The following is an abridged and edited transcript of the March 6, 2025, Quarterly Department Update. To view the entire presentation, click here (hawkid login required).

Can you guys hear me? Yeah, I don’t know if we should get started. Should we do that? Happy National Hospitalists Day. Raise your hand if you’re a hospitalist.

As Brad Haws always says, internal medicine is at the heart of the hospital and the hospitalist program is at the heart of internal medicine. So you’re at the center of it all. Good job. So for those of you who don’t know me, I’m Upi Singh. I’m your new colleague for the last five months. Can you believe it’s already been five months? I can’t believe it, but it’s been a good five months. I thought what we would do today, it’s a quarterly update. We’ll do as we always do, we’re going to have no specific rules of engagement. Other than that I really would like good conversation, no question as far as I’m concerned, is off the table. Please ask. And then I think the slides won’t take more than 25, 30 minutes. And then I think we can have a good robust discussion.

We plan to do these every quarter and happy to get input and feedback about what of these meetings is helpful to all of you, is not helpful, and how we can modify and change. So what we’ll do is talk a little bit today about where we’ve been. So recap of our first five months together, where we are, lots of current opportunities and successes, including some challenges, and where we’re going both short- and long-term goals.

So I’m going to start with the people as we just thank the hospitalists. I’m going to end with the people and I hope I don’t sound like anybody’s mother, but I might for the next few minutes. I’m going to talk a lot about building community and building people first. You all know that this is the core of what Iowa is, right? But I think we want to get back to a new way to converse, a new way to communicate, a new way to discuss. And I do believe that we need to improve our communication with each other and our trust. And we’ll talk a little bit about specific things because at the end, the team who’s sitting here in the front row and me, we’re here to serve you. We’re here to serve the department. And I do think that’s going to take a really good, robust, candid, honest, kind conversation with each other and trust between us that all of us are rowing in the same direction.

We’re looking to improve things. There may be times where I make a mistake, I guarantee you there’ll be times I make a mistake or that somebody here makes a mistake. But then we just have to recorrect. I send out, I don’t know if you guys read this on a regular basis, but I send out something every two weeks about thoughts. Trevor and I write this together and there’s a theme in the last few weeks. If you haven’t read it, I encourage you to read it.

All the photos I include are always taken by me and I love photography. And so that’s sort of my creative outlet. So the first one a couple weeks ago was about the courage to change. And I put a photo of a lion that I took when I was on safari lion. Singh means lion. I dunno if you guys know that. And lions have some interesting behaviors that we may want to think about; lions hunt even when things aren’t so good. Things are tough right now. And lions are the kings of the jungle. And we will also be the kings of the jungle. We’ll survive.

And then last week I was really lucky, I went to a meeting where I ran into Mark Anderson who was getting an award. Dale Abel, there’s myself and that. Who recognizes this person? Gary? Yeah, Gary Rosenthal, who was also an interim chair in the Department of Internal Medicine. He’s now chair at Wake Forest. And so we were chatting at a meeting and somebody said, oh, all four of you guys are chairs at Iowa. Let’s take a photo. And so this was a nice photo and all of them have such fond feelings for Iowa, me included. And it was really nice to sort of connect with people who’ve been here.

So I talked last week about how we’re all leaders. I do worry a little bit or a lot that at least this department or some places maybe it’s Iowa, think that there’s specific leaders. So it’s my job or Grant’s job or Denise Jamieson’s job to make things better. I would disagree. I think if you’ve gotten into med school or getting a PhD, you’re a leader. You’re at the top echelon of your career in terms of who gets into these schools. If you’re at an academic medical center, you’re a leader. If you’re teaching residents, you’re a leader. We’re all leaders. We all have to sort of own it, understand what leadership behavior is, and figure out how we’re all going to contribute. So I kind of sound like a mom, sorry about that. And I sent these write-ups to my kids who my kids are 23 and 20 and once in a while they send it back and say that was good. So it doesn’t happen often, but when it does, I’m very excited.

And then I read this article recently, it was in the Noon News a while ago, maybe a week and a half ago. It was by Patrick Galligan. And it talked about the beauty of vulnerability and about wellbeing. And I read this article and I forwarded it all to division directors and half our team. I love this article. It’s a quick read, literally five minutes. And it talked about how vulnerability connects you with people. And my favorite favorite sentence in this article was vulnerability is not transactional. It’s connective. It builds trust and safety and paves the way to a genuine connection. And I think if we are all working hard, nobody’s trying to make mistakes, nobody’s trying to do a good job. And if at times we can learn to be a little bit more vulnerable in certain situations, I do think that will help. So I’m throwing down a gauntlet to you. I think we can improve our department, but we need to build connections, community, trust. And when you’re comfortable, you can let yourself be vulnerable. That is my style. It doesn’t mean that it has to be your style, but that is something I use on a regular basis. I do think it helps people understand that we’re all human and we’re all doing our best in this situation.

