To be honest, after the inaction on gun control following the tragedy at Sandy Hook Elementary School in 2012, in which 20 of the victims were children between six and seven years old, and the failure of our society to respond to the clarion call of the teenage survivors of the Parkland, FL high school massacre in 2018, part of me feels enshrouded by hopelessness. And now, in just the past two weeks, the horror of Buffalo, NY and Uvalde, TX and more than 30 other mass shootings across the nation, fueled by racism and hatred and god knows what else.
How can we keep from being paralyzed? I’ll tell you how. As difficult and painful as this may be, try and imagine the shattered lives of the parents and other loved ones connected to each of the victims, and see if you can picture if there’s anything – anything – that would at least not make their plunge into darkness even worse. I’ll tell you what they need – showing them that we will never give up hope, and demonstrating this by donating time and money, and doing everything else we can do to fuel a revolution that rids us of this sickness.
And as we move into June, we are confronted by ongoing painful news. In addition to gun violence, we are grappling with a future where the right to have an abortion is abolished and anti-gay and anti-trans legislation prevents individuals, including children, from living their authentic lives. These are dangerous shifts in many states that, without question, will affect poor and disenfranchised people in disproportionate numbers.
The cumulative weight of it all can be overwhelming, and I suggest you consider this poem by Amanda Gorman, “Hymn for the Hurting,” for some solace. But this month, we have many opportunities to stand in solidarity. Gathering for Juneteenth and Pride, whether virtual or in-person, gives us a chance to be in community. Importantly, it also provides time for celebration and reflection on those who came before us.
For this month’s Expresso, I spoke with some of our leaders in abortion rights and women’s health advocacy, who tell how UCSF has fought for the right to choose since long before Roe v. Wade, and how we will continue to lead the way in the new world ahead. You’ll also read about how we’re trying to confront employee burnout and whether the national workforce shortage is affecting UCSF.
This month’s topics:
- Standing up for Women’s Health: UCSF’s history of abortion advocacy
- People Wellness: We cannot thrive without it
- Resignation, Retirement, and Return: How are they impacting UCSF?
Remember, you can always reach me at [email protected].
With best wishes,
Standing up for Women’s Health: UCSF’s history of abortion advocacy
At the end of the 19th century, abortion was criminalized, but the law left some leeway for doctors to decide if an abortion was medically necessary. Further, as techniques improved and attitudes changed over the years, doctors in places like San Francisco found more and more reason to perform an abortion, supporting the woman’s right to choose.
In a notorious case in 1966, a group of doctors known as the “San Francisco Nine” – all of whom had UCSF ties – found their medical licenses threatened because they had performed abortions on women who had tested positive for rubella, which can cause birth defects. Edmund Overstreet, then vice chair of obstetrics at UCSF, led a campaign to defend the doctors, saying, “We do not believe that violation of an archaic statute is unprofessional conduct.” The charges were ultimately dropped.
So when the news site Politico reported last month that a majority of U.S. Supreme Court justices have preliminarily voted to overturn the 1973 Roe v. Wade ruling, one of the first thoughts that occurred to Carole Joffe was: “At a time like this, I am so grateful to be at a place like UCSF.”
Carole, a sociologist, professor of Obstetrics, Gynecology and Reproductive Sciences (OB-GYN), and author of several books on the history of abortion, explains that “UCSF has an extraordinary record of supporting abortion rights as essential to health care rights, and integrating it into its OB-GYN department for years.”
When the “Alito draft” hit the news, Jody Steinauer, director of UCSF’s Bixby Center for Global Reproductive Health, says while she and others in family planning had “intellectually expected this would happen, the leak made me feel sad and anxious. I wanted to believe it wouldn’t materialize.”
