.
As we recruit new faculty, it is essential that our new colleagues hit the ground running. The Department of Medicine Professional Group (DMPG) continues to do exceptional work through their onboarding program, with its focus on ensuring that all or our patients receive best in class care, building a department culture of collaboration and quality improvement with a keen focus on faculty wellbeing. Special shoutout to the leaders of the DMPG onboarding team whose curriculum goals are summarized below:
The onboarding team is meeting this mission through five main pillars of onboarding across DoM divisions and clinic settings: 1) Large group instruction, 2) Specialty-specific instruction, 3) Practice partner program, 4) Communications skills training, and 5) Peer coaching program.
Most departments of medicine do not have anything like this year-long orientation, and the positive feedback from faculty who have participated in this onboarding process speaks for itself.
The positive DMPG onboarding feedback dovetails nicely into our focus on supporting and improving wellness at the DoM. Our people are at the heart of who we are and what we do, and ensuring wellbeing among our community members is among one of our highest priorities. That's why we have deployed an annual wellness survey with a strong 73% response rate, which indicates ongoing significant faculty engagement when it comes to wellness.
The survey results demonstrated a decrease in overall physician burnout from 60.2% to 54.5%., over the past year. While we are encouraged by this progress, there is much work that needs to continue and importantly, we need to double down on efforts to reverse gender disparities in burnout rates.
This gap existed across all physician groups from physician scientists to hospitalists. We take this gap seriously and are focused on identifying the main pain points driving this gap and putting measures in place to address drivers of burnout among all faculty, but especially women faculty. Most of our trainees are women, our trainees are very likely to stay at UCLA and we must ensure that we remain an environment where all of our faculty will thrive both personally and professionally.
Despite our high standards across our missions, the DoM should be a place where people want to come into work. Special shout out to Dr. Sun Yoo, our recently named chief wellness officer, for spearheading many of our wellness initiatives:
There's no doubt that UCLA DoM is one of the leading departments of medicine in terms of research. But don't take my word for it! The data speak for themselves:
As you can see, we boast an impressive number of publications across high impact journals from faculty and trainees. We are also a top funded academic department of medicine, with over $450 million in research funding in FY23, up from all three past years, and as the number 1 highest NIH-funded DoM in 2022, according to the Blue Ridge Institute for Medical Research Rankings. We have an impressive record of bringing in funding across divisions. Last year, the divisions of infectious diseases and hematology/oncology led the way.
We celebrated our success through research symposiums and conferences. Research Day 2023, for instance, was a significant success with over 500 attendees and more than 300 poster abstracts. The Solomon Scholars Research Day focused on presentations from trainees in affiliate programs, achieved similar success with 182 abstracts.
Despite our impressive success, it's important to not get complacent in an increasingly competitive research funding environment and to continue to compete for major research grants. That's why our strategic plan's goal for research is to accelerate the growth and impact of our research and discoveries. We will achieve this through two priority objectives for the first phase of our strategic plan implementation: 1) strengthen the research infrastructure, and 2) develop, retain, and recruit researchers and research staff.
Core to advancing all of our missions is our commitment to education. Our goal is to develop leaders who will drive the future of medicine and health sciences. We are prioritizing two key objectives for our first implementation stage to reach this goal: 1) train leaders who provide holistic, patient-centered care and drive scientific discovery to create a better future for our community, and 2) develop and recognize outstanding faculty educators. We are already well on our way towards reaching this goal as an educational hub in the region and nationally.
When it comes to our residency program, we had one of our most successful match days in FY23 and plan to garner even more success in our 2024 match.
We know that the individuals who come here for residency stay here, which means putting great care into our match selection -- including in terms of diverse representation to match the diverse population we serve -- to invest in what our future will look like in 5, 10, and even 15 years from now (no pressure, Dr. Skinner!).
I also want to give a huge shout out to the chief residents who continue to strongly support our trainees, whose superlative care of our patients are a core reason of why our residency program is as successful as it is.
Our residency program isn't alone in its success. Our incoming fellows and our fellowship-bound residents have both exceeded expectations. All fellowship-bound residents matched, and we are lucky to be keeping 23 of them right here at UCLA. At the same time, we will be welcoming 103 fellows this year from across 17 states, 19 of whom are from backgrounds that are underrepresented in medicine.
Finally, our STAR Program continues to lead the way for physician scientist training nationally and globally. We had 10 new STAR fellows come on board in FY23, including fellows in Infectious Diseases and Hematology-Oncology representing an increase in physician scientist recruitment in these divisions, relative to recent years. We are very committed to prioritizing this program as a recruitment tool for exceptional individuals who will be our future physician scientist faculty.
Community Engagement and Investment
Across all these areas, community engagement is something that we do with pride. Our goal in this area is to advance health and improve outcomes for our diverse communities. We have three main objectives that we're focusing on for the first phase of implementation:
- Increase access to care and health resources for historically and contemporarily under-resourced communities.
- Strengthen engagement and collaboration with organizations caring for historically and contemporarily under-resourced communities.
- Advance health disparities research and policy to improve health equity, in collaboration with health systems and community partners.
We are working towards these objectives through a number of initiatives, including our FQHC collaboration, the UCLA Health Homeless Healthcare Collaborative, providing cardiology services at California Hospital Medical Center, our collaboration with Venice Family Clinic, our residency training at MLK Jr. Community Hospital, the new Sickle Cell Center of Excellence, our work with Olive View-UCLA Medical Center, and through efforts to address occupational health of LA workers, such as Dr. Jane Fazio's work to address silicosis outbreak in immigrant workers.
Overall, we are doing incredible things in an environment with LEADERS values and being recognized for them. I can’t list them all, but across our faculty and trainees, we've been fortunate to receive a wide range of well-deserved accolades, and I couldn't be prouder. This recognition isn't just coming via awards, but also rankings:
We are excellent at what we do clinically and want to be proud of those achievements.
It is an understatement to say that we wouldn't be where we are without our exceptional leadership teams. Some may say we have too many people in leadership, but we have so many people in leadership because we have such a large department! We need a robust infrastructure at the leadership level to keep things running smoothly. I am indebted to all leaders, including our executive leadership, division chief and clinical chiefs, our EDI team, DMPG executive board, VA GLA leadership, and our senior administrative team. Please, make it a habit to share thanks with these leaders and all who report to them for the hard work that they do.
Overall, I hope I've made clear that the state of department is incredibly strong, and only growing stronger. I'm very proud of the successes that we've had over the past year and know we will take it even further over the coming year. It's a tremendous honor and privilege to be the face of the DoM, but the truth is that I look good because you all do such an amazing job in making me look good in how you run one of the best departments of medicine in the country.
With that, and on the subject of excellence and the people who lead the DoM, let me transition to celebrating three of our physician scientist LEADERS -- Quen J. Cheng, MD, PhD, and Elizabeth R. Volkmann, MD, MS, and Ching Zhu, MD, PhD, -- who were honored by the American Society for Clinical Investigation (ASCI) with prestigious physician scientist career awards. Please see here to read more about these awards and their research accomplishments.
My grandchildren and their parents returned to the Midwest yesterday. So the house is unusually quiet. What do you do when the grandkids leave? Pick limes from the tree in the backyard.