So we’ve had a number of events to build community. This was a meeting with the team that did all the residency interviews as well as all the fourth-year medical students who were interested in internal medicine. They came to my house. It was a nice get-together. Everybody wanted to do hem-onc, pulmonary, cardiology. There was one person who wanted to do ID; I was so excited, I had to give her a hug. That’s her right there. And there was one person who was thinking of primary care, but we’ll take it, we’ll take it. And then we had other get-togethers with fellows at my house, then PhD faculty. And then I was also lucky enough to be invited to a lot of the holiday parties. So it was good to meet people there.

And then there was a nice party for the residents. I walked into that one and the first thing I noticed, the residents here have a lot of kids. It’s a very productive group, very productive group. I think that’s wonderful. I think it talks to the family nature of our place. It talks to the fact that you can have a young family here. I think it also talks to different stresses that they have. So again, kind, gentle understanding and give grace to people. My dad is right there. I think I told you guys right, he moved in with us. This is his third month here. He’s getting settled in. He’s always very excited when we’re going to have a party at our house. He gets to talk to people and his first question, if you ever come to my house will be, guess how old I am? And it’ll make him really happy if you say 75 because he’s 91. He’ll be 92 this summer. So he’s just so excited. Somebody said to him 65 and he looked at them and was like, my daughter is 60, how is that possible? So he outed me, but he was still happy. See, I was being vulnerable. I told you how old I am.

Okay, so we’ve done a lot of listing sessions, I’ve been to all division meetings and I have ongoing conversations of course with all of you. And here’s some of the things we’ve been hearing. This isn’t comprehensive, but we’ve talked a lot about the compensation model. We’ll talk about how we’re trying to look at that, talking about sustainability for how all of us are doing our jobs. Talked a lot about mentoring, about research, clinical space and support. And then of course the recent national news and trends are things that we’ve been talking a lot about.

Let’s see, so where are we now? So what are the current opportunities and what are the current challenges? So I want to give a shout-out by starting about all the department successes that there are. So this is looking at the clinical footprint. I think people know we have 450 faculty in our department. We are 32 to 33% of the faculty in the entire Carver College of Medicine. And all of you do an important, tremendous job. We take care of anywhere from 30 to 40 percent of patients in the hospital on any given day. A lot of it is our hospitalist team. A lot of it is the unit and others. We take care of 17% of outpatient encounters. And that’s a lot. We take care of 40 to 50 percent of the patients in any given day.

This is just showing you work productivity year over year. This year, you guys are working hard. So we’re estimated to hit about 1.2 million RVUs by the end of FY 25. This is a lot of hard work by a lot of people. I want you to congratulate yourselves. I want you to also understand because what I’m going to talk about challenges. I think there are some challenges with this. Some of it is around sustainability, some of it is around growth, some of it is around other things. But great work, tremendous work by all of you and kudos to everyone. By the way, a lot of the growth is also at MCD, and great job for the divisions that are there.

Research. So this is the award to date for 23, 24 and 25 listed both as total as well as NIH and other. The 32% of the faculty in the department of medicine at the Carver College of Medicine are responsible for 27% of research in the entire Carver College of Medicine. That’s fantastic, right? That’s fantastic because of the 450 faculty, not all are research-based. So the faculty that are doing research, and I hope that that group expands, are doing a tremendous job. Good job. We’re going to talk about the uncertainties, not trying to pretend there aren’t any, but we’ll talk about that as well.

And then education. These are our three missions. So we had a lot of people apply. 368 applicants interviewed. Almost a hundred schools. There’s a number of faculty interviewers. Can we get this seven divisions to nine? We have nine divisions. We can do it. You can do it, trust me. And then here’s the quality of the educational experience. Our medical students when they graduate, put us in the top decile. Top decile for their experiences. That’s amazing.

By the way, none of this, the clinical work, the research, the education, none of this is accidental. None of it happens without a lot of hard work and none of it should we take for granted because all these things are ongoing efforts at improvement. And then all of these are things that can fall off if we’re not careful.

