The following is an abridged and edited transcript of the December 11, 2025, Quarterly Department Update. To view the entire presentation, click here (hawkid login required).
I want to start by saying thanks for attending. Looking forward to a good conversation and happy holidays for those who celebrate. I hope that whether you do or don’t celebrate that you do get a little bit of time to spend with family and loved ones.
Today, we’ll do the same format that we always do. We’ll talk a little bit about where we’ve been, where we are and where we’re going. The last several times we’ve done this, we’ve had different groups present their programs. We had Hospital Medicine presented by Jeydith Gutierrez and last time it was Dr. Smock. And then today we’ll have Ben talk about Immunology.
Again, as I said last time, I get the privilege of sort of presenting where things are at, but it’s really the combination of a lot of people. So where we’ve been, I’ll start by showing pictures as I usually do. Those who know me know I love nature and this was like a bucket list for me is to see the northern lights and I did get to see them. That’s right outside my backyard. That was pretty amazing. And I did, I must admit that I really loved the fall. This snow is more nature. I mean it was pretty and white. I don’t know what to say about that. There’s some personal pictures here. I was invited to a hoedown at that country bar off of Highway One or whatever. Anyway, so look at me, my husband and I, we actually got dressed up.
And then the other personal photo on here is this one. That’s me. Maybe you do or don’t recognize me. That’s me. Many years ago, this little baby, that was my daughter. We had adopted her maybe three days before. We just had her for three days and she and I have the same birthday. And in November, she is right there, she turned 21. So that was a very timely moment. And so it was a lovely birthday. It was the Iowa-Oregon game and both my daughter and my son surprised me and showed up. So that was one of the best things.
Lately we’ve also had a number of other things that I’ve enjoyed. I went to ID Week in Atlanta, saw a bunch of our ID folks, got to meet people whose faces you might recognize that I know from the ID community as the former director of the CDC and the former director of the NIAID. I went back to California and saw a bunch of friends and colleagues. She’s the division chief who recruited me and then I was chief for many years and this third person is now chief. So it was awesome.
We’ve had lots of other great celebrations here. This was a lovely event to honor one of our senior faculty in genetics for mentoring and a really nice talk on AI and medicine. And I will say Dr. Stoltz did better than AI for that event. So that was great. And then recently we had a nice celebration that the residency program put together. So congratulations to Dr. [Michael] Welsh, but also to the residency program and the chiefs that had a very nice event on Tuesday where we celebrated Dr. Welsh, who’s an alum of our residency program. And I took a selfie with the chief residents.
We also had a couple celebrations. The LCME site visit was fantastic. We got really, really, really, really good feedback. And there was a nice celebration that Dr. Jamieson set up with Amal [Shibli-Rahhal] and then this was a cape they made her and it said LCME Champ, LCME Champ. So we’ll get the formal results sometime in early 2026, but it was really nice and two years of work went into that to celebrate. So these are some of the things that I’ve been up to and I hope you don’t mind me sharing.
What I want to talk a little bit about is the clinical impact of the Department of Medicine system wide. I’ll show you some data from MCNL, both with work from hospital medicine and infectious diseases, some impact at MCD, both with cardiology and GI and then also some data system-wide on the Vizient mortality metrics and then also some information on patient experience and providers who are just knocking it out of the park.
So hospital medicine is one of the two services from medicine that’s present at MCNL. They’ve seen a lot of patients in the PEC clinic. The hospital has 36 inpatient beds. This is a number of surgical co-management consults, and this is the team and the medical director at MCNL, Maneet Multani.
And they’re doing a good job. I think we have to honor and congratulate people. A new hospital is no small feat and there’s always going to have some growing pains as well as some growing opportunities. This is an example in my mind of where medicine, hospital medicine has taken the flagship, is taking it forward and will help both the patients but also grow our presence there. I think Endocrine is also starting, but I didn’t have that yet.
