ANNUAL REPORTexemplary training for this year’s 142 residents. Clerkship and fellowship programs...

ANNUAL REPORTFY16

Contents03 Department Snapshot04 Department Leadership06 Clinical Highlights08 EducationHighlights10 Research Highlights12 Culture and Diversity Highlights13 Engagement Scores14 Financial Highlights15 Philanthropy16 Events17 Goals for FY1718 Department Outlook

UAB Department of MedicineAnnual Report FY16

Department Snapshot

The Department of Medicine drives medical education, accelerates discovery, and delivers extraordinary patient care at The University of Alabama at Birmingham.

The UAB Department of Medicine (DOM) is organized in 11 divisions, which are its major cultural and operationalunits,withacentraladministrationthatsupportsandcoordinates the DOM enterprise across the divisions and in partnership with the rest of UAB Medicine.

CLINICAL We care for people.

DOMengagesactivelyinvirtually every aspect of UAB Medicine’scareforourpatientsand community, from care for the underserved to UAB’s concierge practice,fromtransplantationofcells and solid organs to care for patientswithcomplexsystemicdisease. DOM physicians account forapproximately38%ofUABHospitalAdmissionsand23%ofambulatory visits.

RESEARCH We create knowledge.

We are proud of the major discoveries reported in top scientificjournalsthisyear and the faculty that were invited tomembershipintopnationalhonorsocieties.Ourgrowingresearchportfolioaccountsforroughly45%oftheSchoolofMedicine NIH funding.

EDUCATION We train physicians and scientists.

Oureducationalprogramsareallthrivingwithexcellenceacrossthe spectrum of learners —graduate students, medical students, residents, and fellows. Our physician-educators have been consistently recognized as outstanding teachers who prepare thenextgenerationofdoctorsandinvestigatorsforsuccessfulcareers.

SUSTAINABILITY We aim to thrive.

DOM has 415 faculty, 233 trainees,andover1,200staff.We are providing professional developmentopportunitiesforall our people, whom we consider our most valuable resource. Our financialoutlookispromisingthanks to strategic stewardship.

CULTURE We love what we do.

Diversity is an important means of strengthening our faculty and staff.Wehavedevotedourselvesto removing unconscious biases andtoexaminingourapproachtorecruitmentandretention.Wehave embraced the challenge of creatingacultureofrespectandinclusion for all.

Ourmissionistoadvancehealthandrelievesufferingbycaringforpeople,teaching,andcreatingknowledgeusingcollaborativeandsustainablemethodsthatpromotediversityandexcellence.

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Anupam Agarwal, MDDirector, Nephrology

Monica Baskin, PhDVice Chair, Culture and Diversity

Ravi Bhatia, MDDirector, Hematology and Oncology

Robert C. Bourge, MDSenior Vice Chair

S. Louis Bridges Jr., MD, PhDDirector, Clinical Immunology

and Rheumatology

Cynthia Brown, MD, MPHDirector, Gerontology, Geriatrics,

andPalliativeCare

Department Leadership

Ourtalentedleadershipteamguidesoureffortstorealizethetripartiteaimofacademicmedicine:research,education,andpatientcare.OurChair,ViceChairs,andDivisionDirectorsbringincredibleexpertiseandpassiontotheirroles.

Dr. Landefeld came to UAB in September of 2012. He is an internationallyknowngeneralinternistandgeriatricianwhoseteam invented Acute Care for Elders (ACE) Units. In 2016, he was appointedtotheUnitedStatesPreventiveServicesTaskForcetoexaminetheevidencebaseforpreventivehealthservices.Hewas also named Laureate of the American College of Physicians, Alabama Chapter.

