Moffitt-Long-Mt Zion Division of Pulmonary, Critical Care, Allergy and Sleep:
The modern version of the UCSF Pulmonary Division was founded together with the Cardiovascular Research Institute in 1956. The division has a long history of training the world’s leaders in pulmonary science and medicine. In the late 1970s, Critical Care was added to the training and clinical responsibilities of the division, to keep pace with the rapid expansion of Critical Care Units. In the early 1990s, to accommodate the growth of sleep medicine, the division built the UCSF Sleep Center at Mt. Zion. UCSF had a small Allergy Division that was not financially or academically sustainable on its own. Because of the close overlap between Pulmonary and Allergy in research and in management of patients with asthma, the Allergy division was merged into the new Division of Pulmonary, Critical Care, Allergy and Sleep in 2009.
VA Pulmonary Division:
Starting in the 1970s, the Pulmonary Subspecialists at the San Francisco VA Medical Center belonged to the Pulmonary Section of the Medical Service. Subsequently, as it became routine for Pulmonary Subspecialists to become double-boarded in Intensive Care Medicine, the Section adopted the rubric Pulmonary and Critical Care, acknowledging the greater scope of practice of physicians within the section. This trend towards specialization in Critical Care culminated in July 2004 in the closing of the Medical ICU, which became staffed full time by internists derived from the Pulmonary/CCM Section as well as from the Anesthesiology Service. This increase in clinical responsibility lead to an increase in the number of VA-based, VA-supported physicians, most of whom also maintained NIH-supported research programs, as well as the addition of full-time nurse practitioners. The first decade of the 21st century also saw a remarkable increase in demand for Sleep Diagnostic and Clinical Services, culminating in the design and opening of a new 3-bed full polysomnography unit in late 2011. In recognition of the large and increasing proportion of effort devoted to sleep disorders, the Section was renamed the Pulmonary, Critical Care, and Sleep Medicine Section. In the past several years, the Section also has shouldered responsibility for monitoring, followup and diagnosis of pulmonary nodules and other abnormalities, plus coordination of interventional biopsy, PET scanning, pathology, and surgical/oncological shared decision-making. This has become a major clinical focus of the section because of the large number of chest abnormalities found incidentally and by deliberate screening of a patient population highly enriched in elderly, male, asbestos-exposed, cigarette smokers at high risk of development bronchogenic carcinomas and other thoracic primary and metastastic malignancies. The rising numbers of identified abnormalities, as well as the newer emphasis on chemotherapy and other types of therapy targeted to specific tumor types and mutations, increased demand for biopsy material and staging prior to initiating therapy. To help meet this demand, bronchoscopy services expanded in 2010 to include endobronchial ultrasound to guide transbronchial needle aspiration biopsies by a core of physicians specifically trained in the technique. Because of the Section’s central role in cancer detection and coordination of decision-making, which is unique in the UCSF system, The VA has become a critical site for training of pulmonary subspecialty fellows in this aspect of pulmonary medicine.
SFGH Pulmonary Division:
The SFGH Pulmonary Division has functioned under 3 Division Chiefs, Dr. John Murray (1966-1988), Dr. Phil Hopewell (1989-1998) and Dr. Courtney Broaddus (1998 to current).