ID is one of the services that’s there as well. So they’ve taken care of a number of inpatients and outpatients. This is Poorani Sekar, she’s the primary ID provider, partners with orthopedics for consults for presurgical evaluations. And is partnering and teaching the ortho residents and is leading the ID rotations for new ortho apps. And then Martha Carvour and Ben are providing a number of weeks. And then Endocrine, we have an APP [who] started this month, so in December. So that’s awesome. So three of our services have an important presence there, and I think that’s great.
For MCD, we’ve had growth in EP from the cardiology division. So the EP lab opened on 10-20-2025. As with everything, starting an EP lab is not trivial. Took a lot of teamwork from people here as well as at MCD. And they’ve completed a large number of cases. They’re open five days a week. They have approximately 20 cases a week. Much of this is anesthesia-requiring cases, in fact, all. And so what we’ve really done is decrease the wait times for those patients and they’re also able to do some inpatient EP cases, which we’re hoping is going to improve patient experience, reduce length of stay, and also some of the burden at MCU. So congrats to the Cardiology team and the EP team.
And then the GI-Hepatology team has also worked hard again as a team with a lot of groups, and they’ve increased their capacity for anesthesia-supported cases by about 64 patients a week. There’s presence at the Jefferson Street Clinic with APPs for outpatient clinics as well as an inpatient APP service. This has really taken off. Patients are enjoying the experience. I think our providers are enjoying the experience. We’re partnering with a community anesthesia team. They’re super efficient. I have heard really good feedback from patients. I think it is at times honestly challenging our GI docs, so again, we want to be appreciative of what they’re doing to help us get better care out to our community.
And then this is what I wanted to show. This was shared by James Murphy at the last CSC. This is looking at Vizient adult mortality. And so this is where we were at 1.14 and you can see where we are month by month. So this is July of ’23 to December of ’24, and this is the sort of maybe the new norm at 0.93, which is great. The reason I wanted to show this is when he presented this, he talked about the different initiatives that were implemented. So an ICU checklist, a MICU review looking at trauma and the Obs estimated length of stay, and a hospitalist review. And when he presented this, he talked about the fact that this improvement started in December of ’24.
It’s now been sustained for many months and he actually called out all the departments and divisions and gave kudos for their impact on mortality. He called out internal medicine, I highlighted it in yellow: pulmonary division, hospital medicine, palliative care, and cardiology. Of course it takes a lot of people from other services, but I always want to highlight and point out when we see great acknowledgement of what all of you in medicine are doing to help our patients.
And recently the Office of Patient Experience identified 96 clinicians who are in the top 10 for patient experience for fiscal year ’25. This shows the number of people in Internal Medicine from 2022 to ’25 that are recognized, and we had the highest number this year, almost a hundred. So each of those individuals were notified and congratulated. And I want to highlight that even when things are hectic and busy and it’s stressful, people are doing fantastic jobs clinically taking care of patients, communicating with them, and helping mortality and other metrics. So thanks to everyone for all of this work and thanks for those who support them.
I want to talk a little bit about where we are in our challenges. We’re busy, busy, busy with faculty recruitment. We are searching for an HOBMT division director. We’ve had a couple candidates on site and further on-site interviews are forthcoming. We’re in the middle of a basic and translational cluster hire. We had an initial round of on-site candidates this week. A number of highly qualified candidates have applied and if you have any further questions, Jocelyn and/or Chad are able to help answer. I do think this is an incredibly, incredibly important effort for us to build our research program and to continue to build on it.
We also have an outcomes research cluster hire, and so there’s going to be on-site candidates in late December, early January. There’s good enthusiasm and I know that the co-chairs, Diana and Phil, have talked to all the division directors and are really doing a lot of outreach. And so please if you have ideas or thoughts, please help with that. The one thing I’ll say is when people come to talk or when people are here, I know everybody’s busy. I don’t question that everybody’s not busy, but it’s great if we can show a good in-person presence, engagement, questions, right? People come probably not for the weather and maybe not even for necessarily the building. They come for the people, they come for the collaborations, they come for the ideas, they come for the conversation. They come to see how they’ll be mentored, how they’ll grow. And that really can only happen by meeting all of you.
