In June 2012, I wrote an extensive report on all the ways that UCSF fulfills its mission of public service.
With an overarching mission of “advancing health worldwide,” the University of California, San Francisco (UCSF) is devoted at every level to serving the public.
From free children’s health screenings to providing care for the low-income, homeless and under-insured, from innovative partnerships attacking the roots of poor health care to cutting-edge biotechnology that will cure some of the most pernicious diseases, UCSF brings significant resources to an ambitious public mission — and not only does so every day, but has done so for nearly 150 years.
UCSF’s public mission goes beyond San Francisco, and delivers a substantial impact upon the Bay Area, all of California, the nation and the world. This impact comes not only from the institution, but also from the individuals who comprise it — UCSF’s top-notch faculty, staff and students.
Thanks to their passion to serve the public, their collective efforts provide world-class health care; educate the next generation of doctors, nurses, dentists, pharmacists and scientists; support elementary and high school education; make groundbreaking scientific discoveries; and provide a substantial economic impact for the Bay Area and Northern California.
UCSF’s commitment to public service dates to the founding of its predecessor institution, Toland Medical College, in 1864. Born out of the overcrowded and unsanitary conditions of Gold Rush-era San Francisco, Toland Medical College trained doctors to elevate the standards of public health in the burgeoning city.
By 1873, the University of California acquired the college, along with a college of pharmacy. That year, the University also joined forces with San Francisco General Hospital, forging a partnership that continues to this day and serves as a model for delivering cutting-edge care at a public safety-net hospital.
UCSF cemented its central role in the city’s health in the 1906 earthquake and fire, when many downtown facilities were destroyed and the Parnassus Heights campus proved crucial in treating the injured many of whom took refuge in tents in Golden Gate Park.
The University has taken extra steps in recent years to codify the dedication to service already deeply ingrained in the ethos of the institution.
- In 2006, the University Community Partnerships Office was established, coordinating the many existing partnerships between UCSF-affiliated individuals or groups and San Francisco-based community organizations.
- In 2007, the UCSF Strategic Plan was released, specifically calling on the University to serve the local, regional and global communities and eliminate health disparities, foster research collaborations and “promote civic engagement in all facets of activities at UCSF to strengthen partnerships between the campus and the community.”
- In 2011, campus leadership adopted a three-year strategic plan, based on the 2007 plan, that embraces the public mission in UCSF’s overall vision to be “the world’s preeminent health sciences innovator.”
In one of the most fruitful partnerships, which began in 1873, more than 2,000 UCSF physicians and staff today work side-by-side with employees of the San Francisco Department of Public Health to deliver health care at San Francisco General Hospital and Trauma Center (SFGH). When the AIDS epidemic took the world by surprise in the 1980s, UCSF clinicians and researchers developed the country’s first outpatient AIDS clinic and inpatient ward at SFGH.
UCSF health professionals also provide people with world-class care at UCSF Medical Center, UCSF Benioff Children’s Hospital, the Veterans Affairs Medical Center, and other hospitals and clinics throughout Northern California.
Providing high-quality patient care to scores of men, women and children is just one of the ways UCSF serves the people of San Francisco and the Bay Area. Over the years, many other programs have emerged, from free dental clinics to bolstering science education in public schools, and even to hiring local contractors as UCSF builds new facilities at its dazzling Mission Bay campus, where a new medical center will open in early 2015.
Building on that local foundation, UCSF has taken its public mission across its home state, as well as throughout the United States and the world. Californians represent the vast majority of people receiving UCSF’s renowned education — at its schools of dentistry, medicine, nursing and pharmacy, and through graduate and post-doctoral research programs. Other programs work to expand care for the urban under-served, and for young people in the Fresno area. And the California Poison Control System — run by UCSF’s School of Pharmacy — saves lives and averts more than 60,000 emergency room visits across the state each year, saving the state $70 million.
In just one example of UCSF’s commitment to public service, San Francisco’s Glide Health Services cares for more than 3,000 people, 60 percent of them homeless. These people make more than 16,000 visits to the clinics each year. This federally qualified, nurse-managed health center is staffed by the UCSF schools of medicine, nursing and pharmacy.
On a broader scale, UCSF’s close partnership with the San Francisco Veterans Affairs Medical Center (SFVAMC) serves those who serve the nation through patient care, education and research. With 124 hospital beds, a 120-bed Community Living Center and satellite clinics throughout northern California, SFVAMC serves approximately 55,000 veteran patients per year.
