As this fiscal year comes to a close, so too does an intense evaluation of our financial health as a Department and as an academic health system. I recognize that thinking about finances is not necessarily top-of-mind given the multiple missions to which our faculty devote high levels of energy, as we all seek to maintain strength and excellence in clinical care, education, research, and community service. But as I have highlighted over the past year all the many ways that members of our department make important contributions, it is important to also recognize the efforts of a dedicated team working behind the scenes, ensuring that we have the resources we need to meet our obligations. The fact that our administrators and financial managers continue to achieve sustainability in the face of new and significant external challenges—tightening reimbursements, increasing competition for research funds, decreasing state and federal support for education—is a testament to their integrity and careful stewardship of our resources. A budget is always a forward-looking document, and the budget our team has produced this year is one that preserves our hard-earned position while investing prudently and strategically in our future. This team has performed admirably and has my deepest gratitude for their hard work this season.

Building a budget is a tangible assessment of where we have been and where we want to go, particularly as we align with departmental and institutional strategic goals. This complements my recent reflections on looking back and looking forward in the last couple weeks. As I previewed a couple weeks ago, we recently held our Internal Medicine Residency Graduation, an event I always look forward to attending. The residents’ energy and excitement was just as bright that evening as it has been every day in the clinic, classroom, or lab over the last three years. Although it is difficult to say good-bye to a class that we have watched transform from interns into mature and confident physicians, we do so assured that they have benefited from one of the most rigorous programs in the country. I will miss them all, but the residents I come to know best are the Chief Residents. Not only do we get an extra year with our Chiefs after they complete their residency, but, personally, I am grateful to get to round with them on a near-weekly basis. Each year a new foursome impresses me with their inquisitiveness, their observation skills, and their good humor. I am looking forward to seeing what our new Chief Residents will achieve in the coming academic year.

We have also had an opportunity to revisit our recent history. Organized by the University of Iowa Center for Advancement, the Emeritus Faculty Luncheon brought nearly two dozen faculty members back onto campus for an afternoon. I believe it is as much a pleasure for them to quickly and easily re-establish conversation with old friends and colleagues as it is to witness the ongoing transformation of our department. When I think about the friends I have the pleasure to work alongside now, I am comforted to know that those bonds will persist no matter where life takes us. I also enjoy updating our guests with news of the current state of the department. I make no secret about the challenges we face, but I also strive to make clear to them that the foundation they labored to create has neither been neglected nor unappreciated, but is instead critical to our success today. Though some challenges we face today may be unique to our era, the perspective our predecessors can provide may offer us creative solutions to some of the modern-day challenges facing an academic department of medicine. I want them to know their advice is always welcome in my office.

Finally, I want to give a shout-out to our health services research programs, based mainly at the Veterans Affairs Medical Center. I am proud that this program under the broad leadership and influence of Dr. Eli Perencevich represents one of the most forward-looking health services research programs in the country. The VA supports many initiatives birthed out of Internal Medicine, locally, regionally, and nationally. Research advances do not come exclusively from technological advances, but by collecting high-quality data to provide the strongest evidence for driving meaningful change. And, leveraging the centralized systems and data potential within the VA enables comparisons of large data sets. For example, Dr. Spyridon Fortis took advantage of these databases when he compared mortality rates and interhospital ICU transfers of VAMCs with Tele-ICU services in place against those without. After tracking more than 550,000 patients across four years, Dr. Fortis found that use of Tele-ICU services, which connect smaller, less-equipped rural hospitals with larger institutions, significantly reduced the need for patient transfers without any increase in adverse outcomes. As a tertiary referral center, we face the challenge of balancing our resources and capacity with clinical needs. As such, approaches that ensure that we are using our resources and facilities in the most optimal way to ultimately improve patient outcomes requires innovative approaches and data-driven decision-making. Dr. Fortis’s study was published in the most recent issue of Chest.