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).

Welcome to all of you, to this other holiday tradition, the State of the Department presentation. Loreen Herwaldt asked me if she should introduce me. I said there’s probably no need to. It’s my pleasure to stand here in front of you for this, the second year that I’ve been tasked as the interim chair to give you this presentation.

This has been a year of change and a year for change. We have a new Dean/VPMA, a new CEO. Both of them are starting to leave their mark. Our chair search has resumed and I believe that candidates will be here in February and March. We have acquired Mercy Iowa City. I will give you more information on this in a second, and UIHC this year, again generated a profit and which really puts us in the 50% of academic medical centers to achieve it this year. We say you’ll see some staff shortages overall. There also now are some creative solutions, and inflation has started to slow down a little bit, which hopefully gives us a positive lift next year.

So how have we done according to our mission? Our mission to provide superior healthcare and inspire and educate world-class healthcare professionals and scientists for the people of Iowa and the global community. I have information for you and I will try to tell you some stories, some examples of successes that we had in the last year. I’ll give you a very high-level overview of what we achieved, numbers and dollars and RVUs, and then we will go over what we’ve achieved together in the three missions, how we got there together, and what the road ahead of us may look like.

So what have we achieved together? Finances. Our total revenue this year is up from last year. Our total expenses went up too, due to a number of accounting maneuvers and also due to increased compensation and salaries. Nevertheless, we are still able to generate a margin in FY21 and ’22. We received extra support from CARES funding for COVID. Nevertheless, at the end of 2023, despite staff shortages in many trials and tribulations, we’re still able to generate a positive margin.

Again, this is not really to be taken for granted. Many other internal medicine departments are struggling a lot more than we are. What have we achieved in the clinical mission? Our RVU productivity has gone up again and as you can see, there are many different successes to celebrate, and all the divisions have contributed to the best of what was possible in the last year. And really my thanks go out to all of you for making this happen. Now the other point about this is since our RVU productivity goes up, I think we are in a stronger position to negotiate. It’s easier to go to senior leadership and be able to say, but look, our productivity really looks good in order to get more support for Internal Medicine. So this overall puts us in a strong position. In the first quarter of FY24, shown here in orange, we have already exceeded the RVU productivity of the last fiscal year. And you may ask, so what’s in this for me?

Does this mean that I’ll be expected to produce even more in the next fiscal year? Well, we are working on putting you in a position to work smarter. We have contracted a coding consultant who will come in and work on a trial basis with single divisions and sit down with individual faculty to go over how to code and how to bill and how to write notes in the most advantageous way. So we try to make your life a little easier by introducing this coding consultant.

Our clinical census has remained high. Our number of outpatient visits has increased a little more. The patient days are about stable. We do less outreach than we used to do, and our inpatient consults are continuing to climb. Where do we generate most of our RVUs? In outpatient activities. So whenever we hear that there’s a problem in clinic, we really try to listen and try to help you and the clinic leads find some solutions for this. So outpatient activities are the number one RVU generator followed by procedures and inpatient tests.

All the divisions contribute to the overall RVU generation. There are a number of successes to celebrate. In hematology oncology, many faculty did step up to the plate despite some staff shortages and have really, really carried a heavy load and have done this really magnificently. And there is a beautiful increase in productivity in particular in the EP group and ID is really hitting it out of the ballpark at this point thanks to some changes that the division made in how they staff inpatient outpatient activity. So thank you to all of you. And again, there are some divisions that have been strong for years like nephrology and endocrinology. So thank you for all you’ve done in this area.

Now we don’t have the best parking and we certainly don’t have the glossiest magazines in our waiting area. Nevertheless, the quality of care as rated by our patients has remained very high despite years of COVID and beyond. And you have seen this list before. These are the providers named top 10% for patient experience by Press Ganey. And there are a couple of things I would like to point out here. So if you look at who’s on this list, there are some division directors on it like Mo Milhem, Judy Streit or Barry London. There are some titans of clinical medicine on it like Don Brown who retired in summer after more than 50 years on faculty. But there are also the junior providers on this list. So the very first one, Jason Allen, he just joined us about a year ago. And there are other junior faculty like Maggie Byrne in HemOnc and also a great number of APPs. But what does this tell me? Clinical excellence is something which is deeply rooted in this department and it really gets propagated from generation to generation.

