Physician David Vukich lays solid foundation for emergency medicine department on two campuses

David Vukich, M.D., describes the building of the University of Florida’s department of emergency medicine as “a lot like building a wall ¾ brick by brick, layer by layer.”

As the first Jacksonville-based chairman of a department that spans both the Gainesville and Jacksonville campuses of the UF Health Science Center, Vukich oversees a highly diverse program of patient care, teaching and research. He said a lifelong sense of excitement drew him to his high-energy career.

He recalls that during his teen years in his native state of Colorado, he was always looking for adventure and that he especially liked motorcycles, fast cars and planes. When he wasn’t riding his motorcycle through town, he was learning to fly, making his first solo flight on his 16th birthday.

“Challenges are fun. Maintenance is boring. That’s why I’m in emergency medicine,” he said.

Vukich is in his 19th year with the UF College of Medicine, which he joined after leaving the U.S. Navy Medical Corps in 1984. He became chief of emergency medicine in 1985 while it was a division of the department of surgery and for the next 15 years worked with the emergency medicine faculty to make it a full academic department.

At one point early on, there were only four faculty members on the Shands Jacksonville campus, overseeing 36 residents and providing 24-hour coverage for an urban emergency department with more than 100,000 patients visits annually.

“We used to have our faculty meetings in Terry MacMath’s car,” he recalls with a laugh.

“Those early days were challenging times for us all, and yet we managed to run a much sought-after residency program quite successfully with fewer attending physicians than we have now,” said MacMath, M.D., an associate professor of emergency medicine who has worked with Vukich for almost 20 years. “I believe much of the success is directly attributed to David, who not only carried a full clinical load but also spent still more time and effort in guiding us through difficult periods.”

These efforts paid off four years ago when the department of emergency medicine was born — a significant accomplishment in light of the fact that fewer than half of the nation’s medical schools have emergency medicine departments.

In 2001, Vukich was appointed chairman of the department of emergency medicine, the medical school’s first dual-campus department. He had previously served as interim chairman.

Since then, he has built up the department on both campuses. He appointed an associate chairman David Seaberg, M.D., to oversee operations in Gainesville, began rotating residents and increased staffing. Although still in its infancy, the department has grown to 30 faculty and 50 residents and fellows on both campuses who see more than 145,000 patient visits each year. By this summer, this will increase to 40 faculty providing care to nearly 200,000 patients in four separate emergency departments ¾ one in Gainesville, one in Winter Haven and two in Jacksonville.

While adequate staffing was being developed, Vukich encouraged faculty to pursue their special interests, adding unique services to the department. Faculty interest in toxicology helped build the Florida Poison Information Center on the Jacksonville campus. “Prior to obtaining the state funding necessary for our program, we created a regional clinical toxicology service available by phone or pager,” said Jay Schauben, Pharm.D., the center’s director. “In its infancy, I was the only toxicologist and struggled to keep a 24-hour call schedule by myself. Dr. Vukich was one of three physicians on this campus who stepped up to assist and cover for me when I was unavailable.”

Schauben credits Vukich with much of the success of the regional poison center.

“Through his leadership in the department of emergency medicine, he continued to lobby for development of the program on the local and state levels,” Schauben said. “Without the commitment of his time and resources, I doubt the center would have ever been created or would have survived the early stages of its development. He continues to be one of our most avid supporters, proactively working toward our expansion and stability.”

Today the center serves 42 counties in northern and eastern coastal Florida, as well as the U.S. Virgin Islands. It is a resource for 6 million residents, 139 health-care institutions and 121 EMS agencies. More than 45,000 patients a year are helped through the poison center’s staff of specially trained and nationally certified nurses, pharmacists and physician assistants. Three board-certified medical/clinical toxicologists provide 24-hour coverage for consultation on advanced cases.

A passion for pediatric emergency medicine laid the foundation for the division of pediatric emergency medicine and the creation of a pediatric emergency department with faculty and staff dedicated to the specialty. Under the direction of Phyllis Stenklyft, M.D., the pediatric emergency department on the Jacksonville campus treats 28,000 children every year and offers a fellowship in pediatric emergency medicine.

The faculty’s interest in research has led to the creation of a medical information science branch, with physicians focusing much of their recent efforts on patient safety and error reduction. With all its faculty research efforts combined, the department publishes more than 50 articles, chapters and textbooks each year.

Field operations is the newest division within the department. For years, many of the emergency medicine physicians have worked with local, state and national agencies on public safety issues. Those activities were brought together under one division about two years ago.

UF emergency physicians, along with nurses, paramedics and medical technicians, also are part of a disaster medical assistance team, DMAT FL-4, formed in 1998 as part of the National Disaster Medical System. Teams provide emergency medical care during disasters, including earthquakes, hurricanes, epidemics and explosions. They triage patients, provide immediate medical care and prepare patients for evacuation. In other situations, DMATs may provide primary health care or support for overloaded health-care staffs.

At every space shuttle launch and landing, UF physicians from various specialties, including emergency medicine, anesthesiology, surgery and critical care, are present. They work with the NASA fire/rescue team in the event of a disaster requiring lifesaving procedures. Before volunteering, the physicians go through intense NASA training on chemicals, hazards, space flight physiology, equipment and escape scenarios.

Physicians also provide medical support for the Jacksonville Sheriff’s Office SWAT team. An attending physician is available to the team through a 24-hour hotline that rings into the trauma center. In rare instances, they accompany the team on call-outs. Doctors train with the SWAT team to become familiar with the firearms and tactical gear the officers use. They also provide medical direction and training for fire/rescue operations in five counties in Northeast Florida, as well as ShandsCair helicopter ambulance in Gainesville.

Vukich reminds his faculty physicians not to delay personal development while pursuing professional goals, noting, “It is all too easy to become overly focused upon the problems of the workplace.” Vukich said the most important part of his life is his family — the love of his life. He and his wife Clare are avid runners and enjoy boating, fishing, art and dining with friends. He also enjoys playing with their 6-year-old daughter Nikki.

Last summer, Vukich took on additional duties when he was appointed senior vice president of medical affairs at Shands Jacksonville by Robert Nuss, M.D., who assumed the role of senior associate dean. He describes his job as a lot of fun and a lot of work.

“I have the opportunity to be involved in the evolution of the organization and to help change physician culture on this campus.” While working on a large urban campus has immense challenges, Vukich said he has an intense loyalty to it.

“I love this place and the people working in it,” he said. “And despite the difficulties we face every day, there are many others who love it as well. We’re doing God’s work. We have the potential to make a profound impact on the community here. Our patients are grateful for their care. And just because some of them don’t have money or insurance doesn’t mean they aren’t deserving of the best care.”

MacMath said the way Vukich cares for patients makes him a role model for residents and staff.

“His patients recognize the respect with which he cares for them and readily show that same respect in return. He is obviously compassionate and always keeps patients’ best interests foremost in his mind. My ultimate measure of a physician’s worth is whether or not I would let him or her care for my family. In David’s case, I would.”

The work doesn’t end when he takes off his lab coat and leaves his department. Vukich and other physicians help to lobby for patients and the specialty of emergency medicine at local, state and national levels.

“As physicians, we have the obligation and privilege to care not only for patients but for the community as well. I try to remind myself and the department of this duty.”