In the weeks following the leak, UCSF and the University of California Office of the President began exploring what actions, if any, UC should take in response. Last fall, when the Supreme Court refused to strike down a stringent Texas ban on any abortion after six weeks of pregnancy, Chancellor Sam Hawgood, former UCSF Health President and CEO Mark Laret, and School of Medicine Dean Talmadge King sent a UCSF-wide message, “Abortion Rights are Health Care Rights,” denouncing the law as “deeply concerning” and “uniquely insidious.” It offered a list of resources at UCSF, and rightly framed the issue as one of health equity, saying it “will have a disproportionate impact on vulnerable communities.”
Francesca Vega, vice chancellor of Community and Government Relations, notes that all ten chancellors in the UC system believe that “equitable access to affordable care is fundamental.” She added that the situation is fluid and any call to action will likely be posted on our advocacy web page.
California is one of at least 15 states that would keep abortion legal. However, if the country will be divided with unequal access to legal abortion due to states without protective laws, and many are forced to return to the days before legal access to abortion, then it’s important to remember what life was like before Roe v. Wade – and UCSF’s long history of advocacy and advancing women’s health, reproductive rights, and access to abortion.
UCSF also helped advance the tools that made abortions safer. Harvey Karman, a psychologist who Carole says was a “well-known, quirky character in the abortion world in the 1960s,” developed a plastic, bendable device that became known as the Karman cannula, a flexible curette designed to reduce the risk of perforating the uterus during vacuum aspiration and used in early induced surgical abortion, in treatment of incomplete abortion, and in endometrial biopsy. While many doctors dismissed Karman as unqualified, Carole says that Alan Margolis and Sadja Greenwood, a husband-and-wife team of UCSF doctors, recognized the value of his invention and helped popularize it.
In the years following the Supreme Court’s ruling in Roe v. Wade, abortion was slow to gain acceptance, and UCSF helped expand its reach. UCSF realized before many other medical schools that abortion had to be part of OB-GYN education. Philip Darney started routine resident training in abortion at San Francisco General Hospital in 1981. He initiated the Fellowship in Family Planning, the first of its kind in the country, and Uta Landy launched the Kenneth J. Ryan Residency Training Program, which worked with other academic medical centers to formalize abortion training.
Many of those and other important milestones are included in a commemorative publication the Bixby Center created for the 30th anniversary of Roe in 2003. Jody directs both of those programs today; she certainly has the credentials, having co-founded Medical Students for Choice as a student at UCSF in 1993. She says the training program has supported 109 programs in the U.S., Canada, and Puerto Rico for integrated abortion training, as of last month.
About ten years ago, research by UCSF scholars showed that advanced practice clinicians (nurse practitioners, midwives, physician assistants) could do first trimester “aspiration” abortions using a manual vacuum aspirator as safely as physicians, and California quickly passed a law allowing them to perform the procedure. “This was a big deal in terms of expanding abortion access in California,” Carole says.
Going forward, Jody says she and others at UCSF are working with colleagues across the country to help anyone who needs an abortion get one safely, even as laws change and crackdowns loom. “The Ryan program has been working with programs in restricted and non-restricted states,” Jody says. Providers in states that are likely to ban or have extreme restrictions on abortion clearly need support, she says, but those in states not likely to put restrictions on abortion also need to “think about how to prepare if Roe is overturned.”
“We’re doing a lot of thinking,” Jody says. Thinking – and acting. We’ll be watching, learning, and standing with these and other brave leaders as we enter this new era.
People Wellness: We cannot thrive without it
Do you know anyone who hasn’t experienced the “Sunday blues”? It’s the feeling of anxiety or dread that many experience the day before heading back to work after the weekend, even if the week ahead isn’t particularly stressful.
Can’t blame COVID-19 for creating the Sunday blues, but it surely compounded it – along with what often feels like an overwhelming number of crises in today’s world. Combined, they are taking a toll, and according to studies, worker burnout is at an all-time high.