C. Seth Landefeld, MD, Professor and Chair

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Cynthia Joiner, PhDAssistant Vice Chair, Research

Carlos Estrada, MD, MSDirector, General Internal Medicine

Sumanth Prabhu, MDDirector, Cardiovascular Disease

Elizabeth Turnipseed, MD, MSPHViceChair,ClinicalAffairs

John I. Kennedy Jr., MDVice Chair, Birmingham Veterans

AffairsMedicalCenter

Mona Fouad, MD, MPHDirector,PreventiveMedicine

Kenneth Saag, MDVice Chair, Faculty Development

C. Mel Wilcox, MD, MSPHDirector, Gastroenterology

and Hepatology

Jeanne Marrazzo, MD, MPHDirector,InfectiousDiseases

Stuart J. Frank, MDVice Chair, Research; Director,

Endocrinology, Diabetes, and Metabolism

Victor J. Thannickal, MDVice Chair, Strategic Planning; Director, Pulmonary,Allergy,andCriticalCare

Lisa Willett, MD, MACM ViceChair,Education

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Amongthemostimportantmeansofdeliveringoutstandingpatientcareareour ambulatory clinics, primarily The Kirklin Clinic, as well as our satellite clinic locations.InFY16,DOMincreasedthenumberofpatientsseenby9%andreducedcanceledappointmentsto1.3%. Outpatientsatisfactionincreasedaswell.InfectiousDiseaseswasinthetop2%nationallyandNephrologyinthetop6%.

Clinical Highlights

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Medicine Services

Lung Transplant. DOM recruited a newdirectorandtwoadditionalfaculty members, increasing full-timelungtransplantfacultytofour.We are consistently improving outcomes. The most recent data shows a risk-adjusted one-year mortalityindex(O:E)of0.65forthe 52 transplants performed from January 2013 – June 2015.

Pulmonary Access Clinic. Established toreducewaittimesfornewevaluations,EDandhospitalfollow-up, and acute pulmonary issueswhenapatient’sprimarypulmonologist is unavailable. Facilitates appointments within one week of referral request and same-day add-ons.

Blood and Marrow Transplantation and Cellular Therapy Program. Following careful analysis of factorsaffectingoutcomes,wedesigned and implemented an actionplanthatinvolvedprogramrestructuring, realignment with established hospital services, and monitoring of outcomes in real time.Preliminaryevidenceofimproved outcomes is encouraging. Theprogramcontinuestogrowwith 188 transplants completed in 2015 compared to 163 in 2014 and 132 in 2013. Our goal is to complete 220 transplants annually.

Cardiology-TAVR. AsofAugust29,2016, we performed a total of 480 life-savingTranscatheterAorticValve Replacements. The new

TAVR procedure eliminates the need for open heart surgery and offersashorterrecoverytime.Oursuccessrateisextraordinary,withamortalityindexof0.29.

Faculty Practice. WearestaffinganewDOMfacultypracticeto support our sub-specialists andmitigateACGMEcaps.Theexistingpulmonarywardservicewillfoldintothefacultypractice,allowingustoexpandconsultativeservices and hopefully increase hospital throughput. The faculty practicewillalsostaffthenewSpecialty Care Unit designed to improveweaningofpatientswithcomplicated respiratory failure throughaggressivemobilizationandreductioninvariabilityofcare.

Tinsley Harrison Teaching Service. Continuestobeahospitalmodelin terms of low overall observed toexpectedmortality,lowsepsismortality, and length of stay. As of the end of June, overall O:E byadmittingserviceswas0.86forTinsleyHarrison,0.90forHospitalist and 1.05 overall. Sepsis relatedO:Ebyadmittingserviceswas0.96forTinsleyHarrisonand1.39forHospitalist.LengthofstayindexthroughJuneforTinsleyHarrison was 0.86 and 1.04 for Hospitalist.

Ourpeersandourpatientsrank DOM programs and our physicians as the best in the nation.Fivesubspecialtieswereranked in the Top 50 by U.S. News and World Report, and 53 of the Top 100 Physicians at UAB are appointed in the Department of Medicine.

Cardiology

Endocrinology

Pulmonary

Nephrology

Rheumatology

2015 2016

Programs in US News Top 50

Top 100 Physicans MPCAHPS

53%

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Education Highlights

TheTinsleyHarrisonInternalMedicineResidencyProgramcontinuestoprovideexemplarytrainingforthisyear’s142residents.Clerkshipandfellowshipprogramsarealsohigh-performing,thanksinlargeparttotheextraordinaryphysician-educators in the Department of Medicine.

