Latest / Becker’s Healthcare Podcast / Atizazul Mansoor, MD, Chair of the Heart and Vascular Institute at UPMC in Central Pennsylvania, and Samir Saba, MD, Professor of Medicine and Chief of Cardiology at the UPMC Heart and Vascular Institute

Transcript

Atizazul Mansoor, MD, Chair of the Heart and Vascular Institute at UPMC in Central Pennsylvania, and Samir Saba, MD, Professor of Medicine and Chief of Cardiology at the UPMC Heart and Vascular Institute · Becker’s Healthcare Podcast

• 0:00
  Welcome, everyone, to the Becker's Healthcare Cardiology and
• 0:04
  Heart Surgery podcast.
• 0:06
  I'm Mariah Taylor, assistant editor, and I'm thrilled
• 0:08
  to be speaking with Eighty Zaz Monsoon,
• 0:11
  chair of Heart and Vascular Institute at UPMC
• 0:14
  in Central Pennsylvania,
• 0:16
  and Sameer Sabah,
• 0:17
  Chief of Cardiology and Co Director of UPMC
• 0:21
  Heart and Vascular Institute. Thank you both so
• 0:23
  much for joining me today. I'm really excited
• 0:26
  to hear about how you are using your
• 0:27
  cardiology workforce to help meet the needs of
• 0:30
  patients. But before we dive into that, I'd
• 0:33
  love for you to introduce yourselves and tell
• 0:34
  us a little bit about your background. Doctor
• 0:36
  Mansour, how about we start with you?
• 0:39
  Sure. Yeah. So my name is Atizaz Mansour.
• 0:42
  I'm a noninvasive cardiologist here in UPMC of
• 0:45
  Central Pennsylvania,
• 0:47
  covering the Harrisburg region and beyond.
• 0:50
  I serve currently as the president of the
• 0:51
  Heart and Vascular Institute in this region,
• 0:54
  and I have a focus,
• 0:56
  on a couple different areas, but,
• 0:58
  my real passion is in what's called structural
• 1:00
  heart valve valvular heart disease,
• 1:03
  and preventive cardiology.
• 1:10
  Excellent. Doctor Sabah, how about you tell us
• 1:12
  a little bit about you?
• 1:14
  Yeah. Sameer Sabah. I'm, the co director of
• 1:17
  the Heart Ambassador Institute at UPMC. I'm in
• 1:19
  the division chief of cardiology.
• 1:21
  I'm a cardiac electrophysiologist
• 1:23
  by training. I deal with the heart rhythm
• 1:25
  problems, do procedures,
• 1:27
  and I've been in my leadership position since
• 1:29
  2019.
• 1:30
  Most importantly, I've been in the Pittsburgh areas
• 1:33
  for the past, twenty six years and still
• 1:36
  enjoy all the aspects of my job,
• 1:39
  besides leading, seeing patients, taking care of them,
• 1:42
  procedures, and, in the clinic as well as
• 1:45
  teaching and, doing research. Thank you for having
• 1:48
  us.
• 1:49
  Yes. Thank you both for joining me. Now
• 1:51
  here at Becker's, we recently covered a report
• 1:54
  about how about
• 1:55
  twenty two million Americans are lacking access to
• 1:58
  cardiologists
• 1:59
  and then, of course, staggering numbers. We all
• 2:02
  knew that there were cardiology deserts here and
• 2:04
  there, but it really puts that into perspective
• 2:06
  to see 22,000,000
• 2:08
  Americans.
• 2:09
  I'd love to hear how you all are
• 2:11
  reorganizing
• 2:12
  and deploying your cardiology workforce to help meet
• 2:15
  the needs of patients where they live. And
• 2:17
  what have some of those results been?
• 2:21
  So maybe I can jump in, first and
• 2:24
  say that, at UPMC,
• 2:25
  this is this is a top priority. We
• 2:27
  recognize the fact that
• 2:29
  the workforce
• 2:30
  is today not meeting,
• 2:32
  all the needs of the community around us.
• 2:34
  Although here at UPMC,
• 2:36
  as you probably know, we are, so widespread
• 2:39
  in our presence in the community. So UPMC
• 2:42
  is not Pittsburgh based. The fact that Taz
• 2:45
  is with us here, he mentioned he's in
• 2:46
  Central Pennsylvania.
• 2:48
  So, our clinical operation,
• 2:50
  is across the Commonwealth.
