Chief of Staff and Research

C. Diana Nicoll, MD, PhD, MPAChief of Staff, SFVAMC

Associate Dean, UCSF School of MedicineProfessor and Vice Chair of Laboratory

Medicine, UCSF

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

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)

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

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)

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 VA’s academic investment

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)

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

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

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

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.

Medical Center Director Involvement in Research

• Briefings by Chief of Staff and ACOS for Research

• Research & Development Committee • Research Foundation Board of

Directors

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