UCSF’s public mission does not stop at national borders. Through UCSF Global Health Sciences (GHS), more than 100 faculty and staff work on a growing number of educational, research, and action-oriented projects under way in more than 50 countries around the world. GHS, which brings a relatively new organization to a longstanding commitment to helping people around the globe, continues a long and rich legacy of international health programs and projects in the training and research portfolio of UCSF faculty.
Even beyond any specific initiatives, UCSF inherently provides a public service in meeting its three primary objectives of patient care, education and research. The University trains the next generation of clinicians, not just for UCSF, but also for Sutter, Kaiser, and other Bay Area and national institutions where they are leaders in their fields.
As a leading recipient of federal funding — including $532.8 million from the National Institutes of Health for research and training, fellowships and other awards in 2011 — UCSF has the expertise to quickly translate research into more effective care for all, from pioneering fetal surgery to reducing readmission for patients with congestive heart failure.
San Francisco and the Bay Area
UCSF Medical Center Facts
- Offers care to children, emergency patients and others regardless of their ability to pay.
- Provided $140 million in care for which it received no payments (charity care and bad debt) or payments that were less than the cost of care provided (Medi-Cal reimbursement shortfall) in fiscal yar 2011.
- Employs more than 7,000 employees and generates $1.6 billion in annual revenue and contributes more than $100 million to the research and education mission of UCSF, including $42 million in program support grants to academic programs, $43 million in purchased services from the faculty, and $29 million in salaries for student residents who help care for patients.
- Supports the African American Health Disparities Project (AAHDP), which works to improve the health status of African Americans and to eliminate racism wherever it exists in the health care system of San Francisco. Mark Laret, CEO of the UCSF Medical Center, was a co-founder of the AAHDP in 2002.
UCSF Medical Center, now more than 100 years old, has ranked among the best hospitals in the United States for the past decade, providing world-class care to the people of the San Francisco Bay Area.
With two major sites at Parnassus and Mount Zion, UCSF Medical Center is a referral center for patients requiring highly specialized medical care that involves advanced and complex procedures. The medical center and UCSF Benioff Children’s Hospital together have 722 licensed beds and generate about 763,000 outpatient visits per year.
UCSF will expand its clinical enterprise when it opens UCSF Medical Center at Mission Bay, an innovative 289-bed complex that will feature three separate hospitals, specializing in serving children, women, and cancer patients, as well as a green energy center and a helipad. With a scheduled construction completion date of August 2014, UCSF’s sophisticated, benchmark new facility will usher San Francisco into a new era of health care.
San Francisco General Hospital and Trauma Center (SFGH) is an important teaching and research campus for faculty from all four of UCSF’s professional schools — dentistry, medicine, nursing and pharmacy — who provide patient care services, conduct cutting-edge research and teach future health care professionals.
More than 2,000 UCSF physicians and staff work side-by-side with employees of the San Francisco Department of Public Health. In addition, about 300 residents, 75 medical students and 42 clinical fellows train at SFGH every day. Together, the people of SFGH deliver around-the-clock trauma, psychiatric and emergency care, outpatient treatment and a wide range of other important medical services to everyone in San Francisco, regardless of their ability to pay.
“People who work here are passionate about what they do,” said Sue Carlisle, MD, associate dean in UCSF School of Medicine at SFGH. “They work here because they are dedicated to taking care of patients.”
UCSF School of Dentistry: Over the last 10 years, the UCSF School of Dentistry’s externship program has provided more than $19 million in dental services to San Francisco’s underserved communities through 14 UCSF dental clinics at three sites in San Francisco, as well as at partner sites.
The school’s dental clinics see more than 120,000 people per year. In 2011-2012, students in the UCSF School of Dentistry saw 20,175 patients, accounting for $2.8 million in free services to adults and children in San Francisco.
San Francisco General Hospital Facts
- Provides 24-hour, comprehensive emergency, urgent and non-urgent care to 102,000 adult and pediatric patients each year, with a total of 550,000 outpatient visits; 76 percent of those were at or below the federal poverty level.
- Is the only acute hospital in San Francisco that provides 24-hour psychiatric emergency services.