• 2:52
  It goes into areas of Maryland, New York,
• 2:55
  and most more recently into Ohio. So we're
• 2:58
  already present in the community,
• 3:00
  but the question is very timely too because,
• 3:03
  you know, patients expect us to see them
• 3:05
  where they are and there is always more
• 3:08
  to be done on that front. So we're
• 3:10
  constantly,
• 3:11
  moving into
• 3:13
  the community,
• 3:14
  opening up new clinics so that the patient
• 3:17
  don't have to travel
• 3:18
  too far to see us. So,
• 3:20
  you know, we recognize, for example, in the
• 3:22
  Pittsburgh area that, south of us, we have
• 3:25
  a little bit of,
• 3:27
  a thin presence in the community east of
• 3:29
  us, and we continue
• 3:31
  opening up those clinics.
• 3:32
  In addition, we, you know, we have since
• 3:35
  COVID, I would say,
• 3:37
  been leaning heavily on, telehealth. So and as
• 3:40
  much as patients have the ability to to
• 3:42
  connect with us
• 3:44
  through,
• 3:45
  video visits, we've been doing, a lot of
• 3:47
  that.
• 3:49
  Excellent.
• 3:51
  Now as I'm sure you're well aware, access
• 3:53
  isn't just about the location. Right? It's also
• 3:56
  about getting patients in in a timely manner.
• 3:58
  Manner. So what are some of the strategies
• 4:00
  that are working to ensure that patients can
• 4:02
  see their cardiologist in a timely manner?
• 4:05
  Yeah. That's this is a very important question
• 4:07
  and it's, at the forefront of what we're
• 4:09
  doing, currently. So as you know, when cardiologists
• 4:13
  are become very busy and they build a
• 4:15
  practice like myself over twenty six years, you
• 4:17
  could fill up your clinic,
• 4:19
  all the time with the return patients that
• 4:22
  need care and ongoing care, but that leaves
• 4:24
  a a lot of patients who are new
• 4:26
  patients who need cardiac care, unable to see
• 4:29
  new physicians. So we have a lot of
• 4:31
  initiatives on that front, and, I'm just gonna
• 4:34
  enumerate some of them. One of them is
• 4:36
  definitely
• 4:38
  making sure that in the template of any
• 4:40
  of our physicians, any of our cardiologists,
• 4:43
  the general cardiologist as well as the subspecialists,
• 4:46
  there is a minimum number of slots,
• 4:49
  that are reserved for new patients.
• 4:52
  New patients are, you know, they haven't had
• 4:54
  any evaluation, they need the care, they are
• 4:56
  very worried about potentially having a cardiac condition,
• 4:59
  and getting that evaluation
• 5:01
  is extremely important.
• 5:03
  Our expectation today is that any clinic would
• 5:05
  have no less than 20%,
• 5:09
  new patient slots, and then the rest of
• 5:11
  it would go, towards, return patients.
• 5:14
  We're also making sure that, you know, we're
• 5:16
  in cardiology. We're not, dealing with a skin
• 5:19
  rash or what have you. So the the
• 5:22
  timeliness of seeing patients is very important. So
• 5:24
  the system has
• 5:25
  mandated that a patient who wants to see
• 5:27
  a cardiologist,
• 5:29
  within seven days should be able to, you
• 5:32
  know, see that to see that provider within
• 5:34
  seven days.
• 5:36
  Now it may not be their provider of
• 5:37
  choice. It may be, you know, whoever is
• 5:39
  available.
• 5:40
  We're deploying a lot of cardiologists. We're deploying
• 5:43
  a lot of, allied professionals, nurse practitioners,
• 5:47
  as well as,
• 5:48
  PAs
• 5:49
  to be able to meet the needs, but,
• 5:52
  that is definitely,
• 5:54
  a goal that we have set for ourselves.
• 5:56
  And, you know, this question uncovers a a
• 6:00
  deeper problem, honestly, which is that,
• 6:03
  the fact that, we need more cardiologists. We
• 6:06
  need to train more cardiologists, and I don't
• 6:08
  wanna jump ahead of ourselves, but we're doing
• 6:10
  a lot on that front also to make
• 6:12
  sure that the pipeline continues to continues to
• 6:15
  build as a lot of cardiologists are, you
• 6:18
  know, later in their careers are expected to
• 6:20
  be retiring, so the problem may become worse
• 6:22
  before it comes
• 6:24
  before it gets better.