We also have some new leadership at the VA. I think it’s been announced, but I just want to make sure everybody is aware that Dr. Diana Jalal has been appointed as chief of specialty medicine effective end of December and she assumed her acting chief role early December. I think many of you know, she’s a professor of medicine in nephrology and she’s previously served as a deputy chief of medicine at the VA and more recently as the associate director of CADRE. And then Lee Sanders. Lee, are you here? I didn’t know if you knew I was doing this, but I did knock on your door yesterday. I knocked and you were gone. Sorry, my apologies, but I did.
Lee Sanders: I was at the VA. [audience laughs]
Oh, good job. Good answer if I can ever not find you. You’re at the VA. So Lee’s been appointed as interim deputy chief of specialty medicine effective December. You all know he’s a clinical associate professor of medicine, co-director of the medical student internal medicine clerkship and director of the kidney transplant program. I gave him kudos the other day because I was on a Zoom listening to him present the clerkship results. And it’s not trivial to sort of make everyone happy, to meet all the metrics, to work with a changing demographic of trainees, and you did a great job. So congratulations to Diana and to Lee, and I look forward to seeing everything you’ll accomplish.
A quick research update and thanks to Lori [Bassler] for putting this together. People have asked a lot about the F&A rate. I think we know that’s still in litigation. I think most people know there’s a new NIH biosketch that’s going to be required at the end of January. From what I hear, you can still use the old bio sketch until 2-6-26. Our industry clinical trial revenue has been pretty steady, which is great. And this is amazing: the faculty and the trainees here have just submitted a record number of NIH grants this fall and those are listed here.
It’s an uncertain time and people are nervous, but I do think if we stop taking shots at goal, there will be no goals. So I do think it’s really important for all of us who are senior, for all of us who have trainees, for all of us who are mentoring junior faculty to keep encouraging this. I do think things will stabilize and get better, but I just want us to be positioned in the right place. If we stop taking shots at goal, there’s almost no hope. So keep taking shots at goal, and good luck to all the people who are applying.
I see the residency program leaders here. So the residency interviews, we’ve had 16 dates for categorical and two days for med psych. Over 225 candidates interviewed, a lot of faculty in this room and others have assisted with the program interviews, and Match Day is March 20th, so we will look forward to hearing good news then.
And then our fellowship match, our results just came out. This is where residency grads have gone in the last six years. This year there’s 12 residents that are staying at Iowa. There’s five incoming chief residents that the team has been able to recruit, and then a number of incoming fellows in pulmonary cardiology, hem-onc and GI. Seven of our residents are going to other fellowships in the US, and we have 39 incoming fellows and I think they’re on the board outside. I saw them. So, congratulations. I do think as we recruit faculty for research, recruiting trainees is sort of like reinvigorating, re-energizing, and I think that’s such an important thing.
So I’m going to give this over now to Ben who’s going to talk about the Division of Immunology.
Dr. Davis: Thanks, Upi. So it looks like we have a good turnout today. I assume that everybody’s here to hear me talk. So I do have the pleasure of introducing you to our group, the Division of Immunology, and I think this is at least for me going to be enjoyable because I get to really do some bragging today. So I’m going to tell you about the bright shining spots in our division, and that’s going to include:
- Our people
- Our fellowships
- The different clinics that we offer
- Our research program
- Our national representation
- Our growing scholarly productivity
And then we’ll have a few slides just focused on the theme of growth at the end.
So to begin with, this is a Division of Immunology and it has two sections, the section of Allergy/Immunology and Rheumatology. And I’m showing the allergy/immunology providers here first because I’m one of them, and it’s also alphabetical. So we’ve got eight providers. So moving from left to right, our assistant professor is Jeff Zavala. So he’s been with us for the last couple of years. He’s native to Iowa City. He’s actually a third-generation physician. Some of you may recognize his last name because his grandfather is a well-known or was a well-known pulmonologist here, two associate professors including myself and Bharat. I’m going to talk a lot more about Bharat in the coming slides, so I’ll wait until then. Two professors, Zuhair Ballas, who is a prior division director, and I’m very thankful that he’s sticking around to give me advice and mentor me. And Amy Dowden, who I will also be talking quite a bit about in coming slides.