Checking in with the three central campus units that provide counseling resources and services, i.e., Faculty and Staff Assistance Program (FSAP), Ombuds, and Student Health and Counseling Services, we know that UCSF is not immune:
- FSAP saw a significant increase in the demand for services, which would have been 50% in 2020-21 had the Department of Psychiatry COPE Program not met with an additional 500 employees. In addition, due to employees’ more serious and complex needs, FSAP averaged five sessions each rather than the previous average of three.
- Ombuds is currently up about 38% of visitors compared with last year and has added another part-time ombuds to accommodate the increase in workload.
- Student Health and Counseling Services (SHCS) reports that while the number of requests for mental health treatment remained fairly constant, due to staffing and clinical capacity, wait times for appointments were three to five weeks.
So, where’s air traffic control? Before last fall, there really wasn’t one, but last October UCSF joined a very short list of institutions to prioritize mental health by creating a leadership position focused on wellness.
You may not have heard of a Chief Wellness Officer (CWO) yet, but mark my words, you will. The American Medical Association considers the role increasingly vital to combating stress and burnout among health professionals, and the role of CWO is starting to show up at health systems and universities around the country, such as The Ohio State University, Rush University, the Mount Sinai Health System, and the University of Arizona.
And, yes – UCSF already had people and units focused on wellness, including the Wellbeing Committee, established in February 2021 to bring together leaders and advocates from across the University to work collaboratively towards creating a culture of wellness. The impressive My Wellness Resource Hub it created centralized access to wellbeing resources, categorizing them into seven pillars of wellness, i.e., emotional, physical, social, financial, environmental, career, and spiritual. But, still there was no central, accountable point of leadership connecting the various wellness services to ensure they were coordinated efficiently and effectively.
Chief Human Resources Officer Corey Jackson had the idea to hire a wellness leader even before COVID hit, and the impact of the pandemic reinforced his commitment. Enter Stephanie Collins, UCSF’s inaugural Vice President and Assistant Vice Chancellor of People Wellness.
Stephanie earned her doctorate of nursing practice at the University of Texas at Arlington, and having worked for years as an advance practice registered nurse, understands how stress – whether physical, mental, emotional, or even financial – takes a toll on people’s health and wellness.
Stephanie embraces an intentional and holistic approach to wellness, prioritizing and promoting comprehensive well-being to achieve better outcomes for all – patients, faculty, staff, researchers, trainees, etc. Her job covers both the campus and UCSF Health, and she aims to serve as a bridge, connecting wellness efforts wherever our people are. “We need to continue to investigate opportunities to provide support around burnout and mental health at both campus and Health,” she says. “My vision is for UCSF team members to show up complete, with their peace protected, and the ability to perform in their roles in a psychologically safe environment.”
There are so many potential factors for burnout and strain on our mental health, and Stephanie wants to use wellness to confront the key causes of burnout, depression, and anxiety that can easily occur at UCSF given our magnificent but overachieving community.
I look forward to seeing how Stephanie connects the dots to help improve wellness for all of us and extend my deep gratitude to all of our employees who have been providing support for our mental health, wellness, and engagement.
Resignation, Retirement, and Return: How are they impacting UCSF?
Back in the day, the “Three R’s” used to stand for “writing, reading, and ‘rithmetic.” These days, it’s The Great Resignation, The Great Retirement, and The Great Return. And all three are catalyzing changes in the national work force.
As the U.S. emerged from the initial phase of the pandemic, many people found themselves in a position to be highly selective about where they choose to work and how they earn their paycheck. Indeed, many have left their pre-pandemic job or accelerated their retirement plans.
“It’s a challenge that a lot of employers are facing nationally,” says Corey Jackson, UCSF’s chief human resources officer. “We’ve seen a slight increase but nothing like what many businesses and institutions are experiencing. Thus far, we’ve been fortunate as an organization.”
Corey notes that before the pandemic, national unemployment was already at 3.5 percent – the lowest since World War II. After ballooning when millions of businesses shut down without warning, it’s now back to 3.6 percent as of April 2022 – near the earlier historic low – although in February 2022 alone, 4.4 million workers quit or changed their jobs.
