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).
Thank you very much for coming today for yet another holiday tradition, which is the annual State of the Department presentation for Internal Medicine. It’s been my privilege to serve you in the last year and what I believed was going to be an interesting year really turned out to be a year like no other for us in Internal Medicine and for the institution as a whole. There’s not only an interim chair, also an interim CEO in place right now. The Dean announced his retirement, and the dean search failed, and the omicron wave swept over us in January. And on a bigger stage, we are faced with inflation, cost of labor increases, and staff shortages, and large healthcare system deficits.
It really has been a year like no other, and for us at UIHC and really for people in healthcare and around the country. And while many of these obstacles that we are facing we can’t really solve, I would still like the opportunity to review with you how we’ve done in the last calendar year and also in the last fiscal year, which actually ended on June 30th, with regards to our mission to provide superior healthcare and inspire and educate world class healthcare providers and scientists for the people of Iowa and for our global community. My presentation, like in past years, will mostly concentrate on taking an inventory of what we’ve achieved together. I would also like to speak about a vision. A vision in which a thriving community of people in this department find joy at work and is unleashed to find creative ways for the care, education, and research of the future and how we can join in to get and work towards this mission.
So who are the people of Internal Medicine? At this point? We are almost 2000 with more than 350 primary faculty as of the beginning of this month. We are supported by emeritus faculty and volunteer faculty throughout the state of Iowa as well as faculty at UIHC with secondary appointments in internal medicine. More than 110 APPs support mostly our clinical mission and play an ever-increasing part in what we do in Internal Medicine.
We have close to 200 clinical trainees, residents and fellows. Our research staff is a significant cohort of almost 250 people who support our research mission with their different activities. And we have over 100 trainees in research, and altogether we are supported by an administrative staff, which is more than 600 people. So we are almost 2000 people strong, which makes us the biggest department within the College and really the biggest department within the Carver College of Medicine and at the University of Iowa.
This year the largest cohort of people in our history was promoted to Professor as of July 1, which tells us about our strength and the breadth of experiences within our department. And similarly, the largest cohort of assistant professors went up to be promoted to associate professor and this is in the clinical, research, as well as for tenure track. And my thanks go out to Amy McDonald and Christie Thomas who lead this endeavor every year, but also to everybody on the promotions committee and the chairs for the clinical and for tenure track, Terry Wahls and Chris Benson, who give every single package very thorough review and detailed consideration.
Another great achievement for us is that we’ve recruited another 40 faculty in different ranks and different tracks, and most impressive I think is that many of these young faculty are coming out of our own cohorts of trainees. So we have mentored young people to join us here in our faculty. And this is true for many different divisions. Paarii Dominic will join us. He was a fellow with us more than 10 years ago. He will lead EP and should arrive in the next week or so. Endocrinology and Metabolism was able to bring on a number of our own young talented clinicians and investigators to join the ranks of the faculty. Gastroenterology and Hepatology recruited both very experienced senior providers as well as a few young up and coming stars. General Internal Medicine recruited a number of new providers to help out on the hospitalist service, which really has become the spine of our clinical activities as well as for the activities at IRL. And we also welcomed Bryan Struck, who is going to lead our palliative medicine program.
There are a few well-known faces among the faculty of Hematology and Oncology. Nicole Fleege was a chief resident with us a couple of years ago and we’re happy to have her back. Similarly, Jenny Strouse, another chief resident of a few years ago joined the ranks of our faculty in immunology. Infectious Diseases has two new physicians and one of them, Karen Brust, also took on the leadership position as hospital epidemiologist for UIHC and succeeds Dan Diekema, who left and moved to Maine earlier this year. Nephrology and Hypertension added a young physician to its faculty, and Pulmonary and Critical Care recruited two physicians. Among them is James Murphy, who is the leader of the hospital quality program and has started to make his mark on the institution as our chief quality officer. Welcome to the team, to everybody who’s new, we hope that you will be with us for many years.
