James Brown, MD

Professor

Dr. Brown is a Staff Physician in the Pulmonary/Critical Care/Allergy/and Sleep Medicine Section in the Medical Service at the San Francisco VA. He also is Professor of Clinical Medicine at UCSF. His major contributions are in the areas of direct patient care, providing high-level services to Veterans at risk for lung cancer, participating in programs that make important contributions to improving quality assurance in patient care, and mentoring and teaching.

Direct patient care: Dr. Brown provides inpatient care for Veterans with respiratory diseases admitted to our facility and sees pulmonary patients in our outpatient pulmonary clinics. He is well known throughout the Medical Service for working 12 hours a day and 6 days a week on a regular basis. Clinical productivity data reveal that Dr. Brown is the second most productive provider in our Section in terms of numbers of patient encounters (1360) and RVU Sum (3911) data in FY 2024. He is well respected by the Veterans he cares for and is often an important reason that the Veterans cite for choosing to maintain their care within the VA.

Lung cancer-related services: (a) Lung cancer screening: In 2014, Dr. Brown founded and still directs the Lung Cancer Screening Program at our site. Through this program, we recruit Veterans at high risk for lung cancer based on age (50 to 80 years) and cigarette smoking backgrounds. The patients are screened via annual low-dose chest CT scans. To date, using this screening approach, we have detected 170 lung cancers, of which 78% were at an early stage. The majority of these Veterans have been cured through surgical resection or cyberknife radiation treatments of their cancers. In part through his long-standing advocacy for the value of lung cancer screening, the Veterans Health Administration engaged in a national program for early detection and treatment of lung cancer across the VA. The program, called VHA’s Lung Precision Oncology Program, now includes lung cancer screening programs in 110 VA sites across the nation. Within VHA’s LPOP, Dr. Brown chairs the Outcomes Workgroup, responsible for developing research projects within LPOP that aim to improve the efficiency of lung cancer screening programs within the VA. At the time of the initiation of the LPOP program, the San Francisco VA was awarded $4.5 million over 5 years to support its own program. The portion of this award devoted to lung cancer screening has been used by Dr. Brown to support salaries for Stephanie Novak NP and Denise Lee RN who coordinate lung cancer screening services across San Francisco VHA Health Care sites. (b) Chest Multidisciplinary Lung Cancer Conference: This weekly 1-hour conference, started and still directed by Dr. Brown, provides input related to Veterans with lung cancers, or with high-risk findings suggestive of lung cancer, by a group of experts including chest radiologists, thoracic surgeons, thoracic oncologists, and radiation oncologists. Consensus findings are reviewed with the Veterans and their providers and appropriate diagnostic or treatment measures are undertaken.

Contributing to quality assurance measures: In 2007, Dr. Brown started the Incidental Pulmonary Nodule Program at the SFVAMC. Through this program, interpreting radiologists who detect pulmonary nodules (outside of the screening program), communicate the findings to an RN Incidental Nodule Coordinator, and Dr. Brown then takes steps to make sure these high-risk findings are dealt with appropriately. Without such appropriate management, 10-15% of these nodules would develop into advanced stage lung cancers. Dr. Brown also serves on the Medical Service’s Quality Assurance Committee.

Mentoring and teaching: Dr. Brown helps to supervise UCSF trainees pursuing lung cancer screening- or pulmonary nodule-related research. These include Ali Nowroozi, Justin Zhang, and Sylvia Stellmacher. Much of his recent teaching has been in the form of group teaching sessions, as below:
7/9/2024: Joint Zuckerberg San Francisco General -San Francisco VA Medical Center Medical Grand Rounds: “Lung cancer screening in the VA.”
1/13/2025: VA Noon Medical Housestaff Conference: “Screening for lung cancer”.
2/7/2025: Friday Morning First-Year Fellows’ Conference: “Lung cancer screening”.
3/20/2025: VA Consultants’ Corner: “What’s Important to Know about lung cancer screening.”