In 1817, the University of Michigan was founded as one of the first public universities in the nation. First located in Detroit, the University moved its campus to Ann Arbor in 1837. Just a few years later in 1848, the Board of Regents established a three-member medical school (or the "medical" department as it was then called) and appointed Abram Sager, MD, as Professor of the Theory and Practice of Medicine. This was the first step in organizing what is known today as the Department of Internal Medicine - a department whose rich and stellar tradition of excellence continues today.
In 1850, as the first students arrived in Ann Arbor, Dr. Sager became Professor of Obstetrics. Samuel Denton, MD, was then appointed Professor of the Theory and Practice of Medicine and Pathology. Denton was not only a skilled clinician, but also a politician, having served in the State Senate. He also served as one of the university’s first Regents. He was noted for being a strong advocate of the use of alcohol to treat many varieties of illness. After he passed away in 1860, he was followed by a series of physicians, some of whom maintained private practices in Detroit.
During this time, the University of Michigan became a leader in medical education. Internal Medicine was a central clinical feature of the school and played a significant role in all of the changes. In 1869, the University became the first American medical school to own and operate its own hospital, a key part of a robust clinical educational system. Many other medical schools have followed Michigan’s lead. In 1870, the University became the first major American medical school to admit women. Internal Medicine was also part of what was then an innovative idea in medical education - promoting the importance of scientific thought.
The Department of Internal Medicine honors its history in part by the naming of internal medicine services for key figures of the past. We hope you explore our history and celebrate the University of Michigan's bicentennial with us.
Our Leadership History
George Dock Era, 1891 - 1908
George Dock, MD, arrived at his post as Chair of the Theory and Practice of Medicine in 1891, with the best training his era could offer — training that would ultimately guide his efforts to reshape medical education at U-M and throughout the field.
After attending the University of Pennsylvania’s three-year medical school program, Dock took the unusual step of arranging his own year-long internship at a Catholic hospital in Philadelphia. Alongside his clinical training, he used the opportunity to take language lessons from the German nuns to prepare for a study trip to Germany and Austria, the epicenter of laboratory medicine at the time. Over the next three years, he dug into topics from bacteriology to pathology, and parasites to physical therapy, for a time attending some 30 autopsies a week. He returned to intern under the preeminent American internist and medical educator William Osler, who would later call Dock “a man who knows more about clinical procedures than anyone in the United States.”
With this preparation, Dock was recruited to U-M as the country’s first full-time professor of medicine under newly installed Dean Victor C. Vaughan, MD, as part of a dream team of exquisitely prepared medical faculty. He arrived with the Catherine Street hospital under construction, which by 1900, would give him access to the largest teaching hospital in the country. Dock’s philosophy emphasized laboratory and clinical work over lecture and demonstration, and he put this philosophy into practice directly. He rejected the tradition of repeating lectures for two consecutive years, helping to implement the new four-year graded curriculum during which students actively participated in lab work. He established a course in percussion and auscultation, and held an internal medicine clinic for fourth-year students twice a week where he taught the art of diagnosis through the Socratic method and hands-on training. He also exploited his access to a busy university hospital by introducing the clinical clerkship to Michigan. Established in 1899, it was similar to one launched at Johns Hopkins four years earlier, giving students responsibility for patient care under faculty supervision. The approach became a model for medical schools across the country.
Dock would make other important contributions to the medical school as well. He had a passion for old medical texts and served eagerly as chair of the library committee, where he channeled his love of medical literature into assembling one of the most complete collections of international medical journals available. The aim was to augment textbooks with journal access so that students would develop habits of lifelong learning. He also made his own contributions to the history of medicine by engaging a stenographer to document his clinic teaching, an effort that now fills 16 volumes in U-M’s Bentley Historical Library.
Dock’s tireless efforts to make students active participants in their education put U-M among a handful of elite institutions at the forefront of this movement, prompting Abraham Flexner in his 1910 report on medical education to name Michigan’s medical school one of the best. He also established a tradition of leadership and innovation in medical education that lives on in the department and medical school today.
“George Dock at Michigan, 1891-1908” by Horace W. Davenport in “Medical Lives and Scientific Medicine at Michigan, 1891-1969” by Joel D. Howell and “Dr. Dock” by James Tobin (heritage.umich.edu/stories/doctor-dock).
Albion Walter Hewlett Era, 1908 - 1916
As the second Chairman of the Theory and Practice of Medicine, Albion Walter Hewlett, MD, built upon Dock’s efforts to bring medical education to the bedside by linking the bedside with the laboratory. He believed strongly that academic physicians should do research, and that new clinical laboratory methods should be incorporated into patient care, and he did his utmost to foster these ideas at U-M.
Hewlett’s driving conviction was that disease must be approached from a physiological, rather than a purely anatomical, perspective. This approach, quite prescient for its time, evolved during a training program not unlike his predecessor’s — a medical degree from Johns Hopkins, an internship and residency at New York Hospital and 18 months’ study in Germany with physician-scientist Ludolf Krehl. Hewlett then served on the faculty at Cooper Medical College, where he launched a cardiovascular research program that garnered enough attention for him to be tapped as a founding member of the American Society for Clinical Investigation — an organization that would elect him president nearly two decades later.
When he was recruited to Michigan in 1908, Hewlett set about making his imprint on every aspect of internal medicine’s mission. He set an example of vigorous research, publishing on arrhythmia, cardiac conduction disorders, peripheral circulation and related topics, and he encouraged his assistants to do the same. His contributions led to an invitation from British cardiologist Thomas Lewis to serve as one of six co-editors of his new journal Heart (later renamed Clinical Science), which debuted in 1909.
In clinical care, Hewlett oversaw a dramatic increase in patient volume and revenue. But his primary contribution was encouraging colleagues to adopt recent advances in testing, from lab tests for TB and syphilis to electrocardiography. In fact, Hewlett acquired U-M’s first electrocardiograph in 1913, an instrument in which he saw great diagnostic potential.
