Leaders of UCSF’s Clinical Sites Present Unique Perspectives and a Shared Vision

Leaders from UC San Francisco’s three major clinical organizations joined on Feb. 27 at the Mission Bay Hospitals’ Oberndorf auditorium for an overview of the breadth of the institution’s clinical enterprise.

Their shared vision demonstrated how the expansion of UCSF Health, the Zuckerberg San Francisco General (ZSFG), and the San Francisco VA Health Care System (SFVAHCS), have transformed UCSF into a powerful, far-reaching academic health care system, benefiting patients across California and nationally.

School of Medicine Dean Talmadge King Jr., MD, in his introduction, outlined the structural elements of UCSF’s growing academic and clinical enterprise. He emphasized that UCSF’s affiliations with ZSFG and the SFVAHCS, along with UCSF Fresno, are integral to all our missions. Each site attracts a distinct mix of patient populations, a diversity which benefits our trainees and research initiatives. Seen holistically, “we offer care that is not available anywhere else,” King said.

The event was the second in a series of “Dean’s Forums” hosted by King, who also serves as UCSF Health’s vice chancellor of medical affairs. Joining him were Vice Dean Joshua Adler, MD, executive vice president for Physician Services at UCSF Health; Sue Carlisle, MD, PhD, vice dean at ZSFG; and Associate Dean Diana Nicoll, MD, PhD, MPA, representing the SFVAHCS.

Linking City, State, Federal Facilities

Echoing Dean King, Nicoll stressed the symbolism of the joint presentation. “It is important for us to show that UCSF has city, state and federal facilities linked together, and that this strengthens the missions of all three of us,” said Nicoll.

The forums were conceived by King to bring essential information to the school and campus community, especially to faculty and staff who wanted to gain more insight into UCSF’s complex structure and inner workings.

King opened the presentation with an overview of the entire University of California ecosystem. UCSF is unique among its sister institutions as a graduate campus focused exclusively on health. Only a small fraction of its budget comes from state funding or tuition, making it highly dependent on clinical revenue, research funding and philanthropy. Clinical revenue in particular has traditionally been used to cross-subsidize other missions, particularly medical education. King stressed that in an increasingly competitive environment, UCSF needs to keep its structure flexible and continue expanding in order to thrive.

Adler, discussed how the clinical enterprise was restructured in 2014 to become UCSF Health. Under what he termed the “leadership triad” of Chancellor Sam Hawgood, MBBS, President and CEO Mark Laret, and Dean King, operations were consolidated into a streamlined delivery system that promoted collaboration and reduced the duplication of efforts. The UCSF Health Leadership Council, composed of senior officers of UCSF Health and all clinical chairs in the School of Medicine, serve as the de facto Board, shaping system policies, aligning strategic priorities with system goals and objectives, and maintaining fiduciary responsibility of the system.

People as Key Pillar

“Our faculty, staff and trainees, are critically important to our effectiveness,” Adler asserted, pointing out the key role of the “people” pillar among the organization’s strategic priorities. Responding to concerns voiced by doctors and staff, leadership have implemented several improvements, including scribes, a new physician lounge, an incentive program and an expanded menu of development opportunities for faculty.

People also serve as connectors across the three sites. Physicians, researchers and educators working at the ZSFG and the SFVAHCS are UCSF faculty. Medical students, residents, clinical fellows and postdocs train and work across the spectrum of UCSF’s institutions, including at UCSF Fresno.

The environment and culture at each site, however, is distinct. UCSF Health is chiefly a destination for patients seeking highly specialized (tertiary or quaternary) care. ZSFG, on the other hand, is well-known as San Francisco’s safety net hospital and only level one trauma center in the city.

“That means, if you walk out of here and are injured, you will be taken to the General to be cared for,” said Carlisle. “And that’s where you want to be, because there is a 24/7 team of specialists to treat trauma patients.”

Yet ZSFG’s services are more diverse than is widely known. Among the unique clinical services cited by Carlisle was the fact that ZSFG serves as the largest pediatric outpatient clinic in San Francisco as well as the only psychiatric emergency service, with nearly 7,000 encounters yearly. ZSFG physician-scientists are world-renowned for their advancements in care for HIV infected patients. The recent agreement between the city and the university for UCSF to build an academic and research building on the ZSFG campus assures that this 150 year old partnership of caring for the most vulnerable and injured will continue for many more decades.

Providing Specialty Care for Veterans

The SFVAHCS, which serves veterans across California, also has a long-standing affiliation with UCSF, going back 50 years. In her presentation, Nicoll emphasized the mutual benefits of the partnership. Joint recruitment of faculty has enabled the SFVAHCS to attract top-flight clinician teachers and clinician scientists. As a result, the San Francisco VA site is able to provide a wide range of specialty care not available at many other VAs and has the largest research program in the VA system. And because it draws in patients from as far as the Oregon border, it offers a unique and rich training site for UCSF medical students and residents.

Further distinctions among the three sites are their governance. While UCSF Health is part of a state institution, the reporting structure of ZSFG leads up to the Mayor and the voters of the City and County of San Francisco. In contrast, the SFVAHCS is overseen by the Secretary of the VA, a member of the President’s Cabinet.

The well-attended event was an eye-opener to the staff and faculty in audience at the Oberndorf auditorium

“Sometimes working within a large institution, it’s easy to lose sight of what you are actually a part of,” said Kathryn Quanstrom, a clinical research coordinator and aspiring medical student. “Attending the forum renewed my sense of pride in being part of the UCSF family. I learned not only about how expansive UCSF’s affiliations are in the Bay Area and wider Northern California region, but also about specific programs such as the VA’s localization of mental health providers at San Francisco City College, where over 1,000 of our veterans are enrolled.”

Related Links