Not Just Any Department of Family Medicine: Telling the Story of the First Forty Years of the University of Michigan Department of Family Medicine

Maintaining Our Position While Continuing to Move Forward

Dr. Zazove has long brought a different set of credentials and experience to the Department of Family Medicine (DFP) leadership, although his position there was not clear from the outset. Like Dr. Davies, he was married to another family physician, but in this instance, he was the “trailing” spouse when Dr. Schwenk recruited his wife, Dr. Reed, to come bolster the faculty’s research faculty ranks in 1989. Dr. Schwenk recalled in an interview conducted in 2015 that it was not clear at the time of Dr. Reed’s recruitment what Dr. Zazove would do once he got to Ann Arbor. After exploring some other options outside the department and family medicine, Dr. Zazove joined the faculty in September 1989 as a clinical assistant professor involved in a variety of roles across all department missions. In addition to being named the first assistant chair of clinical programs in 1995, he was also the first faculty member appointed to a major clinical leadership position outside the department when he was named west region medical director within ambulatory care services of the health system in 1997. He continued to serve in other leadership roles within ambulatory care services and M-CARE, along with serving on the medical school executive committee from 2007 to 2010. He also found time between 1992 and 1994 to commute to Evanston to get a master’s degree in management from his undergraduate alma mater, Northwestern University.

In June 2011, he began his term as interim chair. After a national search that brought three external candidates to Ann Arbor for interviews and presentations, Dr. Zazove was selected to be the third chair in the history of the department and was installed as the second George A. Dean, MD, Chair of Family Medicine, with that appointment beginning on December 1, 2012.

NAME: Philip Zazove, MD

ROLE: Third chair and second George A. Dean, MD, Chair

BIO: Previously at University of Utah, faculty member in DFM since 1989

Location on March 1, 1978: St. Louis, Missouri, on a fourth-year ophthalmology clerkship awaiting couples match results

In addition to the successful establishment of the George A. Dean, MD, Chair of Family Medicine position in 2007, other development efforts in that same time period resulted in the establishment of an endowed research professor position. In November 2011, Mack T. Ruffin IV, MD, MPH, was installed as the first Dr. Max and Buena Lichter Research Professor of Family Medicine, a position that was “established in 2007 through a generous gift from Dr. Allen and Evie Lichter and Dr. Paul and Carolyn Lichter. This professorship honors the memory of their father, Dr. Max Lichter, a family physician who practiced in Melvindale, a Detroit suburb, for five decades and their mother, Buena Lichter, and is intended to encourage and support research in family medicine.” Dr. Allen Lichter served as professor and chair of the Department of Radiation Oncology and dean of the University of Michigan Medical School (UMMS), and his brother, Dr. Paul Lichter, served as professor and chair of the Department of Ophthalmology during much of Dr. Schwenk’s term as chair.

In 2012, Lee A. Green, MD, MPH, was named chair of the University of Alberta Department of Family Medicine. Dr. Green became the first residency graduate to become a department chair and also became the third emeritus faculty member.

More student scholarships also made their debuts during this phase. In 2012, Angeline Ti was the first recipient of the Paddy and Donald N. Fitch, MD, Family Medicine Scholarship. (A complete list of recipients of this scholarship and others mentioned in the chapter is included in appendix D.) This scholarship was “established in 2011 and is awarded to a senior medical student based on academic achievement, a demonstrated commitment to the principles of, and a career in, family medicine and demonstrated financial need. Dr. Fitch, a family physician, graduated from U-M Medical School in 1959 and practiced in Escanaba, Michigan. He passed away in August of 2011.”

In 2015, Yorgos E. Strangas was the initial recipient of the Michael Papo, MD, Family Medicine Scholarship, which is “awarded annually to a senior medical student based on the combination of outstanding academic achievement, demonstrated financial need, and a commitment to the principles of, and a career in, family medicine. Dr. Papo passed away in November of 2012.” Dr. Papo played a key role in the efforts of local and statewide family physicians to establish the Department of Family Practice at the University of Michigan. Dr. Papo and his classmate from the UMMS class of 1957, James Botsford, MD, started a practice in downtown Chelsea in 1958 after they completed rotating internships. Later Drs. Papo and Botsford relocated to a new building, the Chelsea Medical Clinic, farther south down Main Street in 1966. In 1978, that building was rented and later purchased by the University and became the first clinical site for the new department when it formally started on March 1, 1978. Dr. Papo also led the effort to establish Chelsea Community Hospital, which continues to be a critical partner in the department’s educational and clinical missions to this date.

Figure 6.1.