So kudos to all of you for all this work. I think I talked about candor. So that means I also have to talk about challenges. Challenges doesn’t mean it can’t be fixed. But my job for you is to be honest, to show you the 35,000-foot view and to tell you where there are challenges that we can get better in. Please don’t walk away saying, “Upi said we worked hard, but now she wants us to do more.” I’m not. I’m saying there are challenges and we just need to acknowledge it and work on them. So we do have lots of staffing concerns. Staff as well as our faculty numbers.

Expansions I think took a lot out of us and will take a lot out of us with MCNL coming on board. And then certain divisions have very specific challenges around volume, et cetera. Despite our growth, I am so sorry to say that we are not meeting our institutional productivity benchmarks. Now you can argue that those benchmarks aren’t accurate. You can argue that they shouldn’t have been set. You can argue that X, Y or Z, maybe all that’s true, maybe at least half of that’s true, but those are the same benchmarks applied for every department. The good news is we’ve really improved over previous years. That’s the great news. And much of this was around efficiency and it’s really variable across divisions. So it’s not that this is happening across, but in general, when we’re looked at, when Brad Haws and Denise evaluate the department, they look at the big picture as they should and it is variable across divisions.

Last time I talked, I talked about the fiscal impact of this, and I said “no margin, no mission,” and I got my wrist slapped by somebody saying they didn’t like that. So I’m going to change it. I got feedback and I’m going to change it. I’m going to say the margin feeds the missions. That is another way to say it. The clinical margin feeds the missions and the missions are in plural because it’s the teaching mission, it’s the research mission, it’s the mentoring mission, it’s the growth mission. So the margin feeds the missions. And so that’s why even if your division directors others talk about this, it’s not to hurt anyone. It’s not to say anybody’s not working hard. It’s not to say that this wasn’t a terrible flu season. None of that is inaccurate, but it is the reality that we need as much as possible to work towards improvement.

I also think that it’s really important to understand that we as a central department are very transparent and we share the division data transparently with all the divisions. We sit in the DD meetings, the division directors see all the data. And if a division that’s having challenges, it’s not always about the DD or the faculty. It’s sometimes operational. It’s sometimes space, it’s sometimes other constraints. And I think when we have those meetings, I always get the feeling that nobody’s pointing fingers, but we’re trying to learn from each other. So if Endocrine has done really great things about their outpatient clinic, Ben talks with Ayotunde and gets ideas. If this is working well, we get ideas if we have different resources we need from the health system, I get ideas from David Elliot and et cetera. So again, we’re transparent because I think that’s the only way we can get better.

And then I just think I really need people to know that I am spending all and any capital I have, emotional, intellectual, social, political, whatever it is with the UIHC leadership to change our funds flow. Right now when I say that we are not meeting benchmarks and where we are financially, I don’t know the numbers. Kristen or Grant can tell me. I think at least 50% of that issue is the funds flow candidly, but 50% is in our control. I’m having a discussion every time I see anybody who’s in a leadership role, but 50% is in our control.

So every opportunity, the four things I say to leadership are Department of Medicine takes care of 40 to 50% of patients in the hospital at any given day. We contribute to a third of the research, we are getting better, we’re improving things on our end, and funds flow needs to change because it doesn’t work. I say it every time.

So I’m pretty persistent and I have great data from all of you to show. And I’m not saying “we’re not meeting metrics and you fix it.” I’m saying we’ll fix it. But it is a WE, us together. Okay. We also obviously have some challenges on the research side. There’s some decreasing funding trends. I think we need to think about whether we increase our efforts at large grants, T32s and others. And I do think we need to improve mentoring of at-risk faculty and junior colleagues. I would’ve said that even before the current administration came into the office. I think this is an Iowa specific need we have right now, period. But now the current trends make it a little bit more challenging, substantially more challenging. And for education, I do think the uncertainties that have happened in the last several months are especially impactful on trainees and junior faculty.

I do think that we can’t pretend it isn’t. I do think trainees and junior faculty and postdocs are sort of at the most tender, most exciting, but most tender and sort of scary moments for themselves. And we have to talk about the importance of the teaching mission and how to support and elevate that. And then how do we recruit and retain residents and fellows and show them a career path at UI. Yesterday night when we were talking about strategy, some of the other DEOs were talking about approaches at other institutions, private institutions and how we were taking some really interesting ideas I had not heard of. We’re actually very open to thinking about how do we increase our physician and RN and APP and other workflows.

