The Changing of the Guard

Transcription

1 The Changing of the Guard During the last year we have seen a very substantial changing of the guard in the Department of Internal Medicine at Saint Louis University. When Dr. Coy Fitch became chairman of the department in the 1980s, he recruited a series of young, vigorous division directors, many of whom have been in place now for 20 years or more. During the most recent years, we have seen some of those division directors retire, take other career directions or try to focus on their clinical or research activities. In the last year new division directors have been appointed in the divisions of General Internal Medicine (Thomas J. Olsen, M.D.); Gastroenterology and Hepatology (Brent A. Tetri, M.D.); Cardiology (Michael J. Lim, M.D.); Infectious Diseases, Allergy and Immunology (Daniel F. Hoft, M.D., Ph.D.); and Hematology and Oncology (Friedrich G. Schuening, M.D.). In addition, the long-time division director of Pulmonary, Critical Care and Sleep Medicine, George M. Matuschak, M.D., left us to enter private practice in the St. Louis area. The division is currently under the ADRIAN M. DI BISCEGLIE, M.D. able interim leadership of Dr. Ravi Nayak. We have had an on-going search for a division director of Endocrinology and hope to be able to end that search soon. Dr. John Edwards has joined us as the Associate Chairman for Research providing additional leadership to the department. Changes have also occurred with some of the partners we work with; in particular, we have a new CEO of Saint Louis University Hospital, Mr. Philip Sowa, in place since January of 2011 and have developed a good working relationship with him. I feel that the future of the department is in safe hands with these new leaders and I expect to see a period of growth over the next few years with their involvement. Department of Internal Medicine Faculty, June

2 Areas of Focus During the last year we have had several areas of particular focus within the Department of Internal Medicine. These include: Financial Performance Although FY10 was a good year for us, in FY11 the department ended behind budget and efforts are underway to try to correct this. We are trying to increase our outpatient volumes as well as our efficiency and patient satisfaction scores. Residency Performance on the Internal Medicine Board Exam Although we recruit outstanding residents who do very well in their years of residency with regard to patient care, in the last year or so a few of them have not passed the Internal Medicine Board Exam, giving cause for concern. Under the leadership of Dr. Miguel Paniagua, the Program Director, we have focused educational efforts on helping residents to study for and pass their Board exams. The Inpatient Service at Saint Louis University Hospital has remained a challenge with large numbers of patients. We do not have a hospitalist service at this institution and have been relying on residents to help us absorb steadily increasing numbers of admissions. However, in order to preserve resident time for education ahead of service work, we have had to create a faculty covered service. In addition, patients have been dispersed more widely across the subspecialty services, decreasing the load on the general medicine service. This is an area that will require continued effort in FY12. Centennial Celebration. At the time of this writing near the end of calendar year 2011, centennial celebrations are winding down. We had a great year celebrating the successes of the previous 100 years with focus and attention on each of the divisions in the department, a very successful CME program held in the spring and successful hosting of the Saint Louis University School of Medicine Alumni Reunion CME Program. The latter has resulted in the production of a series of articles which will be published as a special issue of the journal Missouri Medicine to recognize the department s centennial. Research Research continues to be an important focus for the department. During the last year we have recruited several established researchers who are already funded by the NIH. These include Reigh-Yi Lin, Ph.D., in the Division of Endocrinology; David Q.-H. Wang, M.D., Ph.D., Division of Gastroenterology and Hepatology, and John C. Edwards, M.D., Ph.D., Division of Nephrology and also Associate Chairman for Research, and we will continue to pursue the strategy of trying to recruit already funded investigators to help grow the department s research programs. Briefly, Dr. Lin s focus is in the area of thyroid cancer and particularly the role of cancer stem cells in thyroid cancer. Dr. David Wang focuses on the pathogenesis of gallstones and fatty liver disease. Dr. John Edwards focuses on the CLIC family of chloride channels and their roles in angiogenesis and kidney function. Researchers often find it very useful to obtain small grants to initiate a new project. We have been very successful this last year in having our faculty obtain this type of internal grants. PRESIDENTIAL RESEARCH FUND AWARDEES DURING FY11 Daniel Hoft - Trypanosoma cruzi Mucosal & Systemic Protective Immunity - $25,000 Paul Hauptman Collaborative Decision Making in Cardiac Device Therapy - $25,000 2