2012 installation of Dr. Zazove as the second George A. Dean, MD, Chair of Family Medicine. From left to right: Dr. Dean, Dr. Zazove, and Dean Woolliscroft

Figure 6.2.

2011 installation ceremony for Dr. Ruffin as the first Lichter Research Professor. From left to right: Allen S. Lichter, MD; Mrs. Evie S. Lichter; Mack T. Ruffin IV, MD, MPH; Dean Woolliscroft; Mrs. Carolyn R. Lichter; and Dr. Paul R. Lichter

In 2016, Jonathan Waldmann was the first recipient of the Gazella-­Brandle Memorial Family Medicine Scholarship, which was “established by Gary R. Gazella, MD, in honor and memory of Dr. Gazella’s sister, Kathy Lynn Gazella; Dr. Gazella’s father, Richard LaVern Gazella; and Dr. Gazella’s mother-­in-­law, Doris Arlen Hanson Brandle. It is awarded annually to a senior medical student based on the combination of outstanding academic achievement, demonstrated financial need, and a commitment to the principles of, and a career in, family medicine.”

In all, at the most recent scholarship and award event in May 2017, more than $80,000 was given to residents and medical students, a significant increase from the $20,000 given to students in 2004 when the first scholarships were awarded.

In addition to the efforts to establish additional student scholarships, the first lectureships were also established in this era. The Terence C. Davies, MD, Endowed Lectureship in Medical Education was established in 2014, and the first two visiting lecturers that were brought back to campus were familiar figures in the department. Dr. Schwenk returned from Nevada in 2014 to give the initial presentation, and in 2015, Dr. Green returned from Canada to give the second presentation in this series. (A list of details on these lectures and others mentioned in this chapter is provided in appendix F.) This endowment was created to support “an annual lectureship in family medicine that will feature a prominent speaker and family medicine educator, who embodies the same values and passion that Terry exemplified as Chair of the Department.”

A second lectureship was initiated in July 2015. The Drs. Earl and Louise Zazove Lectureship in Family Medicine was established in honor of Dr. Zazove’s parents. There have been three Zazove Lectures to date, all focusing in some fashion on issues related to the study of aging, as its purpose statement requires: “The Drs. Earl and Louise Zazove Lectureship in Family Medicine will support an annual lectureship in family medicine and an education program focused on aging that will feature a prominent speaker and family medicine educator.”

Changes in leadership positions and the bestowal of faculty accolades continued during this time period. In 2012, Grant M. Greenberg, MD, MSHA, MA, was appointed to replace Dr. Green as associate chair for information management and quality. Also in 2012, Dr. Cooke stepped down as residency director and was named executive director of the University of Michigan Health System (UMHS) Clinical Simulation Center. This represented the first appointment of this kind in department history. After a period of time with Tarannum A. Master-­Hunter, MD, serving as interim residency director, Margaret L. Dobson, MD, was named as the sixth residency director in 2013. That same year, David C. Serlin, MD, was appointed to succeed Dr. Malouin as associate chair for clinical programs.

Outside the department and the institution, Randall T. Forsch, MD, MPH, was named chief medical officer of Chelsea Community Hospital. This was the most significant appointment of a faculty member within the administrative structure of the department’s longtime partnership with Chelsea Community Hospital in providing care in the greater Chelsea community.

Several faculty members received accolades during the early years of Dr. Zazove’s leadership. Stefani A. Hudson, MD, was the second faculty member to receive the MAFP Michigan Family Physician Award in 2012. Dr. Peggs was inducted into the inaugural class of the UMMS League of Clinical Excellence in 2012. Also in 2012, Dr. Reed received the Physician Mentorship Recognition Award from the American Medical Association Women Physicians Congress. In 2013, Sara L. Warber, MD, was awarded a Fulbright Scholarship, the first department member to have received this prestigious recognition while a member of the faculty.

Over this period, progress and challenges continued across department missions. The implementation of MiChart as a new outpatient electronic medical record system in August 2012 served as one example, causing a great deal of stress on faculty, residents, fellows, and staff in the process of caring for patients and teaching students and residents in the outpatient setting. The challenge of procuring and maintaining sufficient space to accommodate the personnel needed to pursue department missions has remained another consistent issue through the history of the DFM. From the original administrative space adjacent to the animal labs to the space in the Clinical Faculty Office Building to 1018 Fuller to the space in Women’s Hospital, the location of the department has been the subject of negotiations regarding space in the agenda of each of the three chairs. With the appointment of Dr. Zazove as the third chair in 2012, the pursuit of more suitable space moved from a “to-­do” list item to action. And through a remarkable series of decisions made at upper levels in the medical center administration, space became available on the seventh floor of Medical Science I, the same space where the dean’s office was housed during the early years of the department. Many critical letters and memos used as contemporaneous documents in writing this history originated from this same space in the 1970s and 1980s.

