The following is an abridged and edited transcript of the July 24, 2025, Quarterly Department Update. To view the entire presentation, click here (hawkid login required).
Can you hear me? Perfect. Nice to see you all. Raise your hand if you’re a new resident or fellow. Welcome. Raise your hand if you’re a student. Oh, excellent. Welcome. Raise your hand if you are a staff member. I’m so proud of all of you. You’re sitting in the front too. And then APPs. Great. Welcome. What division? Wonderful. And faculty? Perfect. Thank you. It’s just helpful for me to see. And then people on Zoom are there, I presume. Yes. And if they have questions, they’ll raise hands or something. Perfect.
So this is part of our ongoing efforts to have as many different communication modalities as we can to let people know what’s happening with the Department of Medicine, where we are. I want it to be as always, very informal and I want people to ask questions. It might be helpful to wait till the end, but if there’s a burning question and you’re afraid we won’t get to it, feel free to stop me. I’ll just say this as I always do, everything is on the table for discussion. There’s no secrets here. If it’s a question I don’t feel like I can answer, I’ll just say that right up front. Okay. And if you don’t ask me questions, I ask you. So remember that.
So this is the format we sort of always follow, which is “where we’ve been.” I’ve been here nine months and 20 days, and then “where we are” and then “where we’re going to go.” And I’d love to get input feedback on all of this.
So this is a nice overview of the Department of Medicine that was developed by Lisa and Teresa, initially started by Shawn Roach. And I love it. It’s on our website. It shows the department starting in 1870 all the way to current and that has a lot of nice updated photos. I do think it’s really helpful for us to think about branding and for us to think about pride in our organization and to sort of also see the history. Sometimes when your students or trainees are brand new, you’re like, yeah, but it is nice to, as you get older like me, it’s nice to sort of look back.
So we’ve been here, I’ve been here for nine months and I want to talk about what we’ve collectively accomplished. None of this is what I’ve done. It’s what all of us have done, including people who are not in the room and people who are on Zoom.
So I’m just going to go over a couple of things and there’s more that’s been done, but just a few things. So we’ve done a lot of data gathering and input from all. We had a couple of sessions here and then I’ve been to faculty meetings. We’ve had quarterly updates. One of the feedback we got was that we don’t give feedback on leadership. So we’ve done reviews of the division directors, DEO, and leadership. I’ve done the faculty meetings once and after six months I’ve started going back to the divisions and it’s been good to hear directly from people.
We’ve established a new Division of Hospital Medicine, and I think that’s needed and timely and a great opportunity. And we’ll hear from Dr. Gutierrez in a minute. We’ve aligned leadership roles that support the department moving forward. So we have new leadership in Hem-Onc, BMT, Nephrology and General Internal Medicine/primary care. And then we have new leadership and vice chair roles.
We’ve celebrated a lot of successes over the last nine months. Over the last few months we’ve had medical school graduation and I’ll show some photos of our resident and fellow graduations, promotions, celebrations, et cetera. And we also heard when I did the round with the divisions, that there was concern about salary structure and compensation plan review. So the division administrators, the division directors, the departmental leadership, we met weekly with the team for about three months, had some good discussions and set the stage for next year. And we are focusing on research missions. And as I’ll show you, we’re going to initiate a number of faculty searches. So the leadership updates are listed here. We have a Division of Hospital Medicine. Jeydith Gutierrez is our interim division director and she’ll talk in a few minutes. I’m really grateful to her for bringing her talents and skills to the role and for taking on this really, really important mission.
We have two new positions, inaugural positions, Vice Chair for Professional Development and Vice Chair for Quality and Safety. We had a request for applications and a lot of individuals applied. We had a team that interviewed them. Dr. Cho was selected to be Vice Chair for Professional Development and Dr. Carvour for Vice Chair for Quality and Safety. And they wrote about what their priorities are in the last biweekly letter from the DEO. And I think that they’re also going to be reaching out to specific divisions and individuals to talk about what they see as priorities. I know that they will be very open to hearing from all of you about thoughts and ideas. They’re the leaders for these things, but there’s going to be lots of ideas and input from everyone.
So I think that’ll be important. And then we have tripartite leadership structure in the Division of Nephrology. Dr. Antes and Dr. Kuppachi have agreed to be interim co-directors, and Dr. Glenn is the senior advisor to the division. And then for General Internal Medicine in September, we’ll be welcoming Justin Smock to be the interim division director for GIM. So new faces, new talents, they will all need your support. They will all need your guidance, they will all need your feedback. They’ll all need constructive comments on how to help move the divisions, the departments, and the programs forward.
We had a lot of successes over the last several months that I wanted to celebrate. Let’s see, these are photos from the opening of MCNL [Medical Campus North Liberty] as well as here. These are photos with Abbey from the grand rounds where we gave the awards. This is a photo on day one with 12 new hospital medicine faculty and Dr. Gutierrez when they were onboarding.