3 Jianguo Liu - Role of IL-27 in protective immune response against mycobacterium tuberculosis - $25,000 James Temprano - The Effect of Estrogen and Progesterone on Allergen Induced Cytokine Production from House-Dust Mite Allergic Individuals - $25,000 Terry Moore - Aberrant IgG Galactosylation in Juvevile Idiopathic Arthritis - $25,000 Guangyong Peng - Functional Reversal of Human Regulatory T Cell Suppression Via TLR8 Signaling - $25,000 Reigh-Yi Lin - The role of cancer stem cells in anaplastic thyroid cancer - $25,000 Susan Kiefer - The role of Sall1 in ureter maturation and vesicoureteral reflux - $25,000 DEPARTMENT OF INTERNAL MEDICINE SEED GRANTS AWARDEES DURING FY11 Xiaofeng Fan Virus Discovery by Pyrosequencing - $25,000 Gul Shah Diabetic Retinal Vasculopathies and Mitochondrial Carbonic Anydrases - $25,000 SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE SEED GRANTS AWARDEES DURING FY11 Guangyong Peng Molecular Control of Human Regulatory T-Cell Suppression - $25,000 The department has undertaken an extensive upgrading project of research space in Doisy Hall and older parts of the building in the Medical School. Now that the new Doisy Research Center is filling up rapidly we have had to accommodate researchers in some of the older space. The space had been somewhat renovated by the School of Medicine but we have worked to upgrade the facilities both cosmetically, but also in terms of buying additional equipment. Thus, we hope to establish a new research core area for the department with a conference room (the Kinsella Conference Room) in Doisy Hall adjacent to space in Schwitalla Hall. Departmental Clinical Activities MGMA AMBULATORY ENCOUNTERS FY 08, 09, 10, 11 Figures below represent counts of patient/physician outpatient encounters as defined by Medical Group Management Association (MGMA) guidelines. PRACTICE LOCATION FY 08 YTD FY 09 YTD FY 10 YTD FY 11 YTD CANCER CENTER 9,202 9,865 10,290 11,392 CARDINAL GLENNON DES PERES 2,774 3,965 5,731 5,817 DOB 51,215 52,680 53,087 48,915 MIDWEST ENDOSCOPY OP CATH LABS SLEEP DISORDERS CENTER 491 1,508 1,877 1,678 SLUH 14,454 13,435 15,334 16,279 SNF/NF/CC/HOSPICE* 6,891 7,313 7,170 7,609 3

4 UNIV CLUB TOWER 10,462 10,587 9,899 9,024 OTHER 6,714 8,042 8,673 8,753 GRAND TOTAL 103, , , ,202 * SNF (Skilled Nursing Facility), NF (Nursing Facility), CC (Custodial Care), Hospice Summary of the department's clinical financial performance fiscal years 2007 to 2011 FY 07 FY 08 FY 09 FY 10 FY 11 Net Operating Revenues 32,379,303 33,519,913 35,769,587 36,762,637 38,037,426 Total Operating Expenses 28,836,060 31,153,364 32,441,083 32,545,897 34,911,305 UMG Overhead Allocation 4,310,267 4,512,516 4,495,035 4,794,015 4,555,669 NET INCOME (LOSS) (767,024) (2,145,967) (1,166,531)* (577,275)* (1,429,548) * The department had a budgeted net loss in fiscal years 2009 and 2010 of $1,758,942 and $1,561,607 respectively. The department's actual performance for these two fiscal years beat the clinical budget by nearly $700,000 in 2009 and $1,000,000 in Departmental Outreach Activities In conjunction with the Centennial Year celebration, the Department of Internal Medicine physicians and staff participated in several activities to increase the department s visibility and provide community service. The Department has been featured in 60-Second radio advertisements on KEZK, Fresh Archives of the broadcasts may be found at Since January 2011, the Department has sponsored a Community Health Literacy Series at the Saint Louis County Library Headquarters. The monthly series was referred to as 60-Minute Check-ups and was open to the public. Blood pressure and BMI (Body Mass Index) screenings were provided. How to Get the Most Out of a Visit with Your Doctor by Dr. Thomas Olsen from the Division of General Internal medicine (January) A Good Cardiologist Is by Dr. Michael Lim from the Division of Cardiology (February) Kidney Disease and Hypertension: Facts and Fantasies by Dr. Kevin Martin and Dr. Paul Schmitz from the Division of Nephrology (March) Blood and Cancer 101 by Dr. Mark Fesler, Dr. Ganesh Kudva, and Dr. John Richart from the Division of Hematology and Oncology (April) Irritable Bowel Syndrome and Colon cancer Prevention by Dr. Jennifer LaBundy and Dr. Mary Burton from the Division of Gastroenterology and Hepatology (May) Vaccines for Living by Dr. Edwin Anderson from the Division of Infectious Diseases, Allergy and Immunology (June) 4

