The Waits That Matter
In a riveting and personal story in the New England Journal of Medicine, general surgeon John Maa, M.D.decries ED boarding and lack of critical services on weekends.
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Innovation Profile
John Maa, M.D.
Assistant Adjunct Professor of Surgery
Division of General Surgery
Director, Surgical Hospitalist Program
Contact Information
Academic Telephone: (415) 476-0762
Fax: (415) 476-8694
john.maa@ucsfmedctr.org
BiographyEducation
- A.B., Biochemistry, University of California, Berkeley, 1986-90
- M.D., Medicine, Harvard Medical School, 1990-94
Residencies
- University of California, San Francisco, Resident, General Surgery, 1994-02
Fellowships
- University of California, San Francisco, Fellow, Health Care Policy, 2004-06
Board Certification
- American Board of Surgery, 2003
Research Interests
- Access to emergency care
- Patient safety
- Quality improvement
- Surgical education
- Surgical health care policy
Biography
John Maa, M.D. is an Assistant Professor of Surgery at UCSF and a surgeon dedicated to improving the quality and access of emergency surgical care. He earned his medical degree at Harvard Medical School, and served as a captain in the medical corps of the U.S. Army for nine years. During medical school, he was awarded the New York City Mayor's Prize for his research thesis entitled "Concomitant Mycobacterium tuberculosis and human immunodeficiency virus infection in New York City, 1986-1991". During his general surgical residency at UCSF, Dr. Maa was awarded an NIH Gastrointestinal Research training grant. He as also published numerous scientific articles on pancreatic and gastrointestinal inflammation.
After his residency, Dr. Maa completed a Fellowship in Health Policy at the UCSF Institute of Health Policy Studies, exploring mechanisms to improve the delivery of general surgical care nationally. During the fellowship, he conceived of the UCSF Surgical Hospitalist Program to enhance the quality and timeliness of hospital based emergency surgical care. This model was implemented at UCSF Medical Center in 2005 to improve the timeliness and quality of emergency surgical care.
In 2009, Dr. Maa was named as one of country's leading advocates for health care reform by HealthLeaders Magazine. In an eloquent and moving essay in the New England Journal of Medicine "Hospital Overcrowding Becomes Personal", Maa addressed a critical issue that had dire consequences for his own family.
John Maa is a member of numerous public health organizations and holds numerous leadership roles including:
- Member, University of California Office of the President Tobacco-Related Disease Research Program (TRDRP) Scientific Advisory Committee
- President-Elect, Northern California Chapter of the American College of Surgeons
- Board of Directors, American Heart Association, San Francisco Division
- Board of Directors, San Francisco Medical Society
Research Summary
Dr. Maa's clinical research focuses on the applying the surgical hospitalist model to improve hospital based emergency care, specifically through new processes and strategies that address the challenges of emergency department overcrowding, boarding and ambulance diversion. Dr. Maa helped create the UCSF Surgical Hospitalist program, which serves as the foundation for quality improvement research programs and collaborations with the UCSF Department of Medicine.high quality and timely hospital based emergency surgical care.
In addition to providing inpatient care more efficiently and addressing the national challenges in emergency call coverage, surgical hospitalists are also more readily available to teach surgical residents and medical students, and thereby promote the overall educational goals for the Department of Surgery
Selected Publications
- Zaid H, Ward D, Sammann A, Tendick F, Topp KS, Maa J. Integrating surgical skills education into the anatomy laboratory. J Surg Res. 2010 Jan; 158(1):36-42.
- Maa J. Defining an enterocutaneous fistula. Arch Surg. 2010 Jan; 145(1):103.
- Mohebali K, Young DM, Hansen SL, Shawo A, Freise CE, Chang DS, Maa J, Harris HW. Open incisional hernia repair at an academic tertiary care medical center. Arch Surg. 2009 Sep; 144(9):848-52.