We have two APPs on the allergy immunology side, Brooke and Lauren. They’re wonderful teammates and great providers, extremely intelligent. Brooke is the lead APP for our division. She also is the lead APP for the Division of Infectious Disease. And then finally, Deanna has a secondary appointment in our division, but we really consider her one of our own. She helps Amy run the drug allergy clinic, which I’ll point out in a few slides.
Next is the rheumatology side. So this is much larger, almost double on the size of the allergy/immunology side. We have six assistant professors, the top three here, Ayesha, Lemon, and Qatra. We just hired her over the summer. And the bottom three started over the last couple of years. Of these six, five of them were prior fellows. So we’ve done a really good job in retaining our own. And three of them are on a research track. So Lemon, Qatra, and Gulsen are all pursuing a research career.
Four associate professors. Again, I’m going to talk a lot about these four coming up, so I’ll save my breath. And then two full professors on the rheumatology side, Petar Lenert and Rebecca Tuetken. Peter will be moving or transitioning to emeritus role come this spring. But he has been instrumental in being a main scholarly mentor, particularly for the rheumatology side. And then we also have two APPs on the rheumatology side. Equally good team members and equally smart is our allergy APPs, Taylor and Rhonda.
This is our admin team led by Danielle Allen, our division administrator. We share her with infectious disease. Danielle built this team and I’m really happy to have this group. So we have Lynne and Dylan as our admin service specialists and Andrew Huizer who is both our division and fellowship coordinator. These four are great people. I think everybody in our division would agree to that. Just great personalities, hard workers, and they’re just very personable. So they’re just a joy to have around.
And then we have seven emeritus faculty. The first two actually were also prior division directors, Bob Ashman and Scott Vogelgesang. Scott really acted as my main mentor as I stepped into the division director role. And then the remaining five continue to remain active within the division, either in an academic fashion or in social fashion or both.
Next is our fellowships. So our fellowships I think are a really strong point to our division. We have a fellowship on either side of the division. So Amy Dowden is the program director for allergy/immunology and Bharat is the program director for rheumatology. Bharat also oversees the dual certified pathway, and this is a pathway that fellows can enter and get certified in both sides of the division or both subspecialties, allergy/immunology and rheumatology. I’m not sure if Bharat’s here today, but okay, you can correct me if I’m wrong on this, but I believe we’re the only active dual cert program, not only in the country but globally. [Dr. Kumar nods.] So pretty neat thing. Each program, the allergy/immunology and rheumatology program, has recently increased complements. So they’re both growing and this is the third year that we’ve matched in the top 10 for all of our fellowship spots. So great job, Amy and Bharat.
Amy and Bharat have also done something pretty spectacular for the division and that is they’ve been awarded multiple fellowship grant awards that are helping fund our growth. And so you can see this growth occurring over the last three years. Moving into next year, we’re going to have over $350,000 to help fund fellowship spots.
These are our fellows. We’ve got four rheumatology fellows, two dual certified fellows, and three allergy/immunology fellows. We are currently actively recruiting Amir and Truman. So we have Dana, Truman and Cassie as our allergy/immunology fellows there. We’re currently recruiting two of them, but to be honest, if I can recruit all of them, I’m going to do my best.
We’ve got an interesting portfolio of specialty clinics that we provide to the hospital and the institution. On the allergy/immunology side, we have a drug allergy clinic, an eosinophilic esophagitis clinic, a severe asthma clinic, a complex disease clinic, an immune dysregulation clinic; on the rheumatology side, a vasculitis clinic and a scleroderma clinic (I’m going to tell you more about those coming up), a Sjögren’s clinic, immune related adverse events clinic, a pregnancy in rheumatology clinic, a peds to adult transition clinic and an autoinflammatory clinic. And with regards to our inpatient consult services, services that we provide really span the entire hospital and that includes pediatrics.