This is a photo from New Orleans where a number of the residents and I were. And this is a photo from graduation. This is from Isabella’s nice event. And then this is again from residency graduation as well. So nice. And then that’s Katie Harris who gave the speech at medical school graduation. So medicine has been well represented at a lot of new events and established events in the department and in the school. So it’s lovely to see that. I’ve also been here nine months. This is my first summer. So last time I talked about surviving my first winter, I’m now trying to survive my first summer. I didn’t know it’d be this hot or humid and I didn’t know there’d be this many bugs. I didn’t know I’d have to buy a whole wardrobe for the summer because winter clothes don’t work in the summer. So there you go.
And so I’ve also been settling in by building my community and figuring out, in addition to all of you as my friends and colleagues, how to feel settled in and become an Iowan. So let’s see, there’s a couple photos. This is one where Marta van Beek, she’s in Dermatology. She’s on the board for the American Medical Association, which is a big, big, big deal. And so it was a nice celebration for her and Kim and I went. This was Employee Appreciation Day. This I think was the celebration for Dr. Grumbach. I went to the downtown [music series]. I don’t know if you can see this. Raise your hand if you know what this photo is, Ian, you better know. Yeah, exactly. So this is the band that has faculty from cardiology. I thought I took a selfie, yep. There he is. And then as well as Ian and Emma. So that was a lovely event.
And then, let’s see, this was a nice crab boil. I even took my dad to this. And then this was from the employee appreciation and we had Herky and Perky. I didn’t know what Perky was until this, when I showed this photo to my daughter who’s 20, she was like, what’s Perky? And I said, it’s with the kids. And she actually thinks Perky is quite scary. She was like, I’m not sure I’ll appreciate this. And then on a personal level, my kids are, one is in Seattle and one is in Boston. So I don’t see them often, but we got to go on a vacation together to Portugal. That was lovely. And then my dad turned 92 and my husband turned 62. So we got to have a combined birthday party for them. So that’s what I’ve been doing and keeping busy. And I will say I am feeling pretty settled in, yeah, I bought bug spray. I did buy the green one, whatever it is.
We’ve also had a lot of community celebrations with divisions and groups that are graduating and I appreciate that you invite medicine teams to that. Hem/Onc, Allergy/Immunology, Pulmonary. I do think it’s important as we start a new year with new students and residents and APPs and faculty to remember that we are a collective and that there are cyclical celebrations and cyclical opportunities for us to impact what’s happening.
So where are we otherwise in terms of opportunities and challenges? I’m going to have Dr. Gutierrez come and talk to about the Division of Hospital Medicine. I do want to say it’s not every day or every year even that a new division is created in a department of medicine. So I do want to give credit to the departmental leadership as well as the health system as well as Dr. [Theresa] Brennan and Dr. [Brad] Manning and Dr. Gutierrez, and obviously Kevin [Glenn] for how this has come about. And Jeydith is going to talk to you about all the opportunities. I will also say right up front, it is up to all of us to ensure that the division is successful. That’s an important thing.
The following section was presented by Dr. Jeydith Gutierrez:
Okay. Well thank you so much for the opportunity.
Most of you probably know me, but if you don’t, I am originally from Venezuela and this here is a picture of the first clinic where I worked as an independent practitioner back in the border of Venezuela and Brazil in the middle of the Amazon jungle. And I just realized that I was also a hospitalist back then. I didn’t know that that specialty existed yet, but it was a 24/7 operation. And I still remember the first patient that came to us was in the middle of the night at three in the morning, knock on the door. It was a venomous snake bite and I was always frightened about how to treat that. So I had just enough antivenom to treat him, which I consider a win. So that was good. He did fine.
But now 15 plus years later, here I am at Iowa. I have come a long ways, about more than 3000 miles for those wondering, and it is my pleasure and I’m very excited and humbled for the opportunity to lead our brand new division as interim director. It is a big operation. We take care of patients at all these five campuses. And at any given day we probably take care of about a third of all inpatients across all these different campuses. It’s a large volume of patients and it does take a village. I am very excited to care for these patients. We have 25 APPs, so we have an amazing team of APPs and about 60 MDs that carry out these daily activities in the Iowa Rehab Hospital. We share our providers with the Iowa City VA, as many of you know.
We have many services at the main campus and also take care of patients at North Liberty on the downtown campus services.
So I am extremely thankful to have an amazing team. We’re welcoming 24 new of those 60 faculty members that we have. So welcome them, greet them with a good Iowa Nice spirit that we always have, help them find their way if you think that they’re lost in the hallways. We do our best to orient people, but they’re still amazed and it’s hard to find our ways in MCU.