OursatisfactionscoresontheACGMEsurveypointtooureducationalsuccess.Residentoverallevaluationsrankus98%positive/verypositive;faculty100%verypositive.Ofthesixdomains,ourprogramexceedsnationalmeansonfive(faculty,evaluation,educationalcontent,resources,patientsafety/teamwork)andequalsnationalmeanonone(dutyhours).

OurABIMBoardpassratescontinuetosurpassthenationalaveragewitha2016UABpassrateof97.5%(nationalpassrate89%).Thisbringsour3-yearrollingaverageforUABto96%(upfrom95%).

James Willig, MD, MSPH, one of the co-directors of the IM Clerkship, was named SOM Assistant Dean for ClinicalEducation.WinterWilliams,MD,isnowtheMS3 Clerkship Director and Brooks Vaughan, MD, is Associate Clerkship Director and Director of the MS4 ActingInternship.

Dr. Vaughan has also developed a new MS4 curriculum andambulatoryexperiencefortheMS3clerkship.ForthefirsttimeinUABhistory,sixfacultyinTheKirklinClinicareprovidingopportunitiesforMS3studentsonIMclerkshiptotraininprimarycarecontinuityclinic.Students began October 24, 2016, with a new case-based curriculum for ambulatory medicine.

We had three faculty recognized by the medical students with Argus Awards this year: Michael Saag,MD,wonBestEducatorinPatient,Doctorand

Society. Former clerkship director James Willig, MD, MSPH, won Best Educator in Pulmonary, and Shawn Galin, PhD, won Best Educator in Endocrine Systems.

Our Department was also thrilled that Ashita Tolwani, MD, received the UAB President’s Award for ExcellenceinTeaching.

Kreisberg Awards for Faculty Development:• Monica Agarwal MD, $15,000 provided to

obtainaMastersinMedicalEducationforHealthProfessionals, Johns Hopkins.

• GauravJain,MD,$8,700providedtoparticipatein SGIM TEACH program (2 year) and AAIM Skills Development Conference.

• StephenRussell,MD,$2,200toattendtheStanford Medicine 2016 Skills Symposium and the Southern Society of Bedside Medicine, Johns Hopkins.

Residents in Training » 117 Categorical 16 Medicine-Pediatrics 9 ABIMResearchPathway

Fellows in Training » 93 Fellowsacross14specialties

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Ourproactiveeffortstoincreasediversityamongunder-representedbackgroundsintheresidencyprogramarecontinuingtobuildmomentumunderthe leadership of Latesha Elopre, MD, MSPH, Program Director of Diversity and Inclusion,andthemembersoftheDiversityEnrichmentCommittee.

Diversity/Special Interest Groups Invited Interviewed Ranked Matched

ABIM Research Pathway 19 17 4 2Alpha Omega Alpha 107 78 68 10Females 167 128 82 12URM - African American 20 19 6 0URM - Hispanic 17 14 8 3URM - American Indian 1 1 0 0

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DOM is proud of its robust research environment, with notable clinical discoveries in hypertension published by Suzanne Oparil, MD, and Cora E. Lewis, MD,MSPH(SPRINT).VictorJ.Thannickal,MD,andRaviBhatia,MD,wereelectedtotheAmericanAssociationofPhysicians.WillGeisler,MD,andJeffreyCurtis,MD,MPH,wereelectedtotheAmericanSocietyofClinicalInvestigation.

Research Highlights

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NIH Funding, Grants and Investigators

Inthepastfiveyears,theDepartmenthasgrownfrom80NIH-fundedinvestigatorstoover100,andthenumberofgrantshasincreasedfrom140to180,witheachinvestigatorholdinganaverageof1.7grants.

About40%oftheyear’spublicationswerefirst-authoredor senior-authored by DOM faculty, with 12 appearing in majorscientificjournals.

NEJM – 5JAMA – 4Science – 3

InadditiontoarobustandgrowingNIHportfolio,theDepartment of Medicine is proudofitsexpandingnumberofinvestigationssupportedbythe U.S. Department of Veterans Affairs.DOMfacultygarnered7new VA research awards in past year, bringing our total to 26 VA-funded awards.

