2019 State of the School

A Five-Year Look Back Selwyn M. Vickers, M.D., FACS Senior Vice President for Medicine and Dean JANUARY 30, 2019

In Memoriam

Harold J. Fallon, M.D. Former dean of the School of Medicine

Bill O’Byrne, M.D. Department of Anesthesiology and Perioperative Medicine

Gwen Claussen, M.D. Department of Neurology

Sabine Huke, Ph.D. Department of Medicine

Nass Cannon, M.D. Department of Medicine

Michael Miller, Ph.D. Department of Cell, Developmental and Integrative Biology

Lane Rutledge, M.D. Department of Genetics

Nancy Swift, BSN Nursing Supervisor in Surgery UAB Highlands

In Memoriam

Bongani Mayosi, BMedSci, MB ChB, FCP(SA), DPhil, OMS Dean of the Faculty of Health Sciences, University of Cape Town

LTC Thomas C. Smith III Director, Birmingham Veterans Affairs Medical Center

Thank You

Ray L. Watts, M.D. President

UAB Administration

Pam Benoit, Ph.D. G. Allen Bolton Jr., Senior VP, Academic MPH, MBA Affairs and Provost Senior VP, Finance, Administration

Paulette Patterson Dilworth, Ph.D. VP, Diversity, Equity and Inclusion

William Ferniany, Ph.D. CEO, UAB Health System

Tom Brannan VP, Advancement

Alesia Jones Chief Human Resources Officer

Christopher S. Brown, Ph.D. VP, Research

John Jones, Ph.D. VP, Student Affairs

Anne L. Buckley, APR Curtis A. Carver Jr., Ph.D. Chief Communications VP, Information Officer Technology and Chief Information Officer

Kathy Nugent, Ph.D. Executive Director, Harbert Institute for Innovation and Entrepreneurship

Selwyn Vickers, M.D., FACS Senior VP for Medicine and Dean of the School of Medicine

Building on Success UAB as the preferred academic medical center of the 21st Century ยง Top 10 in quality ยง Top 10% in patient satisfaction ยง Top 20 in NIH funding ยง Top destination for best talent

Selwyn M. Vickers, M.D., FACS Senior Vice President for Medicine Dean, School of Medicine

William Ferniany, Ph.D. CEO, UAB Health System

Physician Leadership Keith A. (Tony) Jones, M.D. President, UAHSF Chief Physician Executive, UAB Medicine Senior Associate Dean for Clinical Affairs, School of Medicine

FIVE-YEAR JOURNEY Moving from Information to Transformation

Vision for the Future The Preferred Academic Medical Center defined by culture, values, and investments in talent and resources that reflect a commitment to the highest levels of clinical care, scholarship and innovation, which includes discovery of knowledge, the education of medical leaders and the engagement of our community.

Collaborative Governance UA Board of Trustees

UAB Health System Board

UAHSF Board

Gathering Data to Create a Vision of Transformation CULTURE FINANCIAL INVESTMENT PROGRAMS PEOPLE INFRASTRUCTURE ORGANIZATIONAL STRUCTURE

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Challenges Faced in 2013 AAMC audit of Dean’s Office senior leadership revealed staffing was short 18-20 full-time employees compared to competitors:

Dean’s Leadership Team in 2013 Equaled 3.5 FTE

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Challenges Faced in 2013 25 20 15 R² = 0.947

Key principle of academic medical centers: Innovation and discovery drive great clinical care and reputation.

10 Bowman, M.A., Rubenstein, A.H., Levine, A.S. Clinical Revenue Investment in Biomedical Research, Lessons from Two Academic Medical Centers. 2007, JAMA, 207(22):10-13.