Now most of this would not be possible without the many medical directors and clinic leads who help with the daily operation of our clinics. And I was just going to give a shout out to Rebecca Tuetken who runs the MSC clinic. And so she’s been meeting with hospital leadership monthly to discuss arrival time of patients, workflow, staffing issues, room turnover issues. So it does take quite some effort and enthusiasm to work with this issue. So thank you to all the medical directors and clinic leads for trying to make this place run well and work really well for all of us.

We’ve had a couple of other successes to celebrate: Gwen Beck won the Theilen Award and there are some other achievements in clinical care from young faculty, older faculty, people being named to internal or national leadership positions, faculty who won awards or provided new procedures and introduced new care to eastern Iowa.

The VA medical center remains a big part of our activities. We have 99 physicians working at the VA in many different capacities, and our programs at the VA excel in different areas. And this year we received an award for our telehospitalist program, and Peter Kaboli you may remember, won the DiBona Award for academic excellence at the VA. Congratulations to everyone who contributes to our clinical mission at the VA.

What have we achieved in research? Our research funding is continuing to increase and as you can tell, we’ve seen the biggest increases in industry-sponsored drug research, which now is our number one contributor to our extramural research funding. In terms of NIH funding and other federal funding, we have received $34 billion. And again, the VA is a strong contributor to our research operation. This is just a breakdown by division in terms of research received from non-industry sources with really some very strong contributions in different areas including HemOnc and General Internal Medicine.

We had a couple of R01s funded in the last fiscal year and beyond. There are R01s received by junior faculty, Alejandro Pezzulo and Mahmoud Abou Alaiwa. We were also able to recruit faculty who brought funding when they were recruited, like Sabrina Tan. And in the last round of reviews we had really fantastic news from a number of investigators who had tremendous scores and are extremely likely to get funded. Among them, people who have been with us for a while and renewed funding. And there are two faculty members who will receive their first R01, Elissa Faro and Ajit Vikram. Congratulations to everyone. And the research operation at the VA again is a very strong contribution to our overall research activities. We had faculty members receiving a new VA Merit Award and we have a number of high-impact health services research awards, including our fellowship program run by Michelle Mengeling and Bharat Kumar.

And we also have been able to capitalize on the career development awards from the VA. So when it comes to a future of research, I think we can be really proud of our mentees. This is a list of faculty and trainees who received career development grants, K awards, CDAs and foundation funding. And it’s my hope, I’m sure it’s everybody’s hope in this auditorium, that these young investigators will be in a position to successfully compete for R01 funding in the future. And this is just really a testament for how we have been able to renew our research faculty over the last few years. A particular shout out here goes to Aleks Lenert. Aleks Lenert is the first person to have a career development award in allergy rheumatology in many, many years. And he went out to find mentoring by Polly Ferguson in pediatrics and Robyn Domsic at University of Pittsburgh.

Again, congratulations to each and every one of our young faculty and postdocs who were able to secure career development funding. It’s a great, great step forward in their careers. And we also have a list of T32s and a number of pre- and post-doctoral fellows who received extramural funding. And here really my thanks goes to other mentors who took the time to edit the grant and help shape the ideas and help with the submission process. So thank you both to the mentees who put in the work and to the mentors who took the time to support them.

Now this is for the number geeks. This is a list of investigators in order of current total federal funding. The top three investigators here are own Pat Winokur, Jack Stapleton, and George Weiner. And this list is probably going to test your visual acuity for investigators funded for clinical trials research from industry. You will see that Muhammad Furqan’s funding is now close to $10 million. So really congratulations to each and everyone who contributes to this and also find some purpose in doing clinical trials research in our department. There are a couple of other achievements to mention.

This is Jen Streeter, a young physician scientist in cardiology. This was her first year on faculty and she received an AHA innovator award. And there are a number of other achievements worth mentioning, funding, being named an impact scholar, and also doing really innovative research work outside of what I already mentioned.

Together we have authored 1,105 publications. This is almost exactly as many as last year and in many cases there have been contributions from our trainees. Our residents and fellows continue to be incredibly productive and be involved in scholarly activities. Another point worth mentioning is that more than a third of the publications were published in journals with an impact factor of more than five, which really actually puts this into really top-tier publications. And this is just an overview of where we have published Circ Research, Lancet Nature, the New England Journal, JAMA – really I think a testament to how creative our faculty is. Again, thank you for everything that you’ve done in this area.

