Ready, Willing and Abel
As a child growing up in post-colonial Jamaica, E. Dale Abel, MD, PhD, learned an important lesson from his parents, both of whom were teachers and the children of subsistence farmers who themselves had no more than six or seven years of schooling. “They were convinced that the way to make an impact in society and advance in life was to have a good education,” says the newly appointed executive chair of the Department of Medicine in the school of medicine and executive medical director of the Depart - ment of Medicine for UCLA Health. “We grew up being told that we would become a doctor or a lawyer or an engineer. I am one of five children, and, as it turns out, three of us are doctors and two are engineers. So, I guess we ended up listening to our parents.” Dr. Abel joins UCLA at a time when it is expanding its commit - ment to health equity, diversity and inclusion, and as the leader of the school and health system’s largest department, he will play a significant role in shaping that journey. While chair of the De - partment of Internal Medicine at the University of Iowa, Dr. Abel was dedicated to broadening communication to build a greater sense of community; provide strategic direction; and address issues of diversity, equity and inclusion. He talked with UCLA Health interim chief of communications Judy Fortin about his background, thoughts on equity, diversity and inclusion in health care and the value of mentorship.
You grew up and earned your MD in Jamaica, and then went on to earn a doctorate at Oxford as a Rhodes Scholar and complete residency and fellowship training at Northwestern and Harvard. How did that early experience inform your attitudes about medicine and health care?
Dr. E. Dale Abel: I learned medicine at the bedside, talking to patients. Almost every time, the patient tells you something that is nuanced, that is not actually in the record, something that may ultimately alter the course of how to manage his or her care. That has continued to flavor how I practice medicine today. Also, when you practice medicine in a place that is much more resource-constrained than the United States, there is, obviously, less access to the latest and greatest tests that could help you to diagnose a patient. So, you come to recognize that you sometimes must make life-or-death decisions in the face of diagnostic uncertainty based on your best judgment. This gave me a very clear perspective about the power that a physician has over the lives of their patients. When I started to train in the United States, I was struck by how many tests doctors order, and by the many contingencies that are put in place because there is concern that somebody might turn around and take you to court over a decision that you made. I think that there is a fine line between practicing good, safe and cost-effective medicine that is high quality versus practicing defensive medicine. I am encouraged that in the U.S. medical establishment, we are now getting closer to a point where medicine is becoming somewhat more rational in asking questions about how we balance resources with what ultimately is proven to be effective.
What are your priorities for UCLA’s Department of Medicine, and where do you see opportunities for growth?
Dr. Abel: It is remarkable taking over a department that has been led by someone like Dr. Alan Fogelman, (MD ’66, RES ’68, ’71, FEL ’73) who, over the nearly 30 years of his stewardship, has built a department organically that is the envy of the country. He bet on people and he bet on talent, and he told those individuals he brought to UCLA, “I’m going to give you the freedom and resources to excel in whatever way that you want to do that.” The result has been spectacular. Having said that, you can’t keep growing organically when you get to the size of the current Department of Medicine. Both on the clinical and research sides, we will have to identify those critically important priorities where we can really be the world leaders, and then invest to achieve that goal. UCLA is a tremendously collaborative place, but I think there are levels of additional collaboration that can amplify our impact. We can catalyze growth without necessarily having to bring in many more people by embracing points of synergy that just need to be realized for the department to continue to succeed. UCLA has an incredibly strong clinical program, is in a very strong financial position, and it has amazing researchers and very energized and motivated faculty. There are relatively few places that have all of those things together under the same roof. I would like to leverage that strength to expand the reach of our experts on the national stage. I believe that the quality of our faculty, the quality of our trainees and the quality of our entire enterprise deserves a greater level of national attention.
In your previous positions, you have been very focused on issues of diversity, equity and inclusion. How do you plan to carry on that work at UCLA?
Dr. Abel: We need to pay close attention to the people who we recruit into the school of medicine, and ultimately into the department. And we need to have a really important conversation about how we, as an organization, serve the community of Greater Los Angeles in a much more meaningful way. UCLA is located on the Westside of Los Angeles, in an affluent area, yet within a few miles there are neighborhoods and communities that have third-world levels of mortality and sub-optimally managed chronic noncommunicable diseases, like hypertension and diabetes. I know there would be tremendous support for us to broaden our engagement with these communities. Mentorship and paying it forward also is something that I am passionate about, and there, too, are opportunities to expand our connections. UCLA has a tremendous talent pool, and I believe that we have a responsibility to ensure that we provide thoughtful and meaningful mentorship across the entire career spectrum.