- Operates the only Level-1 Trauma Center for the 1.5 million residents of San Francisco and northern San Mateo County.
- Has a robust research program, housing more than 200 UCSF researchers bringing in annual grants awarded of more than $200 million in 20 research centers, affiliated institutes and major laboratories.
In addition to the San Francisco clinics, the School of Dentistry runs 14 community-based externship sites, many of which are located in rural areas or are designated Federally Qualified Health Centers.
San Francisco Health Improvement Partnerships (SF HIP) is a collaboration between community, civic, academic, and other public and private stakeholders to jointly plan, implement, and evaluate interventions that make a measurable impact on health and reduce health disparities. It marks an innovative attempt not just to get discovery out of the lab and into patients, but to do the same with best health practices.
SF HIP is currently developing programs focused on Hepatitis B, children’s oral health, physical activity and nutrition, and alcohol abuse that target more than 20,000 San Franciscans. Support for the planning and implementation of SF HIP is provided by UCSF’s Clinical and Translational Science Institute (CTSI).
Established in 2006, the CTSI was among the first of the now 60-member, National Institutes of Health-funded, Clinical and Translational Science Awards (CTSA) consortium. A cross-school, campuswide institute with scientist leaders at the helm, CTSI’s misison is to foster the rapid translation of research to improvements in patient and community health.
“SF HIP brings UCSF and its resources closer to the community, and all the important stakeholders together to improve community health,” said Amor Santiago, DPM, MPH, executive director of APA Family Support Services, and representative of the Asian/Pacific Islander Health Parity Coalition on the SF HIP Coordinating Council. “This effort has the potential to lead and coordinate public health efforts across the spectrum of providers in medical, mental and social health emphasizing prevention.”
Langley Porter Psychiatric Institute (LPPI) is among the nation’s foremost resources for comprehensive and compassionate patient care, research and education in the mental health field.At treatment centers in San Francisco and Fresno, LPPI offers inpatient, partial hospitalization and outpatient programs for a wide range of conditions including chronic and acute depression, anxiety, attention deficit disorder (ADD) and many others, serving thousands of adults, adolescents and children.
San Francisco Hepatitis B Collaborative (SFHBC). Established in 2004, the SFHBC is comprised of UCSF faculty, students from UCSF’s four professional schools and UC Berkeley undergraduates. SFHBC provides accessible Hepatitis B screening and vaccination to at-risk populations and provides care to chronic Hepatitis B patients through monthly Hepatitis B clinics in San Francisco. Since 2008, SFHBC has screened 1,912 patients and provided vaccinations for more 1,575 people.
The Children’s Health Hut at UCSF (CHH) at UCSF is a volunteer organization composed of dental, medical, nursing, pharmacy and physical therapy students who are committed to improving the health of children. CHH brings interactive health screenings and educational programs to easily accessible neighborhood locations. Since 2011, CHH has screened 224 kids at Companeros de Barrios, YMCA Bayview, Berkeley Eggster, Richmond, and Dolores. Each quarter CHH participates in several health fairs at schools, parks, health centers and other places around the city.
Science and Health Education Partnership (SEP) was initiated in 1987 by UCSF’s Bruce Alberts, PhD, professor emeritus and past president of the National Academy of Sciences to promote partnerships between scientists and educators in support of quality science education for K-12 students in the San Francisco Unified School District (SFUSD).
While the program started as a means for UCSF to distribute surplus lab equipment to public schools, it has broadened to include extending the University’s intellectual power. The program is increasingly crucial, as many elementary school teachers have little or no science background, and standardized tests tend to emphasize language arts and math at the expense of science.
As a diverse array of UCSF scientists come to classrooms, however, students become inspired that they might find a career in science; teachers get extra hands to help do more complex experiments; and science education reinforces lessons from math and English.
“The students report learning more, and retaining more, because it’s a more visceral experience,” says Rebecca Smith, PhD, co-director of the program.
In addition, SEP is incredibly cost-effective, especially in its lending library of scientific materials. “A heart model is ridiculously expensive, about $400, and it might be used for one week of the school year,” Smith says. “But if we own it, it can be used not only by that teacher, but by 50 others as well. All of them have access to fabulous hands-on things.”
In a particularly impressive aspect of the program, SEP participants have access to UCSF anatomical specimens. Smith reports one example of an asthmatic student who got to touch a diseased human lung, and then went home and convinced both parents to quit smoking.
