DEI in the DOM

The Department of Medicine’s commitment to diversity, equity, and inclusion (DEI) is both morally right and pragmatic: supporting a diverse environment in which all our people can do their best work allows us to perform better across all of our missions. While there is much more to do, we are proud of our efforts to build an environment where all our people are treated with dignity and respect. Below we share some highlights of our DEI work in the DOM.

People

The strength, character, and vibrancy of the DOM comes from our extraordinary faculty, staff, and trainees. We continue our efforts to diversify our workforce to reflect the California population that we serve. Currently, our faculty is 11% UIM, which is up from 9% in 2019. This year, we welcomed 107 new faculty to the DOM family, with approximately 15% identifying as UIM. They hail from across the country and many different institutions. Our residency program adds to this richness, as one-third of last year’s incoming intern class identify as UIM, our most diverse group of residents to date. Our UIM data on our fellows isn’t robust, but we are working on improving it so that we can track our progress in diversifying our fellowship programs. Our staff is 69% women and 34% UIM, up from 27% UIM in 2018.

Leadership

The DOM reached a major milestone in its efforts to diversify its leadership this year: fully half of the major leadership positions (vice chairs, associate chairs, and division chiefs) are held by women. In 2016, women held only 33% of these roles. And within this leadership group, 20% are UIM, more than double the fraction in 2016 (9%). 

In addition to our efforts at the departmental level, there is a major increase in DEI work within our divisions. More than 75% of all DOM divisions have named a DEI champion and nearly all receive some form of salary support. The division DEI champions participate in quarterly meetings to share ideas, address challenges, provide support, promote collaboration, and amplify their work.

We would be remiss to not mention the superb leadership of DOM members in initiatives at both the campus and the school. The SOM’s Anti-Oppression Curriculum is led by Director Denise Connor, MD and Associate Directors Denise Davis, MD and Michelle Guy, MD. Malcolm John, MD, MPH is the medical director for Health Equity and the co-chair of the Health Equity Council at UCSF Health. Alicia Fernandez, MD, our associate dean of Population Health and Health Equity, leads a host of outstanding faculty within the Latinx Center of Excellence. And Tung Nguyen, MD is the inaugural associate vice chancellor for Research – Inclusion, Diversity, Equity, and Anti-Racism.

We are also focused on supporting staff leadership development. An internal leadership training course, Strategies for Managing A+ Remote Teams (SMA+RT), was implemented with great success among its first cohort of staff and faculty supervisors. The course has been offered to all division managers. 

Our staff Diversity, Equity, Inclusion, & Belonging (DEIB) Committee is now in its second year, developing programs and partnerships to benefit all staff. We also implemented a search committee procedure for the hiring of division managers using the UCSF Staff Equity Advisor-model, increasing gender and racial diversity in our staff leadership.

Research

Several programs aim to diversify and sustain our research mission. The UCSF Mid-Career Faculty Development Program, whose goal is to support women and URM faculty researchers, selected its second cohort of exceptional mid-career scientists last spring. The awardees are not only outstanding researchers, but extraordinary mentors for historically marginalized students, trainees, and junior faculty. The award provides funding ($75,000 per year for two years), mentorship, and sponsorship, and affords opportunities for community-building and networking with UCSF leaders. We are proud that three of the four awardees are DOM faculty: Carina Marquez, MD (Infectious Diseases, ZSFG), Nynikka Palmer, DrPH, MPH (Division of General Internal Medicine, ZSFG), and Gabby Schmajuk, MD, MSc (Division of Rheumatology, SFVA).

Our diverse faculty have received other prestigious research awards, including the Robert Wood Johnson Amos Medical Faculty Development Program (AMFDP), which awards four-year postdoctoral research grants ($420,000 over four years) to health professionals from historically disadvantaged backgrounds. Neil Powe has been an advisor for this program for over 20 years. Past DOM recipients of this award include Ralph Gonzales, Michelle Albert, Lenny Lopez, Malcolm John, Kirsten Bibbins-Domingo, Esteban Burchard, Meshell Johnson, John Metcalfe, Hyman Scott, Joshua Vasquez, and Diana Alba. The latest recipients are Maria Garcia, MD, MPH, MAS (Division of General Internal Medicine, UCSF Health) and Anthony Muiru, MD, MPH (Division of Nephrology, UCSF Health).