1,315Publications

20VA-FundedInvestigators

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

$70,000,000

$80,000,000

40

60

80

100

120

140

160

180

200

2011 2012 2013 2014 2015 2016

■ Investigators ■ Grants ■ Funding

TheoverallNIHportfoliohasgrownapproximately35%since2011,with$78,053,639millioninfundingrankingtheDepartmentas#16inthenation.Weaimtocontinuethattrendoverthenextfiveyears,addinganother $20 million in grants to land solidly within the Top 10 in funding.

Akeystrategyistocontinuetofocusoncultivatingearlyinvestigatorsuccess and K-awardees. The Department established the Walter B. Frommeyer,Jr.,FellowshipinInvestigativeMedicineasanannualresearchaward designed to support a two-year intensive, mentored research experiencewiththeintenttodevelopmoreK-awardedfaculty.WearedelightedtoseesixnewKawardsissuedinFY2016,increasingthetotalto26awards,upfromanaverageof10overthepastfiveyears.

Grants by Mechanism

F K P R01 R Other T U Total4 26 18 74 25 9 24 180

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Culture & Diversity Highlights

Ourdynamicandcollaborativeacademicprofessionalscreateaculturethatis vibrant and thriving. We have made important advancements towards ourobjectiveto“recruitandhirefromadiverse,qualifiedgroupofpotentialapplicants to secure a high-performing team drawn from a broad applicant pool.”

Inaugural Vice Chair

The Department selected an inaugural Vice-Chair for CultureandDiversity(VC-CD)to,amongotherduties,provideleadershipinactivitiesrelatedtoincreasingfacultydiversity.ThesearchcommitteerecommendedMonicaBaskin,PhD,fromacompetitiveapplicantpooloffiveDOMfacultyrespondingtoourrequestforapplications,andshewasappointedbytheChair.Dr.Baskinexemplifiesourobjectiveforbuildingahigh-performing and diverse faculty.

Her appointment brings a faculty member who is Under Represented Minority (URM) to DOM leadership and adds to the number of female leaders in our Department. Dr. Baskin is passionate about implementingstructuralchangestoensuretherecruitmentandretentionofhigh-qualifiedanddiversefacultyandhasledmultipleactivitiesinthisarea.

Recruiting Best Practices

OurVC-CDhasidentifiedandledevidence-baseddiscussions with Division Directors and Administrators concerningtheneedtoensuresufficientnumbersofqualifiedURMandwomenininterviewpoolsto increase the likelihood of hiring a more diverse faculty.ThisinitialworkisbeingfollowedupwithindividualmeetingswitheachDivisionDirector

andAdministratortoreviewcurrentpracticesforfacultyrecruitmentinordertofinalizeaDOMfacultyrecruitment“bestpractice”guideandassociatedtrackingdocumentstomonitorprogressovertime.

Additionally,wehaveworkedwithourfacultysearchfirmsandTheChalkerGrouptodevelopmoreeffectivestrategiestoidentifyhighly-qualifiedURMandfemale faculty for ongoing faculty searches and how to best present UAB and Birmingham when a diverse candidate makes a visit to campus.

Visiting Lecturers

OurDOMCultureWorkGrouphasworkedtoidentifymore diverse speakers for guest lectures such as MedicalGrandRoundsandVisitingScholarstoidentifypotentialfacultyrecruits.

IM Residency

The Tinsley Harrison Internal Medicine Residency DiversityCommittee,ledbyLateshaElopre,MD,isexpandingeffortstorecruitmedicalstudentswhoareURM by engaging historically black medical schools andpersonalizingeffortswithinternapplicants.

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Engagement ScoresFACULTY SATISFACTION » 82%

Feedback: Areas of StrengthFaculty are proud of the Department and UAB, indicatingtheywouldrecommendUABtofamilyand friends who need care. They believe the Chair is responsive to feedback from faculty, and that they are treated with respect at UAB.

Feedback: Areas for AttentionFacultyhaveexpressedconcernaboutapossiblegapbetweenmenandwomenincompensation.Theyhavealsoidentifiedanopportunitytoengagefacultyineffortstoincreaseclinicalefficiency.

EMPLOYEE SATISFACTION » 84%

Feedback: Areas of StrengthEmployees feel respected by the persons they report to, and in turn respect their supervisors. They also enjoy the work they do and believe their teams work well together.