• 6:27
  Absolutely.
• 6:28
  And I'm sure we all know the cardiologists
• 6:30
  are kind of on the decline. There's not
• 6:32
  a lot of people coming into the specialty.
• 6:35
  So it makes competition a lot harder. It
• 6:37
  makes recruitment harder.
• 6:39
  So on the workforce side of things, how
• 6:41
  are you maintaining a strong recruitment pipeline to
• 6:44
  ensure that you can continue to serve all
• 6:45
  the patients that wanna see you?
• 6:48
  I mean, I can jump in on that
• 6:50
  question for sure. You know, we started a
• 6:53
  Cardiology Fellowship here in Central Pennsylvania to augment
• 6:56
  the fellowship that already exists
• 6:58
  within the broader system in Pittsburgh. So
• 7:01
  we have six Fellows per year being trained
• 7:03
  as Cardiologists. These are internal medicine trained doctors,
• 7:08
  and so they are now going into their
• 7:10
  sub specialization.
• 7:12
  And already we've seen fruits of that effort
• 7:14
  where two of our new Cardiologists that we
• 7:17
  hired this year actually came through this training
• 7:19
  program.
• 7:20
  And so we're able to basically have an
• 7:23
  internal pipeline in that way. And also cross
• 7:25
  pollination. Now our Fellows are going between campuses
• 7:28
  and learning from our colleagues at Pittsburgh
• 7:31
  and bringing that learning back here and so
• 7:33
  we get better integration between the campuses and
• 7:36
  in terms of the cardiac care that our
• 7:39
  patients are receiving.
• 7:40
  And so having that internal pipeline, I believe
• 7:43
  UPMC
• 7:44
  in general is the biggest training program in
• 7:47
  the country and when you encompass all
• 7:49
  subspecialties,
• 7:51
  within,
• 7:53
  medicine. And so we are kind of blessed
• 7:55
  with that abundance and I know Doctor. Saba
• 7:57
  is involved with training of the fellows, over
• 8:00
  on our Pittsburgh campus. So I don't know
• 8:01
  if, Sameer, if you wanted to add a
• 8:03
  little bit to that.
• 8:04
  Totally agree, Taz. I mean, this is this
• 8:06
  is exact, you know, a priority.
• 8:08
  You know, the these,
• 8:10
  the cardiology fellowship in Central Pennsylvania has been
• 8:13
  a huge addition,
• 8:16
  fellows are coming to for subspecialty training in
• 8:19
  Pittsburgh, and we have they're they're they're some
• 8:21
  of the best. The other thing that I
• 8:22
  wanted to mention along the same lines is
• 8:23
  that we've augmented the size of our own
• 8:26
  fellowship here in Pittsburgh from eight cardiology fellows
• 8:29
  per year to 10 cardiology fellows per year.
• 8:31
  This took an investment from UPMC because obviously
• 8:34
  that costs money, but that is a very
• 8:36
  important thing to build that, to build that
• 8:38
  pipeline, particularly that we've been very successful in
• 8:42
  returning our trainees to become our colleagues, to
• 8:45
  become the faculty that are going to be
• 8:46
  serving all of those communities and, you know,
• 8:49
  servicing the clinics that we're opening and the
• 8:52
  and the, you know, the the hospitals that,
• 8:55
  that are in the community.
• 8:57
  But but but there are also things at
• 8:59
  a national level happening that,
• 9:01
  for example in my specialty of cardiac electrophysiology
• 9:04
  is already happening, which is the shortening of
• 9:07
  the training, meaning that how can we get
• 9:09
  the physicians not to to choose Cardiology? A
• 9:12
  lot of them want to do Cardiology and,
• 9:15
  but sometimes the the length of the training,
• 9:17
  three years of Internal Medicine and then three
• 9:20
  years of Cardiology and if you're doing a
• 9:22
  subspecialty like electrophysiology, that's an extra two years.
• 9:25
  How can we reduce a little bit that,
• 9:28
  duration to get people to to work? And
• 9:30
  some things have already happened. There is something
• 9:32
  called the two plus two, which means that,
• 9:35
  for example, people going into electrophysiology
• 9:37
  can short track
• 9:39
  with doing two instead of three years of
• 9:40
  general cardiology and then do two years of,
• 9:43
  you know, electrophysiology.
