Chair's Notes

Colleagues: This will be the last time I write Chair’s Notes for our Department Newsletter, and I will miss the opportunity to communicate with you every few months. Many of you have responded to my earlier columns, and I have enjoyed our interactions. My goal for this report is to review the progress that the Department has made in the last half decade and comment on the challenges for the future.
Overall, your UW Department of Family Medicine is in great shape, with success on almost all fronts. In early November, Eric and I reported to the Department on our financial condition. Our annual revenues now top $26M. The funds come from a variety of sources, with income from clinical care, research and philanthropy increasing. Our biggest area of expenditure is for salaries, and we have finally reached the point where our faculty and staff salaries are at the AAMC 50th percentile for Family Medicine, with individual faculty clinical productivity also at or above the University Hospital Consortium’s Faculty Practice Solutions Center 50th percentile. A significant problem five years ago was low faculty salaries, and this problem has been addressed. One of our major strategic goals was to increase our Department’s involvement in clinical care, and that has occurred. Our faculty and staff continue to grow, with 92 regular faculty members, over 1150 clinical faculty, 68 staff, 25 residents, and 3 fellows. Over the last five years new recruitments have resulted in a faculty that is younger and more diverse.
Medical Student Education (MSE): For the last five years, the strategic goal for the MSE Section has been to maintain and improve the educational and social context that supports UW medical students choosing to specialize in Family Medicine. Specifically, our long-term objective is to have 40% of our graduating class of medical students enter Family Medicine Residencies. While we are not yet at the 40% level, a substantial proportion of our graduates are matching into Family Medicine, and AAFP has recognized UW as a “Top Ten” medical school in producing family physicians for the last 4 years. Our efforts to introduce students to Family Medicine are primarily accomplished through solid presence in the curriculum and the Family Medicine Interest Group. Over the last 5 years UW has been moving through a curriculum renewal program. Our Department faculty members have played key leadership roles and have been very successful in creating important niches for Family Medicine in the foundations or basic science curriculum, as well as maintaining our strong clerkship and sub-internship roles. Integral to our expanded role in the curriculum has been great success in recruiting excellent young faculty members.
Our focus on rural Family Medicine has continued with the development of the TRUST program. The Targeted Rural Underserved Track (TRUST) has grown steadily since the first volunteer Montana class in 2008. In 2014 we welcomed our largest TRUST class ever with 27 students in Washington, Wyoming, Montana and Idaho.  Alaska joined the program in 2015 bringing the total enrollment to 30 Scholars. The TRUST curriculum includes the Rural Underserved Opportunities Program (RUOP) and the WWAMI Rural Integrated Training Experience (WRITE) as well as several other key elements. As part of the support for this program, with substantial funds from the Rosenblatt family, the WAFP, and many others, the endowed Rosenblatt Professorship in Rural Family Medicine was created.
Our Medical Student Education section also hosts a large number of award winning programs and courses and is one of the largest in the nation. Many faculty members have ongoing leadership roles in the UWSOM Curriculum Renewal including in all phases and most themes.
UW Family Medicine Residency: Our strategic plan for UWDFM resident education envisioned continuing to train residents in full spectrum Family Medicine for practice in a wide variety of settings. Health policy and academic Family Medicine were to continue to be special areas of focus, and we anticipated transitioning to a Patient Centered Medical Home practice model. Five years later, we are continuing to do (or have done) all of these things. We continue to train for full spectrum Family Medicine, and several of our residency graduates are in academic Family Medicine. Judy Pauwels has stepped down as Program Director, with Mark Beard moving into that role. We have moved from our Roosevelt practice site to a far more community oriented clinic at Northgate, part of the UW Neighborhood Clinic system, which is using the PCMH practice model. Our efforts to expand our Harborview site and to create an in-patient service at Harborview have not, as yet, borne fruit, but we continue to work toward these goals. Our program has the ACGME’s Next Accreditation System and Milestones guidelines. We continue to experience remarkable national medical student interest in matching in our program, and the Doximity rating system recently rated the UW Family Medicine Residency as the top Family Medicine Program out of the 477 currently in operation. We have made great progress in interprofessional training, with MEDEX Physician Assistant students regularly working in our clinics. One unexpected gain has been to have Valley Medical Center, with its Family Medicine Residency, become part of UW Medicine.
Fellowships: Over the last five years we have maintained our highly competitive ACGME accredited Sports Medicine Fellowship. We had hoped to expand it to two fellows per year, and we did this one year with financial support from Seattle Children’s. In addition, we developed one of the first fellowships in Global Health. This non-ACGME fellowship is self-funded and has been very successful. At this time we are working on new fellowships in Integrative Medicine (with a focus on pain) and Ultrasound. In addition, we continue to consider developing fellowships in Academic Medicine and in Health Policy. With the Department of Medicine, we occasionally support family physicians in their ACGME accredited Geriatric and Palliative Care fellowships.
UW WWAMI Family Medicine Residency Network:
Network Expansion: The Network is growing! We have expanded from 18 programs in 2010 to 24 in 2015. We currently have 5 AOA (American Osteopathic Association) transitioning programs, 2 programs developing and three Rural Training Tracks (RTTs) in development.   The number of Network residents has grown from 411 in 2010,  to 539 in 2015.  By 2017 we anticipate having 30 affiliated programs and 646 residents.
Faculty Development Expansion: Network distance learning programs have significantly expanded in the past 5 years, we have implemented a monthly faculty development webinar series and added quarterly webinars for residency administrative staff.  We expanded the size of our five week onsite faculty development fellowship from ten to twelve positions to meet increasing faculty development needs.  We have also added large collaborative workshop sessions that program directors, faculty and staff attend.  Workshop topics have included NAS (Next Accreditation System)/CLER (Clinical Learning Environment Review) preparation, Residency Best Practices and New Innovations.