This is our core research personnel. So Craig and John are our main basic scientists. Craig’s work focuses on gamma delta T cells and tumor biology. And John’s work focused on t and b cell maturation and signaling. Aleks Lenert is focused on autoinflammatory disease and he is a recent K23 awardee. Hanna Zembrzuska is our clinical trials director for the division and she’s really been doing some impressive work and I’m going to show that in the next slide. Qatra and Lemon are co-leading our vasculitis clinic. Qatra was the one to start this clinic a few years ago, and Lemon has joined this summer. They’re really beginning to make a name for themselves within the field of vasculitis and putting Iowa on the map for vasculitis. And Gulsen Ozen, who’s now going into her second year here. She is also on the research track. Her focus is scleroderma. She actually, just in the last few weeks I think, was awarded a rheumatology research foundation award for young investigators.
This is clinical trial grant awards that we’ve had, and this is really because of Hannah’s work. So you can see over the last couple of years she’s brought in multimillion dollars in clinical trials to the division and to the department. By last count, she had somewhere between 15 to 17 open clinical trials and still enrolling. So just an extremely hard worker and we’re really proud of what she’s doing.
Next is our academic research grant awards. The years that I’m showing here are the years of my tenure as a division director. In 2023 this represents Alex Lenert’s K23. The other story to this slide though, I think is what we see in the coming the following years. So you can see this increase in submissions and awards over the last three years. And I think this represents the effort that’s occurring from our junior faculty that we’ve invested in to begin their research careers. And so we’re starting to see that pay off and we hope to see that continue.
With regards to medical school and residency education, we have a couple of faculty that are involved in these things. Jenny Strouse is the assistant program director for the Internal Medicine Residency program and she’s also the director of the Distinction in Medical Education or the DIME track for the residency program. Brittany is very involved in the medical school as you can see here. She is the course director for a number of courses. The first one, editorial writing for medical students, is a course that she designed. She’s also the course director for Medicine and Society II for the humanities distinction track in the medical school and the Personal and Professional Compass program. And she’s a nonfiction editor for The Examined Life journal, a journal put out by the College of Medicine.
From a service perspective, we have three faculty that are involved in various aspects of service around the institution. Zuhair oversees the Diagnostic Immunology lab and the flow cytometry lab. Bharat is the current VA immunology section chief and he’s also a co-program director of another fellowship. So I think that makes three fellowships. They’re at the VA, the Health Systems Research Fellowship. And then Rebecca is the medical director of the Medicine Subspecialties Clinic here at university campus.
With regards to national representation, Zuhair Ballas is the editor in chief of one of our flagship journals, the Journal of Allergy and Clinical Immunology, which has an impact factor of 11. Barat is a physician editor for the American College of Rheumatology or ACR Journal, The Rheumatologist. Petar Lenert is the associate editor for TouchReviews in Rheumatic and Musculoskeletal Disorders. And Amy Dowden is on the board of directors for what we call the quad AI (AAAAI). And Mary Beth is also on a board of directors for the World Allergy Organization.
Now I’m going to show you some growth that we’ve been experiencing within the division. So this is our publication productivity over the time that I’ve been in this role. Coming out of COVID, you can see that we were struggling a little bit, but we’ve really taken off in the last few years. And again, this trend is something that I hope to continue to see increase.
Outpatient encounters, we’re also seeing increase. I’m going to show you some data on faculty recruitment. And so for sure, some of this is just attributed to increased numbers, but that doesn’t tell the whole story. Our providers are more productive in general over the last few years as well.
So this is our faculty growth. I started as division director in FY22. We’re now in FY26. So we’ve grown from 16 faculty members to 23 in that time. By this coming summer, based on our current recruitments, we should have 27. And we have a recruitment plan looking about a year and a half down the road. And if we’re successful with everything, we will have more than doubled the size of the division just in the time that I’ve been in this role.
