Chief of Staff and Research

1
Chief of Staff and Research

• C. Diana Nicoll, MD, PhD, MPA
• Chief of Staff, SFVAMC
• Associate Dean, UCSF School of Medicine
• Professor and Vice Chair of Laboratory
• Medicine, UCSF

2
The four missions of the VA

• Patient care
• Education
• Research
• DOD support

COS is responsible for the quality of clinical
care and for providing an academic environment
suitable for education and research
3
Competition for Resources

• The four VA missions compete for resources e.g.
  space, Medical Center funding support, clinician
  scientist time
• COS must establish and maintain balance between
  these missions
• Balance is difficult since (at SFVA) most
  physicians have research funding and academic
  promotion depends on research success (not
  clinical productivity)

4
Partnerships needed to establish a common
strategic plan for VA Research

• COS
• Medical Center Director
• ACOS for Research
• Research Foundation CEO
• Clinical Service Chiefs
• Affiliate Dean and Department Chairs

5
COS must bridge differences in incentives

• Medical Center Director is rewarded for clinical
  volume and quality (as judged by performance
  measures)
• Affiliate Dean and Chairs focus on medical
  student teaching (for which VA has no reward
  system) and research productivity of VA faculty
  (not clinical contribution)

6
Relationship of COS (as Associate Dean) with
affiliate

• COS/Associate Dean for VA must be a strong
  advocate for the VA at the affiliate
• As a result of my advocacy, in 1995 UCSF
  Chancellor and Dean agreed to allow VA faculty to
  have grants (including NIH) administered by our
  VA Research Foundation
• SFVA research program subsequently grew to become
  the largest VA research program (78 million
  dollars) successfully leveraging VAs academic
  investment

7
COS, Service Chiefs and recruitment and retention
of physicians

• Recruitment and retention of physicians is a
  major responsibility of COS and Service Chiefs
• Success requires commitment of significant
  research time and resources for clinician
  scientists who must also provide needed patient
  care
• Balance can be difficult because of growing
  clinical demands and increasing competition for
  research grants
• The academic triple threat (an individual who
  is clinician, teacher and researcher) is an
  endangered species (if not extinct)

8
Synergy between the VA, VA Research Foundation,
Affiliate and DOD

• All our physicians are jointly recruited by the
  VA and UCSF (based on VA clinical need) so
  liaison roles of COS and Clinical Service Chiefs
  (Vice Chairs) with the affiliate are important
• Recruitment packages involve contributions from
  VA Medical Center, VA Research Service, VA
  Research Foundation and affiliate Department
• DOD research funding provides an additional
  opportunity for VA researchers (M.D.s and Ph.Ds)
  so VA-DOD relationship is significant

9
COS, ACOS for Research and the VA Research
Foundation

• COS and ACOS for Research are ex-officio members
  of the Board and Executive Committee of the
  Research Foundation
• This is critical since the strategic plan for
  research at the VA must be set by the VA and not
  the Foundation and the VA must know how the
  Foundation funds are being used
• COS and ACOS for Research have responsibility for
  taking this leadership in research direction
  which must reflect clinical needs of veterans

10
COS and ACOS for Research

• ACOS is asked to provide resources for current
  and additional programs (space, lab renovation,
  core facilities etc) and to oversee compliance
  with research subject (both human and animal)
  safety and privacy etc
• COS must support the ACOS for Research and
  advocate for research when resources (space and
  money) are being allocated by Medical Center
  resource committees and the Medical Center
  Director

11
COS, ACOS for Research and Medical Center Director

• Medical Center Director, as the final arbiter of
  resource allocation, is vital to the support of
  Research Service
• Medical Center Director needs to respect the role
  of Research in contributing to all the VA
  missions and to have confidence in and trust the
  COS and ACOS for Research
• The relationship between these three will
  directly affect the success of any research
  enterprise which must to be able to recruit and
  retain top-flight researchers in conjunction with
  academic affiliates.

12
Medical Center Director Involvement in Research

• Briefings by Chief of Staff and ACOS for
  Research
• Research Development Committee
• Research Foundation Board of Directors

13
Benefit of Research to Medical Center and
Medical Center Director

• New knowledge
• Cutting-edge technology/treatment for patients
• Recruitment tool
• VERA contribution
• Indirect costs
• Good publicity in medical journals and the media
• Interest by congressional representatives and VA
  leadership
• Enhanced Medical Center reputation with affiliate
  and the general public