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

Generating Support and Success of Development Efforts

The internal and external reviews of the Department of Family Medicine (DFM) that took place in 2001 confirmed its growing reputation across missions at the institutional and national level. The two external reviewers—­Alfred O. Berg, MD, MPH, from the University of Washington and Stephen P. Bogdewic, PhD, from Indiana University—­identified a number of strengths across missions. These strengths included highly qualified faculty and staff, a highly respected chair, and outstanding educational programs. They also acknowledged recent accomplishments in research endeavors and ambulatory clinical activities. In particular, they noted that the department had achieved a national reputation based on its success across the areas of education, research, and clinical service.

Dean Allen S. Lichter sent Dr. Schwenk the full review and a letter summarizing the next steps in the process following the external review. After sharing the review and Dean Lichter’s letter with key departmental leadership, Dr. Schwenk focused his response to the dean on issues related to developing a plan for research; reviewing support for education; continuing an active debate of the issue of properly supporting primary care sites, most notably the Ypsilanti Family Practice Center; exploring development as a source of recurring support; and reviewing general fund support. While not all of the proposals made to Dr. Lichter were fully enacted, enough of them were for the department to continue to prosper and thrive for the next ten years, including stabilizing support for the clinical enterprise after expanding to Livonia and Stockbridge and then having to close those sites after two to three years.

Several key outcomes were attributable to earlier investments in both people and technology, one of which resulted in the development and licensing of a prompt and reminder system named ClinfoTracker, which was designed as a platform for studying cognitive aspects of prompting clinicians in primary care settings. Dr. Green and Donald E. Nease Jr., MD, were key to developing this platform and incorporating it into clinical and research applications. Eventually ClinfoTracker was sold to a private company, which marketed and sold it as Cielo Clinic.

Several changes in key leadership positions took place during this time period. In 2002, Jean M. Malouin, MD, MPH, was named the third assistant chair for clinical programs, and Eric P. Skye, MD, was appointed as the fourth residency director, replacing Dr. O’Brien, who had served in that role for sixteen years, the longest stint in that key role to date. Dr. O’Brien was chosen as the MAFP Family Medicine Educator of the Year in 2005, and in 2007, Dr. Skye received that same award.

Several other faculty members received significant regional and national awards during this period. Dr. Schwenk was elected to the Institute of Medicine in 2002 and received the Society of Teachers of Family Medicine (STFM) Recognition Award in 2003. Also in 2003, Michael L. Szymanski, MD, was named the MAFP Family Physician of the Year, the first faculty member to receive that honor. In 2004, Dr. Ruffin was appointed the third assistant chair for research programs, replacing Dr. Green in that position. In 2006, Dr. Green was appointed as the initial assistant chair of information management and quality.

In response to institutional and national initiatives, the department made significant changes to the way family medicine was practiced and studied. The creation of the new position of assistant chair of information management and quality reflected the need to have additional leadership and expertise in support of these new efforts.

In 2004, the department began to transform the way care was delivered and to implement innovative components of care into its clinical programs. Efforts affected many aspects of care in the department’s outpatient sites, such as patient access, patient care teams, management of paperwork and communication, population-­based management, and integration of teaching and research into clinical care. The implementation of CareWeb (the health system’s homegrown electronic medical record) and continuing development of ClinfoTracker also supported these efforts.

The efforts to redefine the process of care continued in 2006 as the Briarwood site piloted electronic visits, and across sites there were efforts to change appointment lengths to twenty minutes rather than the traditional fifteen-­ and thirty-­minute time frames. Group visits were explored, and a longitudinal chronic illness management program using registered nurses was also pilot tested.

Finally, in 2011, efforts led by Dr. Malouin were key to the state of Michigan being chosen to participate in the Centers for Medicare and Medicaid Services’ Multi-Payer Advanced Primary Care Practice Demonstration project. Dr. Malouin led the state’s project, the Michigan Primary Care Transformation Project.