Transition to Next Accreditation System:
The Network helped programs successfully implement the NAS, CLER and FM Milestones. We did this by conducting a detailed needs assessment then providing webinars, an intensive hands-on workshop, and mock CLER site visits.  Feedback from programs indicates that our residencies felt much better prepared than other programs nationally and we continue to track NAS best practices and standards developed within the Network.
Transitioning to a Single Accreditation System: Network leadership was among the first in the nation to coordinate outreach efforts to osteopathic GME leaders in the WWAMI community to facilitate the transition towards all family medicine residency programs becoming ACGME accredited.  Judy Pauwels has been busy making site visits and needs assessments to determine what programs need to successfully make the transition.  The Network is actively on-boarding the new osteopathic programs–osteopathic program directors have been added to our directors list-serve and they have been invited to attend the December Directors meeting.

Federal and Local Advocacy & Funding:
The Network has used the Network Legislative Committee to refine and disseminate key messages to educate WWAMI state Senators and Representatives about the Network and the needs of the family medicine residency programs.  This year the many groups who worked together to advocate for family medicine residency education in Washington were successful in obtaining $16.2 million in new funding over the next two years.  This means:  1) Capitation is restored to above pre-recession levels and will include DO residents; 2) There is funding to help DO programs with unified accreditation and to help developing programs get started, and 3) Network core operations are fully funded. This is critical in being able to expand Network services as programs expand.  Tireless work on the behalf of Network leadership was key to the success of this effort!

Successful Strategic Planning:
We have reached many of our strategic plan objectives in the past five years as noted above and attached.  Regular strategic planning sessions and attention to our strategic planning objectives has made success with many of these initiatives possible.

Increased National Visibility:
The Network has been participating efforts to increase our national visibility, including participation in the Colorado GME Summit, presenting at STFM and RPS/PDW and collaborating In national research efforts.  Most recently the Network just finished creating a graduate followup survey for ABFM that will be implemented nationally.  Another example is our success in lobbying the  ACGME to change the requirement that prevented AOBFP certified program directors from being eligible to be program directors.  I understand our effort had a significant impact in changing this requirement for all specialities.  I’m sure Freddy and Ardis can speak to our other efforts on this front.

MEDEX Northwest Physician Assistant Program
: Five years ago the MEDEX Program was part of the Department of Biomedical Informatics and Medical Education. Strategically our biggest step was to move it into the Department of Family Medicine. This alignment with primary care allowed focus on the expanding role of teams of family physicians and PA’s in Patient Centered Medical Homes. MEDEX has been an outstanding partner in this effort, expanding to a new site in Tacoma that focuses on veterans. MEDEX currently graduates approximately 120 PA’s per year from its four branch campuses: UW Seattle, UW Tacoma, Riverpoint in Spokane, and University of Alaska at Anchorage. More than half of the graduates practice primary care. MEDEX faculty has expanded with the student body, and many are playing important leadership roles regionally, nationally, and internationally. In 2015 Terry Scott assumed the new role of combined Section Head and Program Director.

Sports Medicine
: Five years ago the sports medicine group consisted of clinical faculty members practicing out of the Hall Health Student Health Service or the Orthopedic Sports Medicine Clinic. Over the period we have created the Sports Medicine Section and moved these Family Medicine specialists into the Department as regular faculty members. We now have five full-time faculty in the group. In addition to clinical care, they provide care for all of the Husky teams, as well as primary care for the Seattle Seahawks (including attendance at the last 2 Super Bowls). Their research focuses on sudden cardiac death in athletes and is recognized worldwide. In the last five years over 111 articles and 33 book chapters have been published, coupled with almost 120 national presentations. Based on this work, Jonathan Drezner led the creation of the first Institute for Sports Cardiology in the US. Clinical innovations include frequent use of biologic therapeutics for the treatment of tendonopathies and incorporation of musculoskeletal ultrasound into every day practice. The group has been very active in community outreach, working with the Nick of Time Foundation to provide cardia screening for over 15,000 high school students.

