Stuart Wolf (acting Dept Chair) What's New February 7, 2014

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.