When it comes to the statistics, despite a number of retirements and departures we were still able to increase our overall faculty by seven this year. And the racial and ethnic diversity by rank is continuing to increase despite being in a state which certainly is not very diverse in its population. The number of women among our faculty is continuing to increase. Now 40% of our assistant professors are women and the numbers are rising every year. And also the bars to the right in the ranks of professor, division director, associate chair, and chair are continuing to rise. The women that we have are not only increasing in numbers, we also are very strong, and many of the women on our faculty hold leadership positions in research, education, or clinical care at our institution. And these women and a few others or actually many others among us also now have leadership positions on the national and international level.
And lastly, I would like to give a particular shout out to our APPs. The numbers are continuously rising, and now we have 113 of them who help us and really are the face of Internal Medicine in patient care, but also in education and research. So thank you for all you do.
Over the last year I’ve had the great privilege to work with a leadership team which is just outstanding. Every one of the people on this slide really make a very important contribution. I would like to give a particular shout out to Denise Zang who’s holding things together on the financial side and in many other areas. Kim Staffey is really a premier leader in clinical programs and really knows everything about the inner workings of UIHC. Manish Suneja continues to take our residency program to new firsts and new great achievements. And Christie Thomas has been a voice of wisdom when it comes to faculty advancement.
I would also like to point out, and I do with sadness, that Nicole Nisly is going to leave us at the end of the year. She’s moving to the East Coast. She still is and, as of January 1, will have been the associate chair for diversity for more than 15 years. She was named by Dr. Rothman many years ago and only a few of us will still remember Dr. Rothman. But Nicole has been an institutional leader in diversity and she will be deeply missed. The division directors continue to be your strong voice when it comes to promotion, performance, compliances, and so forth. And there are a couple of them who are new on the slide. One of them is Ben Davis who became interim division director for Immunology and Rheumatology in July. And you’d probably just noticed that Dr. Hoffman’s photo flipped over to Kevin Glenn, who as you probably saw in the announcement yesterday, is the interim leader of General Internal Medicine. Judy Streit and David Stoltz just completed their first year as division directors. So thank you for all you do, for your very strong voices for the needs of a faculty and we couldn’t function without you.
The leadership team at the VA continues to make a strong contribution to us in Internal Medicine. And although the VA sometimes appears to be on a different planet, we continue to do our very, very best to work together very closely. So thank you for all the faculty leaders who serve as section chiefs at the VA and for Dr. Dixon and Dr. Jalal and Dr. Smock who are really trying to keep us all well aligned and working in sync.
So this part of the presentation which reviews the comings and goings of our faculty unfortunately always also includes an In Memoriam slide with sad news. These are the faculty members who passed this year, some of them had the fortune of spending a number of years in retirement, whereas others were taken from us much too soon and they all will be dearly missed.
Now what have we achieved together? There are a couple of achievements which deserve to be mentioned. Sarah Kraus, an APP in Pulmonary received the UIP’s Advanced Practice Clinician of the Year award. Congratulations. And there a number of other news and announcements that made it into the press at U Iowa and beyond, including Nephrology’s designation as a Center of Excellence in Polycystic Kidney Disease, a number of our nurses received praise from patients, and IRL this year celebrated its 10th anniversary. Internal Medicine at the VA Medical Center is a strong contributor to our overall activities. In total 104 internal medicine physicians practice at the VA Medical Center, which supports 58 FTEs and generates $4 million in salary support. And also importantly, it is one of the sites where our trainees can gain valuable experience.
What have we achieved in research? Our extramural research funding has remained stable at $87.4 million and I think this is the first year in our history that industry-sponsored research actually exceeded our federal grant support. And this is of course a stunning result and maybe also a small reason for concern. However when you look at the productivity in the different divisions, this is kind of how each division contributes to the total research funding. At this point, Hematology-Oncology, driven by their very strong presence in industry-sponsored clinical trials, is our front runner. Cardiovascular Medicine, very strong with more than $50 million of support. And in some other divisions, it really is kind of a traditional physician-scientist activity with NIH and VA supported research making up most of their research funding. So despite some departures at the beginning of the year, our Blue Ridge ranking, which really only reports the total amount of federal funding without any adjustment for size of the institution or number of investigators, has remained stable at about $40 million. And we were able to achieve rank number 40 as in the past.