One of the significant outcomes of the 2001 review was the recommendation that the department continue its evolution by adding a development officer, who would be partially funded by the medical school and the development office for a period of at least three years. Amy C. St. Amour was chosen to be the first person in this position beginning in 2003.

The success of another anniversary event held in 2004 to celebrate the first twenty-­five years of the department provided evidence of the value of a more formal development focus. The timing was right for having someone specifically reach out to alumni and friends of the department to inform them of recent accomplishments and to establish policies and procedures for giving to support specific program missions. This era was notable for an explosion in the number of awards and scholarships awarded to medical students and residents, with most of the money that was awarded going toward reduction of debt for medical students who had matched into family medicine residency programs.

The first student scholarship, the Department of Family Medicine Senior Scholarship, was awarded in 2004. There were two inaugural recipients, Tracy T. Bozung and Andrew H. Heyman. This has been the only time when two recipients of this scholarship were chosen in the same year. (A complete list of recipients of this scholarship and others mentioned in the chapter is included in appendix D.) This scholarship is “awarded to a senior medical student based on academic achievement, performance in the family medicine clerkship, a demonstrated commitment to the principles of, and a career in, family medicine and demonstrated financial need.”

In 2005, Katherine J. Gold, MD, MSW, MS, was the first recipient of the William Clippert Gorenflo Research Award in Family Medicine. This is the only current award that can be awarded to a medical student or a first-­ or second-­year family medicine resident. Among the medical student recipients, several of them have been preclinical students, so this award is not limited to students who have already matched into family medicine. Dr. Gold was a resident at the time she received the award, and since that time, she has served as the faculty mentor to other recipients of this award. This award is “awarded to a medical student or resident who is doing research with a family medicine clinical or research faculty member. This unique award provides incentive and rewards passion and enthusiasm for research. The William Clippert Gorenflo Research Award was established by Daniel W. Gorenflo, PhD, a former research investigator in the Department of Family Medicine, in honor and memory of his father who died in 2004 at the age of 83.”

In 2005, Sarah Vanston was the first recipient of the Harold Kessler, MD, Scholarship in Family Medicine. As with the Gorenflo Research Award, this scholarship is awarded before students have matched into a specialty, so not all the recipients have entered family medicine residency training following medical school. This scholarship “supports a senior medical student based on academic achievement during the first three years of medical school, performance in the family medicine clerkship, a demonstrated commitment to the principles of and a career in, family medicine, and demonstrated financial need, as well as, an interest and dedication in helping rural and/or medically underserved populations. The scholarship was established by Susan, Barbara and Sam Kessler in honor of their father who passed away in 2003.”

In 2005, James F. Dolan was the inaugural recipient of the Kenneth and Judy Betz Family Medicine Scholarship. This scholarship is “awarded to a senior medical student based on academic achievement, performance in the family medicine clerkship, a demonstrated commitment to the principles of, and a career in, family medicine and demonstrated financial need. The Betzs, who reside in Grand Rapids, established this scholarship in recognition of their daughter’s achievements in family medicine. Mrs. Betz passed away on June 24, 2017, at the age of 70, just three days shy of her 71st birthday. Yet, her legacy lives on in perpetuity through the Kenneth and Judy Betz Family Medicine Scholarship.”

In addition to the increase in the number of scholarships awarded in May 2005, that year also marked the initiation of the Development Advisory Committee (DAC). The DAC was led by Ms. St. Amour and Dr. Lefever with additional involvement from Dr. Schwenk. Two of the DAC members from the beginning were representatives from the Residency Planning Committee (RPC), Gary R. Gazella, MD, and Dale L. Williams, MD. Other early members of the DAC were medical school or residency program graduates who had stayed in contact with the department in various fashions. Before the formation of the DAC, the department began to sponsor a family medicine reception in conjunction with the annual fall event hosted by the Medical Center Alumni Center (MCAS), which was held on a home football game weekend. The family medicine reception was generally held on Friday afternoon in between larger general interest sessions in the MCAS schedule, creating a chance for personal connections to be developed between the department and family physician medical school graduates.