So I think people are thinking a lot about these things and again, even for them, they’re working with us. So it’s not like it’s our job to fix. You all contributed to Working at Iowa survey results. So I just want to show you the results. And your division directors have these data and they have department data as well as division data. And I would encourage all of you to look at this. So there were 576 respondents, so that’s a 62% response rate. The engagement was a little bit better than in past.

And here’s sort of the safety culture, resilience and leadership. But I think it’s helpful to look at what happened last year versus what happened at each level. The top performing items were climate of trust, which is fantastic, physical and emotional health and collaboration to make safe for patients. There was issues around improved resilience and then an improved safety culture, which is wonderful to hear. There were lots of opportunities to improve. I think this work-life balance and job-related stress staffing at the units and then issues around leader index, we’re there. So I think it is what it is. This is where we are, accept it, own it. Try to think of how we’re going to fix it. I do.

We are doing further evaluation and what we actually realize is we can do a deep dive. So we can break down the data for the department and for each division on the type of person who answered a faculty, a trainee, an APP or an admin. As long as there’s five people who contributed to those, that survey in that division, the division directors will get that and we’d love them to talk about this and develop a division specific action plan. One thing I will say about this survey is it tells you stuff, but it doesn’t necessarily give you ideas of how to fix. So I think that’s unfortunate, but it is what it is. We’re also going to be doing a department-led survey as we had promised last time to get input on the DEO, vice chairs, and admin team as well as division directors. And so we’ll talk about that a little bit more later.

Okay, so MCD, who here has worked at MCD? Come on. Own it. Very good job. Congratulations. So the one-year anniversary just happened at end of January and there are a lot of successes. We welcomed an integrated faculty and APPs into the department. We’ve had clinical operations within cardiology, GI, primary care, hospitalist, medicine, ID, nephrology, OC, health and pulmonary. If I’ve missed anything, I apologize. It’s my fault. We have lots of opportunities to expand cardiovascular services. I think EP services are happening. I think hopefully GI. And others will happen soon. And then what it’s going to do is allow us to increase our census and allow us to take care of more patients. All this means there’s some challenges. So continued coverage of some services and moonlighting capacity. We need to recruit additional providers. And then obviously increasing census and increased acuity combined with recruitment needs.

And one of the other sort of overarching things as we move into a multi-site location, faculty practices, faculty versus clinical versus community practice versus other, right? Many. I went to a chairs of medicine meeting last month and every institution is struggling with this. Every institution has slightly different ways they’re addressing it. And since we’re at the beginning of this, I think we can help contribute to what we want. Right now, what I’ve heard from Dr. Jamieson is she would like it to be a department specific. Each department can decide what they want. So I’d love to hear from you. I’m guessing we have nine divisions that we’ll have nine different ways, but it’d be nice if at least we could come up with some general principles and then allow divisions autonomy to do that. It’s better to think ahead and plan for this that have it sort of happen accidentally and then end up with situations that don’t really fit both our core values or our moral compass or other.

Okay, so I have to say this right? A lot of uncertainties at the national landscape, both with NIH, the VA, Medicaid, Medicare, the UI OVPR updates are there. I checked like an hour ago, nothing new, but you never know could be something new by the time we leave here. it’s an uncertain time. It is a scary time.

It is not unmanageable. Has something of this scale happened before? In 2008 it happened at this scale, but that felt more organic. So the scale maybe did happen, but not in this way. That feels very antithesis of the things we hold dear, in an uncertain time, and what happens with NIH funding versus what happens with the VA. Today there was something like a new order is going to come out about the Department of Education and then of course Medicaid and Medicare. I mean this is how we take care of patients here. So those are huge things. And I’m not minimizing it. I’m not saying it’s not there, but I do think we have to think of specific strategies for how to manage them.

So these are ideas, but happy to have a conversation about how to do things more. So I think it’s important for everybody in this room to know that there’s many, many, many efforts behind the scenes and that the leaders at the highest level of Carver College of Medicine and the university are advocating for the institution are patients and healthcare relevant policies. There are really strong advocacy and legislative connections that the university is using. And then I think it’s really important to understand that the university and CCOM are really well-aligned.

And I guess what I’m going to say is what can we do? I think we should keep informed, but I do worry that the uncertainty will paralyze us or demoralize us. And if it has already done that to some degree, I would ask that we try not to and that we need to stay true to our core principles and goals, but we do have to move forward. I had a meeting this morning, Barry was on it as well, with some of the research leaders. We were sort of talking about this. We talked about everything from the uncertainties. We talked about tenure clock extensions. We talked about what the other policies that university may put into place. We talked about are there actually opportunities in a time like this? We talked about vision, and the leadership and everybody believes, and I believe, that this is not the time for us to walk away.