We also have a few ongoing recruitment efforts for the town and the Iowa City VA, so we’ll probably add even more faculty. And I don’t take credit for this amazing recruitment season. I want to make that clear. I really am extremely thankful for the efforts led by Dr. [Upi] Singh, Dr. Manning, Dr. Andy Bryant and Dr. Teri Brennan to just really make this happen with a lot of partnerships, the health systems and others that it’s given the division a head start. We couldn’t have done it [without them]. And this is the first time, by the way, in the 10 years that I’m here, that this will take us to almost fully staffed by the end of the winter. So it’s the first time that we will get to almost fully staffed. This is not increasing our services or our FTE.
And this take us to where we want to go. What’s our vision for this new division? And I think that can be summarized in one sentence that is “delivering the best medicine will lead to the best outcomes.” Keeping the patient at the front and center of all that we do, delivering the care for the patients in the same way that we would want to be cared for. Those are the things that are going to lead to improvement in these metrics that we care about.
We don’t want our providers to discharge patients early because it improves length of stay. We want the providers to do that because it is the best for the patient because it will decrease hospital acquired conditions. And because it’s ultimately what the patients want to go back home and to be there with their families when they can be or to be at a facility where they will work on their rehab.
We want providers to become great communicators, not because it will improve patient satisfaction, but because it will improve the care for the patient because it will give them the tools and the resources they need to succeed when they leave the hospital. And also it will improve our own interactions and experience with the patients, making them more meaningful and more satisfying of practicing medicine.
And we want to provide the best, most updated health care for our patients, not because it will improve our Vizient metrics, but because it’s the best thing for the patient, because it will improve their outcomes and because of what is we all want for ourselves or our loved ones. That will all lead to hospital savings, no doubt, if we get better at this. And we will monitor these metrics, but again, I want to ensure that we don’t lose track of the most important thing and the reason why we’re here is for the patients.
With that in mind, I do think that we’ll become the best hospital medicine division in the Midwest, maybe in the country, because we do have a lot of talent in here already and we have the opportunity to expand in different areas, but we already have a lot of critical missions in clinical research and education.
We are going to focus this first year on increasing our clinical capacity and strengthening our clinical operations, which is the biggest need. But we also want to start working in some of the other aspects increasing research and education. We have a lot of resources and again, excellent providers, Dr. [Eli] Perencevich, Dr. [Peter] Kaboli are leaders nationwide in hospital medicine research. We have others working on quality improvement, clinical educators that are nationally recognized, and we want to increase their visibility here too. We want you all to know these people because they’re part of our divisions and we’re very proud of that and we want to expand these opportunities for our new faculty that are joining us.
The biggest challenge that we have, and if you have been here for a while, you probably know, is that we have a high turnover rate. If you have seen our providers, you know that many of them will go into a fellowship path within two or three years. And to be clear, I don’t think that’s a bad thing. I think that many of our hospital medicine providers have gone into your own fellowships and that makes them probably better clinicians and more rounded. They understand the system, they provide excellent care for our patients and I think that that’s a valuable asset that we have and I think we should continue to provide those opportunities and paths. But it’s very challenging with about 70% of our providers turn over every two years. So we do want to strengthen the other paths that allow people to stay as a hospital medicine provider and to have joy and enjoy this as a long-term career.
We want to have our clinician educators become a stronger part of our medical education from medical school to residency. We will want your help to help us mentor them in giving lectures, in giving grand rounds, in being present for all of these clinical missions. We want to be part of our quality improvement initiatives and as we are the front line of the care of the patients, we can have great opportunities to impact culture and behavioral changes, and we want to support those that have academic research.
And the last thing I want to ask from everybody is of course collaborations to make those a possibility and also feedback. We want honest feedback, we want constructive feedback, but we also want the positive feedback that will help us elevate our providers, recognize them and support the positive behaviors and the great things that they’re already doing. Thanks.
The remainder of the presentation was given by Dr. Singh.
That deserves a round of applause for sure. So super excited about the Division of Hospital Medicine. Any given day, we collectively as a department take care of about 40-50% of patients in the hospital. Hospital medicine is a big part of that and it’s going to be a big part of helping with all the initiatives we have, decrease length of stay, improve quality, improve communication. So I’m really excited about this.
So where are we going? We’re going to have lots of time left for questions. I don’t want people to worry that we’re not. We have a division director, search for HOBMT, and the details are listed here. The search has been initiated. We’re working with Spencer Stuart, that’s a search firm. I’m really grateful to Dr. David Stoltz and Dr. Ayotunde Dokun, who are co-leading the search. The search committee members are listed there. The best practice in the school of medicine is to have members from basic science, clinical research and other. And so the other members are Kim Staffey and Manish Suneja, from the department, Vikas Dudeja, who’s the new DEO for Surgery. He’s a pancreatic oncologic surgeon. Chris Pettker is the DEO for OB-GYN, Dr. [Jon] Houtman and Dr. [Dawn] Quelle, who are PhDs, and vice chair of MNI and in neurosciences, respectively. And then Jessica Zimmerman is a more junior faculty member who’s an MD in Peds Hem-Onc. So I’m grateful to the committee members for taking this on.
