1. REMODELING A DEPARTMENT Society of Surgical Chairs Annual Meeting
DEPARTMENT OF SURGERY
REMODELING A DEPARTMENT
Kevin E. Behrns, MD
Chairman and Edward R. Woodward Professor of Surgery
Lonn McDowell, MHA
Vice Chair, Director of Administration
Society of Surgical Chairs Annual Meeting
October 26, 2014

2. REMODELING A DEPARTMENT Objectives
Discuss highlights of the strategic plan August 2009.
Describe the departmental goals in the context of enterprise objectives.
Outline integration of research mission into clinical and education missions.
Discuss financial considerations of an enhanced research portfolio.

3. REMODELING A DEPARTMENT Strategic Plan – 2009
Objectives (verbatim):
To increase the depth and breadth of our clinical practice by focused program building, especially as it relates to cancer and cardiovascular disease.
To build collaborative research programs focused on inflammation biology, vascular biology and cell death/cell signaling.
To create a clinical quality, outcomes and research program that will assess quality, drive improved clinical outcomes and provide clinical research opportunities.

4. REMODELING A DEPARTMENT Enterprise Objectives
Virtuous Cycle of Growth

5. REMODELING A DEPARTMENT Enterprise Objectives
Clinic Visits (N)

6. REMODELING A DEPARTMENT Enterprise Objectives

7. REMODELING A DEPARTMENT Academic Goals
Improve our academic productivity, profile and stature.
Move into top 20 in NIH funding for departments of surgery.
Develop well-recognized research programs.
P-funding essential
Create a culture of academic achievement.

8. REMODELING A DEPARTMENT Departmental “Gems”
Department research foundation built by predecessors: Edward Copeland III, MD and William Cance, MD
Laboratory of Inflammation Biology
Lyle “Linc” Moldawer, PhD, Vice Chair for Research
Multiple R01s
NIH T32 in trauma and sepsis
Vascular Biology
Thomas Huber, MD PhD and Scott Berceli, MD PhD
Multiple R01s, U54 Hemodialysis Access, VA Merit, NSF

9. REMODELING A DEPARTMENT Needs
A centralized research infrastructure
Contiguous departmental research space
Clinical research integrated with discovery science
Critical mass for cell death/cell signaling concentration
Integration of general surgery residents into research mission

10. REMODELING A DEPARTMENT Strategies to Address Needs
Strategically invest chair development funds to build around existing successful research programs.
Transition from ecumenical to focused investment.
Explicit faculty mission-based assignments with anticipated deliverables.
Recruit established investigators as well as develop junior faculty to address clinical research and critical mass needs.
Engage students and trainees in research mission.

11. REMODELING A DEPARTMENT Infrastructure
Central Research Administration
Lead research coordinator: ensures pre- and post-award compliance.
Two additional research coordinators assigned to divisions.
In evolution:
Financial integration of research revenue and expenses into faculty P&L
Publications office
High-functioning laboratories have a well-oiled machine vs. assistance for developing laboratories

12. REMODELING A DEPARTMENT Infrastructure
Acquisition of Contiguous Lab Space in Close Proximity to Clinical Mission
Senior Associate Dean for Research supports vision for laboratory space and shared resource requirements for clinical departments with their unique needs.
Partnered and negotiated with new chairs of Medicine and Pediatrics to trade space, to acquire large blocks or wings with shared facilities for departmental use.
Shared laboratory space and equipment supported by shared laboratory management personnel.
Investments in shared space, equipment and personnel require investigator “skin in the game”.
Lyle “Linc” Moldawer, PhD
Vice Chair for Research

13. REMODELING A DEPARTMENT Clinical Research Integration
Partnerships- discovery science and clinical science
Play our strengths in inflammation biology
Serendipity- need chief of acute care surgery
Fred Moore partners with Linc Moldawer
Goal- P50 UF Sepsis and Critical Illness Research Center
Awarded in September 2014
Vascular Surgery
Added R01 basic scientist to work with clinicians with a top 10 (volume) aortic practice
Plastic Surgery
Adam Katz- DOD funding (AFIRM)
Discovery stem cell science with clinical application
Adds critical mass and a new dimension a (stem cell biology) to cell death/cell signaling group
Frederick Moore, MD
Section Chief, Acute Care Surgery

14. REMODELING A DEPARTMENT Trainee Integration
Transition general surgery residents (n=6) from voluntary scholarship experience to mandatory two + year commitment in a scholarly endeavor.
Three-year transition
Key concepts
Assessment of scholarly intent during interview process.
HIPAA for researchers during orientation.
All residents consent patients for studies.
Trainee compensation continues to increase during scholarly time.
Research orientation program for residents entering the laboratory.
Semi-annual review for research residents.

15. REMODELING A DEPARTMENT Trainee Integration
How do we fund trainee research?
Two NIH T32s (3 positions per year)
Inflammation Biology (2) (Moldawer)
Surgical Oncology (1) (Behrns)
Philanthropy (1 position per year)
One research position is surgical critical care for one year (GME funded) and outcomes research for one (year)- one year of funding from clinical funds
Clinical enterprise (1 position)

16. REMODELING A DEPARTMENT Trainee Integration

17. REMODELING A DEPARTMENT Results
Since 2005
5 surgical residents have earned PhDs from the Graduate School (Immunology, Molecular Genetics, Cell Biology, Biochemistry).
Two additional residents have remained in the laboratory for three years each to maximize productivity without entering a degree-granting program.
One resident received a NIH F32 award.
Eighteen of 32 residents in academics since 2005.

18. REMODELING A DEPARTMENT Investment
Chair Development Investment in Research has totaled almost $5M over the last 5 fiscal years.
Expenditure
FY10
FY11
FY12
FY13
FY14
Gap Funding
$80,660 $0
Lab Resident Funding
$16,736
$525
$249,654
Research Awards
$1,011
$12,396
$125,384
$52,230
$39,000
Research Equipment
$71,682
$13,421
$108,991
$9,092
Research Faculty Recruiting
$1,399
$28,588
$1,368
$16,648
Research Faculty Retention
$200,333
$1,217
$100,000
$14,900
$45,149
Research Faculty Salary Support
$44,684
$102,378
$314,132
$385,576
$351,840
Research Faculty Startup
$134,564
$83,614
$680,233
$521,551
$518,846
Research Staff
$66,713
$10,283
$147,430
$249,987
$298,025
Total Expenses
$527,964
$282,968
$1,425,924
$1,335,128
$1,528,254

19. REMODELING A DEPARTMENT Investment
The majority of Chair Development research funding, in the last three years, has been on staffing and start-up.

20. REMODELING A DEPARTMENT Return
NIH Ranking increased from 43rd to 21st since 2007 NIH Funding increased 101%

21. REMODELING A DEPARTMENT Return
Funding has totaled almost $24M over the last five years.

22. REMODELING A DEPARTMENT Return on Investment
There has been a 367% ROI in the past 5 Years.

23. REMODELING A DEPARTMENT Return on Investment
5 Year NIH Grant ( )

24. REMODELING A DEPARTMENT Conclusions
A highly-productive clinical enterprise assists research programmatic development.
Focused investment with clearly defined expectations reviewed annually helps direct research programs.
“Play the winners” and partner with successful groups.
Team play is crucial to the success of the research mission.

25. THE ART OF WINNING AN UNFAIR GAME
REMEMBER THAT WE NEED NEW APPROACHES TO PRACTICE THE ART OF WINNING AN UNFAIR GAME.
THE ART OF WINNING AN UNFAIR GAME
Thank you!