If we walk away from research or walk away from X, Y or Z, we are taking ourselves out of the game. Life and politics and all these things tend to be cyclical. This may be a deeper dive, this may be more immediate, this may be more sudden. This may feel punitive, which I think it does to me, but it will get better. I say that a little hesitantly, but it will get better. Let me say it now. It will get better. We have to be as a large leader, academic medical center there at the game. So don’t take yourselves out. I’ve had lots of people come talk to me, talk about concerns, no problems, but don’t take yourself out of the game. Submit grants, do the things you need to do, and don’t let the uncertainty paralyze or stop us.

I do think there’s other ways in which we can sort of stay a little bit more grounded. I’m going to tell you this is me being vulnerable. I’m going to tell you what I do. Doesn’t mean that you have to do it right, but I’m going to tell you what I do. I keep informed with the news just enough, just enough, but not so much once I start clicking on this article, it’s a rabbit hole, and it’s exhausting and I can’t do it. And I feel like I have no control. So I stay informed just enough. I really do trust that the university and the health system are working hard at this and harder than me behind the scenes.

One of my colleagues from Stanford called and we were chatting and they said, aren’t you stressed? I said, yeah, kind of. But actually I can help. You can help. We can make the department better in the next 3, 6, 9 months, one year or two years. I can’t change what’s happening at NIH necessarily, right? But we can make us better. So my sort of lining on this is I’m going to focus on the things I can do, the things I can impact. I would encourage you to focus on the things you can do, which is also wellness, which is also mental and physical and others. And then let’s do the things we do, the things we do while keep doing them and sort of wait for some of this to pass over. But again, just to really understand that the university and the health system are very well aligned on everything. And I do think we have strong leadership both at UIHC as well as the university.

And so it is uncertain. I wish I had an answer. Actually I don’t, because if there was an answer, it would not be a good answer right now, right? Because it’s too quick. So let some of the processes work themselves out. And so those are the strategies I use. And at the end when we talk, maybe there’s better strategies we can talk about.

I just want to call out the VA. We have a lot of VA colleagues here. There was another announcement yesterday about more sort of cuts at the VA. Our department of medicine is integral and embedded within the VA system. So we have 75 internal medicine physicians within nine sections, a number of FTE and the stuff is listed there. A lot of internal medicine residents and fellows and students go over there. A lot of research, a lot of leadership in terms of academic excellence.

And then I listed the photos of Bharat, Michelle and Steven who are three leaders over there right now. And then Eli Perencevich wrote a nice article about celebrating a hundred years of research at the VA and contributions from VA-funded research that span everything from TB treatment to implantable pacemakers. So just remember that you’re stressed, but so is the person next to you. Give grace, acknowledge what we do well and I think stay with our core principles.

So that’s kind of where we’ve been, where we are. And I want to talk for a few minutes just about where we’re going. So I think you all know all these, but there’ve been a number of leadership updates recently. We have a new division director for Hem-Onc-BMT. So please join me in welcoming Dr. Farooq. We have a new CDA Grant Worthington, there he is. Join me welcoming him.

And then we have some additional vice chair roles that I’m excited to announce in a few weeks. We are interviewing people for vice chair of quality and safety as well as vice chair for faculty development.

And I’m excited to have new leaders join us in these important endeavors. MC North Liberty will also open soon. You guys saw the opening date is April 28th. They’re going to offer a number of services around orthopedics, ORs, injury, walk-in in the emergency department. The internal medicine clinical footprint is currently going to be limited to the dedicated hospitalist on site as well as ID, but we’re evaluating. We will sort of see what else is going to be needed and looking to the future, the census impact at MCU will happen. What is going to be the need for the clinical footprint of other services and then growth and expansion opportunities.

I interviewed last year right after MCD had been just announced and the vibe when I interviewed was so sad and depressed and stressed and overwhelmed. Everybody wants to take care of patients, but it felt like we were already stretched thin and how could we do more? And I acknowledge fully that some of you may feel that way about MCNL. Acknowledge it, tell us how we can help you. But it is going to happen. So best to sort of think about. And right now I think it’s really going to be hospital medicine and ID. So we’ll see how things go as we move forward.