The QR code talks about the job description and has all the details. So this is a really important effort for the department. I’m going to need all of your help and input and guidance both on when people come through for interviews and to attend seminars, et cetera. We’ve had two meetings with the division where we’ve discussed the search, gotten input from them, had the search committee chairs, et cetera, come. So I think that’s an exciting important endeavor for the department.
From a clinical perspective, we’ve had some big steps this year. This was the one year anniversary of MCD in January of 2025. Right now we have providers from infectious diseases, cardiology, pulmonary, hospital medicine, nephrology and GI already there. Primary care also has a footprint at MCD at the Heartland Drive location. This fall we expect to have cardiac EP there as well as expanded GI services. And as volume and acuity change we will have to reevaluate the scale and scope of medicine.
I know that when MCD first came on, it brought a lot of groans and concerns from faculty and trainees alike. I want to show this to show everybody how much work is actually going on behind the scenes and how much effort we’re doing there. MCD still has opportunity for growth in EP and GI for example, but even on the surgical size, only 40% of ORs are being used, et cetera.
So there’s going to be a lot of push from the health system to make sure that we’re fully using this hospital, which will always, by definition, mean increased need for Medicine. The fact that Medicine is so all encompassing and that wherever something grows where needed can be seen as a challenge, I see it as an opportunity. We have an impact that we can make in any clinical footprint in the system and I think that’s really exciting. We also were involved in initiating the services at MCNL. So ID and hospital medicine are already present there on a daily basis. Endocrinology is hiring I believe an APP to go there, and we will continue to evaluate additional needs as volume and acuity grow.
Right now, I think it was like 32 out of 36 beds on a regular basis are being utilized. I believe they have 10 ORs. I think eight are open. I think they have the capacity to increase four to six more, so the hospital is already, in month one, pretty busy. Patients love it, just FYI. It’s a beautiful space. The doctors love it, which is wonderful as well. I think that my prediction would be that more acute, more complex patients will end up there because I think Ortho, the nurses, and everybody are going to want to be there. So we’ll see. As that happens, I will need all of your input and guidance for helping if we have to provide cardiology or other support there as well.
All of this is work in progress and I just want to recognize how hard everybody is working and appreciate all your efforts. I know that maybe it feels like we don’t say that enough, but all of this is a success because of all of you. None of it is something that I’ve done alone and I’m really grateful and I want us to hear feedback. Myself or Grant or any of the division directors or all of us, feel free to email and say “here’s opportunities, here’s challenges.” It’s okay to have both come at the same time, but I do appreciate that.
From a research perspective. I mean I don’t know what’s the same as this time last year, probably not much. So a lot of changes are happening. There’s obviously significant uncertainty at the national scale, and I’m saying this, you all feel it on a daily basis, but I want you to understand that we get it both for funding priorities as well as indirect rates, NIH budget, et cetera. The NIH budget, I think the reconciliation will be, well, Congress has gone home for summer, but I think it’ll be in September, so we don’t have that yet.
I want everybody, I said this last time, but I just want everybody to hear that the institution and the department are fully committed to this mission. And in many ways I do think this is a potential silver lining for us to take advantage of. There are institutions that are cutting back, there are institutions that are instituting hiring freezes. There are places like NIAID and other places or CDC where people are leaving. If we are timing this correctly and if we are prioritizing this, I think this can be a silver lining for us to recruit great people here. I do think we have to think about mitigating these challenges. I think it’d be naive to say that this is only an opportunity. It’s a challenge.
I think if I was continuing to do research at this time, I would think about how to do team science approaches. I would think really strategically about research topics. And I’ve written here, don’t think just about bridging, think broader and think about how to lateralize your skillset and experience. And I think that’s good advice in any given day ever. But now with specific challenges that are happening, whether it’s global health, certain types of research, I think we’re all going to have to think about this. I also want, I think everybody’s already doing this, but you have to think beyond NIH and think about industry and foundations and I wanted to list some resources that I think are available for all of us. I just want to say it out here.
I think people know this, but obviously your division director, our vice chair for research, Dr. [Chad] Grueter, our vice chair for professional development, Dr. Cho, and then colleagues and mentoring committees. I want people to take advantage of all of these individuals. It takes a village at the best of times to be successful in research and it’s going to take a village now especially. And then we are also sort of thinking through new funding approaches in the department, specifically thinking about seed grants that we could launch that might help mitigate some of this.