Then I want to end just as Upi pointed out on some of the great things that our people are doing. This is fairly hot off the presses. I think the Patient’s Choice Awards were announced in the last couple of weeks. These are the providers that have been awarded this award in our division. So we have seven providers. We had 20 providers that were eligible for the awards. So of those that were eligible, this is 35%. So that’s a pretty remarkable amount I think, for the size of our division. And I think it just speaks to the type of people that we have.
And then the last thing I wanted to touch on is I think something that is neat about our division. Not to say that it’s unique. I’m sure other divisions have a lot of these same things, but I think it’s what makes coming to work enjoyable. So it’s our people. And so just to explain a little bit about some of the culture that we have in our division, we have five division committees that help advise me and Danielle on decisions that we make for the division. We have a social committee that helps plan all of our social events, and I’ve listed some of those social gatherings down here. So we have a beginning of the year event that usually happens at one of the breweries in town. This year is actually the first year that we are going to have a holiday party. We’re actually having it at The Cidery as well, I think a week after the department has it.
And then I think as everybody does, we have the end of the year fellowship graduation. Throughout the year. We have quarterly potlucks and we also have an ice cream social for our first-year fellows when they first come in July. With regards to our other committees, we have what we call a sustainability committee. And this is really focused on things like wellbeing and feeling included and things that may help retain our faculty. So that activity includes many different things that I don’t think I have the time to go into here. We also have a research committee, a committee focused on our fellowships, and then really a split committee focused on the number of clinics we have. If you look across our division, we have obviously two sections. We have clinics at main campus, IRL, VA, we have some peds clinics. So all said, we have about seven different clinical groups and clinical support staff that we work with.
We also have a monthly newsletter that I’ve been putting out. I think since this past summer, Dylan, one of our administrative service specialists, has stepped in and has really spiced this up. And so this is an example of what December’s cover of the newsletter looks like. And I’m thankful that I don’t have to do that work anymore. So thank you, Dylan. And then another unique thing I think is that we’ve been having yearly retreats. So for the last three years we’ve been meeting at the beginning of September just to talk about where we’re at and where we’d like to be going as a division. At first I was a little hesitant about it, but now I actually look forward to it. I think we all learn a lot about what each of us is doing and what we want out of the division. So it’s been a good experience.
So with that, I just want to thank everybody for their attention, their time. I will just end with a little bit a blurb personally about me. So this is my family. This is us on spring break in Key West, just this past spring break. So my wife, Sarah, is a dietician in the MICU here and our two boys. They’re both extremely active in all things sports. One plays guitar, the other plays piano. Our nights and weekends are just as busy as our days. So it’s chaotic, but it’s a good chaos. And then obviously me and I just want to point out that even though I’m in tropical paradise, I’ve got a University of Iowa Hospital shirt and jacket on, so I’m representing. All right, thank you.
Dr. Singh: That was awesome. Do people have questions for Ben while he’s up here? I think it’s really nice. So even those of you who’ve been here for many, many years, the divisions grow. The divisions change, the divisions evolve, and it’s great for us to hear from somebody within the program. And so we’ll do something like this every time we have this, to present each group.
So just a few slides about where we’re going and then happy to take questions. So we have a couple of upcoming events in addition to everything we’ve talked about. Remember you have faculty searches, DD searches, and then we will have an annual department review. I’m putting the dates here so people can put it on their calendar and come on Thursday, January 15th, 12 to one right here. This is the department review and Q&A session with Deans Jamieson, Winokur, and Hawes. And I’m thinking Bevan Yueh may also come this year. That’s the chance for people to ask questions of the health system leadership. And then at a certain point, I will leave the room and people can give input.
And then there’s also going to be a seven-year departmental review that will happen, which is an academic program review from the provost, which will happen actually on my anniversary. So happy anniversary to me, I suppose. And it’s a great opportunity to get external individuals to come look at our department, tell us where we’re doing well, tell us where there’s opportunities, tell us where there’s some challenges. And I look forward to that.