I do want to talk about supporting research in the department of medicine and I broke it down into two sections supporting the current research and the current people, right? Because at the end, research happens because people, grad students, postdoc faculty are doing it. So we need to continue supporting mentoring and developing current research. As I said, I think we stay updated on national trends. We have to understand the implications for the department, the college and university. I think we should explore all funding opportunities including non-NIH agencies and foster the growth and development of clinical trials. There’s actually going to be a CCOM review of the research landscape by external stakeholders at the end of May, early June, the vice chair for university research from Ohio State University.

The dean at Mayo and the dean at Pittsburgh are all coming to do an external review. So I think that’ll be great. And we had a lot nice discussion this morning about source of what things we can learn from them. I also think we need to, despite what’s happening, reinvigorate research and have had this conversation with Denise and others and everybody agrees that we move along, which the way we always had planned to. So the department is committing to having two large recruitments thought about this a little bit. Have a committee of people that are listed there. And what we’re thinking right now is to have two cluster hires. So instead of hiring in one specific division, if we talk about opportunity to recruit two clusters, I’m thinking four to five in each cluster, hopefully beginning this summer. More to come, thinking right now that one should be more wet bench and one be more health services research or dry-based.

That’ll help us with space, with costs, with ideas, but ideally cross-cutting scientific themes that span multiple divisions. And we’ve had good discussions with the committee that are listed there about how do we take advantage of NIH and non-NIH funding sources. How do we leverage the new cancer center director? How do we leverage what’s happening in cardiology? How do we sort of think about cardio-oncology or the Inflammation Program?

So we are not stopping our commitment to research, current people as well as the future. We are planning on doing the cluster hires and what our thought is that the cluster hires right now are that we would at least have one of those individuals in each cluster be a more mid-level or senior person and then junior people to bring in. So I think it will bring some new energy. And those who are currently here might think, well, you should support me. I’m here instead of supporting new people. I agree. We will support the people here. I would argue in some ways getting in new people does support the people who are here. It invigorates, it supports, it brings in ideas, it brings in mentors.

Then what else is to come? We had committed to you that we would do a department review. So there’ll be a college-led review of the department in early 2026. We have a lot of work to prep for that. We’re doing a self-study to begin. And then the review of the division directors and department leaders is forthcoming. So please complete the surveys. You’ll get them in the next few days. And then one of the other things we’d heard about was compensation. So we’ve been for the last month or two months, been doing a comprehensive review of the compensation model and the incentive plan. It’s actually, I think been really good meetings. We’ve met every week with the division directors and DAs and then finance leadership. They’ve been good conversations. They’re hard conversations. There’s no easy answer. Even if you put a money tree in the backyard, there’s no easy answer because there’s so many principles to think about.

There’s so many issues around equity, sustainability, et cetera. But there’ve been, I think, good conversations. Every division director, every DA, all the finance people, everybody’s contributing. And we’re looking at what is working, what adjustments ideally would occur. And then we’re looking at all levels of our faculty. And this is something we had committed to you earlier and that’s underway. So I’m going to end with going back to my mom status.

So improve communication and trust. I’m trying to do it by being transparent with you. Your division directors will do it by being transparent with you. I think you can be transparent with us. Tell us how the department can support your needs. And I want you to think about how you are going to contribute to departmental success, whether it’s a time of uncertainty or not, how will we contribute to it? I want us to reflect on how we’re going to improve.

Part of that is be courageous. I say this a lot. I want people to think with their heart and their head. I want them to lead with their heart in the head. So we need both emotional connection and intellectual curiosity for each other. And I want us to have honest conversations. I do want people to be nice to me, but I don’t need Iowa nice where you have an opinion of something I’ve said today or in another meeting and walk away and don’t give me input. I actually take feedback very well. I have a thick skin. I won’t be offended. I need it to be said in a professional manner, but I will never be offended because of the idea, and I may not agree, but you may have changed my mind or I may not agree, and that’s okay.

But we have to have honest conversations with ourselves. Think about what you’re requesting, what you’re asking for, how you’re interacting. I always think to myself, if my kids saw me now, would they approve of what they see, maybe they would, maybe they wouldn’t. So think about that.

And then I do want us to go back to vulnerability. So I’m throwing down a gauntlet to all of you. Connect with each other. I think we do that really well at Iowa. But I think when times are stressful, we sort of tend to do this. And I think I would argue that this is a time we need it more than ever. So build community, build connections.

My final thoughts are that I am starting to build my community of friends, colleagues, and local Iowa experiences. So I had started a little “ladies who lead” group, and so we went for drinks.