We had a number of great successes with new R01 funding from investigators in different divisions. The bottom row shows the grants which were given as multi-PI R01s, which is a funding mechanism which the NIH allows investigators with different backgrounds to join together to do some cutting edge research. And it probably is really the way forward in an NIH environment, which strongly focuses on team research. And really this is new for us at Iowa. We have a strong tradition of single-PI funded R01s, and seeing how the numbers of these multi-PI R01s is increasing is actually really very encouraging. And we hope to continue on this pathway.
I think the most stunning achievement in research this year was Mike Welsh receiving the 2022 Shaw Ward in Life Sciences in Medicine which is awarded for his landmark discoveries of the defects underlying cystic fibrosis and identification and development of medicines that can be used to treat people with cystic fibrosis. Congratulations, Dr. Welsh.
And there were numerous other announcements of grants being received by faculty members as well as trainees, as well as a number of really remarkable publications. Another measure of achievement is that Dr. Faraci in cardiovascular medicine is the co-leader of another Trans-Atlantic research network supported by the Leducq Foundation. Here is a list of all of our clinical trials from mega size $2.2 million down to more modest amounts in the $100,000 range. But I mean really, thank you to each and every one of you who contributes and joins in these activities. Reviewing a list of new federal grants awarded in fiscal year ‘22 demonstrates the breadth of our activities in research.
The VA is a major contributor to our research operation. There are a number of new VA Merit Grants, as well as renewals by our faculty. And we also received some other grant funds beyond VA Merits, which were given to a number of our faculty, both trainee grants and other exceptional opportunities. So again, the VA plays a major role in our research portfolio and we hope to expand our activities.
Very important for us is to maintain the pipeline of junior investigators because we’ve all learned that growing our own investigators for the future is one of our traditions and one of our strengths. So here’s a list of our young investigators on K-awards and CDAs and also we do mentor the youngest investigators among our ranks. Here are some pre- and post-doctoral fellowship awarded to our youngest scientists.
In 2022, the faculty in Internal Medicine contributed to more than 1100 publications, 37% of them with an impact factor of five and higher. And there were a number of publications in those luxury marquee journals such as Nature, the New England Journal, Cell, and the Lancet. So thank you to everyone who contributes to this mission. May it be a small paper or one in the New England Journal, everything matters and everything counts. And thank you for taking the time to do some scholarly activities.
What did we achieve in education? Education continues to be one of the highlights of our department in undergraduate medical education. We have a very solid leadership team that provides numerous hours of medical education to our students. And this year as in the past, we actually exceeded the hours required and assigned to us by the college. The residency program is led by a fantastic group of individuals who have taken the internal medicine residency program to new heights. And we have four wonderful chief residents who are a lot of fun to work with and really great examples of what training at the University of Iowa can do for a young physician. Not surprisingly this year we had a fantastic match.
And over the last four or five years we’ve expanded our reach in sync with our increasing national recognition for our internal medicine training. And our trainees come from all four corners of a country, including from numerous Ivy League and other elite institutions. Our curriculum is one of the highlights and really sets us apart from other institutions. We have a new curriculum for ultrasound, which was developed with help of last year’s chief residents. We have a highlight on teaching skills and we are developing a curriculum for DEI in health care inequities. And we hope to bring this online when the new academic year starts on July 1st, 2023.
So one of the things which has attracted a lot of interest from other departments within the college and from internal medicine departments around the country are Objective Structured Clinical Evaluation or Teaching Evaluations, called OSCE and OSTE services. An event which is put on by Manish Suneja as our program director as well as Jane Rowat and a whole team of people. The incoming interns before July 1 go through these different stations on one day. And they have to demonstrate how they do a patient handoff or an informed consent or conduct a difficult conversation being watched by a faculty observer at a station. And what this leads to is that our interns start day one of residency with a plan. So they have been assessed in these skills and they already have a plan for how they can improve their skill set. And I think this really sets the bar and it also creates a kind of more uniform cohort of interns starting on July 1.
And this is then followed up by another innovation of our education team, which is called QuikCoach. It’s an iPhone app and it can be used to provide real time feedback while a faculty member watches a trainee conduct a particular skill, a physical exam or a patient communication skill. And so together these two activities will be rolled out to other departments within the Carver College of Medicine as of the next year.
