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Perfecting the Faculty Practice

Yale Medicine Magazine, 1999 - Winter


New associate dean will keep an eye on quality of care, as well as the bottom line.

David J. Leffell, M.D., medical director of the Yale Faculty Practice for the past three years and a professor of surgery and dermatology, has been appointed the medical school’s associate dean for clinical affairs and director of the Faculty Practice. He will have oversight of all clinical and business activity for the practice, which represents more than 650 Yale physicians and provides tertiary care to thousands of patients throughout the region.

The appointment by Dean David A. Kessler, M.D., effective Jan. 1, comes at a time when academic medical centers across the United States are responding to major economic forces affecting their operation. Lower reimbursements under managed care, along with changes in the way attending and resident physicians must account for their time, have prompted medical schools to re-examine the way they do business in the clinical sphere. Dr. Leffell’s primary task, Dean Kessler said, will be to help define the Faculty Practice as an efficient organization that facilitates the research and educational missions of the school.

“Our mandate is to be efficient, responsive and available,” Dr. Leffell said in an interview. “We can’t serve any of our constituencies, not least of all our patients, unless we’re on a sound economic footing. And without patients, there is no medical school.”

A native of Montreal, Dr. Leffell is a 1977 Yale College graduate who received his medical degree from the McGill University Faculty of Medicine in 1981. He completed a residency in internal medicine at Cornell Cooperating Hospitals in 1984 then spent two years as a dermatology resident at Yale and one as an NIH-sponsored fellow, also in New Haven. He became a Yale faculty member in 1988 after a fellowship in dermatologic surgery at the University of Michigan.

The Faculty Practice, originally established as a billing and collection unit for the clinical services of Yale professors, has evolved into a complex organization responsible for negotiating contracts, marketing its services, and planning strategically in a changing health care environment. For the year ending June 30, the Faculty Practice logged more than 400,000 patient encounters and collected revenues exceeding $100 million for clinical activity at the Yale Physicians Building, Yale-New Haven Hospital, the Yale Sports Medicine Center and other off-site locations. Its operation had been complicated by flaws in the school’s APS computerized billing system, which has been phased out with the successful implementation of a new IDX system.

Dean Kessler cited Dr. Leffell, an authority in the genetics of skin cancer and an expert in the management of the disease, for “his strong administrative skills and an outstanding record of scholarly achievement.” The dean added: “I have every confidence that, under his direction, the Faculty Practice will achieve an even higher standard of excellence.” The school’s chief operating officer, Irwin Birnbaum, was similarly enthusiastic: “David has the professional experience and the vision to help the Faculty Practice truly become a multi-specialty academic group practice.”

Expert in genetics of hypertension is named chair

Richard P. Lifton, M.D., Ph.D., a Howard Hughes Medical Institute investigator whose research in hypertension has led to the identification of more than a dozen genes that regulate blood pressure, has been appointed chair of the Department of Genetics.

Dr. Lifton will preside over a department of 28 full-time faculty members, 58 postdoctoral fellows and associates, and 45 graduate students, including a number of the most distinguished scientists in modern genetics. “What makes Rick an outstanding choice for this job is his great ability to bridge the worlds of basic science and clinical medicine,” said Dean David A. Kessler, M.D. “That is increasingly important in an era when laboratory discoveries are being translated for the benefit of patients more quickly than ever before.”

A native of Washington, D.C., Dr. Lifton is a 1975 graduate of Dartmouth College and holds M.D. and Ph.D. degrees from Stanford University, where he worked in the laboratory of molecular geneticist David Hogness. While at Stanford, he and fellow graduate student Michael Goldberg discovered a short DNA sequence, known as the TATA box, that regulates the initiation of gene transcription in all higher organisms. Dr. Lifton spent four years as resident and chief resident in medicine at Brigham and Women’s Hospital, then three years with Howard Hughes investigator Jean-Marc Lalouel, M.D., D.Sc., in Utah, where he identified the first known gene affecting the regulation of human blood pressure.

Since then, Dr. Lifton and members of his research team have identified a dozen genes that either raise or lower blood pressure by influencing how the kidney handles salt. He came to the Yale faculty, from Harvard, as an assistant professor of medicine in 1993 and was promoted to associate professor in 1994 and professor in 1997. His discoveries in the genetics of hypertension may lay the groundwork for safer, more effective medications for a disease affecting more than 50 million people in the United States alone.

The department was established at Yale in 1972 as the Department of Human Genetics with Leon E. Rosenberg, M.D., as chair. Its focus is unusually broad, with strength in a wide range of disciplines including studies of simple model organisms, inherited metabolic disorders, and the genetics of common human diseases, increasingly believed to have a complex genetic component.

When Dr. Rosenberg became dean of the School of Medicine in 1984, Sterling Professor Carolyn W. Slayman, Ph.D., was appointed to lead the department. After Dr. Slayman’s selection as deputy dean for academic and scientific affairs in 1995, faculty member David C. Ward, Ph.D., inventor of the gene-mapping technique known as fluorescence in situ hybridization, served for two years as acting chair. Daniel DiMaio, M.D., Ph.D., led the department as interim chair last year as a national search was conducted.

Dr. DiMaio said Dr. Lifton’s selection as chair “was an outstanding choice. He’s someone who is interested in the genetics of common disease, which most people agree is the future of human genetics. He knows his way around Yale,” he added, “and his work is superb.”

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