Did you see the selfie here? I just have to point this out. I use Snapchat. I know those. You guys are going to be shocked. Do anybody recognize that is? That’s Dr. Brennan. Look at her. She looks so cute. I went to the cardiology party and then I was lucky enough to go see the women’s basketball game when Caitlyn Clark’s number was retired. I even bought a 22 shirt. I put things on my face. My husband was embarrassed, but he didn’t mind it. And we won that. That was an amazing game. We were supposed to lose to USC, but it was great. So I am doing those things to build my community and I think I’m also doing those to find my joy. So even in the midst of winter and even in the midst of uncertainty and stress, everybody has to find joy. If you sit in the front office, raise your hands.

These two people, I come up to them once a day and say, tell me something good. And they’re like, oh, but it’s really important, and I’m going to give, can I give an example for Monday? So Monday I said, tell me something good. Oh, nothing good. It’s Monday. I was like, no, it’s a beautiful day. It’s 60 degrees. And I heard, oh, but it’s going to snow this week. And I was like, stop. It’s going to snow this week, but today is a beautiful sunny day. That is my joy for that day. I got to own it. I got to enjoy it. If I’m worried at the end, we’re all going to die, right? I’m not worried about that. I’m worried about today. I mean the snow did happen. You were right. And they were trying to just ground me as to what will happen. But even in the midst of that, and then there is really important, but hard work ahead and we’re all going to need to contribute.

I think that’s it. So I want to thank you, but I’m very, very happy to take any and all questions.

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Questions & Answers

Audience member:

You told us what the leadership is doing to talk to our legislators, state level and national level, and we need that. And that’s great. Is there also a concerted effort to reach out to press and make them aware of how all these things happen or that are announced that are going to happen? How those things would affect us and our ability to serve the state. Not wait for the Des Moines Register to call someone here, but call them and tell them all of this right away?

Upi:

Yeah, great question. So the advocacy groups are working really, really hard. How do I say this? I think each of us have a voice and we can use it with a big asterisk. The big asterisk is I’m not using my voice unless I’m asked to by the Carver College of Medicine to use it. Because I think instead of chatter, I’d rather it be focused on four things. We’re here to take care of our patients. Fundamental groundbreaking research has happened at University of Iowa Health Care, which has helped us improve X, Y, and Z. Our cancer rates are going up. We need more doctors. The sign that you see America needs farmers, Iowa needs doctors. Maybe we should have that. IND right on T-shirts. Iowa needs doctors. What are going to be the mechanisms by this? So I think those, and there’s many, many other things. But yes, I think all of those are being very proactively done.  I’m just letting our legislative leads tell me when they need me.

Audience Member:

But I think our patients out there adhere to the news channel. Oh, this is threatening cancer care. Gosh, they saved my life 10 years ago [inaudible] cancer. Then they will maybe call their representative.

Upi:

They will. And Dr. Wiener actually had a writeup in the Des Moines Register or one of the Des Moines papers about that.

Audience member:

It’s hard for me to find out what’s covered at these different hospitals and what’s going to be in different hospitals and what’s official, the vision for MCD vs MCNL.

Upi:

Yeah, so I mean MCNL, North Liberty is ortho, right? And an ED MCD is supposed to be everything, but they’re talking about whether certain services, maybe OB GYN or family medicine will go there. Although we have EP and others, we can think through how to communicate that more carefully.

Audience member:

Kind of from the opposite of that, you talked about how community providers are going to be incorporated and everyone’s struggling with that. I was just wondering if you’ve heard patterns of what the community providers are saying how they want to be.

Upi:

Yeah, no, that’s a good point. I have not, but I have heard from the division directors, so I’ve heard from some divisions that the people want to be faculty here. I’ve heard from others that they don’t care if the title is instructor. They want to stay with the community practice. So I think cardiology, they’d like to be faculty. And I think one of our ID providers, I don’t know if Judy’s here. So my guess, and again, talking, so again, we are behind the curve. If you talk to other academic medical centers, they each have seven hospitals or 10. It is a challenge for all departments of medicine across the entire country. And everybody’s sort of taking kind of a mixed approach. I didn’t find a single chair that sort of felt they had it worked out perfectly. But yeah, we’re happy to get input.

Initially I heard Denise say, oh, I would like each department to work this. I was like, no. I was thinking that doesn’t work. But the more and more I think about it, maybe it’s better if it’s in our control. But even in our department, the needs for every division and the priorities may be very different. I do think even if it ends up being like this, I do think we should think of some core principles that help us guide. I just don’t think I want to end up over there and not know how I got there. I need to get there. I need to figure out the best way. But I think we want input from everyone.