Hewlett made several contributions in the education arena as well. While he rounded daily with medical students, he offered supplementary Sunday rounds to those with a special interest in internal medicine. These lasted throughout the year, not just during students’ assigned medical rotation. He also conducted sessions on new diagnostic techniques, and offered a popular elective on the clinical physiology of circulation, addressing topics such as arrhythmia, valvular lesions, hypertension, and pulmonary edema. On a more operational note, he helped raise the quality of the medical school’s incoming residents by improving their living conditions.
When the promise of expanded laboratory space lured him to Stanford in 1916, its president Ray Wilbur said of Hewlett, “There is no better man of his age in clinical medicine in this country.” He fostered a paradigm shift from the empiric to the investigational from which the field and the department have never looked back.
“Albion Walter Hewlett: Teacher, Clinician, Scientist, and Missionary for ‘Pathologic Physiology’ ” by W. Bruce Fye in “Medical Lives and Scientific Medicine at Michigan, 1891-1969” by Joel D. Howell.
Nellis Barnes Foster Era, 1916 - 1917
Source: University of Michigan Faculty History Project
"Nellis Barnes Foster, MD, was born in Durhamville, New York, in 1875. He received his education at Amherst College, graduating with a Bachelors of Science degree in 1898. Four years later he graduated from Johns Hopkins University. Dr. Foster then spent some time as a graduate student in Munich. Before coming to the University of Michigan Dr. Foster was a Pathol ogist at the Bay View Hospital in Baltimore and a Resident Physician in New York Hospital. From 1914 to 1916 he was Assistant Professor of Medicine at Cornell Medical College in New York City; and from 1908 to 1916 he was Associate Physician of the New York Hospital.
Dr. Foster was a leading diabetologist and wrote a textbook titled “Diabetes Mellitus: Designed for the Use of Practitioners of Medicine” in 1915. In addition he made contributions to various medical journals on gastric disease and nephritis."
Source: University of Michigan Faculty History Project
Louis Harry Newburgh Era, 1917 - 1922
Source: University of Michigan Faculty History Project
"Louis Harry Newburgh, MD, Assistant Professor of Internal Medicine, was born in Cincinnati, Ohio, June 17, 1883. He received his early education in the Primary schools of Cincinnati, and the Franklin Preparatory School also in Cincinnati. He was graduated from Harvard in 1905, with the degree of AB, receiving his MD from the same University in 1908. From 1908 to 1909, he was an internist in the Massachusetts General Hospital; and from 1909 until 1910 he was in Vienna in the Wiener Allgemeines Krankenhaus.
From 1912 to 1916, Dr. Newburgh was Alumni Assistant in Medicine in the Harvard Medical School, also Assistant Visiting Physician in the Massa chusetts General Hospital.
Coming to Ann Arbor in 1916, as Assistant Professor of Internal Medicine, after graduation from Harvard College and Harvard Medical School, graduate study in Vienna and Berlin, and service in both the Harvard Medical School and the Massachusetts General Hospital, Dr. Newburgh was promoted to an associate professorship in 1920. Two years later he was promoted to the professorship of clinical investigation in the Department of Internal Medicine, which he has occupied since that time.
The studies that he has skillfully conducted as an active member of our faculty have made him an authority on the subject of nutrition, obesity, and diseases basically involving metabolism, and his many publications in this field have brought him widespread recognition.
Source: University of Michigan Faculty History Project
Louis Marshall Warfield Era, 1922 - 1925
Louis Marshall Warfield, MD, received his AB and his MD at Johns Hopkins. After serving as an intern there, he was on staff at the Thomas Wilson Sanitarium for Children in Balti more. He then became an instructor in medicine at Washington University in St. Louis. While at Washington, Dr. Warfield also served as chief physician in the Municipal Tuberculosis Dispensary of St. Louis. From 1909 to 1922, he was As sistant Superintendent of the Milwaukee County Hospital and also Professor of Clinical Medicine in the Marquette Medical School from 1914 to 1919.
In 1921, in a report from the Dean to the University of Michigan President, Dr. Warfield was highly recommended and stated that Dr. Warfield's experience "in the practice of medicine and as a consultant assures us a broad type of approach in the problems of medicine." Dr. Warfield's appointment began in 1922. However, for changes that occurred at the University, Dr. Warfield decided to return to his practice in Milwaukee in 1925.
Source: University of Michigan Faculty History Project
James Deacon Bruce Era, 1926 - 1928
James Deacon Bruce, MD, came to the University of Michigan in 1925 and became the Director of the Department of Internal Medicine in 1926. In 1928 he began to devote himself to the Department of Postgraduate Medicine, of which he was made head, and to the University Health Service, to which he was Medical Adviser for several years. In 1931 he was made Vice-President of the University in charge of University Relations, a title he held until his retirement in 1942.
Dr. Bruce's enthusiasm and wide acquaintance in the profession enabled him not only to initiate the University's work in postgraduate medicine, but to build it up to the point of enrolling in its classes fifteen hundred or more medical practitioners a year. These practitioners were enabled to keep abreast of the newest developments or further to qualify themselves in special fields. Though he was especially successful in this work, which involved co-operation with other professional or public agencies, Dr. Bruce's interest in continuing education went far beyond the limits of medicine alone and led him to become one of the University's most vigorous proponents of adult education and a leader in the enormous advances made in that field by the University during the past decade.
Source: University of Michigan Faculty History Project
Cyrus Cressey Sturgis Era, 1928 - 1957
Cyrus Cressey Sturgis, MD, presided over the Department of Internal Medicine for nearly three decades, an exceptionally long run for a department chair, at an exceptional time in history. His tenure witnessed social upheavals from the Depression to World War II; scientific advances from penicillin to cancer chemotherapy; changes to academic medicine, including the advent of significant extramural NIH funding; the trend toward specialization; the rise of new fields, such as genetics and nuclear medicine; and the expansion of postgraduate training.