The department had made previous attempts to participate in MCAS events, but the addition of a development officer and a formal committee provided greater structure and purpose. In this same time frame, the alumni newsletter was updated and increased in size, particularly as more student scholarships and awards were added, and more newsletter space was devoted to articles about the donors and recipients of these scholarships and awards. This increase in the size and sophistication of the newsletter was another indication of the increasing size and reach of the DFM.

In 2009, Puja G. Samudra became the first recipient of the Dale L. Williams, MD, Family Medicine Scholarship. The scholarship is “awarded annually to offset student debt and to recognize an outstanding senior student who has demonstrated a commitment to a career in family medicine and who matches into the U-M Department of Family Medicine residency program. Dr. Williams was on the original committee that presented a proposal to the U-M Board of Regents and the U-M Medical School to develop the Department of Family Medicine. Dr. Williams retired from a private family practice in Muskegon after 30 years and divides his time between Michigan and Florida.”

In 2009, David M. Lessens was the first recipient of the Vincent P. and Genevieve L. Burns Family Medicine Scholarship. This scholarship, which was “established by their daughter, Elizabeth (Beth) Burns, MD, a 1976 U-M medical school graduate and family physician, is awarded to a senior medical student based on a combination of outstanding academic achievement, demonstrated financial need, and a commitment to the principles of, and a career in, family medicine.”

In 2009, David M. Lessens was also the first recipient of the Chelsea Community Family Medicine Scholarship. This scholarship was “established by a long-­time friend and supporter of the Department, Arlene Howe, who played a significant role in establishing the department’s inpatient service at Chelsea Community Hospital in 1978. She initiated this scholarship to encourage students to consider family medicine as a specialty. This scholarship is awarded annually to a senior medical student, who has matched into a family medicine residency program, and is based on a combination of outstanding academic and clinical performance and demonstrated financial need.” Ms. Howe passed away on August 11, 2017, at the age of ninety-seven. Yet, her legacy lives on in perpetuity through the Chelsea Community Family Medicine Scholarship.

In 2009, Tessa Dake was the initial recipient of the Jill and Thomas R. Berglund, MD, Family Medicine Scholarship. This scholarship 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. Berglund, who passed away in 2011, was a 1959 UMMS graduate and a family physician in the Kalamazoo area.”

In 2010, Lindsey V. Kotagal was the initial recipient of the Alpha Epsilon Iota (AEI) Sorority Family Medicine Scholarship. The scholarship was “established by the designated trustee for the AEI Sorority Fund and family physician, Dr. Marguerite (Peg) Shearer, to support medical students who choose family medicine as their specialty. In 1956, the University of Michigan AEI Sorority was an organization that provided support and encouragement for professional women. As the interest in professional sororities declined and the required maintenance on sorority houses increased, AEI sold their house to the University and placed the money in a trust.”

In 2011, Matthew R. Schlough was the initial recipient of the Robert J. Fisher, MD, Family Medicine Scholarship. This scholarship, established in 2010, 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. Fisher is a 1960 UMMS graduate and, during medical school, he had the honor of serving as the president of his class for three years. He practiced for over 30 years in Ypsilanti and sold his practice (now the Ypsilanti Family Medicine Center) to the University upon his retirement.”

In the midst of the steady initiation of new scholarships to support student interest in family medicine came the establishment of the George A. Dean, MD, Chair of Family Medicine Fund. A gift of $1.5 million from Dr. Dean marked the establishment of the first endowed professorship in the history of the department. As noted previously, Dr. Dean was intimately involved in the establishment of the department, serving as co-­chair of the RPC, which recommended the initial establishment of the department as approved by the Board of Regents in November 1976. Dr. Dean also served on the recruitment committee that identified Terence C. Davies, MD, as the founding chair of the department. Dr. Dean stayed in contact with the department in the intervening years and chose to make this significant financial contribution as part of the University of Michigan’s Michigan Difference Campaign. Dr. Dean’s gift was supplemented by an additional amount of $500,000 from the Donor Challenge Fund, bringing the total value of the gift to $2 million.

