1. < Message from the Chair

Last week the UCLA Department of Medicine (DoM) celebrated the results of the 2024 subspecialty fellowship match. By many measures this represents a spectacular success, and I am pleased to introduce you to those who will be joining us as fellows next July and also celebrate the success of our medicine residents who matched into fellowship programs of their choosing. It would be fair to say that there was great joy and giddiness on Wednesday when the results became available, and I hope that you will pass on heartiest congratulations to our matched residents when you see them. This week, we also celebrate new LEADERS in the department through in-depth interviews with two incoming division chiefs.

Fellowship Match Day Was a Soaring Success

The DoM is renowned for producing LEADERS in medicine. The trainees who learn, teach, conduct research and care for patients in our halls and wards go on to run medical systems, lead national studies that inform health care policy, establish new scientific and clinical paradigms, and much, much more. This reputation both perpetuates and is upheld by our ability to attract the most talented, diverse and driven postdocs, residents and fellows in the world.

Last Wednesday, Dec. 4, on Fellowship Match Day, we celebrated once again doing just that. As in years past, we filled every position in all of our internal medicine subspecialty training programs, including programs that nationally tend to be undersubscribed.

 The 104 subspeciality fellows that will join the DoM in July 2025 are some of the brightest minds in medicine, with twenty of them holding an advanced degree in addition to an MD. The “annual migration” of fellows to UCLA was an immense success. Watch the video below to learn more about our new flock!

Our Fellowship Match Day results confirm that UCLA has continued its tradition of match day success, as evidenced by the rare distinction of filling all spots in our internal medicine subspeciality fellowships — an enormous achievement that is a testament to the quality of training in the DoM and to our stellar reputation. The incoming fellows are a diverse group: Twenty-one of them identify as being from a demographic and ethnic group that is underrepresented in medicine. We are proud to continue to diversify the physician and physician-scientist pipeline and to train clinicians that reflect the diverse communities we serve.

Our reputation as a training ground for medicine’s future leaders is not only supported by the quality of fellows we bring in, but by our residents’ ability to match into highly competitive fellowship programs either at UCLA or elsewhere. Once again, we were successful in this endeavor as well: All 62 DoM residents who sought to join subspeciality fellowships matched, 75% of them into highly competitive subspecialty programs including hematology-oncology, cardiology, gastroenterology and pulmonology. I am thrilled that 41% of our residents will enter this exciting new stage of their careers right here at UCLA! We are proud to not only have recruited the best residents but to continue to retain them as fellows. They were highly sought after by other prestigious fellowships, but the strength of our programs made us their #1 choice.

Let me also introduce you to the 11 incoming fellows who will be joining our Specialty Training and Advanced Research (STAR) Program, a nationally-recognized graduate program in which aspiring physician-scientists to engage in rigorous scientific training alongside their clinical residency or fellowship. Alumni of this program go on to have successful careers in academia, research and biotechnology; they are on the leading edge of scientific discoveries that transform our understanding of medicine and patient care. I am pleased to commit to providing these ambitious, talented individuals a world-class training ground where they can spread their wings!

The success of this year’s fellowship match was made possible by the tireless dedication of our fellowship program directors and the many volunteers who took time away from their busy schedules to review applications, conduct interviews and more. Please join me in expressing my gratitude to them for their hard work!

In addition, our residents’ success this fellowship recruitment season was facilitated by internal medicine residency program leadership who provided mentorship and guidance throughout the winding application process. I would like to extend my thanks to this important team as well as to our chief residents, who helped coordinate coverage so residents could participate in interviews. Thank you, and congratulations, to all!

Watch this video and hear directly from our trainees about their post match day feelings!

A Word From Our Fellowship Program Directors

During fellowship recruitment season, some of our fellowship program directors shared their hopes for our next cohort of fellows. Here are a few of their reaction to this year’s results!

In Conversation With…VA Greater Los Angeles Healthcare System Chief of Infectious Diseases Westyn Branch-Elliman, MD, MMSc

In early November the DoM celebrated the appointment of Westyn Branch-Elliman, MD, MMSc as chief of infectious diseases at the Greater Los Angeles VA. Dr. Branch-Elliman is a highly accomplished implementation scientist and epidemiologist whose research portfolio on antimicrobial stewardship and the use of “big data” and clinical informatics complements our work and priorities at the VA. Read on to learn about her journey, vision and words of wisdom in a special Q&A.

What experiences led you to pursue a career in medicine?

When I was a kid, I loved digging in the sand and wanted to be an archaeologist. Over time, this interest in human civilizations and behavior — and answering questions — evolved into an interest in journalism. As a college student, I worked at the student newspaper and I wanted to become a science reporter. In pursuit of this goal, I essentially cold-called one of the top science and health reporters at the New York Times and asked what I needed to do in order to get a job similar to his. He was incredibly generous with his time and expertise and basically told me that I would need an advanced degree, either a medical degree or a PhD, in order to get from here to there. I took this advice very seriously and off to medical school I went. When I started at medical school, I actually hadn’t planned to do a residency or to practice clinical medicine. But even when I was in medical school, it was clear that print journalism was going to be undergoing some challenging times and so I changed course.

