The University of Michigan Department of Urology 3875 Taubman Center, 1500 E. Medical Center Drive, SPC 5330, Ann Arbor, Michigan 48109-5330 Academic Office: (734) 232-4943 FAX: (734) 936-8037 www.urology.med.umich.edu http://matulathoughts.org/ What's New February 7, 2014 Stuart Wolf (acting Dept Chair) A monthly communication to the faculty, residents, staff and friends of the University of Michigan Urology Family. 17 Items, 5 Web Links, 12 Minutes 1. Happy New Year! For those of you who are not acquainted with the Chinese lunar calendar, this is the year of the Horse. Specifically, it is the year of the Wood Horse. The Chinese zodiac, which dates back to some 200 BC, consists of 12 zodiac symbols (all animals) and five elements (wood, fire, earth, metal, water). The entire Chinese zodiac completes a cycle in 60 years; thus for many Asian cultures, turning 60 years old is a very important milestone. 2. For those of you wondering what your Chinese zodiac is, I would refer you to this Wikipedia page: (http://en.wikipedia.org/wiki/Chinese_zodiac). Note that because the Chinese New Year does not coincide with January 1, it is possible that your sign doesn‟t match that Chinese restaurant place mat.  The Wikipedia page gives exact dates so there‟s no mistaking your sign  3. Even our US postal service observes Chinese New Year with postage stamps commemorating the holiday. 4. We also begin this month with a new Chair of the Federal Reserve, Janet Yellen. You can read about her here: http://en.wikipedia.org/wiki/Janet_Yellen. The Federal Reserve is the country‟s central bank, responsible for controlling longterm interest rates, increasing employment, and stabilizing prices. It was created in 1913 with the Federal Reserve Act. One of the most important outputs of the Fed is monetary policy, ie control the size and growth of the money supply. 5. Unlike the Federal Reserve and Treasury, our department does not print money. We have to be fiscally responsible and raise funds through clinical activities, grants and philanthropy, which reminds me to remind everyone that registration has begun for this year‟s Michigan Men‟s Football Experience (Wednesday, June 4 and Thursday, June 5, 2014). This fund-raiser goes to support the prostate cancer research program. Here is a great promotional video I‟d like to share with each of you http://youtu.be/DZhh8mnW3cM featuring U of M Athletic Director David Brandon, U of M Head Football Coach Brady Hoke and head of our Urologic Oncology Division Ganesh Palapattu. This incredible two-day experience costs $2,500 per person ($1,800 is tax deductible; $700 non-refundable). For additional information and to register go to http://footballexperience.umich.edu/. If you have any questions, contact Corey Longley by email at [email protected] or by phone at 734-615-7452. 6. Last month our internal weekly “What‟s New” profiled our Medical Assistants that work in the Taubman Clinic; an overview of the Ghana trip by Casey Dauw and Gary Faerber; a summary of the Society of Urologic Oncology (SUO) Winter Meeting, Dec. 4-6, 2013 by Todd Morgan; and an update from our First Year Interns Neel Gowdar, Amy Luckenbaugh, James Tracey, and Yooni Yi. Website: http://www.med.umich.edu/urology/about/MonthlyNewsletter.html. 7. Lastly, I heard from the AUA Research Council that there were some Research Scholar three awards that were unclaimed in the last cycle. These were in the area neurourology. I would guess that this is an area where we are very competitive. 8. Being competitive requires that we have strong competent leadership. Dr. Wolf, as our acting chair, has been learning much about running a department and he is going to provide us with some insight in this week's what's new. John T. Wei – WN Editor in Chief Now we hear from Stuart Wolf: 9. We are one-third of the way through Dr. Bloom‟s 2014 minisabbatical. No disaster yet has befallen in his absence. Whew! 10. Last month I compiled a “Review of 2013 Urology Faculty What‟s New Contributions.” That was well-received, so this month I will compile a “Review of 2013 Urology Clinical Division What‟s New Contributions.” When Dr. Bloom assumed the Chair position he strengthened the Divisional structure of the Urology Department, encouraging each Division to devise its own clinical goals, research agenda and mission statement. This has been accomplished while preserving the integrity of the Department as a whole. When Divisional aspirations impact the general Department, issues are brought to the Department for discussion and consensus. This form of organization appears to be serving us well. In this edition of What‟s New I hope to convey to you the strength and vitality of our Clinical Divisions. 