5 0 110 11 -2 21 0 -3 31 0 -4 41 0 -5 51 0 -6 61 0 -7 0

Average U.S. News & World Report Ranked‌

Innovation is correlated with clinical reputation:

2013 NIH SOM Rank

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Challenges Faced in 2013 b)

25

20 13 (

25

20 12

22

20 11

22

20 10

19

20 09

20 06 (

17

20 08

20 05

18

20 07

20 04

a)

UAB SOM NIH ranking trend from 2004-2013:

28

29

31

0

10

20

30

R² = 0.9679 (a) Blue Ridge estimated ranking at 33 because JHS departments were not included in the total. The corrected rank is shown. (b) Estimated using NIH data and including Mayo. Identical to rank released by Blue Ridge more recently.

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Challenges Faced in 2013 2013 U.S. News ranked adult specialties of affiliated hospitals compared to peers:

25

5

10

15

20

25

30

20 15 10

0

3 UCSF Hopkins Penn Stanford Yale Wash U Pitt U Wash Vandy Duke U Mich UCSD UCLA UNC Columbia Case…

Emory Mt. Sinai Mayo Baylor Oregon NYU Northwe…

Harvard Colorado Einstein Minnesota UT… U Chicago U… UAB U…

5

Culture

FINANCIAL INVESTMENT

Programs

People

Infrastructure

Organizational Structure

Challenges Faced in 2013 Institutional research growth requires investment; every NIH dollar needs $0.53 institutional dollars in support:

*Error bars represent 95% confidence intervals

Culture

FINANCIAL INVESTMENT

Programs

People

Infrastructure

Organizational Structure

Challenges Faced in 2013 § Only school in the top 35 without clinical revenue to support research mission (Dean’s tax) § UAB SOM had only one top 10 NIH department ranking (OB/GYN) § Clinical enterprise was contributing significantly less revenue to our broader academic mission compared to peers like Emory, North Carolina, and Vanderbilt

Culture

Financial Investment

PROGRAMS

People

Infrastructure

Challenges Faced in 2013 ยง CCTS renewal ยง CCC renewal ยง Renew Liaison Committee on Medical Education (LCME) accreditation renewal ยง Launch of new institutes, centers and departments ยง New regional medical campus

Organizational Structure

Culture

Financial Investment

Programs

PEOPLE

Infrastructure

Organizational Structure

Challenges Faced in 2013 Recruitment, reinvestment, and retention needed in key areas: ü Department (Chairs) § § § § § § § § § § § §

ü Department Reinvestments

Anesthesiology § Medicine Biochemistry and Molecular § Microbiology Genetics § Neurology Biomedical Engineering § Ophthalmology Cell, Developmental and Integrative ü New Leaders for Institutes and Biology (CDIB) Centers Dermatology • Informatics Institute ENT • UAB-HudsonAlpha Center for Family Medicine Genomic Medicine Pathology • Hugh Kaul Precision Medicine Pediatrics Institute Surgery • CCTS Neurobiology • Cystic Fibrosis Center Education • Institute for Cancer Outcomes and Survivorship • Comprehensive Cancer Center

Culture

Financial Investment

Programs

People

ORGANIZATIONAL STRUCUTURE

INFRASTRUCTURE

Challenges Faced in 2013 Creating effective collaborative governance: UAB Medicine as the Preferred AMC of the 21st Century ยง Top 10 in Quality ยง Top 10% in Patient Satisfaction ยง Top 20 in NIH Funding ยง Top destination for best talent

MOVING FROM INFORMATION TO TRANSFORMATION 2013-2018 RESULTS

CULTURE

Financial Investment

Programs

People

Infrastructure

Transformational Change Increased the size and capacity of the Dean’s Leadership Team:

Organizational Structure

CULTURE

Financial Investment

Programs

People

Leadership Support

Infrastructure

Organizational Structure

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Transformational Change Growth in federally funded research dollars: NIH Funding $240,000,000

$232,996,499

$100M in growth in net new NIH dollars

$220,000,000 $200,000,000 $186,070,729 $180,000,000

$171,945,411

$160,000,000

$168,394,834

$162,442,592

$140,000,000 $120,000,000

$195,053,174

$156,324,620 $158,476,912 $143,263,811 $149,533,584

$165,425,015

$132,915,974

$131,505,113

$100,000,000 2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Transformational Change UAB SOM NIH ranking and trend: 2013

