University of Virginia Health System

Strieter Charts Course to Weather the "Perfect Storm"

Fostering Thematic Research, Maintaining Clinical Excellence, Promoting Educational Excellence and Mentoring, Encouraging Subspecialty Differentiation Lead Host of New Initiatives

After just more than a month on the job, Dr. Strieter discussed the Department of Medicine and his vision for the next 18 months.

Q: Why did you decide to continue your career at the University of Virginia School of Medicine?

Dr. Strieter: I had reached a point in my academic career as a division chief where I was looking for new challenges. I had been involved in a reconstruction of a division and realized I truly enjoyed it and wanted to see if there were opportunities on a department level for me to continue my academic pursuits.

I was attracted to UVa because of its outstanding basic sciences and its outstanding academic reputation. Additionally, it's similar to campus town where I grew up in Michigan and I believe that is a great plus to be able to recruit young faculty. Recruitment of faculty was the biggest impediment to where I was in Los Angeles (UCLA), trying to recruit new faculty where the cost of living would force some people to live more than an hour away from our campus. The Charlottesville community and its attractiveness to young clinicians and researchers is very important when you look at sustaining and growing a Department of Medicine. The combination of these factors is why UVa was the right choice for me.

Q: You started July 1^st. What are your initial impressions and what challenges have you identified in your short time as Chairman?

Dr. Strieter: There are so many outstanding people in this department; I believe we have many great opportunities ahead of us. However, we're sitting at a time of a "perfect storm."

In order to maintain excellence in all three academic missions, we are going to have to weather this storm in order to emerge stronger than in prior years. This storm is challenging all of our major academic missions: education, research and clinical activity.

Five years ago, few of us would have projected where we currently stand.

• Our educational program has come under scrutiny and here we are with the probation of our graduate medical education program.

• The NIH pay line has markedly declined over the last three years. This event has had a major impact on our research faculty and we need to do everything we can to facilitate their ability to secure new grants, sustain their grants for their research, and develop new research opportunities for our research faculty.

• Our clinical areas face constant challenges in maintaining excellence. Self-directed plans, challenges related to providing care to all patients regardless of their ability to pay, and even new challenges related to Medicare reimbursement create obstacles to delivering quality care in a financially viable system.

Q: With the "perfect storm", how do you move forward as a department?

Dr. Strieter: We have renewed our focus on our core missions of education, research and clinical activity and added two new areas of concentration: faculty career development and finance/administration. In keeping with these missions, I have created the positions of five Vice Chairs and four Associate Chairs who will work with me, the Division Chiefs, and the faculty to keep our focus on these core missions for the upcoming 18 months.

Education

I'm looking to Vice Chair Jerry Donowitz and Associate Chair Michael Rein to maintain our credibility for graduate medical education addressing the residents and fellows concerns, and strengthening our undergraduate medical education component for medical students.  In addition, we're looking to free up more funds to support our education mission in terms of excellence in providing education to our trainees.

Clinical Affairs

In the area of Clinical Affairs, Vice Chair Bob Gibson and Associate Chair Alan Dalkin are working on increasing institutional awareness of quality monitoring and improvements. In January, the clinical staff retreat will be devoted to quality and its assessment, improvement and leverage in the academic medical center.

We're also looking at expanding our clinical excellence in both the inpatient and outpatient areas. Part of this effort will be a comprehensive outreach strategy focusing first on our efforts in Augusta County and subsequently in Culpeper and the eastern portion of our primary service areas. Another part will be the creation and expansion of our Medicine practices to serve the growing populations around Charlottesville.

Research

In the area of Research, Vice Chair Joel Linden and Associate Chair Susan Moenter will address the issue of the NIH pay line decline and how this is having a major impact on our research faculty. Many study sections will experience pay lines less than 10 percentile. We have to look to new ways to strengthen our research programs. In the face of these funding declines, we also are looking to ways to increase our ability to bridge fund our faculty so their research is not interrupted.

I also want to foster new thematic research, to focus on new initiatives in regenerative medicine, to increase the interactivity within the department for collaborative research, to increase interactions with basic sciences, and increase our presence in opportunities related to translational research. By focusing on these areas, we will be better able to differentiate ourselves from other academic medical centers.

Faculty Career Development

In the area of Faculty Career Development, Vice Chair Coleen McNamara and Associate Chair Mitchell Rosner will develop strategies to help insure our faculty academic success. We need to make sure that beginning with residents, fellows, and junior faculty that we support them with appropriate mentoring, training, knowledge of grant writing, and funding opportunities. We need to make sure they have been mentored to make the transition to midlevel and senior faculty positions. I don't want to see us lose good faculty members because of something we were not proactive in regard to appropriate mentoring and career development.

Administration

We created the position of Vice Chair and Chief Operating Officer to lead the 5^th core of our mission. With Bess Wildman heading up the mission, we are looking to reduce some of the disparities in administration between the various divisions, but at the same time not take away any of the autonomy of the division chiefs.  We will support the divisions by ensuring we are consistent in our practices and keeping focused on the overall core missions.

To meet our goals in the five core missions, we have created a development plan to recognize our faculty for their excellence. We will reward the best educators, researchers, clinicians, mentors and administrators. We will hold a research scholar day for our medical students, residents and fellows. We will have a Department of Medicine research day to highlight the research within the department. We are going to launch a journal, the "Proceedings of the University of Virginia Department of Medicine" to focus on clinical excellence and education. We will generate a Department of Medicine Annual Report to share our academic activities with our peers. Moreover, on May 5^th and 6^th (2007) our faculty will celebrate the 100^th year of the Department of Medicine at UVA by inviting our residency and fellow alumni for a two day event to highlight our department's successes in our core missions .  Furthermore, we plan to do all of this in the next 18 months. So there is a lot of work to do this coming year.

Q: Having outlined the "perfect storm" facing your Department, how will you personally be able to meet these challenges, while maintaining your work as a clinician, researcher, and educator?

Dr. Strieter:  In many ways I have been blessed with the ability to multitask. I am a consensus builder, not a deconstructor. In addition, I have outstanding people in my Vice and Associate Chairs that I can work with and delegate responsibilities to; as they are the ones who will play significant roles in developing the strategies to move the core missions forward in the department. In addition, I have outstanding Division Chiefs who will be outstanding administrators, mentors, educators, researchers, and clinicians who will also support the academic mission of the department. In many ways the philosophy of the Division Chief should be very similar to the philosophy of the Chairman for the success of their division and the department.

Q: How did your choice of clinical subspecialty impact your thinking on leading a department?

Dr. Strieter: I went into pulmonary/critical care, not so much for pulmonary as for critical care, and I have always viewed critical care as critical internal medicine. I think that has helped me to understand the need for a balanced department with respect to all the subspecialties.

Q:  Healthcare and academic medicine are continually becoming more and more competitive both in terms of attracting new patients and new faculty as community and regional hospitals expand their services into areas once reserved for academic medicine. In addition, universities are looking to differentiate themselves and attract and retain the best up-and-coming physicians. As a smaller academic medical center and thus a smaller department of medicine, how can we overcome these factors?

Dr. Strieter:  I believe we need to create opportunities and programs to help each division develop strategies to differentiate and distinguish itself as unique in the region and nation.

We have an outstanding department with outstanding clinicians, researchers, educators and administrators. It is up to us to develop a cohesive strategy and implement it across all the divisions. There are so many exciting opportunities that we have at UVa. to make this an even better department and be more competitive on a national and international level.