Feedback: Areas for AttentionEmployeesdidnotfeelconfidentthattheyarebeingpaid comparably to those working in other health care employers in the area.

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Financial HighlightsFY16 HSF Financials

• $3.8Mclinicaloperatingmargin• $102Kmarginafterresearchandeducationtransfers*toUABandcontributiontoAEF• -$1.4Mreductioninnetassetsafterinvestmentincomeanduseofprioryearreserves• $2.5M of reserves were used for investment, of which $2.2M were used to create or add to endowments• Received100%ofourvalue-basedmetricsfunding * Transfers are comprised of approximately $2.1M (78%) research and $600K (22%) education

FY16 UAB Budget

• TheFY16AlabamaStateandEducationTrustFund(ASETF)andIndirectExpenseRecovery(IER)budgetwillessentiallybreakevenattheDepartmentlevel.Wemanagethisallocationveryclosely.Wealsosupplementedtheeducationandresearchmissionsfromclinicalrevenuebyover$4M,notincludinguseofprior year reserves.

• Wehaveallocated$250KperyearaboveandbeyondtheDOM’sallocationformulatoPreventiveMedicine,our only pure research division. This is the equivalent to the earnings on a $5M endowment.

• EndowmentCorpusgrewby$10.6M.TheDepartmentinvestedapproximately$2.4MofHSFreservesandthe remainder came from individuals.

FY17 HSF Budget

• Anticipateanetassetreductionof-$1.2M(excludinginvestmentincome)• Budgeted to invest $2.7M of prior year reserves in endowment corpus• FundsFlowratesupinalmostallDOMsub-specialties• Increasedrelianceonclinicaldollarsforsustainabilityofresearchandeducation• Partnering with SOM to renovate LHRB 4 for a joint Outcomes Research Floor

EstimatedcosttoDOMofapproximately$2.5M,probablyinFY18

FY17 UAB Budget

• UABASETFallocationisflat• UABIERallocationisupby9%,or$192K

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Endowment Corpus in Millions

Philanthropy

26.4% 26.6% 96.2%1,327 Donors 19 Endowments $22.3 million

The number of individuals and corporations investing in DOM is growing.

Endowments that support our faculty in perpetuity are on the rise.

This year has seen an astounding increase in dollars raised over FY15.

One of our most important revenue streams is charitable giving, which connects generous donors to causes they care about deeply. Through the ambitiousendeavorsoftheDOMdevelopmentteam,millionshavebeenraisedforinternalmedicinetraining,research,andpatientcare.

Endowments grow both by return on investment in the University of Alabama Pooled Endowment Fund, and through additionalgiftsandpledgesreceived.

Above: DCI honored Edwin A. Rutsky, MD (left) with an endowment in nephrology that will begin as a professorship with intent to ultimately endow a chair. Donors Azita Takeshian, MD (center) and Fred Steading (right).

42.6

50.0

55.4

66.0

2013 2014 2015 2016

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Events In 2016FiscalYear16hasbeenfilledwithterrificstoriesofphilanthropy,discovery,patientcare,communityhealth,andstrategicplanning.

1 2

3

4

1. Landmark Hypertension Trial /NOV 2015 2. $1 Million Gift /DEC 2015

5. Strategic Plan /AUG 20163. Parks Rx /SEP 2016 4. S9 Care Team /APR 2016

SuzanneOparil,MD,andBethLewis,MD,MSPH,sharedfinalresultsfrom the landmark SPRINT study, published in the New England Journal of Medicine, confirmingthattreatingadults50yearsandolderwithhighbloodpressure—but without diabetes or prior stroke—to a systolic blood pressure of 120 reduces the risk of cardiovascular disease and can save lives.

TheSickleCellFoundationfulfilleditspledgeofsupportforthe UAB Adult Sickle Cell Clinic, presentingachecktotheDivisionof Hematology and Oncology.

100facultyandstaffgatheredfor Department-wide strategic planning,evaluatingmorethan50 ideas to help shape FY17 Department goals.

Mona Fouad, MD, MPH, unveiled ParksRx—acollaborationofUABMHRC and Birmingham REACH for BetterHealthtoconnectpatientstoparkswheretheycanbeactive.