Any administrator during this time would need to be adroit and well-prepared. Sturgis was both. He was Phi Beta Kappa at Johns Hopkins medical school, interned at the Peter Brent Brigham Hospital, then joined the Army Medical Corps as the U.S. entered World War I. With the assistance of The Brigham’s physician-in-chief, Sturgis was assigned to a Harvard-staffed Army hospital in New Jersey. It was here that he began his career as an investigator, examining the physiologic aspects of “soldier’s heart” (related to what we now call post-traumatic stress disorder). After the war, Sturgis completed his residency at The Brigham and rose through the ranks at Harvard until a compelling offer succeeded in luring this heavily recruited young faculty member to the University of Michigan.
The offer was for the directorship of the Thomas Henry Simpson Institute for Medical Research — a new institute founded to study pernicious anemia. Established through a philanthropic gift from the wife of a Detroit industrialist claimed by the disease, the institute provided a salary and research support package that was impressive for the day. Though Sturgis had no research record on the topic, he was the strongest candidate in every other respect and was brought on board in 1927 with the agreement that he would be appointed Chair of Internal Medicine the following year.
Sturgis made rapid progress at Simpson. He hired talented hematology researcher Raphael Isaacs, MD, as the institute’s assistant director, and within two years, their group had developed a compound for pernicious anemia that freed patients from the existing standard of treatment — eating a half-pound of liver daily. Called ventriculin, it was produced under a licensing agreement with Parke-Davis and established a model of productive industry partnership that would characterize Sturgis’ administration. The publicity surrounding the treatment raised U-M’s profile in cutting-edge hematology research and led to a spike in referrals from Michigan and surrounding states. The institute’s work also impacted the educational mission: Isaacs developed a third-year elective on diseases of the blood, students participated in institute research, and Sturgis himself produced a hematology textbook in 1948. As pernicious anemia became treatable, the institute’s mission was broadened to general hematology.
As Sturgis stepped into the chairmanship, he found the path to success a slightly steeper one. Despite the department’s legacy of excellence, it had found itself somewhat rudderless of late. According to historian Steven C. Martin, “In the decade between Hewlett’s departure and Sturgis’ arrival, five different men occupied the chairman’s post. At one point, the school was unable to attract a suitable candidate and the chairmanship was briefly held by a radiologist. It was clear by the middle 1920s that the department required reinvigoration.”
Among Sturgis’ most pressing challenges were revising students’ clinical teaching and intern supervision, securing sufficient financial support for his clinical and research faculty, and establishing relationships with the department’s eminent researchers Frank Wilson, MD, and Louis Harry Newburgh, MD.
To address the education and training piece, Sturgis replaced the department’s four specialized services — metabolism, cardiology, tuberculosis, and a private medical service — with four general medicine services. On a philosophical level, this move aligned with his reticence about the trend toward specialization and how it might impact physicians’ holistic approach to their patients. On a practical level, his intention was to reduce the time commitment from full-time faculty, thus freeing up more of Wilson and Newburgh’s time for research, while enhancing teaching and supervision by providing senior faculty as attendings on all medicine services.
Sturgis also addressed the financial piece head-on, albeit with mixed results. The area in which he flourished was research funding. He was successful with both of the major sources of support available in the early part of his term — the pharmaceutical industry and private foundations. He developed partnerships with firms such as Parke-Davis, Upjohn, and Lilly, and garnered support from numerous foundations. It was during Sturgis’ tenure, for example, that the Rackham Foundation established a million-dollar endowment and funded the Rackham Arthritis Unit, which Sturgis vigorously supported.
The area in which Sturgis had less success was securing competitive salaries for his clinical faculty. Though his own generous salary was made possible through Simpson philanthropy, the university funded his faculty. He felt the salary levels left the department vulnerable to poaching, a situation compounded by the medical school’s “full-time plan,” which prohibited his faculty from supplementing their incomes through private practice. Though he petitioned his superiors on both accounts throughout his tenure, it was never resolved to his satisfaction.
Despite this, Sturgis managed to keep the department on solid footing. He saw it through the tumult of the Great Depression, during which he had to cut salaries and dismiss a faculty member, and later, World War II, when financial scarcity gave way to a shortage of manpower. During this time, he continued to support leading research by Newburgh, Wilson and Isaacs and to maintain the department’s clinical and educational caliber.
As a consultant to the Army, Sturgis saw that physicians returning from the war were going to seek additional specialty training and worked to make such training available at U-M. He also recognized that the rapid post-war increase in federal research funding was going to reshape the research environment. Ironically, during his tenure the department partook of little of the NIH largesse, in part because Sturgis felt he had sufficient foundation funding for the department’s needs and in part because he, like many in academic medicine, had concerns about the potential for federal extramural funding to politicize the research process. At one point, Sturgis declined an opportunity for such funding, citing the fact that all the department’s research projects were fully funded. Though not an issue during his tenure, subsequent Chairs faced the challenge of repositioning the department to capitalize on NIH support.
Despite many trials, some from within and more on the world stage, Sturgis kept a steady hand, managing to grow the department in size, funding, output and quality. During his tenure, the faculty more than doubled from 20 to 56, the number of inpatients cared for increased from 2,700 to 4,000 and the number of students taught by the department rose from 300 to 800. In addition, the department’s research funding increased exponentially, a new Kresge Research Building provided much-needed research space, and faculty publications increased sixfold. Sturgis’ own stature in the field is exemplified by his election to the presidency of the American College of Physicians in 1953, four years before his retirement.
“Cyrus Cressey Sturgis and American Internal Medicine, 1913–1957” by Steven C. Martin in “Medical Lives and Scientific Medicine at Michigan, 1891-1969” by Joel D. Howell.
William Dodd Robinson Era, 1958 - 1975
William D. Robinson, MD (Rheum), stepped into his role as chair during what his successor Bill Kelley calls “the Golden Age of Internal Medicine.” The public’s respect for physicians and belief in the promise of science was at an all-time high, and the most highly sought residencies were internal medicine’s. Moreover, U-M, the medical school, and the department all enjoyed strong reputations nationally.
