Beyond the Operating Room: Compassionate Care, Leadership, and Mentorship in Urology With Dr. Christopher Kane

Christopher Kane, MD, is the dean of clinical affairs at UC San Diego (UCSD) Health Sciences, CEO of the Physician Group at UCSD Health, and a professor of urology at UCSD. With a remarkable career spanning military service to leadership roles in academic medicine, his journey is one of unwavering commitment to patient care, innovation, and mentorship.

In this exclusive interview with GU Oncology Now, Dr. Kane shares insights into his career trajectory, highlighting pivotal moments that led him to specialize in urology. From his experiences as a Marine Corps battalion surgeon during the first Persian Gulf War to his current roles shaping the future of health care delivery, Dr. Kane’s passion for excellence in patient care shines through.

Can you share a brief overview of your career journey leading up to your current roles? What inspired you to specialize in urology, and how did your early experiences shape your career path?

Dr. Kane: Originally, I aspired to become a heart surgeon, but a rotation on a urology service during my time at Uniformed Services University opened my eyes to the fascinating world of urology. What struck me most was not just the complex surgeries, particularly in urologic oncology, but the camaraderie and dedication of the team. This experience inspired me to pursue urology as my specialty.

I hail from California, completed my undergraduate degree at UC Davis in engineering, and then ventured into military medical school, which provided invaluable experiences, including serving as a Marine Corps battalion surgeon during the first Persian Gulf War. My residency at Oakland Naval Hospital and a pivotal year at UC San Francisco (UCSF) solidified my interest in academic medicine.

Subsequently, I embarked on a fulfilling career in the Navy, initially at the Naval Medical Center San Diego, where I was the residency program director and became the Surgeon General’s Advisor for Urology. When I left active duty in 2001, I was fortunate to join the faculty at UCSF where I held various roles, including chief of urology at the VA Hospital, assistant residency director, and ultimately Vice Chair of the Department. I was then recruited to lead the urology division at UCSD in 2007. We were small and our residency was on probation at the time. Over the next 13 years, we became a Department, expanded our residency and fellowship programs, our funded research, and philanthropy. Ultimately, we have grown into a top-tier department nationally because of the superb performance of our faculty, trainees, and staff.

Over the years, I have assumed additional responsibilities, such as leading the clinical operations of our Cancer Center and serving as interim chair of the Department of Surgery for 2 years. These experiences honed my leadership skills and prepared me for my current roles as dean of clinical affairs and CEO of the Physician Group at UCSD.

Since taking on these positions in 2018, the focus has been on improving operational efficiency and patient experience across the board. By implementing standardized processes and fostering collaboration among specialties, such as through disease teams in oncology, we have made significant strides in enhancing the quality and accessibility of care at UCSD.

Our Cancer Center, in particular, has been instrumental in driving excellence, with urology playing a vital role in both clinical operations and research endeavors. Moving forward, we remain committed to maintaining high standards while preserving the unique strengths of each department and division within our institution.

What are your primary roles and responsibilities on a day-to-day basis?

Dr. Kane: First, I maintain an active clinical practice, operating on Mondays and seeing patients in the office on Wednesdays. This not only keeps me connected to my field but also allows me to interact regularly with residents, fellows, and colleagues, fostering a sense of camaraderie and shared experience.

From a leadership standpoint, my responsibilities are twofold. As dean of clinical affairs, I oversee the clinical activities of our faculty across various departments and institutes, including the Cancer Center, Cardiovascular Institute, and numerous specialty clinics. This work involves spearheading initiatives to enhance operational efficiency, patient experience, and overall clinical quality.

One significant aspect of the role is chairing the Wellness Oversight Committee, where we address the well-being of our faculty and residents through initiatives like improving access to behavioral health services and enhancing the clinical work environment.

Additionally, I oversee the compensation plans of our departments, ensuring standardization and periodic review to maintain fairness and transparency.

As CEO of the Physician Group, my focus is on managing the professional billing and revenue collection processes, as well as overseeing the operations of our ambulatory clinics. This work entails managing the employees, facilities, and resources associated with ambulatory care, which serves around 6500 patients daily.