Science and Health Education Partnership Facts
- 350 K-12 teachers participate in SEP each year, representing 90 percent of San Francisco Unified School District schools, serving more than 40 percent of the district’s K-12 population — more than 21,000 students.
- 250 UCSF staff and faculty volunteers work more than 10,000 hours each year.
- SEP’s high school intern program places 20 students from backgrounds underrepresented in sciences, and students who overcame significant obstacles, in UCSF labs. Each year, 92 percent of the interns matriculate to college and of those, 76 percent major in science and 87 percent go on to graduate work.
EXCEL, formerly the Community Outreach Internship Program, or COIP, has been renamed to emphasize its mission to help people in the community gain employment and self confidence. The program has successfully trained more than 125 community residents in administrative jobs since its inception in the late 1990s.
Approximately 80 percent of the 2010-2011 graduates were immediately retained in their original host department at UCSF, or placed in a new clerical position upon completion of the program. EXCEL offers residents of disadvantaged San Francisco neighborhoods a 10-week job-skills training class, followed by a four-month internship at UCSF.
Most interns have no prior formal employment experience in administrative positions, and are seeking long-term employment.
“Because of this program, I am working for an outstanding medical institution, coordinating clinic procedures for UCSF’s Department of Neurology,” says Chanta Helton, a graduate. Before beginning the program, Helton had lost her job as a shuttle driver and, she says, was “wondering how I would ever get to where I wanted to go.”
Community Construction Outreach Program is a UCSF program that ensures the University’s construction projects provide employment opportunities for San Francisco residents. In 2011, UCSF set — and met — a goal for the UCSF Medical Center at Mission Bay that at least 20 percent of the workforce hours on the site during the first year of construction would be performed by San Francisco residents. With that success, the goal was increased to 25 percent in 2012.
State of California
UCSF provides a variety of public services across California, including:
- The California Poison Control System (CPCS): CPCS, a part of the Department of Clinical Pharmacy in UCSF’s School of Pharmacy, is the largest single provider of poison control services in the U.S. It is usedmore than 900 times every day — more than 330,000 times per year — by California residents and health professionals for immediate expert treatment advice and assistance by phone in case of exposure to poisonous and hazardous substances. It has handled nearly 1.8 million cases since 1997, when it consolidated operations and brought financial stability to a previously fragmented, unaffiliated collection of regional poison centers with operations dating back to the 1950s.The CPCS’s services are free to all callersand accessible around the clock, 365 days a year in more than 100 languages.The system employs more than 75 pharmacists, nurses, physician-toxicologists and poison information providers who undergo intensive and highly specialized training and certification.
- Educating the next generation of health care and bioscience leaders: Eighty-six percent of UCSF’s professional and graduate students are California residents. Additionally, more than half of UCSF alumni reside in California. UCSF has an increasingly diverse student body — 18 percent of 2011-12 graduate and professional students are under-represented minorities. Additionally, UCSF’s student body reflects California’s gender balance, another measure of diversity, with women accounting for 62.4 percent of UCSF’s students.
- Program in Medical Education for the Urban Underserved (PRIME-US): PRIME-US was launched in 2006 as part of a statewide initiative to increase the number of physicians working in underserved communities. The program offers medical students the opportunity to pursue their interest in working with these populations. Eighty-two students have been enrolled in PRIME-US at UCSF, including 15 students in each of the last four classes. PRIME-US partners with dozens of community-based organizations and has placed students at 18 different community clinics in San Francisco, Alameda, Contra Costa and Marin counties. “PRIME-US brings together medical students with a shared vision of caring for urban underserved communities,” says Elisabeth Wilson, MD, MPH, the program director at UCSF. “Our job is to support and sustain that commitment.”
- Faculty at UCSF and the Joint Medical Program (JMP) administered by UC Berkeley and UCSF have been at the forefront of investigating the many factors that contribute to urban health disparities, including geographic mal-distribution of clinicians, lack of insurance, minority race-ethnicity, low socioeconomic status, limited English proficiency, and low health literacy. These issues are particularly acute in California, a state with a high proportion of the population lacking insurance, and a tremendous degree of racial and ethnic diversity.