11. In his February 22, 2013 What‟s New, John Wei of the General Urology Division (which since has been merged with the Andrology Division) provided us with an insightful analysis of the interaction between general urology practice and sub-specialty care. He focused not on these distinctions within the UM Department of Urology, but rather on the more global relationship of community urologists with urologists in academic medical centers. John pointed out that, speaking from the point of view of urology departments in academic medical centers, “our educational and training mission has been so successful that we have now populated the community with subspecialists that do exactly what we can do ... As the overlap between general urology in the community and tertiary academic centers increase, one can expect that referrals will continue to fall.” John then asked “Can academic subspecialized urologic practice survive given the new „healthcare‟ economy? In my opinion, the answer is undoubtedly „Yes‟ as we are a highly adaptable group. But, we have to first recognize our dependency on referrals and that there is a decreasing incentive for these referrals to come to us. We then need to develop strategies that will increase future referrals in order to maintain our clinical volume.” Finally, John suggested a possible solution: “We can increase our own network of general urologists to identify cases that are suitable for sub-specialists. The basis for this is the notion that urologic care flows through primary care referrals to general urologists who then refer appropriate cases to subspecialists … This may be accomplished through primary appointment of general urologists within our department or secondary appointments of general urologists via service contracts.” As the impact of the accountable care organizations created under the Affordable Care Act becomes apparent, and as our Departments own system of adjunct appointments grows, this might indeed be one more step in the evolution of academic medical centers. 12. On March 22, 2013 the Division of Endourology and Stone Disease spoke to us. Our report (I am the Division Chief) focused on the collaboration that has become an important part of that Division. The Division uses a collaborative shared case model for shock wave lithotripsy (SWL), with one faculty member performing SWL for the patients from any other provider at the Livonia Surgery Center (LSC) on the first and third Monday of each month. In addition, 3 of the Division faculty members have block time at the LSC and regularly perform shared cases for other faculty members. Gary Faerber of the Endourology Division has been a lead faculty member in the recent global outreach to Ghana, having gone on two mission trips so far as part of the 5-year plan to establish the collaborative Michigan-West Africa Endourological Center. Finally, the highly collaborative research of the Endourology Division was highlighted, including (among many): a proposal funded by the Urologic Diseases in America (UDA) Project; an academic-corporate collaboration with Litholink Corp. in Chicago; John Hollingsworth‟s research on the influence of physician social networks on quality, outcomes and cost-efficiency of surgical care which has spawned many collaborations; and the complicated collaboration between the laboratory of Will Roberts and HistoSonics, Inc to commercialize histotripsy for treatment of BPH (human pilots are now underway) while also continuing to explore other applications of histotripsy. 13. The Urologic Oncology Division reported in on May 31, 2013. Led by Division Chief Ganesh Palapattu, the Division is aggressively trying to increase its clinical footprint. Measures described in their What‟s New included: using MLine (1-800-962-3555) to enhance communication with referring doctors; rolling out a multidisciplinary high risk prostate cancer clinic which brings together urologic oncology, radiation oncology, medical oncology and translational pathology to provide expert consensus opinion for men recently diagnosed with aggressive prostate cancer (men in this clinic get their cancer genome sequenced via Arul Chinnaiyan’s MiOncoseq program as well as other predictive gene tests); and continuing growth of the robotic-assisted urologic surgery program. In addition, the extensive and comprehensive research program of the Division was summarized, which spans the gamut from Basic Science (Palapattu, Morgan, Keller, Day) to survivorship (Skolarus, Wittmann) and everything in between. Finally, the great effort to improve the Urologic Oncology fellowship, led by Cheryl Lee, was highlighted. We are a very fortunate Department that our largest Division so organically embraces the tripartite mission of clinical care, research and education. 14. The June 28, 2013 report by the Division of Neurourology and Pelvic Reconstructive Surgery (NPR) reported on their clinical and research innovations. Novel delivery systems include the Womens' Urology Clinic in Livonia headed up by Anne Pelletier Cameron, and the Female Pelvic Pain Clinic joint clinic with Gynecology headed by Ann Oldendorf. Further trying to improve clinical care, the NPR division has been administering the Surgical Consumer Assessment of Healthcare Providers and Systems (SCAHPS) survey to their patients after surgery since March 2011. The S-CAHPS survey assesses the patient experience of surgical care by asking about surgeon communication and decision making before and after surgery. The initial results were presented at the AUA Annual Meeting last year. Quentin Clemens, the NPR Division Chief, is Co-PI for UM on the NIDDK MAPP (Multidisciplinary Approach to Pelvic Pain) research