Year 4. September 29. Innovations in Primary Care
Approximately 40% of the full time faculty in the UCLA Department of Medicine (DoM), are primary care physicians, representing the largest mission embodiment of our department. Our colleagues, often serving quietly, are unsung heroes. They represent an essential foundation to our sprawling health system, providing care for tens of thousands of patients across the region and playing an important role in training medical students and residents. This week, I cast a spotlight on aspects of our primary care efforts and ways in which many are collaborating to improve access and operational efficiency to support our colleagues in primary care and the many patients that they serve. In future posts, I will describe some specific efforts that are being implemented to identify challenges that impact the professional success of our colleagues in primary care and initiatives underway or in development to support and improve their work environment. The reflections this week represent a snapshot, and I could spend many pages honoring and thanking each primary care physician in our department. So, at the outset, let me state how much we appreciate all the work that you do to lead in innovation, transform care and advance health for all.
The State of Primary Care in the DoM
There are 505 primary care providers (PCPs) and approximately 40 primary care clinics in the DoM. Each one of them is essential to our department’s work; these physicians manage the health of thousands of patients and are the gateway to our broader network of specialists.
In celebration of the invaluable work of our PCPs, I asked Evelyn A. Curls, MD, MBA, vice chair of ambulatory medicine for the DoM and clinical chief of the UCLA division of general internal medicine and health services research, to share her thoughts on the state of primary care in our department. Here is what she had to say.
“Primary care is the backbone — the very foundation — of our health system. We are the first call, the steady guide, the trusted partner. We prevent illness, treat the acute, and walk alongside our patients through every stage of health. We shepherd, we coordinate, we navigate — and in doing so, we fuel the work of every specialty downstream.
To stand in this role is an honor. It is a sacred privilege to be entrusted with people’s health, their fears, and their hopes. But let’s be honest: carrying this weight is not easy. At a time when access is stretched thin and demands grow higher by the day, PCPs are feeling that strain.
That is why now, more than ever, the need to rally around Primary Care is clear. We must — and we will—invest in the support that allows us to thrive: in-basket relief, smarter scheduling, smoother referrals, stronger clinic operations. These aren’t luxuries. They are necessities if we are to preserve the heart of healthcare.
I believe in the future of primary care within the DoM. And together, we will continue building the system our patients — and our providers — deserve.”
Thank you, Evelyn, and all of our primary care providers for your service to our patients and our mission.
“Medically Speaking” Podcast Promotes Primary Care to Patients
Members of the DoM impress me time and time again with their exceptional public engagement and media skills. Earlier this month, podcaster and primary care provider (PCP) Eve M. Glazier, MD, host of “Medically Speaking” — a podcast for patients — sat down with fellow PCPs William J. Carroll, MD and Maria A. Han, MD to give listeners a beginner’s guide to primary care. Their episode ranged from the importance of primary care to the types of questions to ask when meeting with a new PCP for the first time.
“As a primary care physician, I see every day how a trusted PCP serves as a person’s ‘home base’ — the place where prevention happens, concerns are caught early, chronic conditions are managed proactively, and specialist care is coordinated so nothing falls through the cracks,” Dr. Glazier said. “We wanted to cut through the noise with practical steps patients can use now.”
Dr. Glazier invited Dr. Carroll and Dr. Han as guests on the episode because of their complementary perspectives on primary care. Dr. Han, who serves as chief medical officer for ambulatory care, practices at the Iris Cantor Women’s Health Center and oversees initiatives to innovate primary care delivery across clinics. Dr. Carroll practices both traditional and complex primary care as an extensivist; he also serves as clinical medical director of the UCLA Alzheimer’s and Dementia Care Program and senior care medical director.
“Together, Dr. Han and Dr. Carroll show how continuity, coordination, and thoughtfully designed systems translate into better care for patients across ages and needs,” Dr. Glazier said.
Dr. Han and Dr. Carroll embraced the opportunity to share their expertise on primary care and were particularly grateful for the chance to share their thoughts on the state of the patient-provider relationship — and how they wish it could be. Most conversations around this topic happen tend to happen in academic or scholarly circles “where, frankly, we’re talking with ourselves,” Dr. Carroll added.
“The vast majority of human communication now happens online, where we haven’t been included in the conversation in the way we wish we were so we could boost confidence in our ability to help maintain patients’ health and clarify our roles as PCPs,” he said. “It was really great to have the chance to do that.”
Dr. Han noted that at a time when there are so many specialists, the episode provided the chance to share the practical utility to having a PCP.
“I was excited to hear that explaining this would be valuable for listeners,” Dr. Han said. She
added that as society broadly has become increasingly transaction-based, it is helpful to emphasize to patients the value of having a longitudinal relationship with their physician.