- Maa J, Lubbock C, Harrison M, Corvera C. Perforated ulcer mimicking a spontaneous pneumothorax in a patient with congenital diaphragmatic hernia. Am Surg. 2009 Apr; 75(4):354-6.
- Utley B, Carter J, Maa J. Resident work hour restrictions and the future of medical student surgical education. J Am Coll Surg. 2009 Mar; 208(3):480.
In the News
Physicians Emphasize Importance of Story Telling to Advance Patient Care
UCSF News Center - Jan 24, 2012"Two doctors who have learned the art of telling stories are convinced that it has become indispensable to top-notch medical care. "A slow cultural shift over the past 20 years led by television - from "St. Elsewhere" to "ER" - has been humanizing society's view of the practice of medicine," said John Maa, M.D., an assistant professor in the UCSF Department of Surgery. "... As physicians, we must now harness the power of storytelling to enlighten Capitol Hill to enact new laws" to support emergency health care personnel. Maa spoke at Grand Rounds on "The Future of Emergency Care in America: Doctors as Storytellers." He was joined in Cole Hall by Neal Baer, M.D., executive producer and writer for television's "ER" and "Law & Order: Special Victims Unit." His current show is "A Gifted Man."
For UCSF Surgeon, Hospital Overcrowding Becomes Personal
NY Times, New England Journal of Medicine, Wall Street Journal Digital Network - Sep 07, 2011"The far-reaching implications were made painfully clear" in an eloquent and moving essay in the New England Journal of Medicine by John Maa, M.D., Assistant Professor of Surgery and Director of the UCSF Surgical Hospitalist Program. A national leader in improving emergency care, "Dr. Maa describes the all-too-familiar story of a 69-year-old woman who is admitted to the E.R. for a procedure to correct an irregular heartbeat. Her operation is delayed because she has to board for a full day while waiting for a real bed. During the delay, she suffers a major stroke and dies............The woman, we learn, was the author's mother."
-- From NY Times article by noted physician-journalist Dr. Pauline Chen
Click photo collage or here to enlarge
"The Waits that Matter" - Essay in The New England Journal of Medicine"
NY Times: "When Hospital Overcrowding Becomes Personal"
Wall Street Journal Online Network: "Long hospital Wait Times Can be Deadly"
Lessons Learned from my Uncle's Sacrifice: A Proposal to Reform Medicare
The Healthcare Blog - Jun 21, 2011"It is hardly news that the existing Medicare scheme already includes an element of rationing by limiting the number of Medicare inpatient and long-term care days a person can receive. Our nation has yet to meaningfully discuss end of life care and the potential solutions by setting a budget to overall spending, but starting this discussion will inevitably become necessary."
Note:This is a follow-up to John Maa, M.D.'s blog post Ultimate Sacrifice that appeared several months ago.The most recent issue of the New England Journal of Medicine has a related healthcare policy story, The Waits that Matter, about Dr. Maa's mother.
The Ultimate Sacrifice - Suffering catastrophic illness and being uninsured
The Healthcare Blog - Mar 01, 2011"An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle's tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured. The 2008 recession claimed my uncle's job, health benefits, and assets, except for a small inheritance. By 2009 he found work (but not health coverage) as a consultant."
Dr. John Maa Reviews "The Emperor of All Maladies"; Appears with Author on C-SPAN Booknotes
SF Chronicle, C-SPAN - Feb 18, 2011
Siddhartha Mukherjee, M.D. (pictured left),
Assistant Clinical Professor at Columbia University Medical
Center, is author of "The Emperor of All Maladies, A
Biography of Cancer", dubbed by the N.Y. Times dubbed as
one of the "10 Best Books of 2010". The
book was reviewed in the SF Chronicle by
John Maa, M.D., Assistant Professor of Surgery and
Director of the UCSF Surgical Hospitalist Program at
UCSF (pictured right) who praised it as
"magisterial". Maa recently appeared on C-SPAN's
"Booknotes" at Kepler's Books in Menlo Park, CA
following the author's book
presentation. Maa, a leading advocate for health care
reform, took questions with Dr.Mukherjee about the state
of healthcare in America.John Maa Cited as Leading Advocate for Health Care Reform
HealthLeaders Media - Dec 11, 2009"Our emphasis in the United States is on the elective patient," UCSF general surgeon John Maa, M.D. asserts. "I think that we have to weigh where society's needs are the greatest. And actually, the needs of these patients are greatest in the emergency population-the patient who is critically injured in trauma who has been shot or who has suffered a penetrating stab injury, patients who have active bleeding-those patients whose traumatic injuries have the highest need," Maa continued.
