ACAAM Fellowship Program Member Feature: University of Wisconsin Addiction Medicine Fellowship

randy brownACAAM recently sat down with Randall Brown, MD PhD, Professor in the Department of Family Medicine and Community Health at the University of Wisconsin School of Medicine and Public Health. Dr. Brown is also the University of Wisconsin’s Addiction Medicine Fellowship program director, having established the program in 2010 and overseen its initial accreditation in 2011.  

Dr. Brown has played an important role in the evolution of addiction medicine and ACAAM. He served on the committee that wrote the Program Requirements in 2016–17 that were adopted by ACGME, and he was President of the Addiction Medicine Fellowship Directors Association in 2018 during the period that led to the establishment of ACAAM. 

Dr. Brown is particularly interested in how we can better integrate prevention and treatment for substance use disorders and commonly comorbid conditions into general medical and other community settings. Read on to learn more about UW-Madison’s addiction medicine program and what Dr. Brown sees as the biggest challenges and opportunities facing the field. 

ACAAM: What was the addiction medicine landscape like in your area at the time that your program was established? 

Randy BrownWhen I came out of family medicine residency, I was really interested in addiction work, and I had a hard time finding a training program. There were a couple out there, but they seemed pretty focused on specialist treatment environments. Whereas I was really interested in getting this knowledge and bringing it into general medical settings where, during my training, I really saw some deficits in knowledge and how some patients were treated. That’s what landed me at UW, but it was in a research function. I don’t know to what extent that experience was universal, but for me, a clinical training program that met those needs was hard to find.  

In 2007, I got pulled into a group that included visionaries like Kevin Kunz, Rick Blondell, Michael Miller, Jeffrey Samet, and that’s where the talk started, saying: If we’re going to train non-psychiatrists in this area, what should it look like? From there the more formal and structured training programs were launched. 

I see advocacy as a major charge for folks coming out of fellowship. They are really the seeds of greater awareness and confidence dealing with addiction in general medical settings.

-Randy Brown, MD PhD, UW-Madison Addiction Medicine Fellowship Program Director

ACAAM: Was there someone who played an especially critical role in founding your program? 

Randy BrownI have a wonderful UW colleague named Dean Krahn, MD MS, who was the fellowship director for the addiction psychiatry fellowship. I reached out to him in 2007 as I was working to launch UW’s addiction medicine fellowship program, and he was so wonderful in sharing his own knowledge. Dean helped me sort out the curriculumshared his experience with ACGME, and helped me pull together a program. That collaboration at UW between addiction medicine and addiction psychiatry has endured and been wonderful, and it really sprung out of that openness to sharing that I got from Dean Krahn. 

The other thing we had going for us at UW was an existing addiction medicine consultation service at the university hospital. Michael Flemming, MD MPH—who conducted some of the seminal work around screening and brief interventions for problematic alcohol use in primary care settingsWe already had a fairly well-known hospital-based consultation service, so we really hit the ground running bringing learners into it since it was already well integrated into the culture at the hospital. 

ACAAM: What are you most proud of your fellowship program for having accomplished?  

Randy Brown: I’m proudest of the curriculum here, and that clearly is rooted in fairly significant bias on my part… looking through the lens of someone trained in family medicine and public health where the experiences we have are rooted in these community-based and general medical settings I see as a real need. I’m really excited we’re able to do that here, and that UW has been supportive of it.  

As addiction medicine is becoming more and more well known as a specialty, we’re increasingly being reached out to by other specialty groups, such as pain medicine and OBGYN, and health systems with our colleagues saying, we really need you guys here. That’s been a rewarding thing: The relationships and collaborations that have started evolving more and more as the reputation of the field and program have evolved. 

Our fellows, too. We have had some wonderful people train here and go on to work in primary care, specialty treatment settings, and academics. That’s been really rewarding to see. 

ACAAMWhat do your program faculty and fellows enjoy most about Madison, WI 

Randy BrownThe first thing that jumps to mind is the UW campus itself. Lakes, terrace… it’s a wonderful place. The farmer’s market here on weekends is really fun. It’s close and accessible to nature, bike paths, and running trails. 

ACAAM: Anything you’d like to highlight about your program faculty? 

Randy BrownRecently we got two new faculty members that we’re really excited about.  

Kellene (Kelly) Eagen, MD, came to us from San Francisco. She has been a real leader in homeless health and providing HIV and Hepatitis C treatment. She’s passionate about clinical care and teaching. Kelly is starting as our Associate Program Director this year. 

Elizabeth Salisbury-Afshar, MD MPH, has been super active in community-based settings as well as being involved at the policy level to push out overdose prevention and opioid use disorder management so it might be more widely available and accessible. She’s also involved in funded research here.  

We’re incredibly lucky to have both Dr. Eagen and Dr. Salisbury-Afshar working with us. 

ACAAM: What have the greatest challenges and successes been for addiction medicine as a whole? 

Randy BrownI’d tag this as a challenge, but I think it’s an exciting one. I see advocacy as a major charge for folks coming out of fellowship. They are really the seeds of greater awareness and confidence dealing with addiction in general medical settings. There’s so much that can be done by way of prevention and treatment that doesn’t require specialists in a controlled environment for long periods of time. Primary care and really all facets of health care need to be engaged, and I see advocacy on that front as part of our work as addiction medicine specialists. 

ACAAM: What contribution do you think fellowship graduates have made as a whole? 

Randy BrownIt’s good to see our fellows do everything that they’re doing. I personally enjoy when I hear about a fellow being really integrated into an interdisciplinary system where there’s cross-collaboration by way of sharing knowledge and advancing care for people with use disorders. Thinking of fellows as a whole, nationally and the impact they can have on systems and patient care is what gets me most excited about this field and the fellowship training that’s available. 

ACAAM: What changes (if any) have you seen in those seeking fellowship training in the past decade? 

Randy BrownIt has become a lot more common for us to see applications from individuals coming right out of their primary residency. Eight to ten years ago we didn’t see that as much. We were seeing applications from folks who were mid-career or early mid-career, who—through their clinical practicehad been seeing addiction issues and then sought additional training. Today we’re seeing more younger people who have heard of the field and the availability of training and are seeking it. 

ACAAM: Any thoughts on the future of addiction medicine and where we go from here? 

Randy BrownI think addiction medicine needs to be a program at every academic medical setting. Without a doubt, that’s just something that needs to happen. Addiction medicine needs to be integrated into mainstream healthcare, and that’s one of the major ways to do it. And to have fellows and addiction medicine attendings integrated into the spectrum of health professional trainingundergraduate and post graduateto pass on that knowledge and demonstrate compassion and avoidance of stigmatization, and to improve the likelihood that individuals coming right out of their training feel more comfortable engaging on these issues.

Thank you to Dr. Brown for sharing this information about his experience and insights. If you would like to see your fellowship program featured, please contact ACAAM Headquarters at [email protected].