network, which has finished its fifth year. Over 1000 research subjects have been recruited across 6 research sites, and all have undergone extensive phenotyping studies. Early findings include confirmation that many patients with IC and prostatitis have global sensory sensitivity, suggesting the presence of a “central” abnormality in pain processing, and demonstration that pelvic pain patients exhibit a number of abnormalities on neuroimaging (fMRI). Quentin now serves as Chair of the network. Another NIDDK multi-institutional group, The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN), started its funding last year, with the major goals to develop new patient-reported outcome tools, and to examine for relevant patient phenotypes, in patients with non-pain lower urinary tract symptoms and urinary incontinence. UM is one of 6 clinical sites for this network, which is funded for 5 years. 15. The Pediatric Urology Division produced the July 26, 2013 What‟s New. Led by Division Chief John Park, the group revisited their 2010 Vision Statement, “THE FIRST CHOICE DESTINATION FOR ALL (ROUTINE AND COMPLEX) PEDIATRIC UROLOGY PROBLEMS IN MICHIGAN” and provided an honest appraisal of where they stood in relation to that vision. With 5 faculty, 2 nurse practitioners and an ACGME-accredited fellow, the Division has challenged themselves to reach far and wide, with clinical care being delivered in Ann Arbor, Brighton, Livonia, Kalamazoo, Grayling and Marquette. In 2010 patient access was poor (less than 40% seen within 4 weeks of appointment request) but in 2013 nearly 90% of new patients were seen within 4 weeks. That is only a small part of the story, however. A significant challenge to practicing Pediatric Urology at UMHS is that we are the only state in the Union that lost population from 2000 to 2010. Additionally, UMHS is physically and fiscally (in terms of insurance restriction) far away from the concentrated patient market. The group is facing the hard facts: “Is our quality so much better than our competitors that they would be willing to drive an extra 2-3 hours to bypass our competitors and come to see us?” Quality-improvement initiatives and new programs, such as the unique Michigan Program for Disorders of Sex Development, are important but are not enough. Using a fishing analogy, the group suggested “Our strategies should then be obvious - we need to go to where the fish is, not simply make ourselves attractive and wait for them to come to us.” The Pediatric Urology Division is making huge efforts to do this, and is a great example to the rest of the Department. 16. We include within our Urology Department the faculty of the Ann Arbor VA Section of Urology, who provided the final Clinical Division What‟s New, on September 27, 2013. All Ann Arbor VA Section of Urology faculty members have appointments at UM and practice clinically at UM as well (if not on a regular basis, then at least “on call”). Jeff Montgomery (Urologic Oncology Division) heads the Ann Arbor VA Section of Urology. Khurshid Ghani (Endourology Division) and Ted Skolarus (Urologic Oncology Division) provide full-time VA support, and several other UM faculty spend clinical time at the VA as well. The VA Urology service has become one that other services look to as an example of high-quality and efficient care. Several pilot programs have been trialed in the Urology clinic prior to rolling them out VAwide. The VA Urologic surgeons are regarded as some of the most skilled and reliable surgeons in the VA operating room. Their robotic surgery program was considered a success just a few months after starting. The Ann Arbor VA faculty members are also leading efforts to establish guidelines for evidence-based urologic care that are being extended to other VA medical centers. Finally, the VA is a vital part of our resident educational system. As Jeff writes “The VA is the place where our residents get their most extensive and consistent clinic experience. This is where the 2’s and 3’s first cut their teeth on outpatient urologic care and where the 5’s hone their practice. The volume of general, oncologic and reconstructive surgery is unmatched by other VA or County experiences urology residents have in other programs. One of the most significant contributions the VA provides to our residents’ education is continuity of care. The residents have the opportunity to take a patient from the clinic, to the OR and through their post-operative care. No other rotation in our program offers this.” 17. As you can see, our thriving Department of Urology is made up of several thriving Clinical Divisions. These are not the only building blocks of our Department, which include also our Research Divisions (Health Services Research and Laboratory Research) and the cross-Divisional efforts directed by our Associate Chairs of Ambulatory Care, Surgical Services and Research. Nonetheless, as made clear on our stationary, our “essential deliverable” is “KIND AND EXCELLENT PATIENT-CENTERED CARE THOROUGHLY INTEGRATED WITH INNOVATION AND EDUCATION AT ALL LEVELS.” I hope that this compilation What‟s New has given you a taste of the newest challenges being addressed by our Clinical Divisions.