- The Doctors Academy (DA) is a health professions preparatory academy at three high schools in Fresno County, created to increase the number of students who graduate from high school and college and become competitive applicants for health professional schools. A total of 378 students have graduated from the DA since 1999. Of these students, 372 — or 98 percent — have been accepted into a four-year college. About 84 have graduated with a bachelor’s degree, with 17 students entering a graduate program, and 14 students accepted into a health professional school.
- The Junior Doctors Academy (JDA) program academically prepares middle school students to enter high school and increases their awareness of medicine and other health fields. In 2010-11, 118 middle school students were enrolled in the program, of which 97 percent were ethnic minorities and disadvantaged.
Nation-wide, UCSF serves the country primarily through its relationship with the San Francisco Veterans Affairs Medical Center (SFVAMC), which extends to every part of UCSF’s primary missions — patient care, medical education and research. Every one of the more than 200 MD and PhD clinicians and investigators at SFVAMC has a UCSF academic appointment.
- Patient care: As noted above, the SFVAMC serves approximately 55,000 veteran patients per year.
- Medical education: UCSF medical students, residents and fellows rotate through SFVAMC, which provides nearly one-third of all of the University’s medical training.
- Research: The SFVAMC has the largest biomedical research program in the Veterans Administration system, totaling more than $70 million per year.
UCSF is broadening its reach around the world. The University advances health world-wide in three important ways: patient care, education and research.
All three of these themes have been incorporated in UCSF Global Health Sciences (GHS), thanks to a renewed push in the past decade.
In addition, UCSF-trained physicians and researchers come to San Francisco from all over the world — 94 countries — and many of them work internationally after their education is complete.
On an even more fundamental level, UCSF’s vast research enterprise improves world-wide health through the discovery of causes, cures and treatments of many human ailments. UCSF’s faculty is among the most distinguished in the world, including four Nobel laureates and 18 Howard Hughes Medical Institute investigators.
- Translating research: The CTSI was established in 2006 with a $108 million grant from the NIH and a mandate to find a way to speed scientific discoveries from the lab to patients. CTSI received renewal funding in 2011 with a second five-year award of $112 million.
- Leading biomedical research enterprise: UCSF is first among public institutions and second among all institutions nationwide in research support from the National Institutes of Health (NIH) for fiscal year 2011, garnering a total $532.8 million from the National Institutes of Health for research and training, fellowships and other awardsin 2011.
- Research affiliations: In the Bay Area, UCSF has affiliations with two Bay Area biomedical research organizations: The J. David Gladstone Institutes, which focuses on the study of cardiovascular disease, HIV/AIDS, and Alzheimer’s and other neurological disorders, and the Ernest Gallo Clinic and Research Center, which studies the biological basis of alcohol abuse and substance abuse. Nationally, UCSF serves as one of the host institutions for the Howard Hughes Medical Institute(HHMI), a prestigious medical research center.
- UCSF Global Health Sciences (GHS):In 2003, former UCSF Chancellor Haile Debas, MD, founded GHS, a pioneering program dedicated to improving health and reducing the burden of disease in the world’s most vulnerable populations. GHS integrates UCSF expertise in all of the health, social, and biological sciences, and focuses that expertise on pressing issues in global health. GHS works with partners in countries throughout the world. GHS has expanded rapidly, including launching the first masters degree program in Global Health Sciences in the United States in 2008. Some of the examples of GHS at work around the world include:
- Tanzania: Construction of a new health professional center at the Muhimbili University of Health and Allied Sciences (MUHAS) has begun, with the aim of creating a hub for health professions education and research excellence for all of East Africa. Faculty and staff from across the UCSF campus have made key contributions to the partnership through the Bill & Melinda Gates-funded MUHAS-UCSF Academic Learning Project.
- Cuba: The UCSF Cuba Program in Health Diplomacy, run by Nancy Burke, PhD, and funded by a grant from the Atlantic Philanthropies, includes projects such as workshops for Havana surgeons on clinical research, and data analysis on a project measuring cardiovascular risk factors and outcomes in Havana.
- Cambodia: UCSF epidemiologist Kimberly Page, PhD, MPH, of GHS’s Prevention and Public Health Group — in collaboration with national and community groups in Cambodia, as well as with Australian researchers — conducts the Cambodia Young Women’s Health Study, a large multidisciplinary study of acute and incident Hepatitis C virus infection in a cohort of young street-based drug users in Cambodia.