Education. We are really the bedrock of undergraduate medical education. Your contributions to small group teaching and many other activities for our medical students are just tremendous. And accordingly, we have a number of faculty members who lead undergraduate medical education. And I would like to mention and give a particular shout out to our residency program leadership. This is a group of people who work really well together, pull together, come up with innovative ideas and really develop innovative new programs. And they really do this on an every year basis. Every year there’s something new that they’ve been able to put together.

This group actually is bringing on new talent and there are new faces on this list almost every year. So a shout out goes to Andy Bryant who became an associate program director and to Jenny Strouse, a very young faculty who joined as an assistant director and also to the administrators. Stacy, thank you for everything you do for helping with getting access to Manish but also there many, many other things that you do. Abbey, who helps coordinate all the Zoom interviews. Thank you. You are there every Monday and Friday at 7:55 to make everything run smoothly. Really, thank you.

These are the interns who we matched last year, who joined us on July One. Thank you. We are so glad you are here. We want you to become the best internists you possibly can.

And this is where our incoming residents did their medical school really in all four corners of the country. Stanford, Columbia, Mayo, Southern Texas, WashU, you name it. We have somebody on the list who came from these schools to join us.

Innovations in Education. So I’m always surprised by the newest ideas from the education team. At this point we have three distinction tracks, which allow 30 residents to get some extra training in an area of interest. This may be medical education, ultrasound, or health equity. And I understand that for next year there’s a new program on the docket for international medicine.

We do OSCEs now. If you want to know what this is, it’s objective structured clinical evaluation. And what does this mean? This means that before internship starts on July 1, we have the incoming interns perform a couple of tasks, and they’re being watched and they get some feedback. This includes things like a patient handoff, how to get an informed consent, or how to conduct a difficult conversation. And what are we trying to do with this? We’re trying to make sure that everybody knows which level they are at. And we also provide some pointers as to how to improve in these really key areas of communication and clinical activities. And because this has been so successful, this year we were tasked to run this for other departments as well. So our leadership team not only did this for internal medicine but for other departments including surgery and OB GYN.

Then a special shout out goes to Dave Stoltz who sitting up there. This is for the StARR scholars program. So the StARR program is it’s an NIH funded program. There are 15 around the country and we have one of them. And this allows a resident to conduct one year of mentored research while already being in residency. Again, we have one out of 15 programs and one of the first graduates actually matched for fellowship in a fantastic program.

There are a number of other achievements in training in education to be mentioned including Joe Zabner being recognized as the Distinguished Mentor, and then a number of other achievements when it comes to participating in teaching, being recognized at the institutional level for activities in teaching, conducting the ultrasound class, teaching at the VA. So thank you for what you’ve been willing to contribute to our teaching mission.

And this is a slide we just made a few days ago. This is the fellowship match. These are our residents and it shows where they actually matched, and first of all, everybody matched. And if you go through the slides, some of our residents will stay with us, which I think really also gives testament to how we perform as a department and some of them go to really elite institutions, such as Stanford or Yale. So I think this is really again a testament to how well we educate our residents. This is just a map demonstrating where our graduating residents moved to do their fellowship in the last few years.

Welcome to all the fellows who joined us as of July 1. We are glad that you are with us and we hope that we’ll be able to recruit some of you to stay with us as faculty. So again, a warm welcome after five and a half months.

Philanthropy, what have we achieved in philanthropy this year? We did a grateful patient workshop. The first one we probably did in 10 years and we were able to receive support of about a million dollars, which, maybe for the size of our department, is a little less than we would like to have, and I think this will be an area of activity in the next few years. So thank you for everybody who contributed to this. Again, this is an area of future expansion.

So who are the people who made all this happen? The people of Internal Medicine. We are 373 faculty, primary faculty and there are an additional 76 emeritus faculty and 230 adjuncts for a really impressive number, which are supported by APPs, 130–we’ll look into this in a second–about 200 trainees, there are students, research staff and postdocs and admin staff for a total of almost 1600 people.

My congratulations go to both faculty members who were promoted to full professor as of July 1, and there’s a long list of faculty who were promoted to associate professor. Again, thank you very much for all your work. And as you can see, there are faces which also express that we are becoming a more diverse population of people, with men and women and people from different countries of origin and different ethnicities. And I will show you more data in this regard in a second.

We also were able to recruit new faculty and despite many problems and trials and tribulations and nevertheless, this is a really impressive number, and I’m going to show you the overall numbers in a second. Again, I think this slide also gives a testament to the diversity in the department, people of different genders, again, ethnicities and countries of origin which really adds to the flavor and the overall fabric of our department.