5 Exercise in Older Adults by Dr. Julie Gammack from the Division of Geriatric Medicine (July) What Type of Arthritis Do I have? by Dr. Terry Moore from the Division of Rheumatology (August) Asthma, Hay Fever and Food Allergies by Dr. James Temprano from the Division of Infectious Diseases, Allergy and Immunology (September) Common Sleep Disorders by Dr. Joseph Espiritu from the Division of Pulmonary, Critical Care and Sleep Medicine (October) Living with Diabetes by Dr. George Griffing from the Division of Endocrinology (November) New Year s Resolutions: Diet and Exercise Tips by Dr. Sonia Chacko from the Division of General Internal Medicine and SLUCare dietitian, Camille Jones, RD,LD,CNSD (December) The Department has also participated in the following local health fairs: Saint Louis University Employee Health Fair, ATT Employee Health Fair, Bryan Cave Law Firm Employee Health Fair, and The Shepherd s Center of Webster Groves Senior Health Fair with Dr. Fred Buckhold and Dr. Sonia Chacko providing blood pressure screenings and answering participant s general health questions. In July, the Department partnered with the Department of Dermatology in providing information about SLUCare physicians and services at the Prime Times Senior Expo in South Saint Louis County with over 700 seniors in attendance. The Department also participated in the inaugural Saint Louis University sponsored Open Air Market in October by providing blood pressure screenings and information about physician services. Departmental Research Activities 5

6 Department of Internal Medicine s Research Funding Fiscal Years Fiscal Year 2011 Fiscal Year 2010 Federal Foundations Industry Total Federal Foundations Industry Total Cardiology 305,106 42,646 1,332,888 1,680, ,542 46,981 1,650,086 2,153,609 Infectious Diseases 6,323, , ,848 7,462,397 5,885,778 1,094, ,505 7,407,743 Geriatric Medicine 816,032 74,395 77, ,768 1,058,680 62,176 45,105 1,165,961 Immunobiology 1,173, ,696 26,949 1,382, ,916 43,004 56, ,651 Gastroenterology 1,590,939 92, ,906 2,496,068 1,670, ,444 1,053,425 2,888,843 Other Divisions 563, , ,582 1,107, , , ,720 1,146,185 Total 10,772,678 1,254,967 3,069,512 15,097,157 10,159,136 1,802,284 3,633,572 15,594,992 Cardiology Infectious Diseases Geriatric Medicine SLUCOR Gastroenterology Other Divisions Total Cardiology Infectious Diseases Geriatric Medicine SLUCOR Gastroenterology Other Divisions Total Fiscal Year 2009 Fiscal Year 2008 Federal Foundations Industry Total Federal Foundations Industry Total 520,872 23, ,035 1,275, , , ,971 6,363,473 5, ,225 7,313,698 10,168, ,163 10,986,853 1,266,501 30,094 27,313 1,323,908 1,245,163 1,027 5,406 1,251, ,805 8, , , ,736 9, , ,675 1,502,788 91,483 1,550,868 3,145,139 1,347,489 67,500 1,151,380 2,566, , , ,893 1,010, , , ,371 1,285,707 10,309, ,091 3,930,619 14,709,628 13,909, ,357 3,109,090 17,497,171 Fiscal Year 2007 Fiscal Year 2006 Federal Foundations Industry Total Federal Foundations Industry Total 832,092 (39,299) 1,421,822 2,214, ,915-1,703,674 2,677,589 12,601,549 11, ,758 13,118,446 14,255, ,275 14,985, , ,822 42,770 1,131,978 1,574,020 19, ,569 1,816, ,963 40, ,454 1,136, , , ,733 1,223,150 18, ,179 1,983,856 2,012, ,850 1,147,558 3,375, , , ,477 1,630, , , ,463 2,019,851 16,460, ,969 4,441,460 21,216,201 19,652, ,533 5,100,065 25,321,549 6

7 Endowments and Overheads The department continues to have strong endowment revenues which are used to support its missions. We also contribute substantially to the institution through indirect costs and overheads associated with our clinical and research activities. 7