We employ a tiered management approach, with daily huddles at each clinic to address operational issues promptly. Anything requiring escalation—whether related to personnel, finances, or equipment—is brought to my attention for resolution.

Furthermore, I lead committees and boards responsible for financial management, compensation distribution, and ambulatory operations policy-making. Collaboration and empowerment are key to ensuring smooth operations and continuous improvement across our extensive health care system, comprising 20 departments and numerous specialty areas.

Constant vigilance and process improvement are essential to maintaining high-performance standards in such a complex system.

Can you also share the details of your role as trustee and president-elect of the American Board of Urology (ABU) and president of the Western Section of the American Urologic Association (AUA)?

Dr. Kane: The ABU plays a crucial role in ensuring the competency and proficiency of urologists across the country. As a trustee, my responsibilities encompass various facets of board activities, particularly focusing on examination development and certification processes.

Initially, I served on the examination committee, contributing to the creation of both the Qualifying Exam, which follows residency, and the Certifying Exam, which assesses practicing urologists. These exams are vital in upholding the high standards of urologic care and ensuring public safety.

Transitioning from committee work to the role of trustee allowed me to have a broader impact on the strategic direction and policies of the ABU. Over the course of 6 years as a trustee, I have been involved in decision-making processes aimed at refining certification protocols and enhancing the overall experience for urologists undergoing certification and recertification.

My tenure culminates in serving as president-elect for the upcoming year, where I will have the privilege of guiding the board through its objectives and initiatives. This role involves a blend of leadership, advocacy, and strategic planning to advance the mission of the ABU and uphold its commitment to excellence in urologic practice.

Simultaneously, I have been involved with the AUA, albeit in a distinct capacity. While the AUA shares similar goals of supporting urologists, its primary focus is on education and professional development rather than certification. Serving as president of the Western Section of the AUA allows me to contribute to educational initiatives and represent the interests of urologists within the region.

Both roles are deeply rewarding, offering opportunities to collaborate with colleagues, shape policies, and contribute to the advancement of urologic care on both local and national levels. While they may entail occasional commitments and initiatives, the overarching goal remains ensuring the integrity and quality of urologic practice for the benefit of patients and practitioners alike.

What do you consider to be your most significant accomplishments or contributions in prostate or kidney cancer thus far in your lengthy career?

Dr. Kane: I would highlight the work we have done to understand the intricate relationship between patient factors and prostate cancer outcomes. This encompasses factors such as race, ethnicity, obesity, surgeon volume, and the overall health system environment. My involvement in the Capsure database at UCSF was pivotal in this regard. It demonstrated the power of a meticulously curated, prospectively collected database in conducting innovative research on treatment patterns and outcome determinants.

One area of focus has been exploring the impact of obesity on both the diagnosis and treatment of prostate cancer and how it interacts with socioeconomic status and racial disparities in treatment outcomes. The development of the SEARCH database has also been significant. Initially focused on surgical outcomes data across multiple VA medical centers, it has evolved to encompass comprehensive VINCI data, offering insights into the entire VA health care system.

Through numerous publications stemming from these databases, a crucial finding has emerged: when health care screening, detection, and delivery are consistently administered, disparities in outcomes based on race, ethnicity, and socioeconomic status are significantly mitigated. This finding underscores the importance of equitable access to high-quality health care services, which has the potential to alleviate longstanding disparities in health care delivery, particularly among Black men in America.

While these accomplishments represent just a fraction of the extensive research and projects I have been involved in, they stand out as transformative contributions toward understanding and addressing disparities in prostate and kidney cancer care.

In your opinion, what are some of the most pressing issues or challenges currently facing urology today?

Dr. Kane: The foremost challenge, in my view, lies in the overall state of health care delivery, which often lacks patient-centricity, efficiency, and consistency in quality. Health care systems are notoriously cumbersome and outdated compared with other industries. The patient experience, from navigating through appointments to accessing medical records, remains archaic and challenging.

One significant hurdle is the fragmented nature of electronic health systems and the lack of interoperability, hindering seamless communication and data transfer between health care providers and institutions. This is compounded by regulatory barriers, such as the unintended consequences of laws like HIPAA, which, while designed to protect patient privacy, have impeded efficient communication and coordination of care.

