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Q&A with Joseph Califano III

Although UC San Diego's surgeons often take on leadership roles within the Department of Surgery, many are also recruited to become key leaders at other university institutions. Joseph Califano III, MD, is a prime example. Dr. Califano, a professor of Surgery and Director of UC San Diego's Head & Neck Cancer Center, became Physician in Chief for Moores Cancer Center at UC San Diego in January of 2019. Since then, his leadership has been instrumental in ushering in a number of complex, value-added changes to cancer care for patients in San Diego County and beyond. Here we speak with him about his role as Physician in Chief, the challenges he and his team are working to overcome, and the advice he has for physicians hoping to take on leadership roles at academic institutions.

Q: What is your primary role as Physician in Chief for Moores Cancer Center?
A: My primary role is to be the physician lead for clinical cancer operations across the health system at UC San Diego. I'm focused on making sure we have high-quality clinical operations so that we can take care of our patients, their families and our community, while also advancing the academic mission of the university, including education and research. Prior to my appointment as Physician-in-Chief, Dr. Barbara Parker held a similar role . She did many, if not all of the same things, but my role was somewhat expanded to lead in both inpatient and outpatient care, and also oversee about a dozen or so medical directors with specific leadership roles associated with cancer at UCSD. We also have disease-focused teams with 2-3 disease team leaders, and those also fall under the leadership of the Physician in Chief. I have three very able-bodied and wonderful people with whom I work very closely and who are also essential to the clinical operations team at Moores: Clinical Director for Cancer Surgery Dr. Andy Lowy 9who is also Division Chief for Surgical Oncology for the UC San Diego Department of Surgery, Clinical Director of Radiation Medicine , Dr. AJ Mundt, who also serves as Chair of the Department of Radiation Medicine and Allied Science as well as Senior Deputy Director of Moores Cancer Center , and Dr. Carolyn Mulroney, who recently vacated the position of Clinical Director of Cancer Medicine.

Q: What are some ways you have made an impact at Moores Cancer Center since taking on this role? 
A: It's the entire team I have the privilege of leading that is making an impact, and we do work as a team. I'd say the biggest impact we've made recently is that we've improved our access. For the past two months, thanks to the efforts of Dr. Lowy and Director of Clinical Operations and Patient Access Natalie Wilde, we've had the best access of any unit at UC San Diego Health, meaning that patients can get an appointment within a week. We've also improved clinical quality through a number of metrics. Our in-hospital mortality rates have dropped precipitously, and we are now in the top 10 in Vizient in terms of cancer mortality. Part of that result comes from making sure that we get credit for how complex our patients are, but also our system is helping physicians are doing a better job managing complex patients , including advance care planning. We also have a new triage system and we have partnered with the Department of Emergency Medicine to create an oncology observation unit. With this unit we can deliver really rapid care in less than 24 hours and figure out what our patients need within the same day, whether its hydration or work up for a blood clot. All of these improvements have been very helpful in delivering high-quality patient care. 

Q: What are some of the greatest challenges you face in your role? 
A: The really big challenge that is facing us now is the change in care payments. It's reaching a tipping point where we will have to move from a fee-for-service-based system to a value-based system, giving us the opportunity to expand our clinical networks. That also includes a new project where we're creating a high-efficiency non-licensed infusion center, part of our  bigger effort to move services out into the community. One of the key things we need to do is maintain our role as the leading cancer care providers to all the patients we serve across Southern California; the other key thing is that a lot of our patients don't want to have to travel. We've made a lot of changes and improvements to that end. For example, you can access our palliative or nutritional care services by telehealth and we've also provided greater remote access to clinical trials. We're starting to expand cancer care services in Hillcrest and we are continuing to expand services in North County.

Q: What is the value of having oncologic surgeons in leadership roles at cancer care centers? 
A: It takes a large team to do the job of Physician in Chief, and no one person has all the skills or insights to do this job. But as surgeons, we tend to be fairly goal-directed and metric driven. We also tend to be able to be very decision-oriented in a fast-paced clinical environment where a lot of rapid changes occur, especially in the era of COVID. Having the experience of being able to think on our feet is valuable in a rapidly changing environment.

Q: How do you balance your responsibilities as a practicing surgeon, researcher, director of the Head & Neck Cancer Center and physician-in-chief? 
A: I think I'm constantly struggling to balance those roles. The real answer is I have a lot of support and people who help me. I have a wonderful administrative partner in Moores Cancer Center Chief Administrative Officer Matthew Jenusaitis. It's really Matthew and the entire team who help me do what I do and are really leading these efforts as well. So to answer your question, I don't do all of those jobs. I lead a lot of people who do wonderful work and demonstrate independent leadership in their roles, and that's the way it should be.

Q: What advice do you have for surgeons who would like to work toward becoming Physicians in Chief? 
A: Doing health systems-oriented service as an academic physician can be incredibly rewarding, and there's no question that having academic physicians in clinical leadership roles is crucial to the success of the institutions. The academic mission of the university will not survive unless we have people with the ability to support both the academic mission of the health system and all the operational challenges that go along with it.

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