How did these interests outside of medicine continue to influence your career?

Over my career, I have continued to pursue many of the interests that I have always had — human behaviors, politics, and effective communications are really fundamental to the field of implementation science. During the pandemic, all of these interests and passions sort of came together in the form of op-eds I wrote with several of my colleagues, mostly about opening schools. Communications is really an essential part of infectious diseases (ID) and public health.

What research question are you most interested in addressing?

Although I work in ID, my strongest passions are in leveraging science to support evidence-informed policy, rapid translation of evidence into practice, and de-implementation of low-value care. My interest is less about a specific clinical question per se but rather about how we can do a better job of getting evidence and information where it needs to be, whether that be to policy makers or to patients at the bedside. Aligned with antimicrobial stewardship, I am particularly interested in how we can improve care by discontinuing interventions that are overused, ineffective, harmful, or no longer needed. I will always be fascinated by how information is generated and spreads.

What are some challenges that your field is currently facing?

The standard answer to this question is “compensation and burnout.” While I agree these are problems that must be addressed, I am going to focus on something else: the field is, in some sense, a victim of its own success. I think the incredible achievements in HIV management have paradoxically led to challenges – in the 1980s, HIV was a near fatal illness and a public health crisis. Today, HIV is a chronic disease that can be both managed and prevented — the major barriers are really implementation problems getting the treatments to those who need them, not in complex medical management requiring specialist input. This has had a few impacts — physicians interested in public health emergencies are less interested in ID because there is much less perception of urgency or need. With the tools we already have, public health outreach and prevention interventions can do a lot to address the problem without ID providers ever getting involved. HIV management has become simplified such that ID training is no longer necessary in many cases and non-specialty trained physicians are able to provide the vast majority of the care. The field of ID has in many ways failed to evolve despite these changes and advancements and it needs to if it is going to survive in the long run.

What is your vision for addressing some these challenges in your new leadership role?

That is a hard one! As I alluded to previously, I think we need to diversify the interest and expertise of the ID workforce. With the incredible successes we have had in the area of HIV management and prevention, we need to re-think how we can be most effective and impactful as a field.

Zooming out a bit and thinking about the role the field plays not only in clinical care but also public health, we need to open the Overton window and be more tolerant of different voices and viewpoints — and do a better job of talking with people we don’t always agree with. We are going to have to get comfortable being uncomfortable and convincing policy makers (and the public) of our value-add. I hope in the longer-term, this will help us to rebuild some of the trust that was lost during the COVID-19 pandemic. Hopefully, this will also help with some of the demoralization and burnout we are seeing in the field. Rebuilding trust and re-establishing the importance of the field should have other positive downstream impacts. The reality is that if we do not convince policy makers and the public about the value of infectious diseases, we won’t be able to address the biggest challenge of compensation. ID doctors cannot fix that problem without their buy-in and support.

I also think we need to develop better staffing models, with some degree of flexibility built in. The current system is set up such that essentially people are working at 100% capacity all the time and so when a crisis hits, there is no slack in the system to take up the additional work. We need to find ways to have slack integrated upfront so that we don’t have people working at 200% capacity for years on end- the current model only contributes to the burnout crisis.

What are some instances where “going against the grain” benefited your career?

Earlier in my career, my boss’s boss asked me, “Do you want to be an implementation scientist, or do you want to be an epidemiologist?” My response was, “Both.” And the advice I got was, “Well then you aren’t ready to be an associate professor because you haven’t differentiated yourself.” I thought about this for a while, talked to my mentors, and decided to disregard the advice. Today, I happily consider myself to be both, and I think my work is enriched by both fields of study!

Another key thing that happened was that my career development award — usually the easiest path into a career in academic medicine — wasn’t funded. The focus of the grant was on expanding infection prevention and antimicrobial stewardship interventions to non-traditional settings. The underlying theme of the feedback I got back from reviewers was, “We don’t need an expert in that." But I really felt that we did! So my mentors and I got creative, and I got early funding through other pathways and pursued the question anyway. I guess the first lesson here is that I am quite stubborn. But also, when a global pandemic came around, it turned out to be a pretty important field of study!

What advice do you have for aspiring physicians and physician-scientists?

The first piece of advice: Follow your heart and your instincts. Second piece of advice: Seek out strong and supportive mentors. Without outstanding mentorship, I would not be where I am. And I still reach out to my mentors for help! Mentorship is not just for junior faculty — I still have Rani, Kal, and Sharon on speed dial! My mentors supported me through a lot, and I am so grateful for all of them. The mentoring relationship can also change over time — you need different mentors for different things and during different stages of your career. Different people are good at different things and it’s important to recognize when you need to seek out advice from a different source.