On June 13, 2007, Thomas L. Schwenk, MD, was installed as the first George A. Dean, MD, Chair of Family Medicine in a ceremony in the University Hospital Ford Auditorium. Dean James O. Woolliscroft presided over the ceremony, which included members of the Dean, Davies, and Schwenk families along with department faculty, staff, residents, alumni, and friends. No one could have imagined such an event in the early days of the department, reflecting the remarkable progress made by the department in capitalizing on various opportunities since its establishment.

As noted in chapter 4, the department was first mentioned in National Institutes of Health (NIH) rankings in 1999 when it was ranked third in funding among family medicine departments. The department was first mentioned in the US News and World Report (USNWR) survey in 2002 as the eighth best family medicine department.

NAME: George A. Dean, MD

ROLE: Major donor who established the endowed chair, The George A. Dean, MD, Chair of Family Medicine

BIO: Co-chair of the RPC and member of the founding chair search committee

Location on March 1, 1978: Southfield, Michigan, seeing patients as a community family physician

As a frame of reference, in 2007, at the time that Dr. Schwenk was installed as the first George A. Dean, MD, Chair of Family Medicine, the University of Michigan Medical School (UMMS) was tied for tenth place in the USNWR survey of research-­oriented medical schools. In 2007, the DFM was fifth in the rankings of family medicine departments, the highest ranking among all the UMMS departments or specialties for that year and most years since USNWR has begun to report those rankings.

Figure 5.1.

June 13, 2007, installation ceremony for Dr. Schwenk as the first George A. Dean, MD, Chair of Family Medicine. From left to right: Dean Woolliscroft; George A. Dean, MD; Mrs. Vivian Dean; and Thomas L. Schwenk, MD

In addition to the scholarships and the named professorship, other development efforts helped support initiatives to help preclinical students explore family medicine as a career. Donors were able to contribute directly to a fund specifically used to support the Summer Preceptorship Program for UMMS students between the first and second years of medical school. The students were placed with community-­based family physicians, all with some sort of alumni connection to the medical school or residency program. The program was designed to provide an early experience in the “real world” of family medicine through caring and competent role models. The first students were placed in the offices of community family physicians in the summer of 2010. Since 2017, this has been referred to as the Kenneth and Judy Betz Summer Preceptorship.

In the second half of this time frame, a new fellowship program was established and some other notable changes were made in leadership positions. More faculty and staff members also received local and national acknowledgment for their efforts. Under the leadership of Dr. Skye, an academic fellowship was established in 2006, combining inpatient and outpatient clinical work with participation in structured development of academic and research skills via programs offered inside and outside the department. Jill N. Fenske, MD, was the first person in this fellowship, which—­unlike the existing sports medicine and geriatric fellowships in which the department had long-­standing involvement—­was not accredited by the Accreditation Council for Graduate Medical Education (ACGME). The lack of ACGME accreditation gave Dr. Skye greater flexibility in some of the options available to him and the fellows in this program. Over the years, a number of the graduates of this program have stayed on as faculty, including Dr. Fenske.

A series of additional fellowships were added in this period. An integrative medicine fellowship was initiated by the department in 2007. Andrew H. Heyman, MD, MHSA, was the first graduate of that fellowship. Two other departments initiated fellowships in conjunction with the DFM over the next two years. The Department of Internal Medicine started the Hospice and Palliative Medicine Fellowship, and J. Brandon Walters, MD, was the first family physician to complete that fellowship in 2008–­9. The Department of Obstetrics and Gynecology started the Women’s Health Fellowship in 2006, and Ebony C. Parker-­Featherstone, MD, was the first family physician to complete that fellowship in 2009–­10. As with other fellowships, a number of the graduates stayed on as faculty after completing their fellowship training.

