Q&A with Raj Pruthi, MD, MHA, FACS, Incoming Chair of the UCSF Department of Urology

Submitted by Sarah Paris on December 26, 2019 at 11:28 am

Not everyone might cheerfully welcome trading a 5,500 sq. ft. house on two acres for a modest condo near Mission Bay. Dr. PruthiBut Dr. Raj Pruthi sees the bright side even in the formidable Bay Area housing market. “My wife and I look forward to experiencing urban living. It will be a new chapter!”

The new chapter in Dr. Pruthi’s life means taking on the leadership of the UCSF Department of Urology on January 1, 2020, a prospect both exciting and daunting. “Taking over from someone like Peter Carroll and leading a department that is already extraordinarily successful is a privilege, as well as a challenge.”

This is not the first time Pruthi has moved from one coast to the other for a new challenge. After growing up in South Florida, he travelled to California to attend Stanford University, where he majored in economics and became interested in health economics. He spent one summer working for Senator Ted Kennedy in Washington, before recognizing his true interests and passions were in the field of medicine. Pruthi joined his older brother in attending medical school at Duke, then moved back west for residency and a fellowship in urology at Stanford.

Pruthi traded coasts once again for a faculty position at the University of North Carolina, where he and his wife, Kathy settled for almost 20 years and raised their three kids. In 2011, he was appointed division chief, and in 2013, he transitioned the division into a department and became chair of the newly established Department of Urology. His recruitment to UCSF was announced in the summer of 2019.

Q. What attracted you most to UCSF?

Aside from UCSF arguably being the best Urology program in the country, I saw parallels to what I appreciated most at the University of North Carolina. Like UNC, UCSF is a public institution and shares similar values. A sense of public service and helping our communities is at the core of everything they do.

Also, UCSF is a very collaborative institution. I could observe this at every corner while I was interviewing. A positive culture with great people and teamwork is most important to me. Having a group of people you love to work with – there’s nothing better than that.

Q. The UCSF Department of Urology is highly successful. Beyond maintaining that success, what do you see as your challenge as a chair?

Health care is changing dramatically, and academic medicine is changing dramatically. UCSF is becoming a system, extending beyond the traditional campus walls. At UNC, I was on the board of the clinically integrated network, which has given me some experience with system integration. I was intrigued by the challenge of taking a highly successful department and all of its missions and shepherding it into a new era of system-based medicine.

Q: How will you approach this transition?

A few words that ground me are purpose, service, and humility. Purpose keeps us focused on the why of medicine and the pursuit of health. Service reflects the privilege to take care of patients. In humility, we are reminded of the importance of empathy for the patients and communities we care for. By keeping the patient at the center of everything we do, we can use these principles to guide us in medicine.

How do we best take care of patients?  There are challenges we face in health care delivery: disparities, lack of access, and “financial toxicity,” which is the burden related to the cost of treatment. We also need to better understand not only short-term outcomes of our interventions, but the long-term quality of life needs and impacts on patients and families. Patient-reported outcomes are an important means to understand these unmet needs.

In prostate cancer, there is racial inequity in access and outcomes, and there are gender disparities in bladder cancer. UCSF has already taken on a leadership role in addressing these issues. However, there is a lot more to explore. We need to address challenges of access, quality, and affordability through new and creative approaches.

Q. Adding to your background in health economics, you acquired a Master’s in Healthcare Administration. What drives your interest in areas doctors have not traditionally embraced?

Academic health centers have long represented the pinnacle of healthcare by providing innovative and complex clinical care, cutting-edge research, and the education of the next generation of health professionals. An important role of a department chair is cultivating these three missions. However, with recent changes in healthcare – particularly financial – the tripartite missions are under new challenges. Understanding and responding to these economic and administrative challenges will allow academic departments to change and adapt in order to survive, thrive, and continue to represent the best of medical research, education, and care in the U.S.

Q. The rapid changes in health care are just one factor that has contributed to wide-spread physician burnout, an area you have done considerable research in. How can a chair maintain a supportive environment for faculty, as well as for trainees and staff?