But for all its glow, this period would also see seismic shifts — in both the field of academic internal medicine and the role of the chair — that would require adaptations from its leadership.
Robinson undertook all of his medical training, from student to research fellow, at U-M, where he was mentored by leading metabolism and nutrition researcher Louis Harry Newburgh, MD (MEND). The whole of his career would also be at U-M, save for a stint with the Rockefeller Foundation from 1940 to 1943, during which he spent time in Franco’s Spain studying post-civil war nutritional deficiencies among its people. After WWII, he would consult for the Surgeon General on the nutritional status of liberated Europe.
Robinson joined the internal medicine faculty in 1944, where his interests shifted to arthritis. He became known nationally for research on the effects of adrenal corticosteroids in rheumatoid arthritis, led the Rackham Arthritis Research Unit and served as president of the American Rheumatism Association.
Under his chairmanship, the department made notable contributions along every dimension of its mission. In research, this is when Stefan Fajans, MD (MEND), did his seminal work on Maturity- Onset Diabetes of the Young (MODY), Ron Easterling, MD (Neph), established the first state-wide end-stage renal disease registry in the U.S., and Stevo Julius, MD, ScD (CVM), revealed the enormous public health consequences of hypertension.
But the department’s particular strengths were in clinical care and education. One example was the University Health Plan, led by Robert Carpenter, MD, which former Dean James O. Woolliscroft, MD (Gen), calls “a visionary model for primary care.” In a structure foreshadowing the medical home, a panel of internal medicine residents served at the center of a care team which included a supervising faculty member, nurse practitioner, LPN and medical secretary, with support from psychiatry and social work. “It was a very forward-thinking clinical setting that would inform how I looked at educating our students and residents,” says Woolliscroft.
Yet for these many accomplishments, there were a few areas in which the department would struggle to keep pace with developments in the field. Perhaps the most visible was research support. The NIH instituted its modern granting mechanism in 1946. By 1957, the year before Robinson took office, its funding had reached $100 million; it would grow to $1 billion in 1974, the year before he was ready to step down.
Based in part on the legacy of his predecessor, the department was slow to take advantage of this funding. While some divisions secured federal grants during Robinson’s tenure, the effort was uneven. When Bill Kelley took over in 1975, he was surprised to find the department ranked 42nd in NIH funding, and when former GI Division Chief Tachi Yamada, MD, arrived at his post in 1983, he says the division’s only NIH grants were the ones he brought with him.
Another watershed event in the field was the launch of Medicare and Medicaid in the 1960s, which created a surge in demand for clinical care. Between 1959 and 1970, the U-M Medical School faculty more than doubled, from 300 to 649, the largest proportion of whom were in internal medicine.
This change in scale had important implications. First, in the face of such growth, a chair’s approach to recruiting would profoundly shape the department. In Robinson’s case, limited space and funds for recruiting constrained his efforts, says Jeoffrey Stross, MD (Gen), who served as both chief resident and assistant professor under him. As a result, he did almost all of his hiring from within.
Second, says department historian Joel Howell, MD, PhD (Gen), the increasing size of the department turned the chair into an administrator — and not every chair relished this change. “Robinson was an incredibly nice, understated man who was a wonderful clinician, researcher and teacher,” says Stross. “When he came into office, the department was small, and he could do everything more or less solo. But as it grew, it became clear to him that more administrative structure and a renewed focus on research and recruiting were needed to move things forward.”
When Robinson’s era came to an end in 1975, the time was ripe for a chair with the leadership skills necessary to accomplish these very things.
William N. Kelley Era, 1975 - 1989
Speak with anyone affiliated with the department during the chairmanship of William N. Kelley, MD (Rheum), and you’ll hear a familiar refrain: The era was transformative. Says department historian Joel Howell, “Kelley took over a drifting department in 1975 and yanked it into the upper echelon.”
The data tell the story. During his 14 years as chairman, internal medicine skyrocketed from 42nd to 4th in research funding. Not only that, but Kelley left in his wake a Howard Hughes Medical Institute; state-of-the-art facilities; a departmental structure extolled as a national model; an intensive, structured approach to teaching; and a faculty that would produce many of the great leaders of American internal medicine.
Yet he was just 36 when he took the job and learned later from the consultants who vetted him that they expected him to last just a couple years because the changes he’d make would be so disruptive.
So how did he endure, and go from being “disruptive” to “transformational”?
There are several reasons, say those who worked alongside him. He’s hard-wired to be both uncompromising and tireless — legendarily working through two shifts of secretaries. He also possesses a striking clarity of vision and holds himself and others to exacting standards. Kelley himself credits the fact that he cut his teeth under some of the great chairs of his time — Don Seldin at Southwestern, Alex Leaf at Mass General and Gene Stead and Jim Wyngaarden at Duke. But perhaps most importantly, Bill Kelley has a natural penchant for turning challenges into opportunities.
From Obstacles to Opportunities
As it turns out, the challenges that awaited him in his new position were many. Kelley arrived on his first day to find his house officers picketing. He put out that fire, only to discover the hospital planning efforts stumbling, no space for his lab and a departmental hiring freeze.
Rather than pack up, Kelley decided to find other ways forward. His lab space was the most urgent; his research had not only established his reputation in the field, but kept him at the cutting edge of science, which was essential for recruiting and teaching.
Fortunately, he had a joint appointment in Biological Chemistry and its chair, Jud Coon, PhD, carved out some space for him. But the situation impressed upon him in a very personal way the need for departmental research space.
The next facilities challenge surrounded the planning for a new university hospital. Kelley minces no words about the unsuitability of “Old Main,” with its noisy, open, hangar-like wards, which he saw as a liability to recruitment, patient care, and teaching. When he arrived, the hospital planning committee had been stalled for nearly two decades and was signing off on a plan to create a surgical hospital next to the VA, leaving medical services in Old Main until a future phase could relocate them.
In his first committee meeting, Kelley vetoed the plan. He would later play a similar role with the new ambulatory care center, when it was earmarked for the old St. Joseph Mercy Hospital.
