CCE Dermatology: University of Michigan Health System

University of Michigan Health System
Ann Arbor, Michigan

Patients who are referred to university-affiliated dermatology departments can expect to find the latest in research-based treatment for their skin diseases. But at the University of Michigan Health System Department of Dermatology they also find something more: A level of care, and attention to detail, similar to what they would receive in a Ritz-Carlton.

The similarity to the famed hotel chain is no coincidence. Doctors and staff in the department receive training in patient care from Ritz-Carlton employees. It is emblematic of the way the department strives for excellence in everything that it does, according to Charles Ellis, MD, the William D. Taylor professor of dermatology and associate chair of the department. “We pride ourselves on being one of the top departments in patient care, research, and education,” he says.

Research Forms Strong Foundation
As is the case with most highly-regarded academic medical departments, the UMHS dermatology department’s reputation rests on strong research, both basic scientific and clinical. Its faculty members routinely publish in the leading journals of dermatology as well as publications such as The New England Journal of Medicine, JAMA, and Nature, and their papers are frequently cited in the research of other authors.

The National Institutes of Health awarded the department $3.6 million in research grants in 2008, the fifth-highest amount among the nation’s dermatology departments. In 2007 the department ranked third, with $4.2 million in funding.

Patients Rank Care Highly
Every year UMHS asks patients to rate the quality of care they receive, and for the past eight years the dermatology department has been ranked number one. The department’s innovative Michigan Access Plan has reduced the waiting time to see a specialist from four months to about two weeks. As for teaching, medical school students have ranked the course department faculty members teach number one in the school for the past five years.

“These things don’t happen by accident,” says Ellis. “We decided we wanted to understand what makes for positive perceptions among patients, students, and researchers, and work on constantly improving all these areas.” For example, he said, as part of their service training, staff and faculty get wallet cards with reminders on points such as returning phone calls promptly. “A little bit of training goes a long way,” he says.

Commitment to Excellence Begins at Top
Faculty members credit John Voorhees, MD, FRCP, department chair and Duncan and Ella Poth Distinguished Professor, with creating an atmosphere of mentorship and collegiality in which excellence can thrive. “Everything we accomplish here starts with him. He places a lot of emphasis on mentorship, which makes everyone feel valued,” says Timothy M. Johnson, MD, the Lewis and Lillian Becker Professor of Dermatology. “If you work hard and want to be mentored, you will succeed.”

Voorhees has invested in the department’s research infrastructure, hiring statisticians, photographers, and liaisons to institutional review boards, says Associate Professor Jeffrey Orringer, MD. “The department has seen fit to support a whole team of people necessary to help us carry out the high level of research that we do here,” says Orringer.

Voorhees has chaired the department since 1975, and is only the fourth chair since its beginning in 1913. As a result, “there is a strong sense of continuity and stability in the direction of the department,” Ellis says. A spirit of collegiality also contributes to the department’s achievements. For example, clinicians encountering an unusual dermatologic case will routinely send a tissue sample to researchers for further study.

“Why would a clinician who’s being run ragged stop what they’re doing to give tissue to the lab when they’ll probably never hear about it again? That’s the usual paradigm. The difference is that at Michigan people really like each other and are excited to help each other. So a clinician seeing a patient with a melanoma on his skin is willing to take the time to say, ‘You’re eligible for a study and I’d like you to talk to my research associate.’ There’s really no sense of turf here, and you won’t find that attitude at many places.”

The spirit of cooperation extends beyond the department. For example, Johnson collaborated with researchers from the university’s Life Sciences Institute, Center for Stem Cell Biology, and several other departments in the medical school to produce an article on the causes of melanoma and other forms of cancer featured on the cover of the December 2008 issue of Nature.

Skin Cancer Program is Destination Program Target
Because of its reputation for excellence, the university has made the department’s skin cancer treatment program the first to be marketed as part of the university’s “destination program,” designed to attract patients from around the world.

In doing so the university recognizes what local physicians, such as Michael Goldfarb, MD, have known for a long time. A dermatologist in Dearborn, Michigan, Goldfarb frequently refers patients to the University, even though many of his patients are elderly and reluctant to make the 40-mile drive to Ann Arbor. “I work very hard to persuade them to go, because I know it’s not just the best center in the state, but one of the best in the world,” he says.

Goldfarb recalled the case of an elderly patient who was diagnosed four years ago with what was considered fatal melanoma, and who was successfully treated in the University’s Multidisciplinary Melanoma Clinic with an immunotherapy protocol developed there. As a result, he says, “every time I see him now it pleases me to know we have the UM program so close by.”