Making practice perfect

David J. Leffell, M.D., deputy dean for clinical affairs, chief executive officer (CEO) of the Yale Medical Group (YMG) and professor of dermatology, describes himself as “physician, academic, and administrator,” in that order. “If the dean needs to speak with me, but I have an appointment with a patient,” Leffell says, “he understands that the patient comes first.”

A surprising statement for an academic official, perhaps, but as an unflagging champion of first-rate patient care at the School of Medicine, an institution that has largely built its reputation on research and educational prowess, Leffell feels duty-bound to practice what he preaches—and he preaches about practice. “I am an advocate,” he says, “for the elevation of clinical practice to the same level of recognition as teaching and research.”

After graduating from Yale College in 1977, the Montréal-born Leffell returned to his hometown to attend medical school at McGill University, but never imagined he would specialize in dermatology. Then, during his residency in internal medicine at Memorial Sloan-Kettering Cancer Center in New York in the early 1980s, patients began arriving with purple skin lesions, the first wave of the AIDS epidemic. Leffell returned to Yale as a dermatology resident attracted by the excitement developing around understanding the immunology of the skin. He spent a year as a postdoctoral fellow on a National Institutes of Health Training Grant, where he developed a patented laser device for measuring sun-induced skin aging. In 1987, he moved to the University of Michigan Medical School for training in Mohs surgery, a technique in which skin cancers are removed layer by layer and studied immediately under a microscope using a frozen section method. The Mohs surgeon creates a map of the specimen to allow removal of the entire tumor, providing the highest cure rate and minimizing scarring.

He soon was recruited back to Yale to develop a skin cancer program in the Department of Dermatology. Colleagues were skeptical that Leffell would find enough patients to make his Mohs training worthwhile. “‘There’s no skin cancer in Connecticut, you’re crazy. Go to Arizona, go to Florida,’” Leffell recalls hearing in those days. However, the population of coastal Connecticut spends a lot of time outdoors, a prime risk factor for skin cancer. “Now our program is one of the busiest in the country,” Leffell, who heads YMG’s dermatologic surgery practice, says. “We treat about 4,000 cases per year, and also do significant clinical research.”

Leffell collaborates with several investigators across the medical school and was a member of the team that discovered the skin cancer gene PTCH in 1996.

As CEO of YMG, Leffell manages a practice with more than 800 physicians in over 100 specialties. “There’s no one-size-fits-all at Yale,” he says. “We have a very diverse faculty with many different interests and skill sets; there are many, many moving parts. Out of that soup we need to create an experience for our patients that’s seamless.” His own dermatologic surgery practice fares well on that front, scoring in the 99th percentile in nationwide surveys.

Leffell finds refuge from his many duties at his weekend house in Norfolk, Conn.; at the suggestion of his son, Alex, and daughter, Dahlia, he brought some country to the city in the form of eight chickens that the family keeps for fresh eggs. He is an avid sculptor, photographer and painter, and his photographs, many of Norfolk landscapes, adorn the walls of his offices. A much sought-after speaker and consultant, Leffell is the author of Total Skin, a layperson’s guide to dermatology and skin health.

Along with his wife, Cindy, Leffell recently made a $100,000 gift to the medical school to endow an annual prize for clinical excellence. “It’s a complex environment at Yale; it can be challenging and frustrating. But at the end of the day when you stand back, you can see signs that you’ve made a difference.”