I think this really speaks to our innovative delivery of medical education. There are a number of other achievements, both noting one of a publication from our first resident in the StARR program and just recently a number of our faculty members involved in medical education received some seed grants to develop the next generation of innovative teaching opportunities for our residents.
We had a fantastic match for fellowship just two weeks ago and we are very proud that a number of our residents chose to stay with us, but others are moving on to fantastic other institutions, such as Washington University, University of Michigan, Kansas, some are going to University of Missouri, and Oregon. So congratulations to all of you and we hope that you will stay in touch with us after you leave. And this is a map showing where our residents moved to do their fellowships. As you can see a number of illustrious institutions around the country.
The flip side we were also very happy to see who matched with us. Really a fantastic group of young clinicians will join us on July one and we are very much looking forward to work with each and every one of them and see them go into subspecialties. As in past years we are very proud of the scholarship activities of our residents as well as of our fellows, which just shows how well the different clinical missions are integrated.
Lastly, what did we achieve in the area of philanthropy? I think that COVID has really changed how philanthropy is being conducted. And I would say that it probably hasn’t been easy to reach out to patients and families in the past for years. Nevertheless, we were able to receive support from various donors. And the total amount at this point as of actually December 1, was in the range of 1.5 million. And there are number of gifts given through three different academic missions.
So as you can tell, we’ve actually done really well despite a difficult year and many headwinds in academic healthcare and beyond. So what can the road ahead look like if we think of our mission? It’s a strong mission to serve the people of Iowa and to change medicine and lives. And how can we go towards a vision of a thriving community of people that finds joy in the work and is unleashed to find creative ways of clinical care, education and research in the future?
How can we become a department where a contribution from each of you matters? And you feel that it does. And there are a number of opportunities and challenges that are ahead of us. They include a clinical mission in which workflows may have to be adapted as recruitment and staffing shortages are probably going to persist. And what are opportunities to deliver here in an innovative fashion and how can we serve the people at Iowa and the increasing patient volumes that we are asked to take care of and maintain the research mission?
How are we going to maintain the pipeline of talented investigators, increase team science and develop a bold vision for expansion of our research activities? And in the education world, how can we expand our innovative and even visionary programs, grow our national reputation and increase diversity? How can we become this thriving community of people?
So there are a couple of things that we’ve already done this year and I think building a strategy always starts with asking who are we, what do we want and where do we want to go together. And there are a couple of things. I believe a couple of action items that we have already worked on this year and just under this slogan of “stronger together,” a number of you were actually willing, despite burnout and long working hours to engage and join some committees and help us out in finding and defining some action items and some areas where we want to increase our activities.
The promotions committee met in spring led by Amy McDonald and Christie Thomas and the members of a committee reviewed our promotions pathways and recognized that our structure is strong and only a few tweaks were made to our current guidelines to recognize team science in the tenure track and to provide increased support for our clinical track.
Diversity, equity and inclusion is becoming even more important in academic medicine as a means to provide our patients a framework in which they feel that they have clear voice, but also for us as a community to become stronger in equity and inclusion. Just last Friday I had the great fortune to listen to the members of the new DEI committee that was formed just a few weeks ago to hear about their vision and plans for how we can increase these activities, how we can have champions in each division for DEI, how we can expand our outreach into the community, collaborate with educational leaders and increase our activities within our institution. And we will hear more from this in the next month.
Lastly, the Staff Engagement Action Committee worked over the summer in six meetings. This committee came together in response to the Working at Iowa Survey and I had the fortune also to attend the last meeting about a month ago. I would actually like to give a particular shout out to Dr. Brown who’s not in the audience. Dr. Brown has been with us for 50 years and he’s really a fantastic example of a physician who still cares about what he does, tries to find joy in his daily activities and is really engaged.
And what the committee really asked for was to improve communication between the leaders but also between the leadership and the faculty. And one of several things that we started to institute is Chat with the Chair. Just yesterday, seven people came and joined me in the admin suite and there’s no agenda. They can talk about whatever they feel is most important to them related to their work at UIHC. And it’s a fantastic opportunity for me and for other leaders to actually understand what the most important items to work on are.
