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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY October 2013 | Archived Issues

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Surgery Grand Rounds

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Grand Rounds

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Excellence in a Time of Uncertainty

Message From the Chair

Along with everyone else, Cedars-Sinai is assessing the impact of the many changes occurring in our healthcare delivery system. While the implementation of the Affordable Care Act is just beginning, we are already seeing a number of meaningful alterations in the "business side" of medicine.

In our region, a number of commercial health plans have implemented narrow networks of physician providers, which will predictably restrict patient choice, especially for specialty care. Although Los Angeles has been an outlier to date, other areas of the country have experienced major consolidation of their markets with mergers of previously competitive institutions and accelerated alliances of physicians and hospitals in "full time" arrangements. Finally, hospitals are seeking to enroll potential patients from wide geographic areas in accountable care organizations. Cedars-Sinai is actively engaged in many of these efforts.

It is clear that there will be consequences, some obvious and some unanticipated, associated with such major changes in the single largest sector of the economy. That said, it is important that we not allow this level of uncertainty to distract us from the superb work the Department of Surgery does and the tremendous resources in human capital and facilities we represent.

With the opening of the Advanced Health Sciences Pavilion, we have added nearly 50 percent more capacity to the overall clinical and research space of Cedars-Sinai. The fifth floor operating room is functioning exceptionally well and will be at full capacity in the near term. Plans are being made to build out the fourth floor of AHSP as additional operating room space within the next two years. The new surgical research space (Center for Clinical Innovation) at 825 San Vicente has finally been approved for occupancy and will be a most welcome hub for our research administration and a haven for faculty and residents to pursue academic projects. An opening reception will be held in the very near future to orient members of the department to this facility.

Our residencies, both "new" (orthopedics and urology) and "old" (general surgery and cardiothoracic) continue to attract the best and the brightest. We recently were approved for a new surgical oncology fellowship, one of the few such programs in a hospital not exclusively devoted to cancer. Our residents continue to distinguish themselves as clinical partners in our care of patients as well as future leaders in academic fields. There is hardly a national surgical meeting at which our residents and faculty are not strongly represented on the program, including three resident presentations at this fall's Clinical Congress of the American College of Surgeons (Alexandra Gangi, MD, Scott Short, MD, and Ryan Spurrier, MD).

We have maintained success in our pursuit of the most competitive federal and nonfederal research funding. In particular, our basic science programs in uro-oncology, stem cell biology and molecular imaging have published important papers in high-impact journals in the last year. The stress on the budget of the National Institutes of Health has inspired our scientists to submit even more original grants and successfully cast their net toward the California Institute for Regenerative Medicine and other funding streams.

We continue to develop new clinical programs. With the recruitment of Alistair Phillips, MD, to join with cardiologist Evan Zahn, MD, we have revitalized our congenital heart surgery program. This clinical product line will only enhance the prominence of our internationally known programs in heart transplant and structural heart disease.

In summary, we are experiencing the challenge of "living in interesting times." The next few years will undoubtedly bring some important changes in the underpinnings of academic medical centers. Still, the strength of our clinical volume, the diversity of our private and full-time surgical practitioners and our extraordinary adaptability over the last few years argues strongly for our continued success.

Bruce L. Gewertz, MD
Surgeon-in-Chief
H and S Nichols Endowed Chair in Surgery
Chair, Department of Surgery
Vice President, Interventional Services
Vice Dean, Academic Affairs