State of the Department, 2019

The following is an abridged and edited transcript of yesterday’s State of the Department address. To view the entire presentation, click here (hawkid login required).


It’s always fun to put this stuff together. And to share with you my perspectives on where the department is and where the department is going. My hope is that at the end of this hour we’ll all agree that the department is in a good place and that there is blue sky ahead. But I think we can really define and chart what that ultimately looks like.

Last year I started off with this slide where I made the assertion that we are an outstanding department and the elements of that are you, the people and the members of the department, focused on our multiple missions around education, research, and patient care. And that this needs to be guided by a strategic focus and a strategic vision that promotes growth, fosters innovation, and ultimately, gives us results that we can talk about and celebrate.

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Slide2

 

By the end of my talk today I’ll cover these domains. We’ll talk about money. We’ll talk about people, we’ll talk a bit about philanthropy, and the importance for philanthropy in driving all of our missions.

Then we celebrate our achievements and then speak a little bit about the importance of robust strategies around communicating who we are and what we do. Because the audience that are looking at us now is a global audience. Then we’ll end with a few comments about our vision.

The sources of income to the department fall into five buckets. There’s external sources, which largely refers to dollars that come into the department from grants and contracts. There is revenue that’s generated from patient care, here at the university hospital. There are funds that come to the department or to faculty from the VA, largely salary support for VA physicians, as well as some research support for investigators via grants. We also get some transfers from the college and some transfers from the hospital.

useDSC_0182We ended up this year with a little bit more revenue than expenses, which is how we want to do things, because then that allows us to begin to reestablish our departmental reserves, which is a contrast to last year when we went the other way. If you compare what we have done in terms of pushing more funds toward faculty salary, you can see again, we have been committed to ensuring and maintaining as best as we can, given the funds available, for competitive levels of compensation. This is a work in progress. From an institutional standpoint, there’s a recognition that market forces are continuing to drive the salaries up of our physician faculty and that needs to be addressed, not only at the departmental level, but actually at a system-wide level.

So what has really been the driver of this increase in clinical revenue has been an amazing increase in just the clinical volume. You can see there’s been a significant increase in the total number of RVUs from fiscal years ‘17 through ‘19.

And this really has been pretty uniform across the majority of our divisions within the Department of Internal Medicine. Our faculty are working very hard clinically. There is increasing demand for our services. And what I can tell you based on what’s already happening this fiscal year, for the five months which have passed so far, that the numbers for this current year are going to exceed the numbers for fiscal year ‘19. So there is significant clinical growth and significant increase in activity.

And this of course raises some issues in terms of what are some of the constraints to growth. The clinics are getting to points of access limitation. And so there really needs to be a strategic conversation within the health system leadership in terms of how this growth can continue to be accommodated.

But the reality is that growth doesn’t necessarily always translate to more revenue if in fact the collection rate keeps falling. The good news for us is that growth in the department over the last few years has exceeded the decline in the collection rate, which I think is important for us to be aware of. Those two competing forces ultimately will determine the revenue that we generate from our clinical work.

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And so let me talk a little bit about clinical goals. So in the top half of this are the institutional goals, which we support. Although our focus goes beyond that, at an institutional level, the goal is to increase growth and access in specific areas. The rationale being that if you increase volume in certain clinical areas that will drive a margin to the system, then it provides more resources to invest in the other missions of the system.

And then I think it’s important, however, for me to emphasize that to the extent to which we as a department support these institutional goals, we are completely committed to supporting all of our clinical programs including primary care. So I want to make this message very, very clear as a department that I believe that all of our clinical programs are mission-critical and very valuable to the overall goals of our programs. So I don’t want them to leave here feeling that we are going to focus on two or three areas of high margin at the expense of other clinical programs. We are committed to ensuring that all our programs are robust and growing and vital.

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Now the other elements I want to talk about in terms of revenue, and this is the 37% bucket, because this really tells me that as a department we are actually very good at getting external funding. So much so that the external funding piece is actually larger than the professional revenue piece in terms of what we do clinically. And that really tells me that we have a robust investigative enterprise and our faculty are really very talented in going out and getting external funding for the research that we do.

I think that there are opportunities in other areas, particularly in the area of clinical research, which has actually shrunk somewhat over the last three years. And I recognize at an institutional level that there are barriers that many of us face to opening clinical trials, for example. One of the initiatives that have come through the discussions at the health system level is that there’s a recognition that this is a concern and that this is an area that institutionally we need to invest in to remove the barriers to allowing our faculty to open more clinically focused research opportunities. I think there’s, in my view, significantly more opportunity for growth there. When I speak to my peers at other major academic departments across the country, what I’m hearing from them is that they are seeing their large growth in their clinical research portfolios.

Slide18

So here are some ideas and some goals. First of all, I think it’s very important that we continue to focus very heavily on the pipeline by recruiting physician scientists in strategic areas. Areas where we feel that we can compete aggressively for funding. Also areas that we know that the NIH is targeting and focusing on. I think also it’s important that we look at earlier stages in the pipeline to ensure that we are hiring and recruiting our trainees into our programs both in terms of residents as well as fellows who can then become competitive for career development awards.