"Patients who have cancer, I strongly feel, should be prioritized to get to the operating room sooner than patients who merely have cosmetic conditions or relatively elective conditions," he said."
Smokers Contemplating Surgery: A Unique Teachable Moment
Bulletin of the American College of Surgeons - Nov 01, 2009"Given the enormous societal cost of tobacco, the fields of anesthesia and surgery are presented with a special opportunity to deliver a unified message about smoking cessation that will make a real difference in the lives of patients. The first step is to make surgeons around the world fully aware of the risks of smoking so that they can educate their patients who smoke about the increased risks of surgery. Surgeons should include a discussion of active smoking and its risks during the preoperative informed consent discussion when weighing the overall risks and benefits of an operation."
John Maa Coauthors Surgical Hospitalist Program Management Guide
Surgical Hospitalist Program News - Mar 25, 2009"Hospitalist medicine is the fastest growing medical specialty in the U.S., and surgical hospitalists are especially poised for rapid growth. Many hospital systems see surgical hospitalists as the most valuable response to the growing crisis of general call coverage and as a critical strategy in their effort to comply with quality measures." Acclaimed as a book that "represents the combined wisdom of many of the early physician and non-physician leaders of the surgical hospitalist field, the guide, coauthored by John Maa, M.D., FACS and John Nelson, MD, FACP, provides tools and strategies for executives and physicians.
Dr. John Maa Moderates Smoking Cessation Summit at Commonwealth Club
FORA.tv / Commonwealth Club of California - Nov 18, 2008San Francisco, CA
John Maa, M.D., an Assistant Professor of Surgery, Director of the Surgical Hospitalist Program at UCSF, and a Board Member of the American Heart Association in San Francisco, moderated a panel discussion, "Smoking Cessation Summit: The Solutions" at the Commonwealth Club of California. The panel included health leaders of business, state government and the CDC and addressed the barriers to overcoming nicotine addiction and smoking reduction among Californians.AHRQ Profile: UCSF Surgical Hospitalist Model Enhances Access to Surgical Consultations, Increases Physician Perceptions of Quality
AHRQ Health Care Innovations Exchange - May 26, 2008"The University of California, San Francisco (UCSF) Medical Center realigned its surgical team in order to provide increased coverage and consultations in the emergency department (ED) and general acute care units through use of rotating surgical "hospitalists" who take call for a week at a time (rather than the traditional 24-hour on-call shift). This program, which is believed to be the first large-scale implementation of a surgical hospitalist model in the United States, resulted in quicker response time for consultations and, according to physician surveys, shorter ED length of stay (LOS), better patient satisfaction, improved professionalism and resident supervision, and better overall quality of care."
National Impact of Pioneering Surgical Hospitalist Program
UCSF School of Medicine News - Jun 04, 2007At most hospitals nationally, it takes nearly four hours on average before the surgeon on call becomes available, and even longer before the operation is finally begun. At UCSF Medical Center, the goal is for the patient to be seen by a "surgical hospitalist" in less than 30 minutes................"Over the first year of our program, the average waiting time was 20 minutes," says Hobart Harris, MD, Professor of Surgery at UCSF and Chief of the Division of General Surgery.
Photo Provided Courtesy of Majed Photo