2014

2015

2016

2017

2018 0

5

10

15

21 23 26

31

25

20

23

25

30

35

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Transformational Change UAB SOM public school NIH ranking trend since 2013: 2013

2014

2015

2016

2017

2018 0 2 4 6

8 10

13

10

8

8

8 10 12 14

UC San Francisco Pittsburgh Michigan UC San Diego UCLA- Geffen U Washington North Carolina UAB

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Transformational Change Five-year growth of NIH grant >$100M (Elite 8): 50% 45%

42.8%

43.1%

40.4%

40.3%

40% 33.6%

35%

30.9% 28.5%

30%

23.8%

25% 20% 15% 10% 5%

co an cis Fr Sa n C -U

3

-S ta nf or

d

s St Lo ui

-P it t sb ur gh 6

1

-M 12

U

-C 7

-W as hi ng to n

ol um bi a

AB -U 21

ou nt Si na i-I ca hn

4

16

-N

or th w

es te rn -F ei nb er g

0%

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Transformational Change Outstanding growth in department rankings: FY13 Department Anesthesiology Biochemistry & Molecular Genetics Biomedical Engineering Cell, Developmental & Integrative Biology Dermatology Emergency Medicine Genetics Medicine Microbiology Neurobiology Neurology Neurosurgery Ob/Gyn Ophthalmology Orthopaedic Surgery Otolaryngology Pathology Pediatrics Pharmacology PM&R Psychiatry Radiation Oncology/Radiology Surgery Urology

Ranking 16 46

Funding $ 2,192,070 $ 4,178,056

16 15 23 36 18 35 20 34

$ $ $ $ $ $ $ $

9,063,212 1,831,851 495,731 2,129,322 59,967,759 7,587,757 5,084,104 3,313,868

3 36

$ 7,990,042 $ 1,755,703

14 38 80 19 47 33 31 19

$ $ $ $ $ $ $ $

10,523,045 5,578,556 969,496 398,200 3,439,118 2,685,866 2,871,755 860,463

Ranking 9 52 6 10 1 21 13 16 28 25 17 22 9 6 37 12 17 72 23 36 43 21 12

FY 18 Funding $ 5,396,008 $ 3,576,080 $ 5,285,777 $ 13,873,267 $ 8,277,406 $ 689,469 $ 14,680,250 $ 86,607,537 $ 9,747,471 $ 6,246,385 $ 15,079,112 $ 2,100,868 $ 5,073,835 $ 9,309,000 $ $ $ $ $ $ $ $ $

366,513 14,909,839 15,805,526 1,291,353 129,200 6,341,436 1,076,840 5,535,649 1,597,678

Departments in top 10

1 6

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Transformational Change Ranking trend from 2013-2018: US News Rankings

15 10 5

NIH Rankings 10

9

8

10

6

3

0 -5 -10 -15 -20 -25

24

22

22

21

25

-30 -35

31

More ranked programs than any AMC in the South except Duke (including Emory and Vanderbilt)

CULTURE

Financial Investment

Programs

People

Infrastructure

Organizational Structure

Transformational Change Overall clinical growth:

1000000

80000

$2,500,000

$2,000,000

$2,163,021 $2,035,744 $1,966,522 $1,824,677 $1,653,473 $1,584,379

1200000

100000

103202 100575 90986 86662 82206 79494

1400000

1492348 1424427 1358668 1290806 1178196 1143118

1600000

120000

$1,500,000

800000 49130 46507 45520 44754 43091 41297

60000

600000 400000

$1,000,000

40000

200000

$500,000

0 Outpatient Clinical Encounters

20000

2013 2014 2015

0

2016 2017 2018

$0 Net Patient Revenue Total Discharges 2013 2014 2015

Total Surgery Cases 2016 2017 2018

2013 2014 2015 2016 2017 2018

FINANCIAL INVESTMENT

Programs

People

Infrastructure

Organizational Structure

Transformational Change SOM Academic Enrichment Fund (a need for $0.53 for every new NIH dollar): $45 $40 $35 $30 $25 $20 $15 $10 $5 $0