“That relationship drives individually-tailored care and the best patient outcomes.”
Platforms to reach lay audiences, like the one Dr. Glazier addresses on her podcast, also give physicians a fighting chance against an ever-growing tide of misinformation, not to mention anti-healthcare and anti-science rhetoric. That’s why faculty — especially the kinds of world-class experts we have in the DoM — should take part in them as often as possible, Dr. Han and Dr. Carroll agreed.
"Even if we don’t have a seat at the table, that conversation is going to be happening anyway, and it can be at the harm of our patients and communities,” Dr. Carroll said. “I think it’s more important than it has been in the past to engage with communities so they can successfully navigate contradicting recommendations from ignorant perspectives that may not understand the harm they are doing.”
Congratulations to Dr. Glazier, Dr. Han and Dr. Carroll for their exceptional work on making the , Be sure to share Dr. Glazier’s podcast with your patients, including CORE Kidney Program Founding Director Anjay Rastogi, MD, PhD’s recent episode on kidney health, and look out for more of our faculty from across divisions on the podcast very soon. Dr. Glazier encourages everyone to come on the pod.
PCPs Meet Women's Health Needs
The average wait time for a non-urgent obstetrics or gynecology specialist appointment in the U.S. is more than 30 days. This reflects not only a relative shortage of OB-GYN specialists, but also the reality that gender-specific primary care for women is not the exclusive domain of gynecologists. Here in the DoM, some PCPs throughout our healthcare system are have committed themselves to increase access to women’s health through an initiative where they provide certain basic women’s health services, such as well women exams, contraceptive consultations and menopause care.
“Presently, there are significant delays for basic women’s health services if accessed through gynecology,” Annapoorna Chirra, MD, FACP, an internist based at Iris Cantor UCLA Women’s Health Center who leads the project, said. “This effort is meant to boost patient access to women’s health services by engaging self-identified primary care providers.”
The program was launched as a pilot in May 2023. More than 1,400 referrals were placed for its services in the first year alone; now, it is adding additional treatments and procedures as well as new self-identified family medicine and primary care network providers.
“We are also simplifying access to these services by engaging the UCLA Health Patient Communication Center to improve efficiency in patient scheduling and to offload administrative work at the department level,” Dr. Chirra added.
At Torrance Skypark Primary and Specialty Care in the South Bay, family medicine physician Chris Gornes, MD is one of the practitioners who was enlisted to provide women’s health services. She believes the program is invaluable to helping patients get the care they need as well as preserving appointments with obstetrics and gynecology specialists for more complicated, urgent cases.
“It's extremely rewarding to be able to provide these services to our patients and to partner with them to find solutions that work for their lives,” Dr. Gornes said. “I believe strongly that all women deserve timely, personalized and compassionate reproductive health care and through this program we are able to do our part to address this inequality in medicine.”
Thank you to Dr. Gornes, Dr. Chirra and the many other PCPs who are part of this important program! You embody our department’s commitment to transforming health for all.
Program for Reducing Obesity Builds on Successful Track Record with Expanded Resources
Back in January 2024, I shared with you some updates on the Program for Reducing Obesity (PRO), a community weight management initiative founded by endocrinologist Na Shen, MD, PRO medical director. The program has continued to take off in the nearly two years since, with many more resources for patients including increased variety and number of classes, more body compositions for body fat analysis, and new pilot program addressing adolescent patients with obesity.
“Together we have a comprehensive program to tackle both the medical side of the metabolic issues facing our patients but also improve their physical fitness and work on meaningful behavioral and lifestyle changes,” Sonya S. Heitmann, MD, an internist at Westlake Village Primary & Specialty Care who sees patients in the program, said.
Dr. Heitmann and physical therapist Helen Setayn helped start a new exercise series that is popular with participants in PRO. Other recent additions to the program include a full-time dietician, Jenny Arussi, MS, RDN, and three new physicians: Alina Katsman, MD; Lina Bokhetache Hadj Smaine, DO; and Artem Minalyan, MD.
The number of group classes has grown significantly, from four classes weekly back in early 2024 to now 16 weekly. There are now body composition analysis machines at every clinic where PRO is available, giving patients greater precision in weight management. Yet another exciting development is the launch of PRO Jr., a version of the program geared toward adolescents aged 12 to 17. Classes for this cohort are led by Nazanin I. Gunn, MD and PRO Nutrition Director Lara Al-Dandachi, MPH, RD.
All patients’ progress is now tracked in a database thanks to the work of endocrinologist Deepashree Gupta, MD, who spearheaded its development. So far it includes information for nearly 5,000 patients who have entered the program since 2019.