In both cases, Kelley’s opposition and strong leadership from then-President Robben Wright Fleming and Provost Harold Shapiro helped turn things around, setting the stage for what he calls the “phenomenal” University of Michigan Hospital and A. Alfred Taubman Health Care Center U-M has today.
Kelley’s next challenge was figuring out how to shake loose his hiring. Since his arrival at Michigan, he’d been talking with the Howard Hughes Medical Institute, with whom he had relationships from his time at Duke, and had pitched what he called the Center for the Clinical Application of Molecular Genetics. He envisioned it funding eight research faculty with a clinical orientation in genetics, an area in which his own lab’s work in enzyme-deficient gout gave him particular credibility. He planned to structure the center so that, rather than the HHMI money being distributed to existing senior faculty, as was the case at other institutions, it would be used to fund the recruitment of top-tier, early-career physician-scientists to the medical school, several of whom would be in internal medicine. Bookended with the installment of genetics superstars David Ginsburg, MD (Hem/Onc and MMG), as the first and Francis Collins, MD, PhD (PCCM and MMG), as the last of these new U-M HHMI investigators, the program was a coup — both in launching influential scientists and in funding research that helped unravel the genetics of bleeding and clotting diseases, cystic fibrosis, neurofibromatosis and Huntington’s disease, among others.
In the meantime, Kelley was also working on another, broader mechanism to support faculty recruitment — the medical practice plan. He was eager to implement a system like Duke’s in which full-time faculty were compensated for patient visits, but billing flowed through the department, rather than through the hospital or private practices. The dean’s office was skeptical, but Kelley was a self-described “squeaky wheel.” “The practice plan turned out to be a phenomenal opportunity to grow,” says Kelley. “We began making millions of dollars a year from just delivering the care we were delivering before — but now the department was collecting for it. It allowed me to begin to recruit people starting in the summer of ’77 — and by the time I left, I had recruited 93 percent of the 233 faculty in the department.”
Building a Faculty: The Secret of His Success
When Kelley says “he” recruited them, he means it. He was exceptionally hands-on in faculty recruitment, as he was in every aspect of his tenure. “I was personally involved in virtually every hire,” says Kelley — largely because he viewed the quality of the faculty as the department’s bedrock.
His philosophy was that faculty destined for his new clinician-scholar track — those who would serve as clinicians, educators and clinical or health services researchers — could best be hired from within. After all, he and his faculty had worked alongside them as residents and fellows and knew their clinical skills firsthand. In contrast, he wanted all of his bench researchers to come from outside to broaden the range of expertise. “If a bench scientist was trained at Michigan, we’d just be giving the scientist who trained that person one more set of hands,” he says.
By all accounts, Kelley was unmatched in recruiting. When asked about his approach, he reveals what amounts to a three-pronged strategy. First, he had to know where to look. Though he kept it close to his vest at the time, he started by developing a pipeline from one of his most respected programs. “Gene Braunwald was the chief of medicine at The Brigham and was, I thought, fantastic at recruiting great trainees,” says Kelley. “So I figured if I could get some of his trainees here, I could build a critical mass of faculty who were all good friends, and it would be easier to bring them here. There were exceptions, of course, but we looked at a lot of people from The Brigham in those days.”
Step two was to personally vet the candidates. “I listened to their science,” he says. “If their science was world-class and if I enjoyed them as people — if I had confidence that they could get along well with the other faculty, house staff and students — then we put every effort into getting them here.”
The final step was finding the right pitch. “I used to tell candidates, Look at the advantages in Ann Arbor,” he says. “First, we’ll pay you more, the cost of living is less and you’ll be able to live twice as well. You can buy a four-bedroom home in a great neighborhood with great schools. And look at all the superstars here — it’s just like Boston — but here we interact more. We do things together; we learn from each other.”
The approach quickly bore fruit. “As we got a critical mass of people, from The Brigham particularly, it really began to flourish,” he says.
Of course, hiring is only the first step in building a great faculty; they also need support. This was another area in which Kelley excelled. His method was to seek out junior faculty with star potential, being willing to mentor them as they seasoned their skills. Former Hem/Onc Division Chief and U-M Comprehensive Cancer Center Director Max Wicha, MD, is one such example.
“In 1982, Bill Kelley approached me and asked, ‘How would you like to be Hem/Onc division chief?’” says Wicha. “I was two years out of my fellowship and just starting as an assistant professor, and said, ‘You’ve got to be kidding. I’m just getting my own lab going; I don't know anything about administration.’ He said, ‘You’re a scientist, and I want to build the Department of Medicine into the biggest scientific powerhouse in the country. Just go out and find the best physician-scientists, and I’ll work with you to recruit them.’” Wicha agreed, and like so many other division chiefs of this time, he grew into his leadership role, dramatically increased the division’s research funding and made lasting impacts on the field.
Room to Grow
Of course, with recruitment taking off, Kelley needed a place to house all these physician-scientists, and his stopgap strategy of leveraging joint appointments to secure space in other departments and reallocating existing space was stretched thin. He needed new buildings.
He decided to launch a research institute, which would in turn require a building. He approached H. Marvin Pollard, MD (GI), a well-known clinician with a lot of grateful patients, who Kelley thought might be willing to support this effort, and asked if he could build a research institute in Pollard’s name.
Pollard and the university agreed, and the architects designed a series of three buildings for the allotted footprint: Medical Science Research Buildings (MSRBs) I, II, and III. It turned out that as the finishing touches were being put on the design, the Howard Hughes Medical Institute was committing to Michigan and decided to acquire one of the buildings.
“The reason we had a shovel-ready research building the size that HHMI wanted was because the Pollard Institute had been designed,” says Kelley. “So one building was paid for by HHMI, and we just shifted our funding to the next building. That’s how MSRB I and II got done so fast.”
A Study in Synergy
As important as these individual achievements were, even more important was the way in which they reinforced each other. The new facilities made recruiting easier; the recruiting of physician-scientists positioned internal medicine at the cutting edge of its subspecialties, which spurred referrals; and the growth in the clinical program funded more recruitment.
