Dr. David J. Leffell, medical director of the Yale Faculty Practice for the past three years and a professor of surgery and dermatology at the School of Medicine, has been appointed associate dean for clinical affairs by Dean David A. Kessler.

Leffell also has been appointed director of the Yale Faculty Practice, which represents the clinical activity of more than 650 full-time Yale physicians and provides tertiary care to thousands of patients throughout the region. In his new role, Leffell will have oversight of all clinical and business activity in the Faculty Practice.

The appointment comes at a time when academic medical centers across the United States are responding to major economic forces affecting their operation. Lower reimbursements under managed care, along with changes in the way attending and resident physicians must account for their time, have prompted medical schools to re-examine the way they do business in the clinical sphere. Leffell's primary task, Kessler said, will be to help define the Faculty Practice as an efficient organization that facilitates the research and educational missions of the school.

"Our mandate is to be efficient, responsive and available," Leffell said in an interview. "We can't serve any of our constituencies, not least of all our patients, unless we're on a sound economic footing. And without patients, there is no medical school."

A native of Montreal, Leffell is a 1977 Yale College graduate who received his medical degree from the McGill University Faculty of Medicine in 1981. He completed a residency in internal medicine at Cornell Cooperating Hospitals in 1984, then spent two years as a dermatology resident at Yale and one as a National Institutes of Health fellow, also in New Haven. He became a Yale faculty member in 1988 after a fellowship in dermatologic surgery at the University of Michigan.

The Faculty Practice, originally established as a billing and collection unit for the clinical services of Yale professors, has evolved into a complex organization responsible for negotiating contracts, marketing its services, and planning strategically in a changing health care environment. For the year ending June 30, the Faculty Practice logged more than 400,000 patient encounters and collected revenues exceeding $100 million for clinical activity at the Yale Physicians Building, Yale-New Haven Hospital, the Yale Sports Medicine Center and other offsite locations. Its operation had been complicated by flaws in the school's APS computerized billing system, which has been phased out with the successful implementation of a new IDX system.

Kessler cited Leffell, an authority in the genetics of skin cancer and an expert in the management of the disease, for "his strong administrative skills and an outstanding record of scholarly achievement." The Dean added: "I have every confidence that, under his direction, the Faculty Practice will achieve an even higher standard of excellence."

The school's chief operating officer, Irwin Birnbaum, was similarly enthusiastic: "David has the professional experience and the vision to help the Faculty Practice truly become a multi-specialty academic group practice," he said.