That becomes another important part of the pipeline. And if you look at other institutions in the country, those in the top tier in terms of funding, that’s one thing that gets done very successfully. They bring in amazing trainees who then will continue on the trajectory of going from being a fellow to junior faculty with training grants and then ultimately with career development awards and finally into individual awards. Second, there will be an announcement coming out at the institutional level of a mid-career program to support talented faculty to provide additional resources to individuals with potential.

If you think about that somebody who has demonstrated success in getting extramural funding, then everyone in the country sees them and everyone in the country wants them. And ultimately these individuals are prime targets for recruitment to other institutions. And so we think that supporting our talent in that mid-career window is important. And there’ll be some more word coming out about a program that’s being supported centrally by the institution to to give generous support to mid-career faculty. So it’s really rewarding success with the idea that it’ll grow and gain additional success and retain people here at a more tactical level. Where the large dollars are in terms of NIH funding are in large multi-investigator or consortium-type grants.

Historically, the University of Iowa has, and the department has had, a strong track record in multiple program project grants. The environment has shifted to a certain extent that many of those grants are now time-limited. And so there are fewer legacy grants across the country in terms of large program project grants, but the NIH is still focusing a significant amount of resources on population-based science and grants which have significant budgets in terms of the dollars which are available. We will think strategically about how to position ourselves to get to that next level.

Slide20

So let’s talk a little bit about the individuals who actually make this department strong. And we’re a big department. If you look over the last five years or so, we have had a net gain in our faculty every year and an average about 26 new faculty as a net gain each year. And so this is really a reflection of our ongoing growth.

Slide21

And that’s a good thing, in one sense; it’s a challenge in another sense, because we don’t recruit people here just to have more warm bodies in our department. Everybody that we recruit here, we want to recruit because we want to put every faculty member in an environment where they can really succeed to their fullest potential as faculty members within our department. But I think it’s very promising that we continue every year to have a net increase in the individuals who want to be a part of our community.

Slide22

So on the theme of people, the department has significant strength in leadership. My job is made a lot easier by the fact that there is an incredible team of vice chairs who support multiple aspects of the mission of the department. And I take great pleasure in working with all of the individuals who are shown here.

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And similarly we have a team of division directors. I’ll give a brief shout-out to Dr. (Ayotunde) Dokun, who is the newest division director in Endocrinology and Metabolism. It is our Division Directors really who are driving a lot of the achievements that I alluded to before in terms of our clinical programs as well as our research programs.

Slide24

We have a very strong relationship with the VA. I would say a healthy relationship between us and the VA, which hasn’t always been the case, but I do feel that continuing that is important across all of our missions and that the VA represents a very important hub for faculty development and for bringing brilliant junior faculty into our department.

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I put this slide up because I want to indicate to you that I live in this very interesting space. I work for you. I also work for these individuals shown here. And so I have to manage both up and down, and it is therefore very important for me to hear from you and to understand the issues that I have to communicate up to leadership to ensure that they understand what Medicine is here within our institution and really the importance of having productive and collaborative relationships with our senior leaders. I also put the three other senior leaders within the organization because these are individuals who are the next level down that we probably spend more time talking with both in terms of operational and other issues.

Slide32

So let’s celebrate many of the things that we are extremely proud of in our department. And you know, you’re not necessarily meant to read this slide, the good news is that all of this information is online. Trevor (Jackson), sitting in the front row, has done a remarkable job in really pushing out the news and the things that we as a department, we can be very proud of. And so, you know, I put this up just to make the point that there’s a lot of achievements here.

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One of the things that clearly we want to celebrate are those members of our departments who get promoted every year. And so Krista (Johnson) and Becky Tuetken were the two individuals who became full professors this year. And I’m also pleased because we want to increase the percentage of women faculty and the percentage of women faculty holding senior ranks here in the department. This is the picture of the individuals who achieved the rank of associate professor and, this year, again representing a number of divisions, but a significant chunk from Hem-Onc.

Slide37

We are very proud of our educational mission. I think that the reputation of the University of Iowa as an innovator in both undergraduate and perhaps much, much more so in graduate and resident medical education is strong. I have not been somewhere that I don’t receive very strong compliments about the way that the rest of the country views the way that we are actually educating the next generation of physicians.

Slide38

So our residency program continues to remain nationally ranked and I think we are seeing the evidence of that in terms of increasing competitiveness on the quality of the resident applicants who are coming into our programs. We have 100 percent board pass rates for our residents and fellows, who have been holding that number at least for the last four years. We’re also actually contributing to the increasing interest of our Iowa medical students in internal medicine. If you actually look at the number of Iowa students going into internal medicine for the last four years, it’s continually gone up. And one of the metrics of that is the graduation questionnaire, or GQ for short. And when you look at how our Iowa medical students are ranking our internal medicine clerkships, the ranking scores are in the top 10th percentile. So this is something I think that we should be very proud of in terms of the way our medical students are viewing the training that they’re getting within our programs. So we want to maintain that level of excellence and to continue to innovate. We don’t want to get complacent to say, well, we are good enough.

