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Surgery Grand Rounds

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Grand Rounds

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Education Schedule

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Education Schedule - April 2015 (PDF)

Surgery Scheduling

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Pluralistic Culture Serves Cedars-Sinai Well

Message From the Chair

The physician cohort of Cedars-Sinai is ideally characterized as a "pluralistic" model in that faculty, foundation and private physicians all practice medicine here. Harder to determine are the intended and unintended consequences of this structure. Stated another way, what is more evident — the synergies among the three physician types or the differences between them?

It is my strong belief that the benefits of our nearly unique structure greatly outweigh any downsides. In fact, I consider our diverse physician "architecture" largely responsible for the remarkable success of our institution in attaining national and international recognition while remaining the hospital of choice for consumers in Los Angeles.

For years, our Department of Surgery has enjoyed strong reputations in many clinical areas. These include, but are not limited to, our programs in cardiac surgery, transplantation, minimally invasive surgery of all types, joint replacement, spine surgery and trauma/intensive care. I would submit that the physician leaders in most of these areas hail from all three physician types.

Further, even in those programs characterized as "full time" (cardiac surgery and transplantation), nonfaculty physicians are indispensable to both administrative and clinical success. Think of our private cardiologists such as John Harold, MD, former president of the American College of Cardiology, the foundation-based California Heart Group with Jon Kobashigawa, MD, and his colleagues and J. Louis Cohen, MD, a private vascular surgeon who originated and serves as surgical director of the kidney transplant program.

In another arena, our high volume and internationally known joint replacement program is led cooperatively by physicians from each category (Robert C. Klapper, MD, Brad Penenberg, MD, Andrew I. Spitzer, MD), not necessarily by design but simply because they are the thought and volume leaders.

Another area where we are greatly advantaged by our diversity is in residency and other postgraduate medical education. Trainees effectively get to work in different practice constructs within the same hospital, obviating the need to commute in L.A. traffic to other venues to get alternative clinical experiences. The attractiveness of this is manifest by the robust number of applications for our general surgical, orthopedic and urologic residencies; in recent years, somewhere between 25 percent and 50 percent of all U.S. medical students interested in surgical careers have applied to these programs.

The research performed largely but not exclusively by our faculty, including 16 PhDs or PhD/MDs, is another way our professional diversity enriches our reputation. With nearly $10 million of external research funds every year, it is hard to find a clinical program that can't point to a translation research benefit for our patients.

I would argue that even the good-spirited competition between private and employed physicians for clinical volume has its benefits. It encourages academic docs to provide the same level of service and responsiveness that characterizes our fine private practitioners, while private practices are strongly motivated to attract and retain the most outstanding new associates.

Finally, in these very uncertain times — awaiting the full flower of population health initiatives and alternative payment plans (how exactly are we to be compensated for not doing surgery?) — our pluralistic culture gives us the resilience to adapt in whatever direction is needed. The next five years may be turbulent, but thanks to our different but uniformly outstanding physician groups, we are constructed to survive and prosper.

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