Dedication to hard work, a passion for improving health outcomes and medical curricula, a background in business administration, and a knack for team-building have catapulted Alpesh Amin, MD, MBA, FACP, to the forefront of change at the University of California at Irvine Health Affairs, comprised of the UC Irvine Medical Center and School of Medicine. Those skill sets and determination have landed Dr. Amin an HM first: appointment as interim chair of an academic Department of Medicine.

Dr. Amin’s new role—he supervises 11 divisions and more than 200 faculty—means he’s responsible for the department’s budget and administration. He also is charged with advancing the department’s clinical, teaching, and research missions, demonstrating that it’s possible for hospitalists to rise through the department ranks through an HM track. And that, says Scott Flanders, SHM’s president-elect and associate professor of medicine and director of the HM program at the University of Michigan Health System in Ann Arbor, “bodes well for the future of academic hospitalists at many institutions across the country.”

Traditionally, lofty hospital appointments have gone to academics with a background in biomedical and basic science research. But as academic and teaching hospitals focus more and more on quality issues and improved performance, hospitalists are positioned to advance into department leadership positions.

Alpesh does it all, from clinical research to leading a department to running an outstanding hospitalist service. He’s really a renaissance physician.—David N. Bailey, MD, dean, vice chancellor, UC Irvine Health Affairs

Dr. Amin’s appointment could signal the first of many opportunities for academic hospitalists, according to Joseph Ming-Wah Li, MD, assistant professor of medicine at Harvard Medical School and director of the HM program at Beth Israel Deaconess Medical Center in Boston. Dr. Li, who served with Dr. Amin on SHM’s Board of Directors, was not surprised when Alpesh was named the first hospitalist to chair a department of medicine. “He is a very gregarious person, he’s bright, and he’s logical in his thinking,” Dr. Li says.

Career Foundation

Dr. Amin credits his family with instilling in him strong values and dedication to his work. Born in Baroda, India, he emigrated to the U.S. before his first birthday; he graduated from Northgate High School in Walnut Creek, Calif., in 1985, and from UC San Diego with a degree in bioengineering in 1989. He obtained his MD in 1994 from Northwestern University’s Feinberg School of Medicine in Chicago.

During his internship and residency at UC Irvine, Dr. Amin pondered the possibilities of a subspecialty within internal medicine. He opted to follow his interests in medical education and healthcare outcomes and research. The HM field intrigued him, he says, “because there was an opportunity to improve on systems and patient-care delivery.” Numerous mentors along the way encouraged his interests in curriculum development and design, quality improvement, and developing delivery models for patient care.

Trendsetter

As a medical resident, Dr. Amin demonstrated a desire to become a leader and change agent. “He was truly an outstanding resident, and then he joined the faculty and did spectacularly in organizing the hospitalist program, which has become very successful,” recalls Nosratola D. Vaziri, MD, chief of the division of nephrology and hypertension at UC Irvine’s School of Medicine. Dr. Amin founded the UC Irvine hospitalist program in 1998. At the same time, he acquired his MBA in healthcare administration, thus rounding out an already impressive skill set. “The MBA has been a valuable tool,” says Dr. Amin, “because I learned—among other skills—leadership, strategic planning, developing business plans, and improving on operations.”

He has applied those techniques throughout his career, serving in various leadership roles at his institution, including medicine clerkship director, associate program director for the internal medicine residency program, vice chair for clinical affairs and quality assurance, and chief of the division of general internal medicine.

Are Hospitalists the Logical Choice to Chair Departments of Medicine?

Yes, says Joseph Ming-Wah Li, an SHM board member who heads the hospital medicine group at Beth Israel Deaconess in Boston. “The department chair of medicine of yesterday is very different from today—and that’s due to the changes in academic medical centers. It’s not enough anymore to just be a skilled teacher, or a bright clinician or be able to publish. You actually have to be a very skilled administrator and be able to see the bigger picture. That’s where people like [Dr. Amin] are so valuable. They understand what’s happening in terms of the hospital’s workflow, and he’s had to develop and hone those skills during his years as a hospitalist.”

Perhaps, says Matthew Brenner, MD, professor of medicine and chief of pulmonary and critical-care medicine at UC Irvine, but it’s not just hospitalist training that will project someone into a department chair post. What’s required is specific expertise in the business of healthcare. “It’s hard to be chair of medicine today without knowing how to run a business,” he says.

Yes, says SHM President-elect Scott Flanders, MD, associate professor of medicine and director of the hospital medicine program at the University of Michigan in Ann Arbor. “Many in the hospitalist community, including those at academic medical centers, are required to focus on business and leadership skills. We’re constantly having to juggle clinical tasks and administrative roles, both at a departmental level as well as the institutional level. Those skills are essential for department chairs. As a field, hospital medicine prepares people very well for future leadership roles beyond just the local hospitalist community.”

