The UCSF Department of Medicine: Thoughts as We Begin 2023

Oh, noble and esteemed UCSF Department of Medicine! Thou art a veritable beacon of knowledge and healing, a place where clinicians, researchers, and educators work together with tireless dedication and purpose.

Divided into many divisions, each with its own focus and expertise, thou doth strive to understand more and do better, to conquer a wide range of medical conditions and diseases with all the tools of modern science.

But thou art not just a place of research and study. Thou art also a place of action, where the care of real patients is a top priority. At hospitals and clinics throughout the San Francisco Bay Area, thy dedicated professionals work tirelessly to heal and comfort those in need.

Through all thy endeavors, thou standest as a shining example of hope and progress in a world that is often troubled and uncertain. And it is this sense of purpose and dedication that sets thee apart and makes thee truly exceptional.

Have I gone a little batty? A bit too much eggnog? Nope. Rather, this is the output from the just released AI language creation tool, ChatGPT, when I asked it to “Describe the UCSF Department of Medicine, in the style of Shakespeare.”

I show this to you to illustrate that we’re on the cusp of a technological revolution in medicine, one that will change our work across all our missions. (Of course, before it does that it will make the job of high school English teachers infinitely harder.) Our destiny will increasingly be determined by how well we embrace and master a technological revolution that is likely to transform all aspects of medicine.

I think it’s crucial that our department helps lead healthcare’s technological transformation, both locally and nationally. In July, we’ll launch a new division – the Division of Clinical Informatics and Digital Transformation (DoC-IT) – to help support the many faculty and trainees whose work focuses on digital tools and data. We’ve created new data systems, such as PRISM, to give our leaders the information they need to manage and strategize effectively. And, as you may have noticed, we are on a quest to transform every clunky paper-based process we can find – from new employee onboarding to staff performance evaluations to annual faculty meetings with division chiefs – into web-enabled processes that make life a bit easier for everyone involved.

But technology is only one driver of the need to change. There are many others – economic, policy, demographic, and more – that will impact what we do and how we do it. As we start a new year, I’ll reflect on some of the most consequential areas impacting our department and our people.

Let’s begin with Covid-19. Looking back at 2022, I’m struck by how few surprises there were. After last winter’s big Omicron surge, we’ve been on a roller coaster of modest ups and downs. While the case rate fluctuates, the attitude of the public and policymakers is increasingly fixed: most have decided to move on. A new bivalent booster came out, but most people chose not to take it. Masking, even in crowded indoor spaces, is far from the norm. Luckily, even as many people let down their guard, our hospitals and clinics are no longer overwhelmed. It’s likely that the current state will mirror the situation for the foreseeable future. I, for one, will continue to be moderately cautious – certainly by staying up to date with boosters and by masking and the like when the situation dictates – and encourage people to do the same, guided by the evidence. I remain proud of the contribution our department has made in all aspects of Covid, including public education.

There is no question that Covid sped up several other trends in healthcare. Clinically, it accelerated the move to telemedicine and to virtual care. I believe that this is just the start of a sea change in healthcare, with more patients receiving more of their care outside traditional physician offices and hospitals. It’s important that we continue to adapt to and help lead these changes.

Of course, Covid also stimulated a move to hybrid work, and our department is no exception. While we all have biases about the benefits and downsides of virtual work, my overarching belief is that we need to approach it with an open mind, trying to take advantage of new opportunities while recognizing that something important is lost without flesh-and-blood interactions. We will continue to try various approaches to hybrid work and to learn from each other as we do. Throughout the department, we are building new programs – DOMINOs is one example – to try to restore the sense of community that is so vital to our work experience.

Another set of issues that assumed increasing importance in the past few years surrounds diversity, equity, and inclusion. Our department has made a major commitment to enhance our diversity, and it’s paid off. In our residency program, nearly one-third of residents are from groups underrepresented in medicine (UIM), about double what it was six years ago. Many of our fellowships have made similar progress. We’ve made some strides in diversifying our faculty, but progress has been slower – we are redoubling our efforts to both recruit and retain UIM faculty. I’m pleased that many of the campus leaders in DEI (which increasingly includes a focus on equitable healthcare outcomes) are from the DOM. As for diversifying our leadership, over the past six years, we’ve gone from 33 percent of our senior leadership (division chiefs, associate and vice chairs) being female to 50 percent, and from nine percent UIM to 19 percent. While all these figures are evidence of progress, more needs to be done.

Healthcare’s economic and political realities are also shaping our work. Within the UCSF Health sites, we are growing our network to ensure that patients can receive UCSF-level care closer to their homes. Major initiatives, many led by DOM faculty, are focused on improving the experiences of clinicians and patients – online scheduling, centralized call centers, and a major effort to slay the beast of the electronic inbox come to mind. Budget shortfalls at UCSF Health – a problem that is hitting health systems all over the country – is leading to some belt tightening, but also to new investments in growing our faculty and on improving access for our patients. ZSFG is also being challenged by large patient demand and limited post-discharge capabilities, and it too will need to navigate a leaner city budget. At the VA, the challenges of competing with the private marketplace and building in-person and virtual options for patients who live far from San Francisco are sources of both stress and opportunity.

Our educational programs remain exceptionally strong. Our training programs are frequently the portal through which our future faculty come to San Francisco. (As has often been cheekily said, UCSF stands for “U Can Stay Forever.”) Our programs continue to evolve and innovate in many of the areas I’ve already discussed: they are becoming more diverse, they are adopting digital tools to improve their training, and they are focusing on how to improve the sense of community and joy in learning. We’ve also launched initiatives to enhance the sense of community among our clinician-educators, the most visible being the Program for Clinician-Educator Success (ProCESS). This year, our residency was ranked second in the nation by Doximity.

Our research programs continue to be world-class – this year we were third in the U.S. in NIH funding among departments of medicine nationally. Through programs like iRAPS and NIH-Plus, we continue to invest heavily in supporting our researchers. We have also built programs to teach our researchers core skills in the business and operational aspects of running a laboratory (PIVOT), and to make it easy for early career researchers to receive feedback on their grant proposals (PREPARE). Working with the campus, we have also advocated for, and in some cases invested in, efforts to improve our research infrastructure, including speeding up the clinical trials process and procuring new research space on several of our campuses.

Even with all these changes afoot, it’s the technological revolution that I believe will ultimately be the greatest catalyst for change. The technologies will vary – mRNA, CRISPR, immunotherapy, AI, virtual care, precision medicine, Zoom, and electronic decision support are just a few that come to mind – but the bottom line is the same: sitting on our laurels or working harder is not going to be the ticket to success. Rather, UCSF and the DOM will need to do what we’ve always done: bring in amazing people, provide the culture, community, and tools they need to be successful, and admire what they accomplish, individually and collectively. I, for one, can’t wait to see what we come up with in the future.

I’ll end with how I began. I asked ChatGPT “What will happen in 2023?” It responded thusly:

It is not possible for me to accurately predict what will happen in 2023, as the future is always uncertain and there are many variables that can affect events and outcomes. It is important to approach the future with an open mind and to be prepared for a wide range of potential outcomes.

That being said, there are many ongoing trends and developments that are likely to continue or accelerate in the coming years, such as technological advancements, demographic changes, and political and economic developments. It is important to stay informed about these trends and to be prepared for how they may impact your life and the world around you.

Ultimately, the future is what we make of it, and it is up to each of us to take an active role in shaping the direction of our lives and the world around us.

I agree (this is Bob speaking). Thanks for all you do for our patients, trainees, community, and one another. I wish you and yours only the best in 2023.  

Robert Wachter, MD
Chair, UCSF Department of Medicine