VARIABLE 15 MILLION

Clinical Support

20 13 20 14 20 15 20 16 20 17 20 18

Culture

Goal is to achieve $55 million Budgeted at $20 million (UAB B) $34 million received in 2015 (UAB V/B) Variable at approximately $15 million

Viva

HSF

Hospital

Culture

FINANCIAL INVESTMENT

Programs

People

Infrastructure

Organizational Structure

Transformational Change AEF Investments:

$112M Chair Packages and Department Reinvestments Anesthesiology; Biochemistry; Bioengineering; Cell, Developmental and Integrative Biology; Dermatology; Family Medicine; Huntsville; Medicine; Microbiology; Neurobiology; Neurology; Ophthalmology; Otolaryngology; Pathology; Pediatrics; Surgery; Radiology

$59.1M

$56.4M

Institutes and Centers

Other

Comprehensive Cancer Center

Chair/Leader Recruitments in Progress

Center for Clinical and Translational Science UAB HudsonAlpha Center for Genomic Medicine Informatics Institute Hugh Kaul Precision Medicine Institute Cystic Fibrosis Center

Faculty Recruitment and Retention Inflammation, Infection and Immunity (I3) Outcomes and Population Health Joint Health Sciences Staff Appreciation Payments

Culture

FINANCIAL INVESTMENT

Programs

People

Infrastructure

Organizational Structure

Transformational Change O’Neal Comprehensive Cancer Center at UAB: O’Neal Industries, Inc. and its shareholders gave the single largest gift in UAB history to the Comprehensive Cancer Center.

$30M

Culture

FINANCIAL INVESTMENT

Programs

People

Infrastructure

Organizational Structure

Transformational Change The Campaign for UAB: With the help of the O’Neal gift, UAB surpassed its $1 billion fundraising goal with $1,002,957,673 raised.

$1B+ 67% total funds raised

percent of funds donated to School of Medicine

Culture

FINANCIAL INVESTMENT

Programs

People

Infrastructure

Organizational Structure

Transformational Change Created the Board of Visitors:

Total contributions to date: $46M

Culture

Financial Investment

PROGRAMS

People

Infrastructure

Organizational Structure

Transformational Change Medical Education § LCME accreditation: Last site visit occurred in 2014 and is good for 7 years. Next site visit will take place 2021-2022. § Created Learning Communities § Created Montgomery Regional Medical Campus § Underrepresented in mediucine (URiM) figure never reached >8% for 49 years in a state that’s 24% URiM. § Entering class of 2017: 15% § Entering class of 2018: 16.1%

Culture

Financial Investment

PROGRAMS

People

Infrastructure

Organizational Structure

Transformational Change Challenges overcome:

•CCTS renewal: top three in U.S. •CCC renewal: funded continuously since 1974 •Renewed set of core research science goals to direct growth

Culture

Financial Investment

PROGRAMS

People

Infrastructure

Organizational Structure

Transformational Change Creation of research priority areas:

Precision Medicine Informatics Basic Science Discovery I3: Inflammation, Infection and Immunity Population Health, Health Disparities and Outcomes Effectiveness Research

Culture

Financial Investment

PROGRAMS

People

Infrastructure

Organizational Structure

Transformational Change Creation of key programs:

ยง Established institutes, centers and new departments ยง Collaborated with HudsonAlpha ยง Worked on Global Health, UCT collaboration, Gates Grand Challenge ยง Created funding opportunities and awards to recognize research success (Blue Sky, Multi-PI awards, Second RO1s)

Culture

Financial Investment

PROGRAMS

People

Infrastructure

Organizational Structure

Transformational Change Created Pittman Scholars Announcing 2019 recipients:

Matt Alexander, Ph.D. Pediatrics

Aaron Fobian, Alexa Mattheyses, Ph.D. Ph.D. Psychiatry CDIB

Pankaj Arora, M.D. Medicine

Kyle Wood, M.D. Urology

Culture

Financial Investment

Programs

PEOPLE

Infrastructure

Organizational Structure

Transformational Change Bridging and retaining SOM Faculty: 25 Professors

20 Assistant Professors

8 Associate Professors

49 Bridge Funding Recipients

Total: 102

Culture

Financial Investment

Programs

PEOPLE

Infrastructure

Organizational Structure

Transformational Change

2013-2018 recruited leaders (talent acquisition 17/22 out of state): 1. Dr. Mitch Cohen Chair, Department of Pediatrics

12. Dr. Christina Grabowski Associate Dean, Admissions

2. Dr. Herb Chen Chair, Department of Surgery

13. Dr. Ronald Lazar Evelyn F. McKnight Endowed Chair in Memory and Learning

3. Dr. George Netto Chair, Department of Pathology

14. Dr. Bill Carroll Chair, Department of Otolaryngology

4. Dr. Roger Smalligan Regional Dean, Huntsville Campus

15. Dr. Bradley Yoder Chair, Department of Cell, Developmental and Integrative Biology

5. Dr. Boni Elewski Chair, Department of Dermatology

16. Dr. David Bedwell Chair, Department of Biochemistry and Molecular Genetics

6. Dr. Jim Cimino Director, Informatics Institute

17. Dr. Matthew Might Director, Hugh Kaul Precision Medicine Institute

7. Drs. David and Jennifer Pollock Professors, Department of Medicine

18. Dr. Michael Birrer Director, Comprehensive Cancer Center

8. Dr. Smita Bhatia Director, Institute for Cancer Outcomes and Survivorship

19. Dr. Craig Powell Chair, Department of Neurobiology

9. Dr. Ravi Bhatia Division Director, Hematology/Oncology, Department of Medicine

20. Dr. Irfan Asif Chair, Department of Family and Community Medicine

10. Dr. Jay Zhang Chair, Department of Biomedical Engineering

21. Dr. Dan Berkowitz Chair, Department of Anesthesiology and Perioperative Medicine

11. Drs. Joseph Tector and David Cooper Co-Directors, Xenotransplantation Program

22. Dr. Steven Theiss Chair, Department of Orthopaedic Surgery

Culture

Financial Investment

Programs

PEOPLE

Infrastructure

Organizational Structure

Transformational Change Growth in the number of PIs: 0

50

100

150

2018

323

2017

303

2016

2015

296

267

2014

259

2013

259

200

250

300

350

Culture

Financial Investment

Programs

PEOPLE

Infrastructure

Organizational Structure

Transformational Change Investing in wellness: § UAB Medicine has launched the Wellness website to consolidate information and resources § Well-Being Index participants: § Faculty – 576 § Trainees – 266 § APPs – 152

§ Will continue to roll out to other groups in SOM and UAB Medicine

Culture

Financial Investment

Programs

People

ORGANIZATIONAL STRUCUTURE

Transformational Change Space optimization success: ยง Wallace Tumor Institute ยง 7,500 ASF of recruitment space identified

ยง Shelby ยง 13,845 ASF of recruitment space identified

ยง Renovated McCallum will create space for ~32-40 new recruits

INFRASTRUCTURE

Culture

Financial Investment

Programs

ORGANIZATIONAL STRUCUTURE

People

INFRASTRUCTURE

Transformational Change Organizing for success:

• Alignment of HS, HSF, and SOM • President of HSF full-time position

UA Trustees HSF Board

UAB Medicine Board

-

Board Committees: Executive Finance Medical Leadership Compensation Audit & Compliance

Chair: Dean of SOM

Future State-Chair: Dean of SOM when President chairs a system board

UAB Medicine JOL Council

Executive Policy Council Senior Leaders Forum Operating Committees

THE NEXT FIVE YEARS: CHALLENGES AND OPPORTUNITIES

Challenges § Providing competitive pay and doing our very best to recognize hard work and effort from faculty and staff § Finding $0.53 to support every NIH dollar § Reaching the AEF $55 million threshold to keep the status quo § Needing ~$115 million to support our current research base § Producing an operating margin >3% in U.S. with worst Medicare Wage Index (MWI) § Maintaining and developing a culture of cost reductions with improved quality § Developing local statewide and national partnerships for UAH and VIVA § Recruiting and retaining our best faculty § Needing new or designated rehab and cancer homes § Aging clinical plan and insatiable need for capital expenditures

