Q & A with Dr. Lowy

Andrew Lowy, MD, FACS has been appointed the new Clinical Director for Cancer Surgery at UC San Diego Health Moores Cancer Center. Since joining UC San Diego Health in 2007, Dr. Lowy has served in a number of leadership roles supporting cancer surgical services across the institution, including his role as Division Chief of the UC San Diego Department of Surgery Division of Surgical Oncology, Clinic Medical Director for the Moores Multi-Specialty Clinic, and as a Disease Team Leader for Gastro-Intestinal Cancers. While Clinical Director, Dr. Lowy will maintain these leadership roles as well as his active clinical practice.

The principal role of the Clinical Director for Cancer Surgery is to serve as the senior advisor and report to Moores Cancer Center Physician in Chief Joseph Califano, MD (also of the Department of Surgery), on all clinical matters related to cancer surgery. This includes oversight of the clinics, operating rooms and inpatient services as related to the cancer surgical faculty across all UC San Diego Health Cancer Services locations.

In our Q&A with Dr. Lowy, he elaborates on his new role and vision for cancer surgery at UC San Diego.

June 27, 2019 | Interview by Tiffany Fox

Q: What are your priorities as the new Clinical Director of Cancer Surgery?

A: Clinic flow optimization is one priority -- how to efficiently get our patients in and get them seen. This is something I've been working on as Clinic Medical Director and will continue to work on. Along with that, we have a lot of issues around our rapid growth and space allotment that we need to address. On the hospital side, opening Jacobs Medical Center has been a great success -- almost so successful that it's now created problems with hospital flow. Yesterday, in the operating room I couldn't start my case for an hour and a half because there were no beds in the hospital that would allow cases to get started. We have capacity issues, so one of the focus areas is how we can improve and reduce hospital length-of-stay. 

Q: Do these problems with capacity occur outside surgical oncology?

A: Yes, they happen frequently. There have even been days -- rarely, but they happen -- where operations have been canceled because we don't have the capacity. Obviously, we never want that to happen, particularly for the patients, but also for the surgeons because it just wreaks havoc on our schedules if we have to operate the next day when we have a full calendar of other things. It's a domino effect. We need to create this capacity so we can grow. We're all out there trying to do the best job possible, and a lot of our surgeons are out there spending time meeting with community physicians, giving talks, trying to promote business development, but that's all for naught if you don't have the capacity to meet the demand when it happens. There's nothing more frustrating for referring physicians and patients when they want to come here but they can't get in the door. That's a major issue.

Q: Why is capacity so impacted?

A: One of the issues revolves around length-of-stay in the hospital, and our comfort level with knowing when someone is ready to be discharged. Sometimes -- and I am certainly guilty of this -- patients don't need as much time in the hospital with people observing them on a regular diet, for instance, before they're ready to go home. But there are other issues -- for instance, with patients who are not going home but are going to a rehab facility. We often have delays because it takes a while for the case management to connect with the family and for them to decide where to go. There are other, even simpler things. For example, yesterday the reason the case was held up is because discharges for that day hadn't been processed yet. That might be because the team wasn't able to see the patient in the morning and write the orders, or because we haven't gotten the patient their medicine or because they don't have a ride home. All these different things that delay discharges also delay our ability to get patients in. It's just like a hotel -- you can't check into your room until the other person checks out and the room is cleaned. We have to do the same thing in the hospital. If our discharges are all happening late in the day, that messes up the whole OR schedule. To improve this, we'll be working with the hospital, which has a lot of data on these issues. These improvements should also benefit people beyond surgical oncology, because creating bedspace doesn't just help cancer surgeons, it helps any surgeon trying to get patients into the hospital. 

Q: What are your other priorities?

A: I want to be involved in marketing and communications, because I don't think we've adequately gotten the message out about the expertise that we have at UC San Diego and Moores Cancer Center. Many faculty here who treat cancer are nationally and internationally recognized, and that's not a message that most of the folks in this city have gotten. It's incumbent upon us to get this message out there because our job is to elevate the level of cancer care in our community. There are times people seek care outside the city that they don't think is available here, when, in fact, it's not only available here, it's often better here than in many of the places they're going. We deliver very high-quality care, and in many respects that alone is cutting-edge. But we offer the whole package. When people think about the best hospitals or the best cancer centers, they don't necessarily think about a procedure. It's a view of the whole enterprise as being high-quality, and that's how we want people to see it. 

Q: Isn't there an inherent tension between marketing the services UC San Diego offers while also not always having beds available? 

A: You're right -- it's kind of burning the candle at both ends, so to speak, and do these things simultaneously. Sometimes to improve things or to get change to happen, there has to be pressure. If there is pressure from patients trying to get in, that will help us make changes in the way some of our operations work, because we have to. Sometimes if you don't have to, you don't do it. For the viability of the health system, it's clear we have to address capacity because we do have to still grow. 

Q: What can affiliates of the Department of Surgery expect in the first year of your leadership as Clinical Director of Cancer Surgery?

A: One example is that Dr. Bryan Clary, Dr, Jason Sicklick and Dr. Gabriel Schnickel are participating in an effort to put together a multidisciplinary clinic around hepatocellular cancer primary liver tumors here in Moores Cancer Center. There are a lot of logistical issues around that, because the clinic will be multidisciplinary, involving hepatology and GI medical oncology, so trying to create a clinic flow structure support for that kind of thing is a project I hope a year from now will be up and functioning. 

Q: You're very new to the role, but have you thought much about the legacy you'd like to leave as Clinical Director of Cancer Surgery 10 years from now?

A: I haven't thought about it in those terms, but I guess the simplest thing I can say is that I would like to see UC San Diego surgical cancer care metastasize across the city and be directly involved in delivering care at multiple other sites, as well as being a major influence in how that care is delivered. I want us to really elevate the level of surgical cancer care in our community. UC San Diego has had a very limited footprint compared to the other health systems, and I would like to see that change. We want patients to see that UC San Diego provides comprehensive cancer care that's not only excellent, but the best.