Palliative Care
: Five years ago our Palliative Care effort consisted only of Stu Farber and his pioneering work in teaching this important topic. Palliative Care is now a significant new section of the Department with a multidisciplinary group that provides comprehensive consultative Palliative Care Services for all clinical areas at the University of Washington Medical Center. In February 2014, the program achieved the first Joint Commission Advanced Palliative Care Certification in the Northwest. We recruited Lu Marchand from the University of Wisconsin to lead the program, and she began work in September 2014. Since then 7 new interdisciplinary Palliative Care team members have been hired. The group includes 3-4 full-time fellowship trained Family Physicians, 4 nurse practitioners, 2 social workers, and a chaplain. This robust model of interdisciplinary care allows us to offer educational experiences to learners who are medical students, residents, fellows, nurse practitioner students, chaplain residents, physician assistant students, social work interns, and others. Our program was featured in the American Academy of Hospice and Palliative Medicine Quarterly lead article in the fall of 2015.
Referrals for Palliative Care consults come from every service at UW Medical Center and are steadily increasing. In addition to family physicians on the team, we also have a pediatrician and a cardiologist who work with the team.
In the fall of 2015, Lu Marchand, MD was named the Stu and Annalu Farber Endowed Faculty Fellow in Palliative Care Education. This is a transitional position, until we have full funding to convert the Farber endowment to a Professorship. Funds will help support skills development for the UWMC PC program. As you consider your year-end giving, please think about donating to the Farber Professorship.
Research: The Department of Family Medicine Research Section is one of the longest standing sections within the Department, and has grown from a focus on rural health and health workforce at its inception in the 1980s, to span a far broader portfolio of research areas and methodologies. However, as federal funding levels dipped in the mid-1990s, and research faculty turned over, the Section was reduced to only a couple of active researchers when I became Chair.
The strategy of rejuvenating the Research Section required major investments by the Department. This included several strategic hires, including clinical researchers at the Assistant (Alison Cole), Associate (Emily Godfrey) and Professor level (Matthew Thompson, Ian Bennett), bringing in new expertise in areas of practice based research, women’s health, and behavioral health. Additional PhD research faculty hired have included Davis Patterson, Bianca Frogner, and Annette Fitzpatrick, bringing proficiency in rural health, health workforce, health economics, epidemiology cardiovascular disease and global health. We successfully recruited a new section head and created a new Vice-Chair position for Research and invited Matthew Thompson to fill this role. In addition to longer standing researchers (Laura-Mae Baldwin, Eric Larson, and Abigail Halperin), the section now has a total of 10 faculty. The growth in faculty has been supported by excellent administrative team.
The expanded faculty has been accompanied with prominent success in grant funding. This has included continued grant success in the areas of rural health with the WWAMI Rural Health Research Center, and the re-establishment of the Center for Health Workforce Studies–one of five Health Workforce Research Centers across the US, under new leadership of Dr Bianca Frogner. The WWAMI region practice and research network (WPRN) has continued to grow with funding from the UW’s ITHS federal grant, and includes over 50 clinics in the WWAMI region who participate in a large and rapidly growing portfolio of research studies. Additional areas that have attracted significant funding are primary care innovation (with funding from PCORI), global health (with funding from NIH and the European Union), behavioral health and implementation research, and women’s health.
In terms of metrics of success, our Research income is increasing sharply, now approximately $3m/year. This brings additional research cost recovery funds to the Department.  In addition, research output has been exceptional, with approximately 100 publications last year from the Department (including the Research Section and other sections). Other measures of success have been the number and diversity of collaborators, not just across the Department, but also across numerous UW Schools and Departments, regionally and nationally with multiple clinics and collaborators such as Group Health, and internationally with academic collaborators in the UK, Sweden, Ireland, Malawi, Nepal, Cambodia, and Vietnam.
The trajectory of the Research Section is now very robust. It has the faculty, know-how, and both breadth and depth of expertise, to continue to flourish and become even more firmly established as a leading center of primary care research in the US.
In summary, the Department is in fine shape! We have arrived at most of the strategic plan destinations that we envisioned when we began our journey five years ago. It will be the task of our wonderful team of faculty members and staff to work with the next chair to establish and implement a new strategic plan. With Matthew Thompson’s leadership as Interim Chair and an excellent Search Committee led by Jurgen Unitzer, I am confident that we will have an exceptional new Chair in place by the end of 2016. The UW Department of Family Medicine is a wonderful group of people, of which our WWAMI Network members are key participants. I have no doubt that we will continue our leadership role nationally, as we transform Family Medicine for a bright future.
I strongly appreciate the support from our many friends and colleagues that have allowed the progress that is described here. Thank you!
Tom E. Norris, MD
Professor and Chair