Jeoffrey Stross, MD (Gen), Kelley’s first chief of general medicine and associate chair of patient care, shares the synergistic aspects of the practice plan as an example. “The start of the practice plan was important overall because it brought a great deal of money to the department — but it had a number of other effects, as well. In order to bill for what you did, you had to be involved in patient care. So the attendings began taking part in rounds on a regular basis and became more actively involved in teaching and care. This meant the house staff got a great deal more teaching, the faculty worked harder but got paid more, and patient care improved because more senior people were involved — we saw this through a dramatic reduction in patients’ length of stay.”
And like most of what Kelley did, these synergies were no accident; they were the result of careful planning and structure.
The Value of Structure
Structure was a hallmark of the Kelley era, and nowhere was it more evident than in the realm of education. Recalls Stross, “When I went through the program in the late ’60s and early ’70s, you worked on the inpatient service and had faculty members who would attend and help, but there was no formal educational program. All that changed the day Bill Kelley got here.”
Kelley implemented a fixed weekday schedule with a very deliberate goal. “We needed time for a real exchange of ideas and listening to what’s happening in the world of science as it applies to the practice of medicine,” says Kelley.
He felt that participating in rounds kept him connected with the students and house staff, lent an air of formality to the experience and kept learners on their toes. Each student had the chance to present to him once, and they were expected to appear in appropriate dress — for men, this meant wearing ties as a mark of patient respect — and to report on their patient’s history and physical findings from memory at the bedside. After this, Kelley grilled the group: reviewing the history; performing his own exam; and probing each presenter on the implications of various findings, rationale for therapies, and latest research. His intensity was legendary; colleagues recount stories of students going mute, fainting and conjuring up last-minute trips overseas at the prospect of Kelley rounds.
In addition to making medical education more rigorous, another key goal was making it more relevant. James Woolliscroft, former dean of the U-M Medical School and the Lyle C. Roll Professor of Medicine, was a chief resident under Kelley and was chosen by Kelley to serve as the department’s clerkship director. “Around this time, we began to recognize that our graduates would increasingly be providing care outside of the hospital, and they’d need a new skill set,” says Woolliscroft. “So I pioneered moving students into the community — into clinics and facilities for the elderly. We were, if not the first, among the very first in the nation to make ambulatory-based education a requirement for all of our internal medicine students.”
Kelley also worked to make the faculty accountable for their teaching. At the end of the year, he sat down with each resident for feedback on the program, asking them to rate every faculty member as a clinical teacher. “Knowing that the chairman was going to find out how residents viewed their teaching certainly improved the faculty’s effort,” he says.
As hands-on as Kelley was during his tenure, he recognized that even he and secretary Candy Johnson, who, he says, “could do the work of five people,” couldn’t meet all the demands of a large and growing department on the rise. Much like the structure he brought to the educational experience, he brought a clear delineation of leadership roles to the department. In addition to the division chiefs, he instituted a series of associate chairs for patient care programs, research, house staff education, medical student teaching, medical services at the VA and affiliated hospitals and a business administrator.
In a special article in the August 28, 1980 New England Journal of Medicine, Robert Petersdorf, outgoing chairman of medicine at the University of Washington, cited this structure as a possible solution to the growing demands on chairs of medicine for the decade ahead.
But the real proof of whether a department is organized and functioning well, of course, is what it is doing. The research, clinical care and education timelines in this report are rich with breakthroughs catalyzed during the Kelley era. There is also little question that Kelley helped launch to international prominence several subspecialties and research emphases that were just taking shape as he took office — from geriatrics to health services research to molecular medicine and genetics.
Tadataka "Tachi" Yamada Era, 1990 - 1996
“The University of Michigan is known by the quality of people it has and the quality of people who have spent time there. These include leaders in every aspect of the field — the pharmaceutical industry, major foundations, the NIH and academia. And the people who stayed created an enormous powerhouse of medical research and clinical medicine at U-M.” - Dr. Tachi Yamada
Following in Bill Kelley’s steps as chairman was a person he’d not only hand-picked to head the Division of Gastroenterology six years earlier, but was willing to wait for. When Kelley first tried to recruit Tachi Yamada, MD, PhD, to U-M, Yamada wasn’t quite ready for the move — but Kelley promised to hold the position until he was.
Kelley felt that a scientist of his caliber was worth the wait, and both were well-aligned in their molecular biology orientation. Yamada’s focus was on the synthesis and function of gut hormones, and his lab helped detail how the peptide somatostatin regulates GI function.
As division chief, Yamada demonstrated many of the skills needed in a department chair. Forging ties across departments, he won an NIH Center grant, which would form the basis for the Michigan Gastrointestinal Peptide Research Center. He took the division from having no NIH grants prior to his arrival to $4 million in research funding at the end of his six years as chief. He also made a number of strong recruitments and enhanced clinical care by creating the Medical Procedures Unit to house endoscopy and related services.
When he was tapped to replace Kelley, Yamada’s goal was to continue the department’s momentum, though his style was markedly different than his predecessor’s. “Dr. Yamada viewed his department as an extended family,” says Jeoffrey Stross, who served as his associate chair for patient care programs. Even so, under Yamada’s tenure the department reached unprecedented levels of both research funding and clinical activity, and had responsibility for a third of all medical student teaching.
Yamada says he worked to take a number of strong elements to the next level. He played an important role in helping the young but ascendant Division of Geriatrics secure a grant from pharmaceutical company Tanabe to bring the principles of geriatric medicine from the U.S. to Japan. “I think it’s telling about the quality of the work the division was doing that a Japanese pharmaceutical company would want to partner with U-M,” he says. “It was, and still is, one of the leading geriatrics divisions in the world.”
Yamada also played a major role in supporting the smooth development of the cancer center. “There could have been a struggle as the cancer center got on its feet because to some extent the NIH cancer centers could be seen as competing with existing departments,” he says. “But I was able to negotiate a deal with the executive director of the hospital, John Forsyth, to commit $10 million of his reserves as an endowment to support the Hem/Onc Division under Rob Todd and another $10 million to support the Comprehensive Cancer Center under Max Wicha.”
