Programmatic Implications of National Recent HIV Infection Surveillance in Cambodia.

Introducing a Comprehensive Score of Systemic Anticancer Treatment Relevance.

2018 Year in Review and A Big Year Ahead

This was another fantastic year for the UCSF Department of Medicine. In this note, I’ll highlight some of our major accomplishments in 2018 and a few of the big issues that are likely to take center stage in 2019.

Clinical Care

Our clinical programs continue to do very well. In the US News & World Report annual rankings, our Department ranked third, and several of our divisions scored in the top ten (nephrology #4, diabetes and endocrinology #6, pulmonology and rheumatology both #7, cancer and geriatrics both #8). At UCSF Health, we saw tremendous clinical growth, with volumes up by 10% over the past year, in both our inpatient and outpatient services. We also saw impressive growth at ZSFG, with inpatient admissions growing by 17%. At the VA, perhaps the most striking growth was in our telemedicine services, where the VA has been a pacesetter. Nearly 3,000 veterans cared for by our VA received care through telemedicine services last year, and we have established national leadership roles in areas ranging from primary care to sleep and related disorders.

At UCSF Health, 2018 was the year in which our network development efforts hit a tipping point. Early in the year, we launched partnerships with four hospitals affiliated with the multi-state Dignity system (St. Mary’s, St. Francis, Sequoia, and Dominican). Our affiliation with John Muir Hospital in Walnut Creek has matured, this year culminating in the opening of a large outpatient medical practice in Berkeley, jointly staffed by UCSF and Muir physicians. We also began an ambitious partnership with Marin General Hospital in the North Bay, along with one with Sonoma Valley Hospital. All these partnerships, plus the parallel growth in our Bay Area-wide Accountable Care Organization (ACO) known as Canopy Health, are critical to positioning our health system as a central player in the highly competitive Northern California Healthcare market.

Many of these partnerships are moving rapidly from agreement to reality. In Marin, for example, a 100-physician clinical practice just became part of UCSF’s clinically integrated physician network, and our UCSF informatics team is currently installing our APeX (Epic) system into this practice. At St. Mary’s Medical Center in San Francisco, the entire hospitalist service is now staffed with UCSF faculty, and a variety of other UCSF specialties, both inside and outside our department, are considering opportunities for growth in this and other Dignity facilities. While much of the expansion of the UCSF Health clinical delivery system in the coming years will come through these partner relationships, we also continue to build out our own facilities, most notably with the 2019 opening of the Precision Medicine Cancer Building (PCMB) at Mission Bay and the start of serious planning for a new hospital tower on the current footprint of Langley Porter at Parnassus.

Research

Our research enterprise remains enviably strong. In 2018, faculty and trainees in our department published 2,834 papers and received support for 510 new sponsored projects (grants, contracts, fellowships, subcontracts), for a combined dollar amount of $412.9 million in extramural support, including $235.7 million from federal sources. As of the most recent ranking, we remain first in the nation in federal research support among departments of medicine.

While money is always hard to come by, space may be an even scarcer commodity. This is why we’re so excited about major initiatives to increase the amount of space for our researchers on all of our campuses. Most importantly, a program has been launched to re-invigorate the Parnassus campus. The overall effort is being led by Vice Chancellor for Research Lindsey Criswell, who also serves as our chief of rheumatology at UCSF Health. The first program in the New Parnassus initiative will be the CoLabs, a broad-based core facility to facilitate much of the basic science work on that campus. That effort is being led by our Associate Chair for Basic Research, David Erle.

New research buildings are also planned at ZSFG, where a 175,000-square-foot research building is slated to open in 2022, and the VA, which just received a green light from Washington to begin planning a 110,000-square-foot research building at our Fort Miley site, which will house 41 principal investigators. When all these buildings are done – several years and a billion or so dollars later – we should be left with terrific research facilities on all of our campuses.

Education

Our educational programs remain incredibly strong. This year, US News & World Report ranked our medicine program 3^rd in the nation, just behind Harvard and Hopkins. We had fantastic matches in both our residency and fellowship programs. Notably, 58% of our residents going on to fellowships chose to match in a UCSF fellowship, a strong endorsement of their experience with us.

As we redouble our efforts to diversify all of our programs, we have focused particularly on the residency and fellowships, in part because our faculty are drawn disproportionally from these groups. In efforts led by Sarah Schaeffer, Assistant Program Director and lead for our GME diversity programs, our residency has gone from 15% underrepresented in medicine (UIM) to nearly 30%, a fraction that has remained stable for the past three years. Our fellowships have also become considerably more diverse.

We were thrilled this year to welcome a new residency director, Dr. Rebecca Berman, recruited from the Brigham. Rebecca began in June and is already making a strong mark on the program in curricular design, mentoring, and innovation. We also welcome several new associate program directors: Larissa Thomas, Vanessa Thompson, and our new ZSFG primary care residency program (SFPC) director Joanie Addington-White, who joins us from the University of Wisconsin. I’m excited to work with this new residency leadership team as we build the training programs of the future.