We are still reliant on outdated methods like fax machines, and the process of making a simple appointment can be needlessly complicated and time-consuming. This stands in stark contrast to the streamlined experiences we encounter in other aspects of modern life, such as online shopping or booking services.

Reflecting on my career, while I take pride in the advancements made within my department and institution, such as enhancing clinical quality and educational programs, my passion lies in breaking down these barriers to health care access and improving the patient experience. At UCSD, we have strived to create a culture of saying “yes” to patients, minimizing hurdles, and facilitating easy communication and scheduling.

However, the broader health care system still has a long way to go in terms of embracing technology to improve patient care and accessibility. My involvement in leadership roles, both locally and nationally, stems from this passion for enhancing the ease and quality of patient care. Despite incremental improvements, there is much work to be done to truly revolutionize the delivery of health care in the United States.

Another critical aspect to consider when discussing motivation for this demanding work is the core drive for excellent patient care, compassionate education, and impactful research. At its essence, our primary motivation should always be to better care for individual human beings. Central to this goal is valuing the interpersonal communication between health care provider and patient, which I consider the most crucial aspect of health care delivery.

When considering the importance of research, education, and clinical care, it is evident that clinical care takes precedence as it serves as the foundation informing the other 2. The ultimate mission and vision of research and education should be enhancing patient care, making patient care the top priority. Within patient care, I believe that excellence in interpersonal communication skills is paramount. How we communicate with patients, offer reassurance, perceive them as individuals, and actively listen to their concerns profoundly impacts their overall experience.

I am deeply passionate about teaching and improving interpersonal communication skills among physicians when interacting with patients. During my rotations, I emphasize the significance of simple gestures like introductions, seating positions, acknowledging family members, and actively listening for emotional cues. By allowing patients to share their stories and acknowledging their significance, we not only improve their experience but also establish a stronger connection that enhances our own fulfillment in providing care.

Reflecting on my experiences, I recall moments like receiving a late-night emergency room consultation for a patient experiencing urinary issues. Despite exhaustion, the sight of a frail elder in distress instantly ignites a sense of purpose. In such moments, it is not ambition, status, or financial gain that drives us. Rather, it is a profound sense of humanistic love. Seeing the patient as someone we care deeply about, whether it is envisioning ourselves in their position years from now or seeing them as a loved one, fuels our commitment to deliver care with empathy and compassion.

I remind my trainees never to lose sight of this fundamental connection to humanity in health care. It is this humanistic love that underpins all our efforts and drives us to deliver exceptional care, even in the most challenging circumstances.

To stay on this topic of mentoring trainees, as an educator and mentor, what advice do you give to aspiring urologists or surgeons who are just starting their careers?

Dr. Kane: I have immense gratitude for the career path I have chosen, particularly within urology. It is a specialty that offers a diverse range of surgical interventions and patient interactions, from voiding dysfunctions to urologic cancers. The immediate impact we can have on patient lives is truly rewarding.

The versatility of urology is another aspect I cherish. Whether you prefer surgical procedures or office-based practice, there is a niche within urology for everyone, be it men’s health, pediatric urology, or women’s pelvic medicine.

Moreover, the field is continually evolving, with advancements in technology and treatment paradigms reshaping our approach to conditions like kidney and bladder cancers. The pace of change is staggering, offering ample opportunities for innovation and discovery.

For those entering the field, it is important to recognize that despite the remarkable achievements of pioneers like Drs. Patrick Walsh or Charles Huggins, there is still so much left to uncover. Many of the most groundbreaking discoveries in urology are yet to be made. Embracing this sense of untapped potential can be a powerful motivator for aspiring urologists and surgeons.

Furthermore, mentorship and fostering a spirit of inquiry are crucial. Encouraging the next generation to think critically, ask probing questions, and pursue research endeavors that push the boundaries of knowledge is essential for the continued advancement of our field.

In essence, my advice to budding urologists and surgeons is to approach their careers with a sense of curiosity, humility, and dedication to improving patient care. The journey ahead is filled with opportunities for growth, discovery, and making a lasting impact on the lives of countless individuals.