Core Needs § High-end imaging capabilities for research and clinical purposes § Single-cell analysis capabilities § Cryo-electron microscopy acquisition § Bioinformatics support services to assist investigators with experimental design and data interpretation § Expansion of microbiome analysis capabilities § Optogenetics and behavioral assessment capabilities

Space Goals: ยง Creating/optimizing space for ~60-90 net new researchers ยง Creating wet lab and dry lab spaces that are modern, attractive, safe, reliable, manageable, and sustainable ยง Provide a governance strategy and space policies that are transparent, equitable, and competitive with our peers

Total Net New PIs Experimental Current Initiatives

Dry

~70-80

~52-62

~18

LHRB as Genomics

~19

0

~19

Total New Recruits

~89-99

~52-62

~37

OPPORTUNITIES

Advancing Wellness § Stress Management and Resilience Training (SMART) § Eight members of the UAB Medicine community will train to lead group-level versions of the intervention

§ EMR streamlining (Scribble) § Engaging with the provider community to identify features of the EMR that could be modified to decrease unnecessary work

§ Reducing administrative burden § Engaging with faculty in early 2019 to identify the source of their burdens, so we know where to work to reduce them

AGHI and All of Us § Alabama Genomic Health Initiative participants have been recruited in 65 of Alabama’s 67 counties § All of Us is rapidly expanding the number of institutions where people can enroll in the research program § A top priority for both programs is achieving a diverse participant community, especially by including those who are underrepresented in biomedical research

21st Century Cures Act Funding for NIH Innovation Projects under the Cures Act ($4.79B): Fiscal Year

Precision Medicine Initiative

2017

BRAIN

Cancer Moonshot

Regenerative Medicine

$40,000,000

$10,000,000

$300,000,000

$2,000,000

2018

$100,000,000

$86,000,000

$300,000,000

$10,000,000

2019

$186,000,000

$115,000,000

$400,000,000

$10,000,000

2020

$149,000,000

$140,000,000

$195,000,000

$8,000,000

2021

$109,000,000

$100,000,000

$195,000,000

2022

$150,000,000

$152,000,000

$194,000,000

2023

$419,000,000

$450,000,000

$216,000,000

2024

$235,000,000

$172,000,000

2025

$36,000,000

$91,000,000

2026

$31,000,000

$195,000,000

TOTAL

$1,455,000,000

$1,511,000,000

$1,800,000,000

$30,000,000

Designed to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently.

In addition to this, more than 2.3 billion is available for Alzheimer’s and dementia related research and 3.8 billion for neurosciences.

Regional and National Impact § Filling gap in the “Stroke Belt” as one of 25 institutions to join the National Institutes of Health StrokeNet § One of nine NIH Udall Centers for Excellence in Parkinson’s Disease Research § Hugh Kaul Precision Medicine Institute became a partner coordinating center with Harvard for the Undiagnosed Diseases Network’s 11 clinical sites

What is our WHY? Impacting the future of medicine in the United States by transforming Alabama and the Deep South Alabama • 1st worst state for stroke • 3rd worst state for diabetes • 3rd worst state for kidney disease • 4th worst state for heart disease • 6th worst survival rate for chronic lower respiratory disease

Impact • Continue to provide clinical care and make translational research strides to treat the burden of diseases in our region • Utilize programs like All of Us and the Alabama Genomic Health Initiative to continue reaching out to those who have traditionally lacked representation in medical research • Maintain dedication to health disparities and outcomes effectiveness research

Better is possible. It does not take genius. It takes diligence.

It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.

Atul Gawande, M.D., MPH

A Five-Year Look Back

Questions?