UCSF has seen a slight increase in retirements as many older workers – concerned about their vulnerability to COVID – chose to retire during the pandemic and begin their next chapter in life. But overall, the impact has been minimal, as baby boomers started retiring in 2002. And with the impending peak of retirement season for 2022, we’ll no doubt experience the annual fond farewells to many colleagues.
Recruiting new hires is more challenging, and of course, UCSF is always hiring. Some positions are especially hard to fill because of the knowledge and skills required, and we’re competing with other top universities and health centers. We also can’t forget the added challenge of the Bay Area’s cost-of-living, e.g., housing, commute, gasoline, parking (or lack thereof), and family care.
A boost to our success at recruiting and retaining employees has been the adoption of flexible work policies for certain job functions during the pandemic. Many employees adapted very well to remote and telework, and now we’re embracing a hybrid model.
But we also must remember the many jobs that are 100% on-site, so the cost of getting to work is higher than a hybrid position – a significant consideration when deciding where to work. The key is demonstrating and communicating why UCSF is one of the best places to work.
The largest demographic group in the workforce now is millennials, people born between 1982 and 2000. “Different things are important to millennials, in terms of lifestyle, in terms of what their employer is bringing to the table,” Corey says. A quick search shows, regardless of the pandemic, that what’s important is an emphasis on flexible work hours, remote positions, becoming more progressive about the structure of a typical workday, equity, transparency, and purpose.
Whether a perceived increase in productivity is real, we know that UCSF is benefitting from our collective ability to be agile. “Our teammates have been really amazing during this time period,” Corey says.
Corey considers colleagues and employees teammates, which illustrates his collaborative culture and is reflected throughout his department. This is another selling point. An increased emphasis on employee belonging and wellness also demonstrates our commitment to and regard for our community members.
In addition, early in 2021 UCSF was one of the first large employers to commit to a return to on-site work date of March 2022, “which gave people confidence and clarity,” Corey says. This and other important protocols and COVID-related policies are delivered via our town halls, which feature UCSF experts who respond to questions from viewers on a regular schedule. This demonstrates and reassures folks that the University prioritizes the welfare and engagement of its community – an important factor to job seekers.
Despite the challenges of recruiting, Corey sees so many things tipping in UCSF’s favor – above all, the great things that happen here. “Our teammates, the faculty members, the frontline staff, really stepped up,” he says. “Sometimes they don’t even know how they’ve helped people during these difficult times. We have amazing people working here.” For instance, people have donated personal time off so their colleagues could care for family members. “And day to day, people are picking up shifts for people, if for instance they know their colleague’s child’s school was closed. It happens on a regular basis, but it doesn’t get talked about.”
Of course, there are quite a few faculty and staff who are still struggling (e.g., women clinicians who need to be at home to care for dependents, and cancel clinic, but are expected to make up the RVUs and feel pressured to work harder at some future date to compensate for any “time off”). The situation is complex, but UCSF is deeply rooted in identifying solutions and interventions to mitigate career-related ramifications wrought by the pandemic.
Accounts and actions like those above make me beam with pride. I’ve asked countless people why they chose to work at UCSF, and it’s always the mission – it’s what brought us here and why we stay through thick and thin – and what we’ve demonstrated over the past two-plus years: great resilience.
Dan’s Tip of the Month
In the hours following the May 24 shooting in Uvalde, several news outlets showed the impassioned pre-game press conference of Golden State Warriors coach Steve Kerr. He used the platform and opportunity to make a forceful plea for change – “we can’t get numb to this” – resonating the shock, outrage, and call to action we must now carry forward. I’m a night owl, so later that night, I caught Jimmy Kimmel Live! in which Kimmel also leveraged his position and privilege to speak from his heart. His introduction spoke to mine. I encourage you to watch.