Third, as a physician scientist, it’s really important to remember your value-add: You see patients, understand what is happening at the bedside, and know what questions are really important for clinical care. Seek out strong methodologic collaborators and know your strengths — clinical medicine and expertise — and weaknesses (you probably are not the best methodologist in the room). This is how the most important questions are addressed in the most rigorous way, and how you will have the strongest impact. Lastly, be ready to make the case for your work and why it is important. Talk not only to colleagues and grant review committees but also to the public. We are here to make people’s lives better — you need to explain to them how and why you are doing that. Bringing it full circle, communications are essential!

In Conversation With…Arun Karlamangla, MD, PhD, Chief of the UCLA Division of Geriatrics

Let me now introduce you to Arun Karlamangla, MD, PhD, who was appointed chief of the UCLA Division of Geriatrics in October. Dr. Karlamangla is a practicing geriatrician and clinical researcher who has played key roles in major epidemiological studies on health conditions and aging. Learn more about his vision for the future of the geriatrics division in our Q&A.

What experiences led you to pursue a career in medicine?

I began my professional life in an entirely different field; I was originally an electrical engineer doing signal and image processing research at the University of Illinois in Champaign-Urbana. I had begun to appreciate the connections between the algorithms we used to create images from radar and sonar with those used to construct images from CT and MRI scans, and my graduate students had gone on to work at GE Medical in Milwaukee. Then my wife joined medical school and her excitement was infectious. One summer I picked up one of her old undergraduate biology textbooks and couldn’t put it down. I read it cover to cover. I decided to apply to medical school to learn more about medicine, but I still had no intention of becoming a doctor. I thought I would eventually return to engineering with new expertise. But I fell in love with internal medicine as an M3, both for the intellectual challenge and the interpersonal connections with patients. I have been captivated by it ever since.

How has the field of academic medicine evolved over the course of your career?

There have been striking advances in our ability to care for patients: statins, ACE-inhibitors, SGLT2 inhibitors, GLP1 agonists, biologics, immunotherapies, just to name a few that have revolutionized the playing field. And technology has changed how we do clinical research. Through electronic health records we can extract data across huge numbers of people, and increased computing power and machine intelligence methods make it faster and easier to generate new knowledge from these and other large datasets. Graduate medical education has become more humane with workhour restrictions. The journey through all this has been fun and rewarding.

What research question are you most interested in addressing? How have you approached it?

I am intrigued by the large variability in how people age. I have 90-year-old patients who run every day or regularly travel around the world; many others are not so fortunate. The socioeconomic gradient in how well people age is evident in the population we serve at UCLA. I have been trying to understand the mechanisms that underlie this gradient, the early midlife biological changes that are harbingers of (un)successful aging, and the effects of lifestyle on the risks for later life functional decline. For decades we have been collecting detailed data on national cohorts starting in midlife and following them into old age to try to answer these questions.

What are some challenges that your field is currently facing?

There are woefully few geriatricians nationwide. There aren't enough fellowship programs for the country's fast-aging population, and most that exist only graduate two to four geriatricians a year. I'm proud that UCLA has the largest fellowship class in the country; we send 11 to 12 fellows every year into the community, where they are highly valued. Still, without enough geriatricians nationally, we'll need innovative ways of spreading geriatrics knowledge and its ethos to the other doctors who will be caring for older adults. A corollary of few and small training programs is the paucity of geriatrics clinician scientists; one of my big challenges will be growing our research presence back (and beyond) where it was before the Recession when funding was tight, and we lost many excellent researchers to other institutions.

What is your vision for addressing some these challenges in your new leadership role?

Growing our clinical footprint in the UCLA Health System in the ambulatory, hospital, and post-acute nursing home settings is a priority, especially as Medicare Advantage becomes more pervasive. In addition to hiring more geriatricians, we will need to bring in advance practice providers with geriatrics training, to bolster our presence. I would love to situate either a geriatrician or a geriatrics-trained nurse practitioner in every UCLA Health community clinic across the health system, as well as an inpatient geriatrics team (either primary or consultative) in each of our four hospitals. I envision partnering with our VA and other divisions in DOM to find mentors for junior clinician scientists we bring in over the next few years.

What inspires you to do the work that you do?

I draw immense satisfaction from my primary care practice, enjoy attending in Santa Monica hospital with bright medicine residents, and find eudaimonic pleasure from research discoveries. I cannot imagine doing anything else.

What advice do you have for aspiring physicians and physician-scientists?

Find a mentor early; I cannot overstate the importance of good career guidance. Second, make learning a career-long objective.

Anything else you would like to share?

I have been blessed with wonderful teachers, mentors, and colleagues at UCLA, and this is becoming even more evident to me in my new role.

Research Day Poster Winners 

The strength of our Fellowship Match Day and the caliber of talented LEADERS we attract to the DoM, such as Dr. Branch-Elliman and Dr. Karlamangla, speaks volumes about our excellence in education, academic medicine and patient care. So too does the research from our trainees and junior faculty, as exemplified in the recently-announced poster winners from the 2024 DoM Research Day. Please join me on congratulating them!

Dale,

P.S.

One of the nice things for me during the long Thanksgiving weekend, was being able to go running four days in a row in the early morning. I ran a total of 35 miles! (Over four days). The weather cooperated and I was blessed with amazing sunrise skycaps, some of which I share below.

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