EffortstoreuniteaterminalpatientwithhisfamilyinMexicobroughttheentirecareteamtogetherinanincredibledemonstrationofhumanity and advocacy.

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Goals for FY17 Clinical• Maintainandgrowclinicaloperatingmargin• Build structures to improve quality of care in

collaborationwithotherUABMedicinestructures• Ensurecontinualimprovementoftheinpatient

sub-specialty consult process• EstablishaClinicalEfficiencyTeamtomatch

HealthSystemresourceswithDOMclinical/operationalpriorities

• DeveloprecommendationsforcreationofDestinationProgramswithintheDOM

Culture and Diversity• Develop and implement strategies to increase

diversity of faculty and trainees.• Objectivestudytoidentifypossiblegapsin

compensationforfemalefacultyinDOM• Catalogknownopportunities/requirementsfor

awardstopromoteDOMfacultynominations• Support the Clinical Workgroup in establishing its

ClinicalEfficiencyTeam

Sustainability• Maintain DOM reserves at 120 days cash on hand• Increase new endowments by $10 million

• Standardize Annual Comprehensive Performance Reviews for faculty

• Develop guidelines for an on-boarding and ongoingretentionprocessfornewDOMfacultymembers

• Establish a follow up interview process for candidateswhodeclineafacultyposition

Education• Increase diversity of the incoming PGY-1 class• Ensurethateducationactivitiesarediscussedand

recognized at the annual faculty review• Enhanceincentivesandresourcesforoutstanding

medical educators• Expandlastyear’sworktoimprovethequalityof

Medicine Grand Rounds

Research• Increase NIH funding to $85M • Pursueelectionof3ormorefacultymembersto

nationalhonorsocieties• Evaluatetheincentiveprogramforresearchfaculty• Evaluatethepercenteffortrequirementandsalary

coverage among research faculty• ImprovePhDandMDfacultycollaborations• Exploreappropriatemetricsforassessingthe

impactofinvestigators’scholarlycontributions

5

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• Building clinical programs across UAB Medicine. DOMsupportofanexpandinghealthsystemwillrequireincreasedcoordinationanddevelopmentof new leaders and leadership structure.

• Funding of “over the cap” salaries for research faculty. ThisisespeciallyproblematicintheDivisionofPreventiveMedicinewhichhaslittleclinical revenue or endowment.

• Ongoing investments in research. To become aTop10departmentby2021(representingagrowth in NIH funding of $22 million annually), DOM has developed plans with all divisions and submittedarequesttoSOMfornetresearchinvestmentofapproximately$10millionperyear.

• Space and infrastructure to grow in all missions, especially research. Based on surveys of developmentplansacrossDOM,weestimateaneed of new incremental research space of about 7,000 square feet of wet lab and about 7,000 square feet of desktop research space annually forDOM.WeanticipatethattheNIHdirectcostsrelatedtonewspacewillbesubstantiallygreaterthan $250 per square foot.

• Building endowments to sustain research investments. Endowments need to increase by $5 million per year to compensate for the decrease in ASETFofapproximately$250,000peryear.

• Building the faculty of the future. Weanticipatethat DOM needs to recruit and develop about 10facultyperyearforthenextdecadesimplytoreplaceretiringfaculty,includingmanyofourmostproductiveclinicalandresearch-orientedfaculty.

• Enhancing quality education. Faculty perceive otherdemandsincreasing,consistentwithnationaltrendsofincreasedfaculty“burnout.”

Department Outlook

As we look to the future, we recognize that many obstacles lie ahead. Our resolve to meet these challenges head-on is unwavering.

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StreetAddress:18087thAvenueSouth|Birmingham,Alabama35233-1912MailingAddress:BDB420|17202ndAvenueSouth|Birmingham,Alabama35294-0012

Phone:(205)943-7700|Fax(205)934-1477www.uab.edu/medicine/dom

ANNUAL REPORTexemplary training for this year’s 142 residents. Clerkship and fellowship programs...

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Transcript of ANNUAL REPORTexemplary training for this year’s 142 residents. Clerkship and fellowship programs...