These are the new faculty members in cardiovascular disease. We recruited two new faculty to endocrinology and metabolism, three new faculty members to GI and hepatology, and 14 new faculty members to general internal medicine. In addition, eight new faculty members in hematology oncology, one new faculty member in immunology and two new faculty members in infectious diseases. We also had three additions in pulmonary and critical care. And this is the overall slide demonstrating that we were able to overall have a net gain of six faculty members in 2023.

Now one word about APPs. Nurse practitioners and physician assistants are becoming more and more an important part of our department. The number of APPs has doubled since 2016, and we are continuing to showcase the contributions of our APPs in our weekly announcements. And moreover, we have six new lead APPs for a total number of 12, which really exemplifies that the number and the contribution of APPs in our department are constantly increasing.

The leadership team. There have been a couple of new additions and new members who have started to make significant contributions. Shout out goes to Jeydith Guttierrez as our vice chair for DEI. Chad Grueter took over as the vice chair for research. He’s also the only PhD on the leadership team, and Kristin Goedken who joined us as the associate clinical department administrator. And I will talk in a few minutes about particular contributions that these individuals are making to the department.

The division directors. There are really no changes this year. My shout out goes to each and every one of them. I’m sure that many of them have received an email from you about a problem or issue, something which needs to be fixed, something that needs to be made better in the division. Our division directors deal with difficult problems every day. They try to provide opportunities for faculty, look out for them for their development, and also help with bringing this department in line with the overall mission of the institution. So thank you very much for everything you do. It’s a lot of work and it’s very important, and you really help us, every one of us make this department be a success. The leadership team of the VA has slightly changed. Justin Smock now is the deputy chief of medicine at the VA and also the associate program director for VA residency program. Brad Dixon promised to stay on for another year, and we have a number of new section chiefs, for example, Bharat Kumar who now is leading the activities in immunology, rheumatology at the VA as well as Kartik Mani who joined us from Wash U in summer.

There’s always a slide which makes me pause and makes me wonder what I can say and what I need to say here. I would like you to remember Dr. Hegeman, who passed away earlier this year. He was a faculty in general in internal medicine for many years and contributed to education, and as you certainly know, he’s Rebecca Hegeman’s husband. So really our thoughts go out to the Hegeman family and we were in touch earlier this year to let them know that we’re keeping them in our thoughts.

Now. How did we get here? How did we get to this point to this day? How did we generate all this revenue, these funds? How did we have all these successes in education? And I think our way of doing this is to be stronger together and stronger together means lots of things in many different areas.

Clinical operations. The department supported the THRIVE program which allows young clinical faculty to learn more about the institution and learn more about leadership opportunities. We had a couple of our faculty participate in this program. If you get another email later this year, please consider. Then there are people in the background who make incredible things happen. And these people are Kim Staffey and Amy McDonald. Kim is, as you know, our vice chair of our clinical programs. And so she sent me this list of things that she achieved this year, and it’s a long list and really it all boils down to doing continuous data analysis for the department in thinking about how we can optimize our operations and how can we be more engaged in quality and safety.

And both of them sit on multiple leadership committees in the institution and really represent the view of internal medicine in many different areas. And they were also instrumental in helping others in the department set up for coding consultant. So while there are no flashy things to announce here, no big grants, no gold medals, I don’t think we would be able to operate the way we are without the work of Kim and Amy and a number of others who help them.

Jeydith Guttierrez has been working with the DEI committee, which has representation from all different divisions on a number of different topics. For example, writing a newsletter, and conducting a faculty survey, and listening sessions.

Chad Grueter came on as our vice chair for research a few months ago. We went through meetings with researchers. We had some research advisory groups over for lunch and listened to the needs of our researchers and Chad really spent a lot of time developing some action items. The top of his list is to form internal grant review groups, and he already has an example of how this works well and has worked well for the department. There’s one group of junior faculty in internal medicine and other departments which together has been able to bring in a lot of grant funding. There are a number of other things on this list, mock study sections. We are also working with Lori Strommer on updating all research websites.

And there’s faculty promotions. This is a process which requires a lot of effort and I’m really grateful to all the members of a promotion committees on the clinical and on the tenure track. It takes a lot of time to review each single dossier and form an opinion and actually write a summary. So thank you for all you do. This is a lot of work in the background and we really, really appreciate it.