We are also initiating a number of cluster hires, going back to our commitment to the research mission. And so we have two cluster hire recruitments to support and rejuvenate the research mission of the department. The goal is to have a search for 4 to 5 faculty in each of these two clusters. I’ve listed them very broadly here and we’re happy to get input. So one will be Cardio/Pulm/Onc/Metabolic/inflammation and the second will be more health services/data sciences/outcomes research/AI. We have co-chairs for the searches. Dr. Cho and Dr. Grueter are going to co-chair this search. And then Dr. [Phil] Polgreen and Dr. [Diana] Jalal will co-chair the others. So I’m meeting with them next week to form the full search committee, engage, and then I want all of you to engage with us in the next steps. And that’s going to include all of these things, outreach, interviews, recruitment. I think this is again a great opportunity and we want to sort of move fast and get good people here.
In terms of education. Everybody knows this is an ongoing priority for our department, but I want to call that out. We’ve had a lot of successes and the departments want to welcome the new interns and fellows. I don’t know if people know, but OSCE has been rebranded to Clinical Skills Coaching. I didn’t know about this program until recently. They’re in their ninth year. And I don’t know . . . Manish, how many departments did you involve this year in doing this training?
Dr. Suneja: Close to eight or nine.
Upi: That’s awesome and nice publications around it, nice reputation for the institution, but also the department where all of this started. So congratulations to all of you.
Recruitment is always a challenge. I just want to remind faculty to volunteer with residency or fellowship PDs for when the season starts. And then I also want to make a call out for DDs and PDs in the divisions that residents are always looking to engage with subspecialty faculty. So if Manish or any of the other PDs reach out to you and say somebody wants to do research and X, Y or Z, please make your faculty available. This is the next generation. I think it’s a great opportunity to retain some of our best. And so I think that’s important.
This is the incoming class of residents and incoming class of fellows. I was at a party and ran into people and they said they were on this photo and so here they are. So it’s nice. It’s good to have so many new faces. I always think, as you get older you reflect, I always think the youth and the exuberance and the excitement and the potential is phenomenal, and we want to encourage people and give them all the opportunities as well as your wisdom. So I think it’s a great opportunity every year when we get new people.
Other issues we’re working on just as we end: compensation model. We did hear that this was a concern for many faculty. So as I mentioned, the DDs, DAs, and department leaders met regularly at the end of FY25 to look at the current comp plan and identify opportunities. We’ve already made some adjustments for junior PhD faculty and those adjustments have already been implemented for FY26. We were working very quickly, but we felt we couldn’t do a big adjustment for the entire department thoughtfully and carefully enough without getting input.
So we are going to continue to work with the DDs and DAs and plan to make some changes for FY27 while restarting some intensive reviews in the late fall or early winter. And as the work progresses, we’re going to be committed to doing division outreach and conversation and getting input.
I just want to say there is no one perfect comp plan. You can never make one perfect comp plan even if there’s all the money and all the reimbursement in the world because how we prioritize or support X, Y or Z seems to imply what we value and we value all of these things. So I’m going to need all of your input, guidance but also grace and tolerance as we try to develop a plan that supports as many things as equitably and transparently as possible. We also are looking at financial and operational assessment of the department.
I think I mentioned last time that there have been definitely some challenges. This will be completed by the health system and department leaders. We’re going to look at current opportunities as well as challenges and we’ll share the outcomes with division leaders and ask them to share it forward with all of you. Our philosophy in the department has been full transparency. So from week one we’ve been sharing with the divisions, the numbers, the data, the opportunities, the challenges, and we’ll have them take it forward to you as we share them. There is no way for the department to be successful if we don’t share with you all the amazing things. But also then all the opportunities and all the challenges.
We’ll also do an annual department review. I think this happens every year. It’s an annual review of the department. It’s planned for early 2026. I think Dr. [Denise] Jamieson will come. Last year she came with Brad Hawes as well as Dr. Winokur. I think that will happen as well. And then the other new thing that will happen this fall is a seven-year department review. This is the time for the department to be reviewed. It’s an every seven year thing. It’s led, led by the dean’s office. It will include internal stakeholders and external stakeholders, and that’s planned for spring of 2026. I show you all this to let you know that the department is going to be busy getting all the data for this. When we reach out to DAs and DDs and staff and say, we need help with gathering this. We have to make a booklet for the external reviewers to look at.
And then as we are doing the financial operational assessment and compensation model, we’re going to engage all of you in the process just to sort of remind us of where we were and where we’re at. Now. Still tons to do, but I think tons of opportunities. I’m happy to help answer any questions and see what things that we didn’t address that you’d like to hear about on a regular basis or if there’s other questions or concerns. Thank you.
Questions & Answers
Audience member:
Thanks for that presentation. I’m wondering, I agree that it’s a good time to take advantage of other people’s losses from recruitment. That makes a lot of sense, but I’m wondering where that funding is coming for that when faculty salaries haven’t kept up with inflation over the last several years. How is it that we are going to be able to afford to bring more faculty on board?
Upi:
So yeah, those are good questions. And I’m not saying we recruit 30 more researchers. I’m saying four to five in each cluster and what we’re doing is instead of saying to each division, go ahead and hire two research faculty. We’re sort of doing it across the board. So that’s one thing. The second is I negotiated a startup when I came, so we have dollars for research hires. I think as a department we should decide whether it should be all physician scientists or physicians versus PhD. I think there’s pros and some challenges with both approaches. I think being strategic.