Over Memorial Day weekend of 2013, the faculty and staff members who had been based in Women’s Hospital since 1999 were relocated to the seventh-­floor suite along with other faculty and staff who had remained in the 1018 Fuller building. While there was not enough room for the research faculty and staff and some general administrative staff to make the move to the suite, the new location did open room for some new faculty and staff associated with research mission efforts to move into 1018 Fuller. The symbolism of the move to the seventh (and top) floor of Medical Science Building I was apparent through the medical center. As Dr. Lefever emailed at the time of the move, the department had gone from “the doghouse to the penthouse” in the thirty-­five years since its inception.

A celebration of the first thirty-­five years of the department was held in April 2014. Dr. Davies—­who had also returned for the events in 1998, 2004, and 2008—­and Dr. Schwenk attended, and both made formal comments along with Dr. Zazove and others. Many former faculty, residency program and medical school graduates, and other friends of the department assembled for the celebration, which included a gathering of resident graduates in an informal setting on Friday evening followed by a more formal event on Saturday evening. The size and scope of these events and the number of participants would have been inconceivable in 1978, much less in 1982 or 1988 when the initial celebrations of the department were held.

The department’s focus on education was acknowledged in 2013 when four faculty members, Drs. Cooke, Peggs, Sheets, and Skye, were all inducted into the inaugural class of the UMMS League of Educational Excellence. In 2016, four more department faculty were inducted into the league: Kristina M. Gallagher, MD; Dr. Heidelbaugh; Margaret A. Riley, MD; and Pamela G. Rockwell, DO.

Figure 6.3.

Dr. Davies and original members of the 1975–76 Residency Planning Committee in April 2014. From left to right: Dr. Dean; Dr. Davies; Gary R. Gazella, MD; and Dale L. Williams, MD

In 2014, Dr. Sheets received the UMMS Lifetime Achievement Award in Medical Education, and in 2015, Dr. Skye was named one of four learning community directors within the structure of the new UMMS curriculum. In the same year, within the research mission, Dr. Ruffin was inducted into the UMMS League of Research Excellence, and Ananda Sen, PhD, received a Collegiate Research Professorship Award.

Just as Dr. Green had left to become chair of a department elsewhere, Dr. Ruffin left in 2016 to become chair of the Department of Family and Community Medicine at the Penn State University Hershey Medical Center. Caroline R. Richardson, MD, replaced him as associate chair for research programs and was also named the second Dr. Max and Buena Lichter Research Professor of Family Medicine.

Dr. Greenberg also left in 2016 when he was named chair of the Department of Family Medicine at the Lehigh Valley Health Network in Allentown, Pennsylvania. He was replaced on an interim basis as associate chair for information management and quality by Heather Holmstrom, MD, before she left in 2017 for a position at the University of Colorado in Denver. The position was renamed as the associate chair for population management, assumed by Kathryn M. Harmes, MD, in 2017.

In 2017, the residency program began to initiate a “Clinic First” approach to residency education that would prioritize ambulatory care and continuity of care practice over inpatient care. The program was also authorized to recruit thirteen residents per class beginning with the incoming class of June 2018, a significant increase from the class of four who started in July 1979.

Figure 6.4.

Caroline R. Richardson, MD

Three faculty members were honored at the 2017 Society of Teachers of Family Medicine’s (STFM) annual spring conference in San Diego. Anne L. Kittendorf, MD, received the STFM Advocate Award, and Margaret A. Riley, MD, received the STFM Innovative Program Award. Emeritus faculty member Mack T. Ruffin IV, MD, MPH, was the recipient of the Curtis G. Hames Research Award.

In the summer of 2017, word came that it was time for the department to move its administrative offices yet again. Planning began for moving the department administrative offices from the seventh-­floor suite in Medical Science Building I to the fourth floor of the 300 North Ingalls Building, which had been the site of St. Joseph Mercy Hospital until 1977.

As noted near the end of chapter 5, Dr. Schwenk gave a talk to the Dean’s Advisory Council in March 2011 in which he highlighted a number of the accomplishments of the department from 1978 to 2011. Those accomplishments are summarized in the text near the end of Chapter 5.