That’s really all I had. I do want to end by wishing all of you the best of health for 2026. I wish us all stability and joy and happiness and not so much snow. I will admit to that. And happy holidays! I’m happy to answer any questions that I could.
Audience question: We’ve heard about the institution having some financial issues, which obviously has a lot of impact on us. Now I’m wondering what the cause of that is in the sense that clearly there’s reduced reimbursement coming down the road from federal programs and that’s not going to be good. But also, we bought a new hospital, we built a new hospital, we acquired an expensive cancer center. How much is the output for those affecting the overall revenue growth?
Dr. Singh: So just to repeat the question, current financial status of the health system and UIHC is not as great as we would’ve hoped. And how much of that is impacted by all the sort of output we’ve had to acquire hospitals and building hospitals? So I don’t know that I can answer the second part. I don’t think it is actually. What I can say is this year there’s substantial issues to us meeting budget, and it’s probably multi-factorial the things that are causing it. Some of the things that we think we can do to fix and some of the things that are going the wrong way is definitely our length of stay is going the wrong way. We need to decrease. We’re probably 1.6 days above estimated length of stay for each patient and we’re going the wrong way. We’re increasing that. So there’s a huge, huge, huge effort as a health system each day that’s excess in the hospital is about $3,200. If we can decrease excess days, we would save about $23 million. So there’s a lot of effort to that.
The other thing that has happened, and I think this is unfortunately a chicken and an egg situation. I was on service last week and I will say the one thing I’m so impressed by is everybody’s doing absolutely their best to take care of patients, number one. Number two, patients are sick here. They’re really, really, really sick. They’re complex. And three, they come from far away. So very, very rural state as you know. And so one of the challenges that I think that’s happened is that we have a hard time getting our patients when we’re going to discharge them in for imaging or procedures. And so I think what may be happening is with all the best of intentions, we keep them here two or three extra days to do that CT scan, to do that MRI, to do that biopsy. If we had better access, we’d be able to send them home where it’s safer for them, in all honesty, right? You’re not going to have hospital-acquired infections and other issues and just bring them back. But because we’re seeing challenges on the outpatient and procedural sides, we keep them in house. So I think that is one of the things. I do think our services seem to be in need more and more.
The funding climate and the concern you have about reimbursements that have come up in the Big Beautiful bill haven’t actually even started. That’s the scary thing. Those things and the issues with Medicaid and other cuts haven’t even started. That will happen a tenth one year at a time over the next nine to 10 years. We’re talking this year, we are having financial challenges. I’m not a finance person, maybe Grant or somebody else. So I think definitely Mission was a big investment. I think in the long run, hopefully it will pay out, let’s say it we’ll pay out for cancer patients and for the state. But some of the challenges we’re having this year I don’t think are related to that. MCNL, from what I understand, I mean obviously I’ve seen it and we’ve been into this beautiful site. Clinics are full, ORs are full, hospital beds about half full. So sort of a lot of work within the system to sort of figure out who are the best patients to be seen there safely so we can offload beds here.
So our amount of utilization of traveler nurses has gone up. And so that is expensive. We all know that. So I think part of the reason we are not meeting budget is length of stay has gone up. Our amount of utilization of travelers has gone up. So that’s some of it. The other thing is that with MCNL happening, with buying MCD, I think the thought was that our access would improve and it would get fully used and maybe it didn’t happen as well as we’d hoped. So there’s a big incentive initiative to sort of push through.
I will say, let me take the other side. You’re talking about money. I’m talking about patient care. So at the end of this, if our length of stay is higher than it should be, if it’s taking us an average of one and a half to two days to get patients out, what it means is that our ED is full. Last time when I was on service, I had to go see patients day after day after day in the same ED bed, day after day after day. Not great. You don’t want to be there. You don’t want to be examined in the hallway. So when length of stay is up, when we can’t get patients home safely, what it means is that we have patients waiting to get transferred here. We have patients in the ED. It’s stressful for everyone. And we are not, as far as I know, a hospital that could say no to a bunch of sort of transfers and other things. I do think whether it’s not, let’s take money out of the system regardless of the money, we have to fix some of these issues of access and length of stay. Because over the next several years as smaller hospitals or sort of catchment area hospitals have financial issues, we’re only going to get busier.