The result was that both entities had the resources they needed to ramp up their activities: the cancer center embarking on the new building it would share briefly with the geriatrics center, and the division beginning a wave of clinical recruiting that would allow it to take a leading role in cancer clinical trials.
General Medicine was also on a roll. Laurence McMahon, MD, and Joel Howell, MD, PhD, secured a Robert Wood Johnson Clinical Scholars Program, and Rodney Hayward, MD, took the reins of the new VA Health Services Research and Development Field Program, both of which would strengthen the department’s burgeoning health services research effort. In addition, some of the department’s new recruits, such as Steven Katz, MD, and Mark Fendrick, MD, would go on to become national leaders in this arena. On the clinical care side, Yamada recruited David Spahlinger, MD, now an executive vice dean and president of the clinical enterprise, to run the primary care program, overseeing enormous faculty growth and the expansion of primary care activities to satellite locations across the greater Ann Arbor area.
In the realm of education, Yamada had two goals for the department: to ramp up house officer training and medical student education, under the direction of Joseph Kolars, MD (GI), whom Yamada recruited, and James Woolliscroft, respectively.
Though the increasing size of the department forced Yamada to scale back a bit from his predecessor’s five-day rounding schedule, he retained a hands-on philosophy, conducting chief rounds and morning reports three days a week. In addition, he met with the chief residents every Friday to discuss the trainees and program — and put particular effort into resident recruiting. “I think the quality of the house officers we attracted reflected the care and attention Joe Kolars and I put into improving that program,” he says.
A second effort was in medical student education. “I had inherited Jim Woolliscroft from Dr. Kelley’s time, and he was a consummate educator and scholar,” says Yamada. “He understood how to measure the impact of teaching, not just in terms of outputs but outcomes. I worked closely with Jim to make sure our curriculum was relevant and we had multiple methodologies in place to measure the quality of education.” With Yamada’s support, Woolliscroft built on work he started under Kelley, positioning the department at the forefront of a national movement in competency-based education and assessment.
When Yamada left for the pharmaceutical industry in 1996, the department was on strong footing and ready for another physician-scientist to make his mark.
Marc Lippman Era, 2001 - 2007
Marc E. Lippman, MD (Hem/Onc), was recruited to take the reins of the department in 2001 by then-Dean of the medical school Allen Lichter, MD. The two had worked together at the NIH: Lippman, as head of the Medical Breast Cancer Section and Lichter, as head of the Radiation Therapy Section at the National Cancer Institute.
Both men knew their outlooks aligned, and after chairing the Department of Oncology at Georgetown and heading its Vincent T. Lombardi Cancer Research Center, Lippman says he was eager to make a wider impact.
“I had spent my career becoming more and more expert about a more and more narrow field,” he says. “I was excited about the opportunity to lead something broader – a department of medicine – exploring how multiple disciplines could work together, play together and create a community of scholarship that would transcend what a single cancer center could do.”
Looking back at his tenure, his impact was far-reaching. He left the department eighth in NIH funding, its highest ranking in years; grew the faculty from 325 to 500; and took the endowed chairs from 15 to 28.
The department was also playing central roles in a number of high-profile cross-disciplinary efforts. The U-M Life Sciences Institute was founded under Alan Saltiel, PhD (MMG), with strong departmental membership. Steven Bernstein, MD (Gen), and Caroline Blaum, MD (GPM), were among the UMHS leads for a Centers for Medicare and Medicaid Services Demonstration Project, which was able to improve quality while reducing costs, making it a prototype for aspects of the Affordable Care Act. Internal medicine faculty were also principal investigators on NIH Roadmap grants in nanoscale membrane research and clinical research infrastructure, and partners on several others.
On the education side, the department developed a “short track” program to recruit top fellows, supported scholarships to attract students to internal medicine and engaged the Simulation Center to build trainees’ skills while enhancing safety and quality.
This just scratches the surface. But when asked about them, Lippman says he sees these as outcomes rather than causes of excellence. He says the real effort of his tenure lay in understanding and improving how different parts of the institution worked together. This took many forms. Culturally, he says, he was eager to reinforce a sense of connectivity and of departmental identity. “I was trained in an older era of great internal medicine departments,” he says, “and over the next couple of decades, we saw the field fragment into its subspecialties. I wanted to remind people that they were part of something bigger.”
One of the ways he did this was by establishing the Society of Professors of Medicine. It featured an annual event in an august building with cocktails, dinner, distinguished guests, a scholarly talk and special scarves and ties signifying membership. “We tried to create a sense of tradition,” he says, “with pomp and circumstance, and a sense of permanence and institutionality. It was a very retrogressive step that I thought was wonderful.”
He spent even more effort enhancing scientific connectivity. In his recruiting role, Lippman naturally found himself at numerous scientific presentations, which positioned him perfectly to link researchers working on similar questions from different angles. “To use a metaphor, I found myself coming into a room that looked somehow familiar, but I’d come in through another door,” he says. “It gave me a chance to see that the forces underpinning many of the advances in academic medicine were common to multiple disciplines. So I spent a great deal of time trying to enhance that.”
For example, he says, he might connect cardiologists trying to stop apoptosis in the context of hypoxia with oncologists specializing in how cancer cells circumvent this programmed cell death. His goal was to link researchers studying related pathways and processes — expanding their networks beyond the traditional relationships of disease or organ.
And though his approach tended to focus on individual matchmaking, it would complement the more structural mechanisms — such as the Life Sciences Institute and A. Alfred Taubman Medical Research Institute — that aimed for similar ends.
Another important way Lippman helped reshape how various parts of the health system worked together was in the area of finance. He addressed the challenge of rising costs and shrinking reimbursements with tools to track and reward productivity — from effort reporting to incentive plans — but put particular effort into a new financial model. Called the “four walls model,” it was a way to share the margin generated within the four walls of the cancer center, allowing a more equitable allocation of income and expenses among the hospital, cancer center and department.
