DOM at SFVA: Steadfast Through Change

Healthcare and federal policy have shifted rapidly this year, creating uncertainty across federal and private health systems alike. Budget challenges, hiring freezes, a cascade of executive orders, impending reorganization, and a government shutdown have all tested the VA.

Yet the Department of Medicine at San Francisco VA Health Care System (SFVAHCS) has remained strong, anchored by our people, our sense of community, and our shared commitment to advancing science, teaching, and providing excellent care for Veterans. Our 150 faculty members across 13 divisions serve 30,000 Veterans from the Bay Area to the Oregon border. We feel like family, work among unassuming luminaries, and have much to celebrate.

RESEARCH

Many of our clinicians are accomplished investigators advancing basic, clinical, translational, and health services research. With nearly $30M in research expenditures in 2024 and $67M in total Northern California Institute for Research and Education (NCIRE/VA) direct funding as of May 2025, their work helps keep SFVAHCS at the forefront of innovation as the largest competitively funded research program in the Veterans Health Administration. This year brought remarkable achievements.

In 2024, the SFVAHCS was designated a Center of Innovation (COIN), a milestone achieved through collaboration between Medicine, Integrative Health, and Mental Health. Directed by Salomeh Keyhani, the new Center for Data to Discovery and Delivery Innovation (3DI) brings together 27 core investigators, including 14 from Medicine, to advance Veteran health through research, data, and partnerships. Its cores provide the infrastructure that helps investigators connect, collaborate, and succeed.

Our junior investigators continue to thrive under the mentorship of outstanding faculty and guidance from the Medical Research Council, chaired by Mike Shlipak. With nine VA Career Development and K Awards across our service, the pipeline is strong, advancing toward VA Merit Awards and R01s that will shape the next generation of discovery.

We also secured generous programmatic support in 2025. Funding for the VHA’s Lung Precision Oncology Program, which supports lung cancer screening and research, was extended through 2027 (Jim Brown and Sunny Wang). Additionally, we obtained funding for the new Sierra Pacific Precision Oncology Clinical Research Center, which Sunny will co-direct.

The VA Office of Rural Health committed new support to Mary Whooley and Sanket Dhruva for their work on oral anticoagulation in pacemaker- and ICD-detected atrial fibrillation, and to Charlie Wray for his role in developing and co-directing the VHA Hospital Medicine Analytics Team (HMAT). HMAT aims to improve the quality of inpatient medicine services, particularly in rural areas.

Senior investigators also received exciting news on NIH funding, including two grants of more than $10 million led by Phyllis Tien and her team: one focused on stimulant and polysubstance use, inflammation, and sex effects on myocardial disease in HIV, and another for the Center for Alcohol/HIV Innovation and Biomarker Research.

Finally, Carl Grunfeld who recently retired after an extraordinary 48-year career, received the Barbara West Award for Distinguished Service to VA Research Administration. A flag was flown over the U.S. Capitol in his honor in September.

EDUCATION

With a close-knit community and deep bench of expertise, our educational programs create an ideal environment for personalized learning. Students, residents, and fellows alike regard the SFVA Medical Service as one of the premier places to train.

Since 2011, SFVAHCS outpatient clinics have been recognized for educational excellence in interprofessional collaboration, patient-centered communication, and team-based care in the Education in Patient Aligned Care Teams model (co-directed by Denise Davis). And inpatient rotations boast high ratings, exciting medicine, exceptional teaching, and a close-knit consultant community.

We celebrate educators who push boundaries—whether going head-to-head with AI (Gurpreet Dhaliwal) or hosting acclaimed clinical reasoning podcasts (Rabih Geha). Our ranks include 11 Bridges coaches, three fellowship directors, countless site directors, four associate program directors, and many elective and clerkship leaders. Associate Chief of Staff for Education Rebecca Shunk calls medicine her home, as do the highly regarded longitudinal clerkship (VALOR, Calvin Chou) and the research track for internal medicine residents (PRIME, Evan Walker and Beth Cohen). Master Clinicians and Academy of Medical Educators members fill our hallways, and teaching award recipients are many.

We are launching an Education Council to support clinician-educator careers and ensure programmatic excellence, compliance, and innovation. James Frank, as associate chief of education for the VA Medical Service, will help design and lead this effort. We are also selecting a new VA site director for the upcoming Family and Community Medicine residency program, which will be housed in our service. In-person conferences, M&M, and grand rounds continue to draw robust attendance, and the future of education at SFVA looks bright.

CLINICAL OPERATIONS

Construction on a new ICU is set to begin this month, with funding secured for state-of-the-art hemodialysis and endoscopy units to follow. Faculty searches are underway in cardiology, emergency medicine, hospital medicine, gastroenterology, and nephrology, and strong applicant pools show that VA positions continue to attract top talent. To meet growing demand, we are expanding specialty clinics in Santa Rosa, now offering echocardiograms that have greatly reduced wait times and reduced the need to send Veterans to the community. We also added renal denervation and phrenic nerve stimulation to the list of advanced procedures available to Veterans, and we remain a top referral center in the Veterans Integrated Service Network for complex cardiac disease.

VA quality metrics improved significantly this year, with most now in the first or second quintiles, contributing to a 2025 CMS 4-Star rating. Nationally, the VA continues to provide high-quality care for Veterans and remains a workplace where clinicians find fulfillment and build sustainable, meaningful careers. The evidence is clear: we are doing something right.

LEADERSHIP TRANSITIONS

2025 brought several key leadership changes. We bid farewell to retiring Medical Service Chief Kenneth McQuaid and Emergency Section Chief Jody Garber, who together have contributed nearly 65 years of service to the VA. Their departures mark the start of a new chapter for the Medical Service. Holding down the fort are myself, as service chief, along with our leadership team, Josue Zapata and Dan Wheeler, and an exceptional group of section chiefs, including Kip Mihara, newly appointed as Emergency Department chief.

WHO ARE WE & WHERE ARE WE GOING?

Beyond our academic and clinical work, our camaraderie defines us. We are artists, musicians, beekeepers, athletes, and mountain climbers. We take pride in our publications, grants, awards, clinical expertise, new roles, and grateful patients. We run marathons, climb El Capitan, stop to chat in hallways, and decompress on the Lands End trail. We battle each other in tug-of-war, then share root beer floats in victory or defeat. We celebrate weddings, babies, and personal milestones. Year after year, our physician experience scores are outstanding. Our shared mission and commitment to Veterans and to one another are the foundation that keeps us steady in an ever-changing landscape.

As part of a tri-site powerhouse in healthcare, education, and research, the UCSF Department of Medicine truly demonstrates that the whole is greater than the sum of its parts—and the SFVAHCS is deeply proud of its unique role in that synergy.

Heather Nye, MD, PhD
Chief of Medical Service, San Francisco VA Health Care System
Vice Chair and Professor, Department of Medicine
University of California, San Francisco