After serving as the initial clerkship director since 1996, Dr. Peggs became the first member of the department to hold a position in the medical school dean’s office when he was named assistant dean of student programs in 2007. Joel J. Heidelbaugh, MD, at that time the medical director of the Ypsilanti Health Center, was chosen to be the second clerkship director and continues in that role to this date.

Also in 2007, Dr. Schwenk changed the titles of the existing assistant chairs to associate chairs, with Dr. Peggs’s position changing from associate chair to senior associate chair. Dr. Lefever retired in 2007 and was named the department’s first emeritus professor, a fitting person for that role as he was the first faculty member hired by Dr. Davies in 1978.

James M. Cooke, MD, was selected as the fifth residency director in 2007 when Dr. Skye assumed the position of assistant chair for educational programs (renamed the associate chair for educational programs as those changes were put into effect).

Earlier in this phase of department history, Quinta Vreede had been chosen as the second department administrator in 2005 to replace Ms. Bomar when she left after fifteen years as the inaugural full-­time department administrator. Ms. Vreede served in that role until 2010, when Matthew Bazzani was chosen as her replacement.

For the first thirty-­two years of the department’s existence, the chair had also served as service chief, with Drs. Davies and Schwenk serving in that role from 1978 to 2010. Given the continuing growth and complexity of the department’s position in the health system’s inpatient settings, Dr. Schwenk assigned that role to Dr. Chavey in 2010.

Finally, in 2008, Dr. Sheets received the STFM Excellence in Education Award. In 2010, Blythe A. Bieber, the executive administrative assistant to the chair and a staff member since 1979, was acknowledged with the University of Michigan Health System Support Staff of the Year Award. This was the first time a DFM staff member had received such a prestigious honor.

In early 2011, Dr. Schwenk announced that he had accepted the invitation to become dean of the University of Nevada School of Medicine and vice president for Health Sciences at the University of Nevada, Reno. He had joined the department during a time of anxiety regarding the uncertain outcome of an external review and had been its leader through many key moments of the first thirty-­three years of its history.

As Dr. Schwenk was completing his time as chair and was preparing to leave for his new position in Reno, he was asked to make a formal presentation to the Dean’s Advisory Council (DAC), which included department chairs and administrators, members of the dean’s office, and other medical center leaders. Highlights of that March 23, 2011, presentation provide a fitting summary of the twenty-­five years from 1986 to 2011 when Dr. Schwenk served as interim chair and chair. The PowerPoint slides from that 2011 DAC presentation provide the content for the following text and tables.[2]

By that point in time, more than 2.5 million patients had been seen by department clinicians, including the delivery of more than 7,500 babies. Cumulative clinical revenue was calculated at $220 million, with $1.2 billion in referral revenue having been generated. At that time, it was estimated that more than 3,600 students had been taught in M3 clerkships and fourth-­year (M4) subinternships and electives. There had been 229 residency graduates to date. The department was ranked as the fourth best family medicine department by the USNWR methodology, the highest ranked of all medical school departments at UMMS.

Here are the clinical programs identified by Dr. Schwenk as notable in March 2011:

• Sports Medicine Consultation Program
• Medical Urology
• Integrative Medicine Oncology consultations
• Family Center Obstetrical and Newborn Care
• Japanese Family Health Program
• Palliative Care Consultation Program
• Adolescent medicine, School-­Based Health Care, Corner Health Center
• Patient-­Centered Medical Home developments
• Cielo (originally ClinfoTracker)

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

• Admissions Committee, FCE (Family-­Centered Experience)
• M3 Clerkship Ranking
• Residency recruitment success
• RWJ Clinical Scholars Program
• Multidisciplinary fellowships in Palliative Care and Sports Medicine
• Educational relative value unit (RVU) program
• Family Medicine Educational Scholars Program

