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June 23, 2016

Selling the city to medical residents

There’s a good reason Pittsburgh City Council is declaring July 1 “Graduate Medical Education Day” in a proclamation that honors UPMC: Pitt’s medical system partner has the third-largest number of residents and fellows (more than 1,700) among this country’s hospital systems, with a third arriving or leaving every year, and it has the fourth-highest number of medical specialties (138) available among which residents may choose.

This prominence has growing importance, says Anna M. Roman, vice president of UPMC medical education, given the increasing national physician shortage due to physician retirements. The Association of American Medical Colleges (AAMC) reports that in Pennsylvania, physicians over 60 comprise 30 percent of those practicing today. In the U.S., AAMC projects a shortage of as many as 94,700 physicians by 2025.

But AAMC also notes that 45 percent of U.S. physicians who train in a state as residents or fellows stay in that state. In Pennsylvania, the retention rate is 41 percent. Says Roman: “The more people we can encourage to stay in the state … is going to be very beneficial to us.”

While the latest report from the School of Medicine says 44 Pitt med graduates constitute the largest group returning this year to UPMC to be a resident or fellow, it is the residency and fellowship experience that seems to most influence physicians to practice and teach here.

“In our community settings,” says Roman, “you will see a lot of the hospital presidents engaged with the residents who rotate through there. It’s a way to engage them to stay.”

UPMC and Pitt still have to work to sell Pittsburgh, in comparison to some larger metropolitan regions, especially those with warmer weather. But Roman credits frontline residency recruiters and the approximately 200 residency program coordinators as “the best ambassadors for the city.”

Residents are invited to a series of events in UPMC hospital cities. In Pittsburgh, that includes a day at the zoo, networking at the University Club, a trip to the food trucks at Bakery Square, the Squirrel Hill Night Market and a South Side art crawl, among others.

Pitt medical faculty who first came here as residents share why they stayed:

• To learn the latest: When he came here from the University of Virginia School of Medicine, Johnathan A. Engh, a neurosurgery resident in 2001, says that “breakthrough procedures in the operating room seemed to be coming from this place.” Today he is a faculty member in neurological surgery and radiation oncology and directs the adult neurosurgical oncology program and the neuroendoport surgery program. Engh has gravitated to UPMC Shadyside, he says, because of its association with the University of Pittsburgh Cancer Institute and its Hillman Cancer Center. “I love having the relationship I have with all the cancer doctors.”

• For the clinician education program: Jody Glance was a psychiatry resident (2007-11), then immediately joined the faculty. In her last resident year, she was part of a pilot clinician education program for faculty at Western Psychiatric Institute and Clinic. The program was crucial to her decision to remain here. Adds Glance: “The collegiality of the people and how people work together, the camaraderie is really essential.”

• For the job of a lifetime: Edward Monaco, neurological surgery faculty member, was finishing an MD/PhD program at Columbia when he did a sub-internship here. It helped draw him here as a resident in 2006-13.  “You could tell that the end-product of the residency was the best,” says Monaco. “They really had the highest surgery skills because of the training and opportunities here. Really the only way you can learn to take care of patients and do surgeries is to do it.” He estimates he was sometimes involved in 500 surgeries a year. “I wanted to go to a place where the training was more difficult and more rigorous than any job I would take,” he emphasizes. Why stay on as faculty? “I knew UPMC and felt very comfortable here.” Most importantly, he adds, he was able to work as a resident in the Center for Image-Guided Surgery, where he uses the gamma knife; when another faculty member left the center, he took the job.

• For the constant mentoring: Katie Berlacher grew up in Toledo and was a med student at Ohio State; she was looking for a large residency program close by. “I fell in love with the medical department when I interviewed,” Berlacher says. Melissa McNeil, medicine faculty member and chief of the Section of Women’s Health, “convinced me that there was no better place. It was good people, good colleagues and constant mentorship” — in her career and in her life. The latter “helped even more in a career that perhaps wasn’t too traditional,” she says, such as in her pursuit of a master’s degree in science in medical education while here. Michael Mathier, section head of advanced heart failure and cardiac transplantation in the Division of Cardiology, remains a primary mentor, she says. Berlacher joined the medicine faculty in 2012 and now directs the cardiovascular fellowship program.

• For lessons in leadership: Vida Almario Passero was a resident beginning in 2002 in internal medicine, then was chief resident and a hematology/oncology fellow. Although the proximity to family in Wheeling was one draw, so was the chance to be guided by physicians here: “I had great mentors throughout the entire system,” she says. “They always had my back to support me. I could always stop by their offices. This network is kind of built into the training.” Passero now is division chief of hematology/oncology for the Veterans Administration hospital system in Pittsburgh. She credits the leadership training gained from Frank Kroboth, who was the residency program director and is now George H. Taber Professor of Medicine and assistant dean of Graduate Medical Education.

• For the unique opportunities: Michael J. Curren Jr. wanted to stay in the state, since his roots are in northwestern Pennsylvania. “UPMC has the things I was looking for,” he says. “It was in a big system [in] a good, small-sized city and relatively close to home.” He began his residency in internal medicine in 2007 and continued as a cardiology fellow. “The residency program was doing some very innovative things,” changing training emphases as medicine changed, he says. It helped teach the nascent physicians about “providing health care and doing it in a very forward-thinking way,” he adds. He stayed on as a faculty member because he already was connected with others here who were working on his area of interest: clinical informatics in electronic medical records. Today Curren is a clinical faculty member in medicine and eRecord medical director of provider documentation and EMR optimization.

• For the best program: Juan C. Fernandez-Miranda, originally from Spain, went to medical school in the U.S. and joined UPMC in 2008 as a fellow in endoscopic and open-skull-base surgery. He worked with a pioneer, Amin Kassam, whom he replaced in 2010. “This program was no question the best in the country and the best in the world” in that specialty, says Fernandez-Miranda. “I acquired the type of training it was impossible to get anywhere else. This is a place, UPMC and Pitt in general, where innovation is part of the culture. We are never afraid of facing the most difficult cases and that is what I wanted to be trained on.”

• For the academic environment: Sanja Dacic, now a pathology faculty member, came from Croatia to the U.S. in 1995, joining UPMC as a resident two years later, thanks to its reputation in lung pathology and transplantation, she says. Driving in from the airport for the first trip through the Fort Pitt Tunnel, Dacic says it was “absolutely like I’m in love with this city.” As a pathologist, she sought out difficult, unique cases most available at a tertiary medical center like UPMC, with teaching hospitals that see patients who already have undergone treatment elsewhere and are seeking second opinions, specialty treatments or participation in clinical trials. She joined the faculty in 2002. “For me the academic environment was very important,” she says. “And I had already established relationships with both clinical and teaching colleagues. The opportunity to balance the two, do clinical work and academic work, was a big attraction to me.”

• For a unique career: “There are very few places in the world where I can be me — a surgeon-scientist in orthopaedic oncology,” says Kurt Weiss. Although he didn’t have to go far to find someplace with a large cancer center focusing on research — he’s a graduate of North Hills High School — Weiss says few have three others in similar positions on staff, as he found here; many other hospital systems have only one, or none. He did his UPMC residency in orthopaedic surgery 2003-09, then a fellowship at the University of Toronto, before joining the Pitt faculty in 2010. “It is a very strong clinical program” and an equally valuable research program, he says. “It’s a great blend. It’s a hardworking program but a hard-thinking program too,” with all facets of his specialty under one roof, “and that’s actually not so easy to come by.”

—Marty Levine 

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