Lastly, staff engagement. So this is born out of the response to the Working at Iowa survey of actually two years ago and we’ve been working with this committee for more than a year. This group consists of many different members, different ranks within the department. Earlier this year we asked the $10,000 question, how can we help make your life better? We started the employee pop-up lounge, which I think now is just becoming the employee lounge. And thank you for all the positive feedback that you and others wrote down on the board. We have an Internal Medicine Honor Roll which is just starting, and an upcoming event to recognize division coordinators for all their efforts during COVID-19.

The Road Ahead. Well the future is unknown as you know. As Yogi Berra mentioned, there are challenges and there are opportunities.

In the clinical mission, we still see a high patient volume and there are a number of opportunities that we’ve been working on for the last year, which include telemedicine, innovative care delivery. Hem-Onc just started a new clinic to keep people out of the hospital. We’re working on delivering care under the UIHC umbrella outside of Johnson County. We are out of space, we are still working on the new inpatient tower and of course on how to leverage the opportunity at Mercy, and more on this in a second. We are lacking support staff, we are lacking faculty and other providers, and we’ve really worked on numerous opportunities, how we can be quicker in providing offer letters, how we can be nimbler, how we can do better in marketing ourselves. And Trevor and his team and some of our chief residents have been incredibly helpful with this. We are trying to work on optimizing our clinical operations with direct scheduling, and of course equitable compensation remains an important discussion with the college and also with hospital leadership.

Now Mercy Iowa City, I know you’ve heard a lot about this and it’s in the news on a daily basis. I personally think that this is the opportunity to expand our access and our reach in the community. It’s really an opportunity that we’ve been waiting for for such a long time. And now here it is. So the day one of Mercy UIHC or however this new entity will be called will be on February 1. There’s going to be a transition period of months, about six to eight months, where we will evaluate the opportunities at Mercy and we are in constant conversation with the physicians at Mercy. And thank you for the people in the audience who are part of these conversations, and we’re working together and we need your input on a bold and shared vision for this community-based site.

When it comes to research, there are opportunities to maintain the pipeline of talented investigators. We have done this extremely well for mentoring. We have new opportunities coming online. Some of them are led by people in this audience. Thank you for all you do with expanding health services research. Eli has taken a lead in some of these new programs. So we’re also trying to expand internal support for young talent and more to come on this. And we’re working on really strategic recruitment to build stronger teams. And we’re always out of space. We are trying to optimize space utilization and there’s a new research building somewhere on the horizon, although I think it’s probably going to be 10 years until it will open its doors.

Our opportunities in education remain to grow our national reputation, increase diversity, and expand innovative in visionary programs. And something we are really good at. And that is to maintain a pipeline of talented leaders in education.

So I think we are excellent because we have fantastic people. So excellence really comes through the people in the department and it does take a village. And this village that’s all of us and we are supported through the executive leadership team with Dean Jamieson, executive dean Pat Winokur, and our new CEO. And then there are people who support us on a daily basis. Pete Snyder would be one of them who helps with matters of faculty affairs and development and probably gets a call about every other day from us.

The other faces in administration without whom really nothing would run very smoothly. So my thank you goes to each and each of them. And Anni Thorn is on new administrative services coordinator in the office, so please stop by and say hello to her at some point.

The division administrators – thank you for working every day towards making this department run. There’s been a very recent transition in cardiovascular medicine to Molly Flynn, and thank you to all the other administrators who worked here with us for a long time or came on recently like Collin Just in endocrinology, and Hillary Humphrey and Jamie Paul who transitioned from division coordinator to division administrator. The division coordinators, they make this place run, and we will thank them for all they’ve done, especially during COVID in February in a separate event. So thank you for being here for us every day and helping us solve our daily problems.

So we are stronger together because of communication, and communication is a big part of how we try to work together. And there are multiple channels, how we’re all telling our story. And this is beautifully run by a group of really talented people. Some of them actually make these slides. Trevor Jackson now is supported by Claire McGranahan as a second writer, and you probably all have met and worked with Teresa Ruggle and Ann Armstrong, Kris Greiner, Cory Sheets, and of course with Lori at some point. So thank you for your continued activities to put Iowa on the map and to put the Department of Internal Medicine on the map. And so the Design Center continues to provide services far beyond internal medicine. We really work with about every department in the College of Medicine and about every college at the University of Iowa. My State of the Department credits go to the people who have to pull all the data, put them on slides, worked on making them understandable for people who don’t really do accounting on a daily basis. So thank you for all your work and support to the department and to me. And with this I’m going to end, and I’d be happy to take any questions. And again, thank you for everything you do.