"Thanks to the creation of this PRO database, there is a lot of potential for future research that can not only help this program evolve but also streamline collaborative efforts with all related disciplines,” Dr. Shen said. “We are already working with cardio-oncology, GI and rheumatology about potential projects which is very exciting."
PRO was the first UCLA weight loss program established outside of the main Westwood and Santa Monica campuses when Dr. Shen launched it in 2019. It is covered by insurance and includes individual visits with obesity medicine board-certified physicians and shared medical appointments with these physicians, dieticians and physical therapists.
PRO is currently focused on providing high quality weight management to the UCLA Northwest community with offices available in Ventura, Thousand Oaks, Westlake village, West Hills and Pasadena.
“Positive patient feedback has probably been the most rewarding part of starting and running PRO these past five years,” Dr. Shen said. “Knowing that we can offer more resources, support, and evidence based obesity care to a growing number of our UCLA community adult and now adolescent patients is our greatest success — all thanks to a team of passionate physicians, dieticians, physical therapist and ancillary staff in addition to the generous support of Dr. Abel and our division leadership."
Please join me in thanking the providers involved in the PRO for guiding our patients in their quest for better health!
Operation “Tetris” for Space and Creative Scheduling Has Major Impact on Providers and Patients
The optimization of exam room space and physicians' schedules may not sound like exhilarating tasks, but as Northeast Region Ambulatory Director Jeff E. Borenstein, MD, MPH can attest, doing them well can have a major impact on patient access while supporting physician wellness.
Initially, as part of our objectives under the patient care pillar of the UCLA DoM Strategic Plan, Dr. Curls sought to understand how well the DoM was using office space in an effort to increase overall clinic capacity and thereby improve patient access. Working closely with clinical directors and office management staff, Dr. Borenstein began to examine schedules for every exam room in every clinical suite in every site in his region, which includes the communities of Porter Ranch, Pasadena, Burbank, North Hollywood, Encino, Santa Clarita, and Simi Valley. Recognizing that the format of current schedules, which depicted the use of every exam room in 15-minute segments, made such assessments difficult, he and Hope Jin, a DoM project manager, designed a simpler but more informative tool. Based on its colorful representations like the one shown below, Dr. Curls rebranded the effort as “Tetris.”
The Tetris approach gave team a clear picture of exactly how each room was being used and where there were pockets of empty space. Working with regional administrative leadership, office management, and DoM clinical chiefs, the team began to adjust schedules to fill in gaps. Ultimately, the optimized schedule for exam room use significantly increased the number of physicians that could work in the region’s clinics. As a result of the success of this effort, Dr. Curls has begun adopting the approach for the entire DoM ambulatory network.
The Tetris project dovetailed nicely with a separate effort to support physician wellness — one of our key focuses as a department — by increasing the flexibility of primary care physician schedules. The effort, extended across the faculty primary care practices by all of the ambulatory regional medical directors, parallels an initiative started by Dr. Curls and Dr. Borenstein a several years ago amongst the DoM subspecialist divisions and sections. In addition to supporting physician wellness, the projects offer the opportunity to increase the efficiency of exam room utilization.
“Physicians like to have flexibility. It’s one form of autonomy, and we know autonomy is linked to wellness,” Dr. Borenstein said. “This was an attempt to help with wellness and efficiency.”
One example of a scheduling innovation was allowing for the consolidation of four hours of weekly “sustainability time,” which had previously been distributed among clinical care sessions, into a single four-hour block. Since PCPs already had a four-hour block of administrative time, having a four-hour sustainability block on that same day allowed physicians the option to spend four days in clinic a week, a blessing for those with long commutes. Another example is the creation of four-hour blocks of telehealth, conducted from home, which could similarly decrease time in clinic without compromising patient access. The team also worked on creating extended primary care specialists, shortening the days in clinic even further and allowing PCPs to work three 9-hour clinic days along with a 5-hour telehealth block at home.
How do these options help improve access? Imagine a clinic in which four PCPs elect to have a telehealth block on the same day as they have a four-hour administrative block. This arrangement collectively frees up four days a week of clinic time, allowing another PCP to be added to the same clinic space.
In the new Pasadena clinic, extended primary care schedules had a particularly significant impact.
“In Pasadena, we have eight primary care exam rooms which would fit four physicians with standard schedules — now we can fit seven” Dr. Borenstein said. Like the Tetris project, the use of these scheduling tools would not be possible without the ongoing and dedicated efforts of our office management staff.
Another innovation to offer primary care physicians a new scheduling option that also improves productivity and compensation while increasing access for new primary care patients, was suggested by Adam F. Cavallero, MD, the northwest ambulatory regional medical director. For many years, primary care physicians could opt to increase their salary by having an extra clinic day a month on Saturdays. Dr. Cavallero suggested that those same eight hours of extra clinic time could be done on weekdays but making them only available to new patients. The strategy helps increase new patient access while affording PCPs an additional scheduling option. This is an especially important program, since increasing the number of new primary care patients supports growth throughout UCLA Health.