• 9:45
  And a lot of these things are happening
• 9:47
  in the field, including discussions at the national
• 9:49
  level as to whether we can even shorten
• 9:51
  a little bit the internal medicine training and,
• 9:54
  you know, short track
• 9:56
  physicians into or trainees into into cardiology. So
• 10:00
  a lot is happening on that front.
• 10:03
  Absolutely.
• 10:04
  And there's a lot happening in cardiology
• 10:06
  across the board. And I know for some
• 10:08
  leaders, it can be a little difficult to
• 10:10
  figure out, you know, where do I focus
• 10:12
  my attention? Where do we focus our resources?
• 10:15
  So I'd love to hear from both of
• 10:16
  you. What's your next priority for improving cardiovascular
• 10:20
  care?
• 10:22
  I think, you know,
• 10:24
  I was thinking about what our goal should
• 10:26
  be as a system, as a department. And
• 10:29
  I, you know, we just finished talking about
• 10:31
  the topic of training Fellows, which is
• 10:34
  an education goal.
• 10:35
  And I feel like as a physician, never
• 10:38
  mind as a cardiologist,
• 10:39
  a big part of my job is education,
• 10:41
  whether it's educating the next generation, educating myself
• 10:44
  to keep up to date or educating our
• 10:46
  patients
• 10:47
  and our primary care partners.
• 10:49
  So I think there's only so much load
• 10:50
  that any one
• 10:52
  provider is gonna be able to handle because,
• 10:54
  you know, that's just a natural,
• 10:56
  way of things.
• 10:57
  And so in a long winded way, I
• 10:59
  think one thing we can do is better
• 11:01
  educate
• 11:02
  our providers at large, our primary care providers,
• 11:04
  our our allied health professionals, nurse practitioners, PAs
• 11:08
  in caring for and managing of these patients.
• 11:11
  It's a it's a team effort, right? And
• 11:14
  so as we kind of started with the
• 11:15
  access issue with cardiologists, there's going to be
• 11:18
  only so many times and so many slots
• 11:20
  that you could ever see a patient as
• 11:21
  a specialist
• 11:22
  and so a big load comes on the
• 11:24
  primary care providers, both physicians and allied health
• 11:28
  professionals.
• 11:29
  And so educating them, giving them the resources,
• 11:31
  fortifying their
• 11:34
  workforce
• 11:35
  will help the patients
• 11:37
  both cardiac wise and in a broader sense.
• 11:40
  What are your thoughts on that, Sameer?
• 11:42
  No. Totally agree, Taz. I mean, again,
• 11:45
  you know, the question could go in so
• 11:47
  many different directions, honestly. And I was thinking,
• 11:48
  well, you know what? Education is a big
• 11:51
  part of it.
• 11:52
  Providing excellent clinical care, you know, day in
• 11:55
  and day out and,
• 11:56
  and, being able to retain your own trainees
• 11:59
  in a system, you know, especially like UPMC
• 12:01
  that is so wide and different hospitals are
• 12:04
  over a large geographic location
• 12:06
  creates that, you know,
• 12:08
  unity and that consistency in the quality of
• 12:11
  the care that, one would be able to
• 12:13
  provide.
• 12:14
  You know,
• 12:16
  Taz touched on something very, very important. We
• 12:18
  think that we train people
• 12:20
  and, that, they become physicians, and that's it.
• 12:23
  They they you know, whatever they learn during
• 12:25
  training, that's it, what they're using. I mean,
• 12:27
  I I can basically think back at when
• 12:30
  I was in training twenty six years ago.
• 12:32
  What I do 90% of what I do
• 12:35
  today, I did not train on doing. It's
• 12:37
  learning, you know, as we go. And that
• 12:40
  is the beauty of medicine. That is the
• 12:41
  beauty of cardiology.
• 12:43
  And, it's a it's a necessary thing to
• 12:46
  be able to continue providing the best care
• 12:48
  for our patients. So, I think that both
• 12:50
  Daz and I agree that education,
• 12:53
  in that broad sense that Taz just, you
• 12:56
  know, explained,
• 12:58
  is is probably the top priority. Of course,
• 13:00
  we can talk about research and about,
• 13:02
  a lot of other things, but, but, that
• 13:04
  if I had to be choosing one thing,
• 13:07
  that would be the top priority.
• 13:09
  Excellent. Well, this has been such an informative
• 13:11
  discussion. Thank you both for being here today
• 13:14
  and sharing your thoughts.
• 13:16
  Thank you for having us.