A recent UCLA study found that the proportion of Black physicians, specifically men, who are being trained in the United States has not increased in 120 years. Do you feel there are new training opportunities that can be created through the Department of Medicine to increase those numbers?
Dr. Abel: First of all, we have to get more Black men into medical school. I have colleagues in other parts of the country who actively mentor young Black men ages 13 to 17 to show them that a career in medicine is very much within their grasp, and also to show them what it takes to become competitive for medical school. It really has to start early, and not just at the time of admission. The second point is that I really want the department to be a magnet for minorities, and particularly for Black and Latino physicians and medical school graduates who are thinking of training in internal medicine. UCLA should be at the top of their list of places to apply. There is strong competition from a few other elite and premier programs across the country. A “holistic” review is an excellent approach to achieve this goal. I know that the training departments in the Department of Medicine at UCLA have been active in their recruitment of diverse trainees and do this, and Massachusetts General Hospital in Boston does this as well. With a holistic approach, there are independent “academic reviews” and “holistic reviews.” The individuals who are focusing on recruitment through the lens of diversity, equity and inclusion will pick up on things in the application that the folks doing the academic review may have missed because they are focused on test scores or more traditional academic metrics. As a result, both UCLA’s Department of Medicine and Mass General achieved among the most diverse and accomplished incoming residency classes in the country. I look forward to continuing our journey together to build on this progress in our quest to leverage UCLA’s incredible pipeline opportunities to increase diversity within our department. I believe that excellence and diversity go hand in hand.
As the leader of a very large department, how will you maintain the balance between your personal goals as a researcher and your responsibilities as an academic chair and administrator?
Dr. Abel: My research group has been with me for a fairly long time, and they are pretty mature independent investigators. A few people are relocating with me; I believe that they will rapidly size up opportunities on campus to enhance not only our work, but also their own work. At this stage in my career, it doesn’t have to be all about my own research anymore. I think that there are a lot of young people with great ideas — probably better ideas than mine — and if I can just point them in appropriate directions, then they can run with things. One of my goals is to identify, nurture and encourage young and upcoming investigators and physician-scientists within the department, and to really ensure that we can develop a strong community of young people who are being supported and actively mentored to achieve their full potential.
You’ve mentioned mentoring several times. Who has had the biggest influence on you personally and professionally?
Dr. Abel: A critical mentor was my PhD supervisor at the University of Oxford, Professor John Ledingham. After we began working together, he asked me, “What do you want to do when you finish?” I said, “I want to go to the United States.” He marched me over to the chair of the department, Sir David Weatherall, and introduced us. Sir Weatherall picked up the phone and called friends who were senior academics in the United States, and he said to them, “This young man from Jamaica who is sitting in my office is someone I think you should meet.” That opened doors, and it is how I met another significant mentor, Lewis Landsberg, when he was a professor at Harvard before going to Northwestern, ultimately as my chair in the Department of Medicine. Dr. Landsberg asked me: “What do you want to do after residency?” I said, “I think I want to be an endocrinologist.” He said, “Okay, fine. You’ve got to go to Boston. Here are the people I want you to train with.” He was a tremendously generous mentor. It didn’t matter who I was or where I came from; he just saw what the future could be like for me and then essentially facilitated that. At the end of the day, what makes me look good, or what makes anyone look good, is not how many papers I have published or how many honorific societies I’ve been a member of. It’s the people who you can say you have touched and who would have your back. The success of others amplifies what your personal impact might be.
Now that you are working just a short skip from Hollywood, do you have a favorite movie that perhaps reflects on your own attitudes and/or style?
Dr. Abel: Dr. Zhivago. That is my favorite movie because it really captures this amazing, tragic story of a time when Russia was undergoing convulsive upheavals. When I watch it, I reflect on how our life experiences are framed both by history and by circumstances over which we often have no control, and which can really shape the way that we ultimately interpret future events. I think that stories that really touch on a deeper aspect of life and humanity are the ones that tend to appeal to me the most