Audience member:

As MCD becomes more and more integrated. I was wondering how much thought there is to developing a residency group or something. If Iowa is considering expanding residency programs, that might be a good place for medicine and family medicine to have a residency rotation through.

Upi:

Who went to the governor’s office where they talked about expanding residency? Do you want to talk about that?

Audience member::

Sure. I mean, that’s one of the priorities for the government. When we went there with the Iowa Medical Society, the physician position was mostly about capacity. And the biggest governor’s request to the federal government is to increase residency and fellowship slots to Iowa. And I don’t know how we’ll necessarily take part on that and is not exactly defined which specialties.

Upi:

OB-GYN. And I think I keep hearing primary care, OB-GYN, and mental health / psych. So those are also the priorities for the state, right? For health care. So yeah, I think it’s a great opportunity. At Stanford, we had a community hospital we bought, and six years into it, they’re actually just starting a family medicine residency, a new family medicine residency. I do think there’s lots of opportunities. We have to make sure we have clinics, we have to make sure we have space, we have to make sure of X, Y, and Z. But I do think that should be part of it

Audience member:

As we are growing outwards and building new hospitals. Is there any plan to upgrade the facilities here?

Upi:

Yep. Yep. So there is a plan to build a new tower with, I don’t know how many beds, but all private beds, and it’s needed. So we’ve had meeting after meeting after meeting about this. At one point I said, do we need it? And they said, yes. Because everything in the hospital, everything from the labs to where the infusions happen to X, Y, and Z, to the ORs need to be upgraded. So big capital projects.

So I think parking lot one is going to come down, A new tower is going to be built. Somebody has to remind me the number of beds. I want to say 300 ish, 400, 400 beds. But that’s not 400 net new. It’s like 200 net new because some of them are to replace doubles. So definitely a big commitment to that. And currently as well, a big commitment to building a new research building, which will be a cancer research building and will offload some of our other spaces. That is the current plan. I don’t know if there was specific outpatient growth plans. Do you know of any outpatient growth plans? I don’t, but I may have missed that conversation.

Audience member:

I think there is an outpatient . . .

Upi:

So there’s a strategy group that’s going to start talking about it, but I don’t know if it’s going to be upgrade, like our clinics at MCD or other, I don’t know. Grant, do you have any other . . . ?

Audience member:

We’re going to renovate the Jefferson Street building, so that’s one of the next steps, terminating that outpatient space. And then they have in the broader 10-year plans, renovation for the existing clinical space here as well.

Upi:

I walk in the morning and there’s a picture of Boyd Tower. It’s a hundred years old. And we still see patients there. So I brought my dad and my kids in over Christmas to see my office. They wanted to see it and they walked past it, that picture, and they’re like, that’s still here. I was like, yes. Old is good, but new is needed.

Audience member:

Yes. So at these meetings with leadership, are you hearing any discussion of strategies for primary care and how to grow and support primary care or not?

Upi:

So it’s said that it needs to grow. Whether that primary care will be adult primary care versus family medicine, I think the health system really wants us and family medicine to sort of help lead that. So yeah, I think we need to think about that. So the primary care umbrella has to increase if we want to as we go into both those different sites as well as what we do here. So it’s definitely a priority, but I find that right now it’s mostly focused on cancer and heart and GI, but we are bringing up primary care often as needed.

Audience member:

I want to thank you for this inspiring talk about uncertainty. One of the things that I have been thinking a lot about is that scarcity is the mother of invention, right?

Upi:

Yeah, exactly.

Audience member:

Are there opportunities for us to think outside the box and do things differently? And the way I see it is there is going to be a need for health care and for research and other stuff, but the funding might be coming from other venues, diversify the portfolio, but there be more thoughts about how to facilitate or train people or establish collaboration with pharmaceutical companies. Companies that will be taking over some of that.

Upi:

Companies take the place of the government ultimately. Yeah, no, I think all those conversations are happening and actually the external group that’s coming, one of my questions was those places have tremendous clinical translational industry-based research programs and how can we learn from them? You can say grow this, but then we have to have the infrastructure here to be able to do it. So just saying “let’s do it” is good, but then we have to, what’s the investment that’s going to be needed? I think we always should have looked at all of these things, but I think we need to look more.

Any other questions? I have to say again Happy Hospitalist Day. Again, a very personal thank you all for coming.