Using presentation slides, Dr. Schwenk showed the dramatic growth in the number of faculty members, outpatient visits, work RVUs, inpatient volume, and research expenditures across time frames for which appropriate data were available. Here are the notable research programs Dr. Schwenk identified at that time:

• Cancer screening and prevention
• Cross-­cultural medical care
• Women’s health
• Mental illness in primary care and special populations
• Physical activity and chronic disease management in high-­risk populations
• Physician decision-­making and clinical management support
• Health information technology
• Integrative medicine and alternative therapies
• Frailty in the elderly

In nearing the end of his presentation, he listed the following activities as examples of outreach, volunteerism, and community service at the time:

• Corner Health Center
• School-­Based Health Centers
• EMU and UM Athletic Medicine
• Latino Health Center
• Japanese Family Health Center
• Migrant farm worker clinic
• Hope Clinic
• Quito Project
• Haiti, Dominican Republic, Jamaica, Ghana

In summarizing the role and visibility of the department outside the institution, he identified the following examples of national leadership and contributions:

• ASCCP (American Society for Colposcopy and Cervical Pathology)
• JNC VII (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure)
• NHLBI (National Heart, Lung, and Blood Institute)
• NCI (National Cancer Institute)
• AAFP (American Academy of Family Physicians)
• STFM (Society of Teachers of Family Medicine)
• Residency and Department development consultations
• Cielo
• Institute of Medicine

Another graphic in his presentation summarized the department’s national rankings. Rankings for NIH funding within family medicine departments were noted as ranging from third to seventh between 1999 and 2010. Similarly, he listed USNWR department rankings between a tie for third to tenth between 2002 and 2011. While he did not include an average ranking on his slide, these rankings equate to an average ranking of 5.3 for NIH funding within family medicine departments and an average ranking of 6.5 among family medicine departments for USNWR rankings in those time frames.

In a slide labeled “Not the Small Department It Used to Be,” Dr. Schwenk noted that the DFM was now at the median of nineteen UMMS clinical departments in the categories of size of faculty, work RVUs, clinical revenue, research funding, and philanthropy.

In another graphic, he noted collaborations with twenty-­two other departments or centers in activities related to patient care, education, and/or research. For eight of the departments or centers, there were activities in patient care, education, and research.

In looking to the future, he spoke about how both the department and the family physician needed to be experts in health care delivery and meet the following criteria:

• Population-­based
• Outcome-­driven
• Emphasis on chronic disease management and preventive services delivery
• Based on the principles of the patient-­centered medical home
• Dependent on robust and innovative health information technology

The presentation to the DAC provided Dr. Schwenk a large venue of medical school and medical center leaders in which to highlight the progress the department had made since its inception in 1978 and in his twenty-­five years as chair. It was an appropriate setting in which to laud department accomplishments and to set the stage for the next phase of the department.

A longstanding tradition among chairs of UMMS departments is to have each chair sign the diploma of each UMMS graduate. A classroom was set up with diplomas on tables so that each chair could come in and easily move from one diploma to another throughout the room and sign in the appropriate spot according to seniority. By the time he signed his last set of diplomas in 2011, Dr. Schwenk was second in seniority. As he was preparing for his move to assume his new position in Reno, he remarked that the diploma he had received when he graduated from medical school in 1975 listed the last chair in terms of seniority to sign his diploma as John J. Vorhees, MD, the professor and chair of the Department of Dermatology. When Dr. Schwenk signed his last set of UMMS diplomas in 2011, the only chair with more seniority was Dr. Vorhees.

As Dr. Schwenk prepared to make his transition from Ann Arbor to Reno, Philip Zazove, MD, was selected by Dean Woolliscroft to serve as interim chair of the DFM. Dr. Zazove began his term as interim chair of the department on June 1, 2011. He had extensive experience in many roles in the department, health system, and medical school since September 1989 on which to base his approach to leadership of a growing academic department with extensive clinical, educational, research, and service missions.