Yes, says Jeffrey Wiese, MD, FACP, professor of medicine and associate dean for graduate medical education at Tulane University Health Sciences Center in New Orleans and an SHM board member. “There is now an acceptance toward a mentality and culture that is empowered to fix the problems. And that’s our task, as hospitalists—to work as part of the patient-care team.” He also believes the research agenda may also benefit with a hospitalist-trained chair: “The more you can evoke collaboration between all subspecialties of medicine, the better off you will be in terms of fostering meaningful and fruitful research.”

Yes, says Eric Howell, MD, assistant professor of medicine at Johns Hopkins University School of Medicine, where he is also division director of collaborative inpatient medicine service; he is also chair of SHM’s Leadership Committee. “My belief is that hospitalists will be natural leaders of hospitals in the private sector, and also of departments and divisions in some academic environments. All hospitalists are trained to manage teams, so it’s not such a big leap for a hospitalist, as it might be for another specialist who may not be quite so used to managing teams.”

By developing and nurturing the UC Irvine hospitalist program, Dr. Amin has exhibited a deep commitment to the core missions of hospital medicine. “Our multidisciplinary program has nine different specialties managed under one program,” he notes. He has structured the program in such a way that members hold dual appointments in the HM program and their individual departments or divisions, thus creating a bridge between the HM program and other departments.

“We have an integrated group that is working together for the focus of advancement in the hospital setting, in terms of clinical care, teaching, team-building, quality and systems improvement. As a result, we’ve had great outcomes in terms of length of stay, quality, and core measures,” Dr. Amin says. “I’ve been fortunate to work with a team of hospitalist faculty who are spectacular and collectively deserve kudos for the success of our group.”

Dr. Amin has shared his passion for quality improvement and curriculum development with all of hospital medicine. As chair of SHM’s education committee, he pushed for the first education summit in 2001, securing support to form a core-curriculum task force. Four years later, Dr. Amin and a small group of industry leaders published “Core Competencies in Hospital Medicine” in the Journal of Hospital Medicine (www.hospitalmedicine.org/corecomp).

“Dr. Amin has really set the trend [for improved hospital performance], not only here for the hospitalist program, but nationwide,” says David N. Bailey, MD, dean and vice chancellor for UC Irvine Health Affairs.

Department Chairs Wear MULTIPLE Hats

The Department of Medicine is the largest department at the UC Irvine School of Medicine, with 11 divisions and 200 faculty members. Its residents rotate through three sites, including UC Irvine Medical Center, the Long Beach Veterans Administration, and Long Beach Memorial Hospital. In his new role, Dr. Amin must be an advocate for all the divisions in the Department of Medicine, not just the HM division.

Dr. Vaziri, who previously served as department chair, says Dr. Amin already has a track record in representing the broad interests of the faculty and the department. On more than one occasion, Dean Bailey has received a letter written by Dr. Amin and endorsed by the division heads: “He’s able to pull them together on initiatives,” the dean says.—GH

Bucking Tradition

Hospitalists have been advancing into leadership positions in the private sector for many years. It’s been a slower ascent in the academic medical center setting.

“Until recently, it would not have been possible to ascend to the level of chair at most academic centers unless your background was in biomedical and basic science research,” says Robert Wachter, MD, professor and chief of the division of HM at the University of California San Francisco, a former SHM president and author of the blog Wachter’s World (www.wachtersworld .com). “Quality, patient safety, and systems improvement were not considered to be legitimate enough academic work to garner the necessary credibility. I think that’s changing.”

Jeffrey Wiese, MD, FACP, professor of medicine and associate dean for graduate medical education at Tulane University Health Sciences Center in New Orleans and an SHM board member, believes Dr. Amin’s interim appointment “speaks in broad strokes to the new skill set—that is, financial and organizational abilities—that are increasingly becoming valued by academic medicine.” Agendas of patient safety, quality, and delivery of efficient, cost-effective, and safe healthcare are gaining parity, Dr. Wiese says, with academic research agendas. “For one to supercede the other is not a good thing, but for the two to be in balance, I think, is a very good thing,” he says.

“Renaissance Physician”

Dr. Bailey appointed Dr. Amin to what he describes as a “long-term” interim post last June. To make his decision, Dr. Bailey consulted with 11 division chiefs, and Dr. Amin emerged as the leading candidate. “Alpesh does it all, from clinical research to leading a department to running an outstanding hospitalist service,” Dr. Bailey says. “He’s really a renaissance physician.”

The promotion coincides with another of Dr. Amin’s recent accomplishments: He received the Laureate Award for the California Southern Region 2 of the American College of Physicians.

Ever energetic, Dr. Amin is not resting on his laurels. “I’m looking forward to helping the department continue to be a flagship within the UC Irvine School of Medicine,” he says. “This is a challenging and positive opportunity to balance systems-based practice, the business of medicine, and the science of medicine.”

Dr. Amin thinks his appointment signifies the new opportunities open to the growing number of U.S. hospitalists—now more than 28,000 strong and growing every day. “This [appointment] shows that hospitalists can move in the direction of being both academic leaders and healthcare administrative leaders.” TH

Gretchen Henkel is a freelance medical writer based in California.

Alpesh Amin: HM's History maker