I am lucky to take over a department that is already operating at the highest level of success, with a highly supportive chair. Nurturing professional as well as personal growth and diminishing dissatisfaction starts from the top, but we all have a role to play. Maintaining excellence in a culture that fosters wellness, resilience, and happiness is really our fourth mission. At UNC, our urology department was the only one in the SOM that achieved 100% faculty satisfaction. That’s perhaps the accomplishment I am most proud of in my time there.  

Q. Ninety percent of your publications include a resident or student as a co-author, giving them the experience of authorship early in their careers. What other approaches do you take to develop trainees and junior faculty?

I believe most education happens by role modeling. Teaching students and residents to be educators themselves is one way to help them grow. At UNC, we also introduced a leadership curriculum as part of our educational program, which is something I would like to continue at UCSF. You can better navigate modern healthcare systems and better advocate for your patients if, for instance, you have some basic understanding of the administrative processes that are now a large part of medical care. Accounting, public speaking, cultivating emotional intelligence, lean principles, even how to run a meeting – those are skills we don’t typically get trained in at our medical schools or residencies. Developing future physician leaders is and will continue to be an important tradition of UCSF Urology.

Q. How will you continue to promote research, including basic research, in your department?

The urology research group at UCSF is unparalleled. When you’re #1 in NIH funding and succeeding at this high level, my job is to support the leaders already there and cultivate collaborations across the institution.Pruthi working with post-graduate student studying the genetic and epigenetic events involved in the initiation and progression of bladder cancer.Pruthi working with post-graduate student studying the genetic and epigenetic events involved in the initiation and progression of bladder cancer.

We are starting to see are a shift away from “lone rangers” to breakthroughs made collaboratively – not just among lab teams, but in collaborations between departments, institutions, and by bringing together basic and clinical sciences and public health. I want to be particularly supportive of enabling these connections and collaborations.

I believe that we also need to treat process innovation as a science – to improve patient experience and safety. Let’s take surgery, for example. We should begin to look toward innovations in how people carry out their work “on the ground,” before, during, and after the surgical episode. Innovation in surgery must shift from the technical or structural aspects to emphasizing how people, processes, and practices come together in the pursuit of optimizing patient experience and safety. Innovation must be actively cultivated by teaching it, supporting it, and providing opportunities for its implementation.

Q. How will you promote diversity among the faculty?

The importance of diversity is no longer up for debate. Diverse teams come up with better, more innovative decisions, have better outcomes, and better reflect the values of their constituency. Yet, in the U.S. only 8% of practicing urologists are female -- which is a black eye on our field. We have worked hard at UNC to bring on and help support the development of talented female urologists who are already becoming future leaders in our field. At UCSF, Peter Carroll has done an amazing job recruiting female residents and faculty, and this is a legacy that we must embrace and continue.

Our biggest challenge is recruiting faculty from groups underrepresented in medicine. We need providers who look like our patients, if we are to overcome racial disparities. Nationwide, only 2-3% of urologists are URM. We know the talent is there. This is a pipeline issue, and we need to make a stronger effort to figure out how we can get URM students and trainees interested in urology.

Q. What do you like to do in your personal time?

Every day, I go on runs or walks with my wife Kathy. It is an opportunity for us to spend Raj Pruthi, MD, MHA, FACS and wife Kathleen (Kathy) McMahon PruthiRaj Pruthi, MD, MHA, FACS and wife Kathleen (Kathy) McMahon Pruthi time together and decompress. And of course, I’m very interested in everything my kids are doing.

My oldest son Nicholas, a 2017 Dartmouth alum, works in biotech consulting in Boston. My daughter Amanda recently graduated from Duke and is working at Morgan Stanley in New York City. The youngest, William, is a freshman at Vanderbilt, and also interested in business. None of them in medicine!

Kathy and I have been married for over 26 years, and after taking care of our kids, she is really looking forward to returning to nursing at UCSF.

I’m also a big college basketball fan. This was tough at UNC, because they are arch competitors with my medical school alma mater Duke, so my allegiances were torn. Given that there is a similar rivalry between Stanford and Cal, I hope the UC folks won’t hold it against me that I was once a Stanford fan ...