“Scheduling has a profound effect on access and new patient enrollment,” Dr. Borenstein said. “And physicians value the flexibility to see patients in a schedule that works best for them.”
While there are many factors that affect patient access and physician productivity, the latest reports indicate significant growth among both metrics for UCLA primary care physicians. Please join me in thanking Jeff, Evelyn, Adam, Hope, and the many other members of our teams who have made these initiatives a success.
Primary Care Training for Student Nurse Practitioners Improves Patient Access
One innovative and impactful initiative being led by PCPs is the integration of nurse practitioner (NP) student training directly into primary care practices. With the increasing demand for accessible, high-quality care — particularly in underserved and rural areas — primary care physicians are stepping up not only as clinicians but also as educators and mentors. One such education initiative is being spearheaded by Adam F. Cavallero, MD, our regional medical directors for the Northwest region. He and Steven McCarthy, MD, an internist in Thousand Oaks, have been successfully teaching NP students once weekly for three months at a time since 2021.
“By opening our clinics as clinical training sites, we can provide NP students with immersive, hands-on learning experiences that reflect the complexity and pace of real-world patient care. Unlike simulated or classroom environments, these settings expose students to the full spectrum of primary care, from preventive services and chronic disease management to patient counseling and care coordination.”
Physician-led training helps close educational gaps by offering rigorous mentorship in diagnostic reasoning, pharmacologic management, and nuanced clinical decision-making. It also models the kind of collaborative, team-based care that is essential in today’s healthcare landscape. NP students benefit from observing how physicians navigate challenging patient scenarios, handle uncertainty, and communicate across interdisciplinary teams — all of which are critical for independent practice.
“This educational collaboration is not only enhancing the clinical preparedness of future NPs but also fostering mutual respect and trust between professional roles,” Dr. Cavallero said. “By investing in the next generation of advanced practice providers, primary care physicians are contributing to a more integrated, resilient, and patient-centered healthcare system. It’s a forward-thinking approach that addresses both workforce shortages and care quality —while exemplifying the spirit of innovation in primary care.”
“It has been a joy to contribute to the education and development of clinical acumen in these students,” he added.
Thank you, Adam and Steven, for your exceptional work!
Tyler Larsen, MD, FACP Recognized for Excellence in Medical Student Education
Although this newsletter is dedicated to our primary care providers, I wanted to take a moment to share that Tyler Larsen, MD, FACP was recently honored for his innovation and excellence as a clinical educator with the Clerkship Directors in Internal Medicine (CDIM) Early Career Medical Student Educator Award. As co-chair of the internal medicine clerkship and director of physical exam education at David Geffen School of Medicine (DGSOM), Dr. Larsen has contributed immensely to the growth of future physicians.
"It is a profound honor to receive the CDIM Early Career Medical Student Educator Award. Teaching and mentoring the next generation of physicians is one of the greatest privileges, and to be recognized for the work I truly love is deeply humbling,” Dr. Larsen said. “I am immensely grateful to my family, mentors, colleagues, and our students who have inspired and supported me along the way and without whom this recognition would not be possible.”
Dr. Larsen is a hospitalist at the Greater Los Angeles VA and a highly regarded expert in medical education. His academic interests focus diagnostic reasoning, the physical examination, simulation and digital media within medical student and resident education. He has served as a mentor to students and trainees throughout his career and is the author of numerous peer-reviewed publications about medical pedagogy. His teaching practices have led to increased enrollment in elective sub-internal medicine rotations at the VA, strengthening the pipeline of physicians who are developing an interest in internal medicine and who will obtain direct experience working in this essential clinical setting.
Dr. Larsen’s dedication to clinical education was recognized last August with the Rising Star Award from the David M. Worthen Awards for Excellence in Education, presented by the Veterans Health Administration. In 2023 he received the DGSOM-UCLA Kaiser-Permanente Award for Excellence in Teaching. He has also been recognized as an exceptional health educator as the first-place winner of the Society of Hospital Medicine Converge 2024 National Meeting MED-TED Speaker Competition and the first prize winner of the iMED National Conference Digital Teaching Awards – Digital Education 2022.
Please join me in congratulating Dr. Larsen on this achievement!
Dale
P.S.
I want to thank many of you who sent me notes of congratulations or directly spoke to me last week following the announcement of my receipt of the Robert H. Williams Award from the Association of Professors of Medicine. It has been an honor and privilege serving a team of amazing colleagues in this role. I texted the announcement to my mother. Her response was priceless!
She later called to say more…
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