So I do think the C-suite, we talk a lot about money and I understand it’s important, but also I want us to focus on patient care and access, which is really what we’re here for.
Audience question: So there are a couple of initiatives I’ve seen at the state level, the government is trying to push through. One is the increase for residency spots and two is the increase for telehealth funding for health. How are we managing that and are there opportunities for us to increase residency spots?
Dr. Suneja: So a lot of those spots are Family Medicine, Psych, and now they’re also pushing for, they’re now looking at university level partnership. They’re looking at some of the off-sites, Mason City and other places. The problem is a lot of those residency spots already go vacant in the Match. So about 78% of the spots don’t fill. So now there’s going to be even more spots which don’t fill through the Match. So I think we need to figure out what is the right solution? How do we create partnerships? How do we still maintain? So that is a work in progress. We are, from the college level, we are actually looking into seeing how do we actually use the Big Beautiful bill, which has some money to actually expand our rural footprint, those and the education footprint. So that is all in the works. So hopefully there’s going to be a lot of research grants which are going to be coming out, hopefully if we get some funding from the state. So it’s not been appropriated. I think the appropriation is still, we’ve asked for money, but the appropriation still hasn’t happened.
Dr. Singh: There’s also, as a part of the reduction in Medicaid and other funding, there’s supposed to be money for rural states to provide care. And so the timeline is very, very short. But it looks like there’s going to be four or five initiatives that we’ll participate in as a health system. One is on cancer access and screening for rural populations, one is for primary care, one is tele. Do you remember all? I don’t remember all of ’em. So those conversations are starting. We’ll pull people in. We need access for cancer screening in remote sites. And there was one more cancer lung screening and one other, anyway, maybe it’s breast, but I’ll look it up. GI access. So I mean, I think in all of these efforts, a lot of the health system people are leading it. A lot of the groups are, I’m going to these meetings. And as there’s a need for telehealth or others, we’re definitely pulling people in. I actually think without tele we won’t survive. But then I think there’s also sort of some uncertainty about what it takes to implement a really effective program statewide. Costs and then reimbursement that becomes a bigger issue. Grant, did I miss anything?
Grant Worthington: No, you’re correct. And there is a broader health system group that’s looking to your point of telemedicine infrastructure. So partnerships with other community organizations as well.
Dr. Singh: And when we’ve talked about the rural health stuff, I’ve mentioned Peter [Kaboli]’s program at the VA and said, let’s talk to him and sort of figure out what it is. This is through the governor and it’s going to be, I think a billion dollars a year. And so they want to have ideas, but then they want sustainability. And the question is really, in all bluntness, whether they want UIHC as the hub and spoke, or whether they’re really looking at smaller community places. So my impression, my feeling is that if we are seen as a big, whatever, big gorilla in the room, that takes up resources. People may not want us to be the hub or in the spoke, but the reality is, in my opinion, there’s no way for these smaller places that have 20 hospitalists, 30 hospitalists, but no subspecialists to actually function. So our strategy and outreach team has been doing a lot with going and trying to build up partnerships.
Dr. Suneja: That’s exactly what the expansion in residency programs is going to look like. That there is a core program. And are we able to support some of the residency spots all across, right.
Dr. Gutierrez: Exactly. But I think that there is that opportunity to also fill some specific needs. Even like a, for example, like a med-peds program that can feel a lot.
Dr. Singh: We’re talking about med-peds. Yeah. As a partnership. Yep. A hundred percent. Other questions?
No other questions. So I’m going to wish you all a happy holiday. Stay safe, stay healthy, come back energized in 2026. Thank you.