In July 2017, Dr. Zazove reviewed the PowerPoint slides from that presentation and provided a written document in which he noted additional accomplishments that had occurred or been enhanced in the six years since Dr. Schwenk’s presentation.[1]

Here are the additional clinical programs identified by Dr. Zazove (in addition to those listed in chapter 5) as notable in July 2017:

• MiPCT (Michigan Primary Care Transformation Project)
• Scribes
• Pre-­visits
• Quality and Guidelines Leadership
• C-­Sections Conducted by Family Physicians

Here are the educational programs he similarly identified as notable at that time:

• Residency expansion
• Medical student program leadership in new curriculum (MHome, Branches)
• Multiple new fellowships
• Clinical Simulation Center Leadership
• Ongoing Highly Rated Continuing Medical Education Programs

Here are additional notable research programs identified by Dr. Zazove in July 2017:

• Disabilities
• Mixed Methods
• Health Literacy
• Substance Abuse

In addition to the extensive examples that Dr. Schwenk listed as evidence of outreach, volunteerism, and community service in 2011, many of which continue to this date, Dr. Zazove added the community of Flint and the Deaf population to the long list. He also added the Association of Departments of Family Medicine and multiple specialty organizations such as the International Society for the Study of Vulvovaginal Disease, the Society of Decision-­Making, and the Association of Medical Professionals with Hearing Losses to the list of national leadership and contributions in chapter 5. In regard to research, Dr. Zazove identified new research collaborations in three of the twenty-­two departments or centers identified by Dr. Schwenk six years earlier.

In looking to the future, Dr. Zazove added three new items in bold print to Dr. Schwenk’s 2011 list of health care delivery criteria: an emphasis on quality and maximized value, the address of population health in addition to individuals, and evidence-­based work.

In the previous chapter, information was provided regarding averages for NIH and USNWR department rankings up through 2011. These average rankings are now updated with data available as of September 2017. Rankings for NIH funding within family medicine departments ranged from third to twelfth between 1999 and 2017. USNWR department rankings ranged from a tie for third to tenth between 2002 and 2017. These rankings equated to an average ranking of 5.4 for NIH funding and an average ranking of 5.8 for USNWR rankings.

On September 13, 2017, the most recent SODA presentation was given by Dr. Zazove. The entire 2017 SODA “report card” is included in appendix H. One notable highlight is the size of the department in terms of human resources statistics: 99 faculty, 290 staff, 33 residents, and 12 fellows.

At this point in time, considering all the clinical activity between 1978 and September 2017, more than 3.2 million patient visits had been documented by department clinicians, including the delivery of more than 10,900 babies. At this time, it was estimated that more than 5,300 students had been taught in family medicine clinical clerkships, subinternships, and electives. There had been 289 residency graduates. The department was tied for the fourth best family medicine department by the USNWR methodology, the highest ranked of all medical school departments at the UMMS. The estimated NIH ranking among family medicine departments across the nation was sixth. The total research grant funding for 2016–­17, including direct and indirect costs, was over $3.5 million. The total research grant funding from 1978 to 2017 was over $60 million.

As the period of time covered by this book draws near present day, new opportunities and uncertainties regarding the short-­term and long-­term priorities of the department across missions need to be recognized and addressed. In 2016, Dr. Zazove commissioned Dr. Lefever to work with department leadership to fashion a strategic plan to guide the department moving forward. As of early October 2017, the faculty leaders and groups had completed the plan and now are fully engaged in the important implementation process.

In an email communication, Dr. Lefever summarized the strategic plan in this fashion:

• Education—­(1) students and residents will experience the essential elements of providing comprehensive family medicine, while training in our practices, and faculty will identify and educate learners on these shared, core components; (2) a well-­defined cohort of residency-­focused faculty will be identified and serve as the core faculty for our residency training program; and, (3) strategies for impacting the overarching medical education experience/curriculum for all medical students will be developed to assure family medicine input and influence.
• Research—­(1) position the Department as one of the top, three research programs in family medicine at the national level; and, (2) move the Mixed Methods Research Group and the Disability Research Group toward official recognition as research centers with institutional support and national recognition.
• Medical Care—­(1) position the Department as a national leader in exemplifying family medicine care delivery, developing a model that enhances the patient’s experience and maximizes physician satisfaction; and, (2) pursue collaborative opportunities and projects with other primary care departments/divisions to develop an advocacy group for primary care influence.
• Advocacy—­(1) develop sustainable, department processes that promote diversity, equity and inclusion and support our commitment to recruit and retain diverse talent such that faculty members, residents and staff “mirror” the diversity of the communities we serve; and, (2) increase the “joy of practice” and decrease “burnout” rate to be at or below the national rate for non-­physician professionals.
• Faculty Development—­intentionally invest in faculty development to ensure the department’s core interests and commitments are continuously supported through the development of a “pipeline” of leaders and area experts.[2]

The department and its leaders have proven to be resilient and perseverant throughout its history, and using the most recent strategic plan to guide future development, they will continue the tradition and processes followed since 1978.