I think we need to always be striving to be better. We want to continue to focus on increasing the diversity in our class of residents and fellows and obviously supporting opportunities for trainees to be on the national stage to increase the visibility and stature of our trainees.

Slide39

So this is my happy place. These are the current house staff and you might be wondering about the headgear. This is how we dress when we aren’t, you know, taking care of patients. This is the picture of our incoming class last year, and (below) you can quickly see that we are really recruiting nationally.

Slide41

We are already drawing the best trainees from across the country and that’s shown graphically here. We just keep stuffing logos on.

Slide42

We are sending our trainees across the country to good places. And interestingly when our trainees go to these good places, we see an uptick in medical students from these good places wanting to come here to become residents. So this is saying to us that they see a product that goes outside our walls. The effort we put into the pipeline is really paying off at the level of our trainees. You can see that over the last five years we are about 93% for fellowships. But for the last two years we are at 100%.

Slide43

And in fact, the breaking news is shown here that yesterday we got the news that 100% of our core internal medicine fellowship positions were filled for next year. And I want to pause here for a second because it turns out across the country a lot of fellowships were not filled.

I’m going to give (Nephrology Division Director) Chou-Long (Huang) a shout-out. Because it turns out that probably 60% of nephrology programs in the country were unfilled. So that actually does reflect something is happening here that we are able to fill our program. Infectious Diseases filled. And I can tell you across the country about 40% of ID programs are unfilled. And so this is something that we really need to celebrate because we are getting people to come to a little town in the Midwest to do fellowships. We are doing something here that others want to come and do. All of our residents who went into fellowships this year also matched into their fellowship of choice.

And what warms my heart is that 43% of you residents are choosing to stay here to do your fellowships. We have seen in the last few years that our own residents are actually voting with their feet to stay here.

Slide50

I want to knowledge the leadership of the education team. Joe Szot, our Vice Chair for Education, and Manish Suneja is the incoming Vice Chair for Education. But I really want to highlight the entire education team for a strong effort in maintaining a very high level of quality in terms of education across the entire spectrum.

Slide52

And then of course, our residency program leadership. I’m incredibly proud of our residents. I’m incredibly proud of our residency program. This wouldn’t happen without the strong dedication of the team shown here. Including the Chief Residents in the front.

Slide54

Our clinicians are phenomenal. And this year, two of our faculty won UIP awards, Alicia Gerke and Poorani Sekar. We also get a lot of love letters in terms of making a difference. I get them every week. Our patients are telling us that they really appreciate what our clinical faculty are doing.

Slide59

Research is clearly a big part of our mission. And again, I can’t go through everybody who has really contributed, importantly to a research mission. Again, it’s on our blog. You can go and find your favorite person.

Slide63

We are publishing really well, almost a thousand papers in the last year in some good journals as as summarized here. And you know, the other way to look at the quality is by impact factor.

Slide64

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We have grown with lots of new faculty across multiple divisions and ranks as shown here. I’m pleased to see the distribution being modified somewhat at the assistant level, where we’re bringing in more tenure track recruits. I think there’s still work to be done there. But we are recruiting faculty into all of our divisions. This is growth across all of our department.

Slide79

So I’m going to end with the fact that it’s very challenging for a department of this size to get the word out of all the things that we are doing. And I am very proud of our communication strategy. We want to hear from you if it’s working, if there are other channels that you want to hear from us. We know that you are reading these things, because we can check clicks and links. We know that people are reading what we are putting out.

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But we want to ensure that we are keeping in touch with all of you in terms of what you need to know both in terms of news and celebration, but also in terms of policy and things that you need to be aware of.

Slide81

Our work as a department is not simply inwardly focused, but we also are committed to having an impact on our community. This year our committed focus was on The Bird House Hospice Home. I want to acknowledge Rethy (Krishnamurthy) and others for spearheading this.

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I want to thank the administrative support. Steve Blanchard came out of retirement to keep things going administratively. We are in the midst of recruiting a new division administrator and hopefully we’ll have good news to share soon. A thank-you to Trevor (Jackson) and Ann (Armstrong) for helping to put this slideshow together even until the wee hours of the morning.

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This is my last slide. I think what drives me and what drives our department is a few things. One, we really want to bring the best people here in our department. We also want to build a strong community that ensures we’re all rowing in the same direction as a department. And whatever we do, we need to do it with rigor and integrity, that we’re doing it because it’s the right thing to do, and it’s the best possible thing that we can do. Finally we want to have a mindset that we never get stuck in our ways, in the way we think about things. We should always be willing to innovate and reinventing ourselves to do things in more exciting ways.

The department is in a good place, and I want to thank all of you for making me want to wake up in the morning and continue to offer leadership to a remarkable department. The state of the department is very strong. Thank you.

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About E. Dale Abel, MD, PhD

E. Dale Abel, MD PhD Francois M. Abboud Chair in Internal Medicine John B. Stokes III Chair in Diabetes Research Chair, Department of Internal Medicine Director, Fraternal Order of Eagles Diabetes Research Center Director, Division of Endocrinology and Metabolism Professor of Medicine, Biochemistry and Biomedical Engineering

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