Denise says that if you’re not leading, you’re lagging. And I think we have lagged unfortunately for a little bit of time and we need to start leading again. So it is a tough time. There isn’t an unlimited amount of money. We do have to take care of the faculty who are here now, and this is not to bring in new people and ignore the individuals who are here who may have challenges, but I think we have to do both things. I think if we don’t, we’ll fall further behind. In terms of compensation, I do think compensation is maybe not where it should be. I think it has gotten better over the last several years. We’ll continue to look at that when we do the comp review. Thank you for asking.
Audience member:
The New York Times had a piece a couple days ago looking at the proposed Medicare reimbursement changes that start January, 2026. Which would include that 2.5% cut for all procedures as well as a move away from complexity to time-based compensation. Is the department, is the institution strategizing for if those come to pass as it looks like they might?
Upi:
Yeah, so that’s the case-based index and the complexity care for individual things. The bigger elephant in the room is Medicaid cuts, which have already been approved in the Big Beautiful Bill, or Big Beautiful Law now that was signed on July 4th. The Medicaid impact is phenomenal to the institution. It’s going to be about a 1.5 billion loss over the next 10 years, starting in two years. There’s also a part of that bill that was 50 billion for rural states. It’s not clear how that money will be allocated. Equally to all states, or whether people will apply. Or whether half of that will be equally allocated to all states and then the other half you apply. So the Medicaid billing and those things, the health system leadership are modeling numbers on a daily, weekly basis about what this means. What can we afford to do, what can we not afford to do, what can we really not afford to do but must be done?
And so we have to figure out a way to do it. The article and the new thing you talked about is pretty new, so we haven’t modeled how that will be. I will say, how do I say this? I do think it’s a risk of course, right? No ifs, ands, or buts. But I think it’s a risk that we’re going to have to work pretty aggressively at trying to mitigate as much as possible. So whether that means that we bill differently or code differently or do more time-based billing or do other things, I think yes, yes, and all of it we’ll have to do.
Was there an opinion piece or something that I read that the AMA used to be like the elephant in the room and you didn’t go against the medical community? So medicine and science do seem to be in the negative camp right now and we’ll have to see how that plays out. I will say, yeah, we are in a better position than many places, surprisingly. So there are many systems that are running in the red as institutions. We are still running in the black, not in the black enough to build everything we need to build, but we are. There are other places that are having freezes for hires.
We are not at that. I think we’re also not at that because we so far have not been in the limelight of the schools on the east and west coasts, but that could change at any time. I also do think, and Denise has heard this from us, that we are pretty far behind on many things including infrastructure. And then recruiting and faculty things has to still stay priority. How we do it all, how we mix and match what’s going to be the thing. I don’t think we know, but a lot of bright people are looking at this. And the other thing I mentioned last time as well is I do think this is a big priority obviously for Dr. [Barbara] Wilson at the university leadership. And so a big advocacy with both state as well as federal seats.
Audience member:
A related question. Over 60% of the hospitals in Iowa are critical access hospitals. And I don’t know the finances, but I suspect this bill is going to really affect those. Are our leaders factoring that in in terms of what the university is going to do in terms of the patients who no longer have access to care in their communities?
Upi:
So it’s a good point. It’s a concern obviously. I think it’s a concern for every place, but I think for Iowa, we’re the only academic medical center. We will stay upright whereas other places may close. I think that’s a big concern. And I think they’re strategizing to get more information on this $50 billion that’s going to be available to rural hospitals and strategize how to make sure that we position us better. Whatever we get, even if we get 5 billion or 10 billion of it, which we won’t, we still cannot take care of every patient in the state without access or telehealth or something else. It is a tough time overall. It’s a tougher time in Iowa because some of our other demographics. We have sick patients in the hospital. We have really sick patients. And every time I round with the chiefs, I’m amazed at how complex the patients are. So either people inherently are sicker or wait until they’re sicker to come here or we’re a referral hospital, so we get everything. It’s good training though.
Audience member:
I think earlier in the year you mentioned in your presentation about staff and faculty satisfaction, I think with some of the stuff that came from Press Ganey that was done, I was just wondering, is there going to be part of this evaluation that’s coming up that we get to see some of that stuff from Press Ganey in more detail and more the department and division level?
Upi:
Yeah, the employee engagement survey, we shared those with the divisions and that has staff and faculty and I presume the division shared it forward, but we can do that again. As a part of our departmental review that just happens here where Dr. Jameson and Dr. Winokur come with Brad Haws. But as it is part of the larger departmental review, I do want to make sure that we always are thinking about our collective team with faculty, APPs, residents, fellows, staff. I’m going to guess there’s some really common themes, and then I’m going to guess there’s some very specific themes. And so I do think we want to keep our attention on it. If you have ideas of ways to engage differently or more, I’m happy to hear that.