With negotiations guided by David Spahlinger, MD (Gen), then senior associate dean for clinical affairs, the new model allowed the Hem/Onc division to more than double its faculty — and to broaden its basic science emphasis to include more clinical and clinical research expertise.
But Lippman thought the model was capable of more nuanced effects as well. “If you think of it not just as sharing money,” he says, “it can also help physicians see the interconnectedness of things — that they could personally make more money if they turned off the lights or spent less on malpractice insurance — so suddenly safety is in physicians’ personal interest. It’s a way of keeping everyone invested in the process.”
Having said that, Lippman acknowledges that this type of personal invest¬ment in one’s work and the institution are among the things he appreciated most about his time as department chair. “That is truly one of Michigan’s strengths,” he says. “There’s a tremendous amount of joint spirit in working together, and people see the institution as a place worth investing some of your heart into. In my role as chair, I tried endlessly to advance that.”
John M. Carethers Era, 2009 - present
When John M. Carethers, MD (GI), was recruited to the chairmanship in 2009 by Dean James Woolliscroft, it felt a bit like “coming home,” he says. Having grown up in Detroit, Carethers had family in the area. He’d also done his fellowship at U-M during the Yamada era — with Chung Owyang, MD, as his division chief and Rick Boland, MD, as his mentor in gastrointestinal oncology.
After almost 15 years at the University of California, San Diego, Carethers was ready for the next challenge. His lab had risen to prominence for its work on genetic instability in colorectal cancer, having revealed the mechanisms by which standard chemotherapy is affected by DNA mismatch repair. He had also served UCSD’s GI division in several administrative roles, from fellow¬ship director to section chief of the Veterans Administration Medical Center to division chief, overseeing a period of substantial growth and success.
He would do the same at U-M during his chairmanship — expanding the faculty from 585 to 760; securing seventh place among internal med¬icine departments in the 2015 U.S. News & World Report; and presiding over unprecedented levels of scholarship, research funding and patient care.
A Focus on Primary Care
There were also specific areas Carethers was eager to advance during his tenure, and high on his list was the climate for primary care. “Early on, I did a survey of our primary care physicians,” he says, “and they were in the doldrums.” Physician satisfaction was faltering, and they felt disconnected, practicing in outposts, cut off from each other and a sense of departmental identity.
He did a number of things to address this. The first was helping to launch a Primary Care Council charged with restructuring primary care in the U-M Health System. Formed under his leadership, the task force included chairs and faculty representatives from each of the health system’s primary care departments: internal medicine, family medicine, pediatrics and obstetrics and gynecology.
“One of our goals is to ensure that each practitioner — whether an MA, LPN, RN, nurse practitioner, PA or physician — works to the highest level of his or her degree,” says Carethers. “We’re making sure we have the right ratios of practitioners and are improving workflow so that everyone makes the best use of their expertise.”
They are also in the process of transitioning primary care from a productivity-based payment system to a more quality- and value-based one. “Instead of rewarding physicians for simply taking on more and more patients,” he says, “we give them a panel of patients, but reward them for quality — for keeping patients out of the hospital because they’re controlling their blood pressure or diabetes, for example.”
Another thing the council did was work with the Faculty Group Practice (now known as the U-M Medical Group) to raise primary care providers’ salaries — twice. In addition, the department has introduced loan repay¬ments to attract physicians to primary care, has pursued chief medical residents with signing bonuses and has reinstituted a primary care track in the residency program, providing two new internal medicine residency slots with enhanced ambulatory care rotations and primary care mentoring.
Carethers has also done important work in connecting primary care providers with both the department and each other. On the most basic level, he has made it a priority to visit the clinic sites. “When I first came on board, I’d go to Briarwood or Brighton, and people would say, ‘Wow, this is the first time we’ve seen a chair here in 10 years,’” he says. “They felt forgotten. So I visit each of our outposts at least once a year to engage with our primary care faculty there.” To further strengthen that connection, the department hired Rob Ernst, MD, as assistant chair for primary care, and Sandeep Vijan, MD, MS, to help the Division of General Medicine and the department implement value-based interventions based on metrics.
To help the faculty connect with each other, the department has established the Steven Gradwohl Art of Primary Care Award and Workshop. Initiated through an outpouring of support in memory of one of U-M’s great primary care physicians, the award recognizes a UMHS physician who embodies Gradwohl’s approach to patient care, and the workshop gathers faculty, staff, residents and students to explore issues and advances in primary care.
Yet another outgrowth of the discussions around primary care is one of Carethers’ signature creations: Academiae Laureati Medici, a Clinical Excellence Society he launched with funds from his own Searle Profes¬sorship. Once elected, physicians are members for life, receiving both recognition and special benefits, from enhanced support for continuing medical education to sabbaticals.
“We wanted to create something long-lasting that would recognize our very best clinicians, many of whom are primary care providers,” says Carethers. “It has worked out wonderfully. As people began seeing the Latin name on physicians’ coats, it created buzz around a very important topic. They now have officers and quarterly meetings, they mentor junior faculty and I use them for advice because they’re our wisest clinicians.”
Supporting Quality and Research
Carethers has worked hard to enhance other aspects of the department, as well. One of these is quality. When he arrived, there were no departmental quality structures in place, so in 2014, Carethers named Scott Flanders, MD (Gen), as internal medicine’s first associate vice chair of quality and innovation. Flanders, who also directs a collaborative quality initiative of some 50 Michigan hospitals, is charged with measuring the quality of care delivered by the department, identifying opportunities to improve and devel¬oping ways to more rapidly implement best practices and standards of care.
Enhancing the research environment was another priority. Carethers undertook a number of efforts to bolster the department’s research readiness in an era of tight NIH funding. The first was a near-tripling of endowed professorships, from 28 to 80, which provide not only prestige but a source of continuous funding.
Sources: Department of Internal Medicine division histories, division chief and faculty interviews and the U-M Medical School historical timeline.