Looking Ahead

There are several large issues on my radar screen for 2019. While there are challenges, there are also immense opportunities:

1. We are in the midst of recruiting a new cadre of leaders who will undoubtedly reshape the department in coming years. Most prominent among them are division chief roles at UCSF Health (gastroenterology, endocrinology, rheumatology, and hematology-oncology), ZSFG (pulmonary and rheumatology), and the VA (pulmonary, endocrinology, and DGIM). In 2018, we welcomed several new division chiefs who are already making their mark, including at the VA (Jorge Kizer in cardiology, and Sunny Wang in heme-onc) and ZSFG (Terry Friedlander in heme-onc, and Joel Ernst in experimental medicine). Just this week, we also announced the recruitment of a new chief of medicine at UCSF Fresno, Greg Buller, currently professor at Yale and chief of medicine at Yale’s Bridgeport site.
   
   We were sad to say goodbye to several prominent faculty who became division chiefs elsewhere, including Chuck Ryan (heme-onc at U Minnesota), Kirsten Johansen (nephrology at Minnesota) and Norah Terrault (GI at USC). While it’s always hard to part with faculty of this caliber, populating other institutions with great leaders is a natural part of the academic life cycle and consistent with our special obligation.

2. The massive growth of the UCSF Health network creates opportunities and challenges. This year, our focus will be on integrating our faculty with the partner sites, planning new and exciting programs that create a win-win for all the involved parties, and tightening communication links. In some instances, there may be opportunities to build research or educational links in addition to the clinical relationships. We will be paying particular attention to ensuring that our clinical growth does not overwhelm our academic programs and culture – a delicate balance, to be sure.
    
3. At ZSFG, the implementation of the Epic electronic health record is a key priority; it will go live on August 3, 2019. Demand for inpatient care at ZSFG has led to a record high census on the medical service, and the department is working closely with hospital leadership on a plan for increased staffing. The old inpatient facility at ZSFG, Building 5, is being transformed into an ambulatory health center, with co-location of related specialties, with a goal of promoting more integrated and efficient care.
    
4. The planned rebuilding across all of our sites is extraordinarily exciting and vitally important. But it will also involve considerable planning and creativity. For example, the planned modernization of the Parnassus campus will require that we figure out how to move existing programs to create space for renovation, identify the resources needed to remodel or build buildings, and – probably most importantly – plan strategically for the clinical, educational, and research needs of the future. Several groups being led by DOM faculty have come together to reimagine key parts of our work, including immunology, microbial pathogenesis, clinical and translational research, and clinical informatics. At ZSFG, the design phase of the new UCSF Research and Academic Building is underway, with a goal of breaking ground in late 2019.
    
5. The central services that support clinical research – IRB, contracting, privacy and more – are under considerable stress and, in some cases, underperforming. The department has been a vocal advocate for improving these services, working closely with leaders in the SOM and the campus. While improving infrastructure is rarely as exciting as building new programs, we recognize that friction in the system compromises everyone’s ability to do their best work.
    
6. While the department has done well financially over the past few years, the projected downturn in the economy will likely lead to tighter budgets, and we need to begin planning accordingly. On the good news side, housing prices in the Bay Area are also softening a bit (yes, I realize that may not be good news for homeowners), which should make recruitment a bit easier.
    
7. I continue to believe that no institution can be great unless it is great in informatics –everything from building new apps, to using artificial intelligence to predict outcomes and guide care, to managing new sources of data, including data from sensors and wearables. The DOM is helping to lead efforts to better integrate the many informatics-related programs on campus, trying to maximize the synergies and to create a single “front door” for all kinds of users – whether you’re a clinician, researcher, or a Silicon Valley giant that wants to work with UCSF. We’re seeing wonderful examples of tech-related innovations around the system, innovations that are demonstrating the capacity of digital to improve quality, safety, access, and productivity. While much of the activity is at our UCSF Health sites, there is also tremendous amounts of tech-related innovation at our VA and at ZSFG. 2019 will see the launch of Epic at ZSFG, which will increase the opportunities for integration between UCSF Health and ZSFG.

I could go on, but I hope this gives you a sense of the dynamic environment we find ourselves in, and how well positioned our department is to continue to innovate and lead. I continue to be inspired by all of the great things that our faculty, staff, and trainees do, as well as the commitment to equity and social justice that is so characteristic of UCSF and so vividly illustrates our values in these challenging times.

Robert Wachter, MD
Chair, UCSF Department of Medicine
Holly Smith Distinguished Professor of Science and Medicine
Lynne and Marc Benioff Endowed Chair in Hospital Medicine

Pain and death: neurodegenerative disease mechanisms in the nociceptor.

Green tea consumption and stomach cancer risk: a meta-analysis.

Clinical islet transplantation at the University of California, San Francisco.

Assessment of mitral valve disease: a review of imaging modalities.

Parallel RNAi and compound screens identify the PDK1 pathway as a target for tamoxifen sensitization.

Effect of cyanide and electrical stimulation on phosphoinositide metabolism in lobster nerves.

Patient-Reported Functional Outcomes in Patients with Chronic Myeloid Leukemia after Stopping Tyrosine Kinase Inhibitors.

Estimated Kidney Tubular Secretion and Kidney, Cardiovascular, and Mortality Outcomes in CKD: The Systolic Blood Pressure Intervention Trial.

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations.

Tetraoxane-pyrimidine nitrile hybrids as dual stage antimalarials.

Screening mammography in women less than age 50 years.

Low-level detection and quantitation of cellular HIV-1 DNA and 2-LTR circles using droplet digital PCR.