A Tale of Two Cultures Family Medicine

A Tale of Two Cultures: Family Medicine & UC San Diego Rusty Kallenberg, M. D. Ted Ganiats, M. D.

History UCSD – Founded to have strong research Letter to Founding Chair of Dept of Community Medicine

Infancy “…we are trying to create a training program which begins to fill the critical need for delivery of medical care outside the walls of the hospital to the community at large…

…should take account of the diversity implicit in this goal, e. g. , communities can be rural, urban, poor, affluent; medical care can be preventive, educational, curative; trainees can be pre- and postdoctoral, physicians and non-physicians; and the end products might find themselves serving any number of roles in the health care delivery system. ”

1969 October 1969 …title of Associate Professor with the salary in the range of $27, 000…. if I left … would forego college tuition support in excess of $1, 000 for each of my four children …

Early Childhood Years (70 s) Department of Community Medicine Epidemiology Family Medicine Health Care Systems

Middle Adolescence Years (80 s) Dept. of Community & Family Medicine Epidemiology Family Medicine Health Care systems International Health and Cross-cultural Medicine

Early Adulthood Years (since 1990) Department of Family & Preventive Medicine Epidemiology Family Medicine Health Care systems International Health and Cross-cultural Medicine Biostatistics and Bioinformatics Preventive Medicine

Current Department - Teaching Medical students 4 residencies (Rusty will discuss) 2 fellowships (Rusty will discuss) 1 Masters program (1/2 of another) 3 Ph. D programs (1 in the wings)

Current Community Links Participate with other departments Ties to School of Public Health Other projects AHEC Por la Vida Smoker’s Helpline

Department’s Role in School With strengths in clinical trials, biostatistics, epidemiology, and health services research, seen as a critical resource to advance the School’s three missions. Question from the new dean….

Division of Family Medicine Current Division 38 faculty; 53 residents and fellows 3 clinical offices; 25, 000 pts. - 68, 000 visits – 110 deliveries – 500 admissions - EPIC emr – 45 staff Educational programs in all 4 undergraduate years Core residency; Combined FM-Psych residency; Scripps Chula Vista residency; Sports Medicine Fellowship; Fellowship in Underserved Medicine; Preventive Medicine Residency (DPM) Missions important to UCSD Education Community Service Clinical Delivery System Research

Education Educational Programming: Student-run Free Clinic Dr. -Pt. Course Intro to Health Care Systems Primary Care Core Clerkship (with IM) + FM Clerkship SOM Curricular Renovation Project Learning Communities; “doctoring curriculum; ” organ- based BS; Independent Scholarly Project Above courses are forerunners of the “Practice of Medicine” integrated 3 -year doctoring curriculum Leadership positions

Community Service Development of several unique and award winning programs: Student-run Free Clinic Combined FM-Psych Residency Program at SVDP Village Scripps Chula Vista FM Residency Program (AHEC, Scripps, San Ysidro Community Clinic and UCSD) Major draw for candidates to SOM Major PR value to SOM vis-à-vis community All contributors to the CTSA application

Clinical Service 1999: Creation of the Primary Care Business Plan PC services for FM, IM and Peds separated from parent depts. and placed in an administrative unit Model for the rest of the Medical Group for: measuring clinical productivity new models of service delivery c/w the PCMH (advanced access, collaborative MH care, GMVs, Chronic Care Model) Introduction of new technology: EPIC, My. UCSDChart Serves as entry to Medical Group practice in highly vertically integrated health care market

Research Previous ineffective attempts: Research Vice-Chief, research meetings Title VII grants, Surf*Net Very modest results w/o counting Ted(!) and three K- award winners Recent Divisional History – 2001 Re-commitment to research as 4 th mission Functional and unifying dfn. of research: “the way to make our other missions better” Started from scratch really - in the “midst of plenty”, i. e. the rest of the department

Recent Divisional History Title VII grant – 2003 -2006 “Capable collaborators” 7 fellows: volume vs. quality; culture change Environmental scan lead to Theme Identification: mental health/PC, PBR with emphasis on exercise, error and common problems, competency assessment [ACGME], underserved community Research infrastructure Research leadership and importance of mentors Reinvigoration of Surf*Net: “supersites” (less is more)

Current Efforts New EMR - EPIC - is key Collaboration – we have patients but also interest in research question ▪ With our other sister divisions ▪ With other depts. (psych, urology, cardiology, GI, genetics) CTSA CACCC (CA Academic Chronic Care Collaborative) ▪ Chronic Care Model ▪ Practice Change (translational research) Clinical trials New theme: Genetics is the “basic science” of FM: phenotypic descriptions of and clinical management of common genetic diseases Further infrastructure development: ▪ PEA (Practice Enhancement Associates) training ▪ Mechanisms to facilitate the melding of QI and PBR – (IRB) ▪ Registries / GIS Impact for SOM: Connecting UCSD’s research power with improving the health of our surrounding communities (aka CTSA efforts)