Audience member:
In terms of the new tower and the other building plans, does any of this get affected by the current situation?
Upi:
Everything gets affected by the current situation, because it’s substantial. But I think the commitment and the need that we have to improve our physical infrastructure, to get away from semi-private rooms, improve the ORs, is there. That’s what I can say. I asked this question of Brad Haws, I said I know this is going to get asked of me. So everything is on the table, but knowing the priorities is pretty important and I think those things are recognized.
Audience member:
In terms of maximizing our income as a department, as divisions, as individual faculty. I think that we need more resources to tell our faculty exactly how to do that because we get feedback on coding. Is your documentation in accordance with your billing? But we’re extremely conservative here. No one ever tells you if you do this, you’ll get more money. And I think we really need that information. And I don’t believe I learned that in medical school, residency, fellowship over the last 30 years as a faculty member very well.
Upi:
Yeah, you raise a good point and I think I’m glad to hear you say that. So true. We are very conservative in Iowa everywhere. On this as well. I do think in medicine we tend to be very conservative. We think we went into medicine to take care of people and the money is too unrelated. We did go into medicine to take care of people and to do research, but money does make the world go round. And I do not feel in any way, shape or form any shame or any concern. I’m not money-hungry to say, please bill and do the appropriate things. Right? Because at the end it’s the clinical mission that is going to help support financials for the research mission, for the education mission, for the mentoring mission. So I’ll work with Grant and the team to sort of figure out exactly what there is.
I think with coding, I think there’s other opportunities for sure. And I am glad to hear you say that. Here’s a senior faculty member who’s saying, listen, we have been in this bubble here. Other parts of the country, the east and west coast, they’re doing this. They have been for 10 years. Nobody here goes and gets their car fixed. And expect that the people feel bad about what they charge you. They charge you what they’re going to charge you. And we in medicine for whatever reason, have felt like we are not going to worry about the business of medicine. We’re going to worry about the care. And that’s fine. I think care is, as Dr. Gutierrez said, items 1, 2, 3, and 4. If my dad is in the hospital, I want the best care regardless of the financials, but the financials do make the world go around. We have to just acknowledge it not in a way that’s harmful to the care we provide, not in a way that’s unethical or immoral, not in a way that’s illegal, but in a way that’s appropriate for what we’re doing here.
Audience member:
So one of the complaints I hear from the community is that there are no primary care providers. And the people in Iowa City and new faculty are surprised. Is that a priority?
Upi:
It’s a huge priority for the department and for the institution. I don’t know if Dr. Glenn is here. I think we are losing five primary care providers this year. Is that right? For retirement and others? So it’s a huge challenge. Recruiting primary care has been challenging. I was having this conversation with Denise Jamieson and she’s like, but you have to think about what would bring them here. And I was like, okay. So there’s many issues, right? I do think, I’m just going to give an example. I do think part of the reason that Dr. Glenn and Dr. Guttierez and others have been successful with hospital medicine recruitments is we finally right-sized the salaries.
It is kind of about right-sizing some of the things we need to right-size. So primary care is my next priority with the health system. And the good thing is when we right-size the salaries, we got 24 new faculty plus maybe, hopefully more. And to recruit a hospitalist and lose a hospitalist costs us $400,000 per person. Because you recruit them and you onboard them and you train them and they’re not as productive in years one and two. And then by year three they’re good and then they have to leave. Come on. So I do think, I understand that we tend to be more conservative fiscally in other ways, but I think you have to invest in the things that are important. And to me, for example, the research faculty and primary care is an example.
Audience member:
Coming back a little bit to Dr. Kline’s question. So as someone who does some time both at the university and at MCD, I’m really struck by kind of the MCD billing approach. And I would just reiterate in my university new faculty coding audit, they were accusing me of overbilling. And what makes me concerned is how many people are not fighting back with the coders here.
Upi:
I took your comments forward to Brad Haws and I was like, Hey, this is in the same system. Why is it that our docs notice this difference? How we can bring good things that are there here, whether it’s with coding or other things. So I took that forward.
So Dr. Stoltz forwarded that email to me and we’re discussing that with the health system. I think it’s probably not just you and not just your division. Everyone.
Audience member:
So just want to bring up the VA because it’s big. We’ve been thinking it’s going to shrink or disappear, but it looks like the budget’s stable. So that’s good to know. But in addition, CADRE, thanks for mentioning our center. We’re one of only 14 academic medical centers. So the postdoc fellowship program for health services, the center, and also VA Quality Scholars. So that’s a lot of resources that we can be proud of, can recruit into. So it’s great to see Diana Jalal and Phil are looking into health services. And then lastly, completely underutilized–I wish he was here–is Peter Kaboli, he’s our National Director of Officer Rural Health. He sits on over $350 million of research funding to expand in rural health. He’s never mentioned in the college, he’s rarely mentioned by the department. We really need to involve him somehow in this. And so we can help do research in things like critical access hospitals and community care and things. So the huge opportunity, he’s not going to be in that position forever. So I encourage you to, as someone, and maybe you could do that through Hospital Medicine. There is research money that could expand your portfolio.