The DOM has been the home for nearly 25% of the Watson Scholars, with three of the eight awardees for the class of 2022: Ana Velasquez Manana, MD, MSc (Division of Hematology/Oncology, ZSFG & HDFCC), Ashraf Abugroun, MBBS (Division of Hospital Medicine, UCSF Health), and William Brown, III, PhD, DrPH, MA (Division of Prevention Science, UCSF Health). 

In 2022, we welcomed several faculty researchers determined to tackle issues of health equity. They include:

• Julio Lamprea-Montealegre MD, PhD, MPH (Division of Cardiology, UCSF Health & SFVA) is studying the cardiovascular health consequences of chronic kidney disease. Julio and his team just published an article in JAMA last September, “Association of Race and Ethnicity With Prescription of SGLT2 Inhibitors and GLP1 Receptor Agonists Among Patients With Type 2 Diabetes in the Veterans Health Administration System.”
• Aaron Baugh, MD (Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, UCSF Health), whose work focuses on understanding how social disparities inform differences in lung function and worse outcomes in lung disease. Aaron is on the American Thoracic Society’s Task Force charged with evaluating the consideration of race and ethnicity in pulmonary function test interpretation. He also has multiple publications on the impact of systemic racism on health, mentoring, and medical education outcomes.
• Alfredo Aguirre, MD (Division of Rheumatology, UCSF Health) is interested in healthcare disparities in lupus treatment and the pharmacology of lupus drugs. His paper, “Race, Ethnicity, and Disparities in the Risk of End-Organ Lupus Manifestations Following a Systemic Lupus Erythematosus Diagnosis in a Multiethnic Cohort,” was published this month in Arthritis Care & Research.

We continue to encourage all eligible PIs to obtain NIH Diversity Supplements, which can fund students, post-doctoral scholars, fellows, and early faculty for up to two years. The DOM received seven Supplements last year. For more information, please contact either Jon Rueter or David Erle.

We continue our work to diversifying our world-class group of lab-based scientists. Our Diversity in Bench Sciences (DiBS) program provides up to $100K over four years to awardees for research support. Candidates can be nominated by their divisions, either after being offered a spot in our Molecular Medicine pathway or as a fellow beginning subspecialty training. We have made offers to 17 such trainees (82% of them women) and look forward to supporting their training and welcoming many to our faculty.

Addressing Health Disparities

We have always been a leader in providing exceptional care to our patients, particularly those who have been marginalized by the healthcare system. Our DOM patient care programs are a testament to our deep commitment to promoting health equity. Below are examples from each site: 

UCSF Health 

DGIM – With the discovery that nearly 25% of the patients at Mt. Zion report some form of food insecurity, our faculty created the DGIM Food Pharmacy in 2019, supported by a grant from the Mt. Zion Health Fund. The Food Pharmacy provides healthy groceries, monthly meals, nutrition education, and cooking demonstrations to DGIM patients with food insecurity. Of those most affected, 72% are BiPOC. Nearly 5,000 bags of groceries have been distributed, and the number of patients who report sometimes running out of food is down 17% in the last year. 

ZSFG

DGIM –The DGIM’s focus is on groups with well-described health disparities, including Black/African American patients with hypertension or cancers of the colon, prostate, or breast; Latinx patients with diabetes; and patients with Limited English Proficiency, in whom efforts to improve access are focused. The division has hired a data analyst, enabling them to track their patients and quantify the impact of interventions to eliminate disparities. 

VA

Nephrology & DGIM – Primary Care and Nephrology providers are piloting a renal management clinical dashboard at the Ukiah Community Based Outpatient Clinic (CBOC). This program aims to improve delivery of guideline and equity-directed clinical care in diabetes, hypertension, and chronic kidney disease to veterans in rural Northern California. If the project is successful – and early data suggests that it is – the goal will be to scale up this program to include more clinic sites, all of SFVA, and ultimately, all clinic sites across the entire VA.

There is still much work to be done, and we’re holding ourselves accountable. In the months ahead, we’ll continue to develop initiatives, refine the metrics used to measure our progress, track our results, and iterate where necessary. The effort, spirit, and heart of everyone engaged in this work will continue to help us build a stronger, more inclusive DOM that is diverse, equitable, exceptional, and just. 

Meshell Johnson
Chief, Pulmonary, Critical Care, and Sleep Medicine, SFVAHS
Associate Chair, DEI

Robert Wachter
Chair, Department of Medicine