There is a request from faculty and staff on mentoring and we’ve worked on several activities before COVID hit. And we will go back to working on improving mentoring for staff and faculty. And I think the loudest voice, the greatest consensus was around the idea of people wanting to be empowered to do their core work. And we understand that there are a great number of requirements when it comes to compliances and other things and we will continue to work with the college to try to dial back on some of these requirements. Another idea that we are actually currently exploring is how we can help you to work smarter. And what we mean by this and we will roll out in the next few weeks, is how can we help you to capture all your clinical activities so that you get full credit, not only when it comes to RVU productivity, but also when it just comes to feeling satisfied with your work. And again, we will work on this with you in the coming month.
Lastly, we started Grateful Patient Philanthropy after a hiatus of a few years. This is really an opportunity for patients and their families to express their gratitude for the care that you provided and to share the purpose of improving medicine in health care for research, education and clinical activities. And for some of you, it has already led to increased autonomy in mastery in their work. And the example that I’m thinking of is Terry Wahls, who received some philanthropic support at the beginning of her endeavors to explore dietary interventions in various diseases including multiple sclerosis. You will actually see an invitation to engage in some activities in the next few weeks.
The road ahead, it certainly won’t be simple to fix some of the greatest challenges that we are facing and some of them are probably beyond what we can do. But what I envision is to really work on finding joy in the work again, to feel recognized for your activities and to also feel empowered to be creative when it comes to finding new opportunities for the clinical operation in research and in education.
Now, it takes a village to get there. And I will actually start by recognizing the executive leadership. And in many conversations I hear that there’s the impression that it’s us against them. And really that’s not the case. I think it’s very well known in the dean’s office and the C suite that the success of this healthcare institution depends on Internal Medicine, being by far the largest department and a great contributor to the clinical mission. And on various occasions in the last year we were able to get support from the leadership, even sometimes in situations when I thought that the interest would not be very great. So overall, I think it’s been a good year for us to build connections and build relationships and we have received on various occasions, more support than we actually anticipated.
And then there are the wonderful people who work in the administrative suite and really, I mean in the last year I’ve really learned to rely on the data provided by our applications developers, data analyst, business analyst, and by our financial people. Sherry Mattison took on the job as the executive assistant in August and she really had to start from scratch and we had to open some drawers and to find out what was there. And she has taken on this job with great courage and enthusiasm and she’s just a great, wonderful person to be around and great support for all of us.
Then in the middle of July, there was one day when we realized that we really didn’t have a human resources group anymore. The only two people who we could count on were Barb Jaeger, who’s been really a rock for our HR group in the last year. And Trae Stutzman who started earlier this year and really has hung in here and has learned a lot. So we had to rebuild and my particular gratitude goes out to Carol Wehby, who came back from retirement to take us through a really difficult time.
Also Ann Howard came back to help us out and rebuilt how we bring on faculty and she trained Eileen Fürstenberg, who joined us last month and will be our person when it comes to faculty recruitment. And our latest recruit is a new director for HR, Kaila Boothroy, who just started at the beginning of this week. So I think together we should be in a position to really help you out in many different ways and will be stronger going forward. There are a couple of other people in central HR including Ellen Twinam and Kiley Skay, who we wouldn’t have been able to do without in the last few months. Also shout out to the division administrators and the division coordinators who make sure that you have what you need and help you stay on track in all your different activities. So thank you for all your support and all you do. Again, this place wouldn’t run without you.
So lastly, communication, and being stronger together really means that we need to communicate and learn how to leverage the different technologies to do this in the most efficient way. And our Design Center and our communications group is really leading the way. Trevor Jackson is our director of communications, and there are a number of other people who work with him on making all these things happen. Views from the Chair, the announcements in the hallway, thank you for doing this. And the Design Center also provides services to other departments within the College of Medicine and beyond. So lastly the credits for the State of the Department address go to the people on this slide who are willing to gather the data and review them and remake the slides and so forth. Engagement in putting this together has been just remarkable. And with that I will end and I would like to thank you for everything you do for our department and I’m looking forward to a successful year 2023.