Upi:
Yeah, no, that’s a great comment. And I do agree. And that’s why I was also sort of saying think about what people’s research priorities are and how to lateralize to a slightly different thing. And that is, we know, I mean, number one, it’s a need for Iowa, right? And number two, it’s also going to be I think a national priority.
Audience member:
Yeah, I just want to make a comment regarding primary care. I think we have amazing residents who are primary care physicians and they’re staffed by us. And I do think that a lot of think they think of faculty, but just remembering that they’re there as a resource, they’re excellent physicians. And so if you hear of colleagues who need a new primary care doctor really recommend our residents, they’re fabulous. And then also just wanted to thank you for next year. We’re going to have a new chief resident of ambulatory with the idea that they will be a role model to their peers and in our training and hopefully help us. Just wanted to acknowledge that.
Upi:
Yeah, I’m glad you mentioned that. So I think, yeah, next year that’ll be great. And then we’re also working with the division directors and the division administrators to think of creative solutions of how we can keep some of our trainees.
We have eight minutes for those burning questions. Are these sessions helpful? Yes. No. Yes, we should continue? I’ll take a quick poll. So we have these sessions quarterly. I’m coming around to meet with divisions. I send out an email every two weeks of just sort of random thoughts and a good photo usually. How many of you read the email every two weeks? Keep your hands up if you like the email every two weeks.
Okay, the last one had a picture of my dad and me. Did you see that? For those of you who didn’t see it, I was on his shoulder. I was like eight months old. I showed that picture to my dad and I said, happy 92nd birthday, papa. I said, he stays very young, mentally and emotionally and physically. And I said, you’re always carrying me on your shoulders. And I showed it to him and he started crying, very sweet, but he remembered exactly where we were, whose backyard we were in when we got that photo taken.
Okay. And then so wait, what was the thing? Oh, so you guys read that and then these are helpful to sort of get an overview. I do think everybody’s working very hard, but sometimes we’re siloed and we don’t actually know everything else that’s happening. So I do think that hopefully this is important.
Are there other mechanisms or venues or ways that we can improve communication in a department of 450 faculty, 2000 total people, you can’t over communicate. And I know that some people read emails and others don’t, but if there’s other ways or venues that you think we could do that, please do tell me. My other job is to make sure the department is elevated at the institution and the school. And so you see me with selfies with every event that happens because I go and I represent medicine, I represent all of you. I think that is an important thing. But if there’s other places that you think I or the division directors or the leadership should be doing more, tell us.
Audience member:
The NIH has announced significant changes in funding priorities, specifically stating that they will no longer fund animal-only studies. Has the institution discussed the strategies to enhance our access to IPS organoids-on-a-chip and related technology?
Upi:
Yeah, thank you so much. That’s a great question. So that funding priority came out recently. We are talking at a school level to think about what this means for individuals. It’s not easy to have a specific aim that’s animal in one specific aim and a second that is clinical. It’s not trivial. So I think thinking about ways to mitigate that will be really important. I also saw, I noticed that anyone, I think this is true, that one faculty member won’t be able to submit more than six, either initial or revisions or others per year, excluding T-grants and something else, U or some of the R series. I mean, so six for you, but six is not that hard to do. I was routinely submitting two. So we’ll have to think about how to work smarter. And it’s not just, I mean, I always say it’s about shots on goal, which it is. But then also to make sure, I do think Dr. Grueter has a really nice program for people to share grants and other things before. So I think the more we do, whether it’s with your review committee, whether it’s with your DD, whether it’s with Dr. Grueter and others, I think, but that’s a great question. I’ll take that comment forward.
Audience member:
So we’re starting, there’s an epidemic growing of measles, and I think it’s an opportunity for development for the medical school to educate people in Iowa about the importance of vaccines. How would we do that?
Upi:
So I’m on the board for the Infectious Diseases Society of America, and we talk about this all the time. It is a really, I mean, whatever your beliefs are one way or the other politically, the fact that science and evidence-based medicine and X, Y, and Z are vilified is a concern. There is an epidemic.
Audience member:
I was going to say that we have been contacted sometimes for community organizations to go to participate in community events. And I think that going to communities, and especially if you’re invited by community leaders, it’s a good way. And I had one of our former fellows here in infectious disease actually participate in a Hispanic radio station event to educate people about measles specifically, so kind of finding ways where the message could go to some of the people that might need to hear it and not have the access to the information as opposed to going to the ones that don’t want to hear it.
Upi:
Outreach is really important. I think having people who speak the language or the community is going to be the right for me.