Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Angelo Milazzo, Vice Chair of Practice and Clinical Affairs at Duke Health

Transcript

Dr. Angelo Milazzo, Vice Chair of Practice and Clinical Affairs at Duke Health · Becker’s Healthcare - Clinical Leadership Podcast

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That's the beckershospitalreview.com
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1:14
This is Chris Sosa with the Becker's HealthCare
1:16
podcast.
1:17
I'm thrilled to be joined by doctor Angelo
1:19
Milazzo of Duke Health, where he is vice
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chair of practice and clinical affairs in the
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pediatrics department and a professor in the pediatrics
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division. Doctor Milazzo, thank you for joining us
1:28
today.
1:29
Thank you, Chris. It's a pleasure to be
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back with Becker's and speaking with you today.
1:34
As you just mentioned, you are a frequent
1:36
guest on our podcast, which is wonderful. But
1:38
for our listeners who are not familiar with
1:40
you, could you please introduce yourself and tell
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us a bit about your background?
1:45
Happy to do it. So I am a
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pediatric cardiologist
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by training, so I take care of children
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of all ages who have
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either acquired or congenital cardiac problems,
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and that keeps me very busy.
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I'm also
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the administrator at Duke Children's Hospital here in
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Durham, North Carolina.
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I serve as the vice chair
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for clinical practice.
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So I have the opportunity
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to work on
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strategic growth and operational management for our clinical
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practice, which includes
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primary care, specialty care,
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procedural care, emergency care,
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inpatient care, outpatient care and a variety
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of variations of all those things.
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And what's
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so gratifying
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is the opportunity to
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speak with the Becker's team because I know
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that you guys are constantly
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thinking about, how we can iterate and improve
2:39
and advance the ball, so to speak, in
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what we're doing.
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And that's what I try to do on
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a daily basis in my role as the
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vice chair of the department.
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I'm constantly thinking through how we can advance
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the care,
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of children here in the central part of
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North Carolina.
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Doctor, thank you for setting up the rest
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of this podcast so beautifully.
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Where we're gonna start is what are your
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top priorities today at Duke Health?
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At Duke Health, we are
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wrestling with many
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of the challenges that our colleagues,
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our sister institutions, our like minded institutions
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across the region and across the country are
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wrestling with,
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we are looking at workforce challenges. And that's
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probably one of the top priorities
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in pediatric care because,
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as you may know, the pediatric workforce,
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particularly in the last couple of years, has
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been challenged, challenged both at the level of
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our trainees where we're seeing
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less people choosing pediatric residencies and pediatric fellowships.
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We're beginning to see shortages in many
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critical and important areas of pediatric practice, including
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some very important
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sub specialty areas like endocrinology,
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rheumatology,
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behavioral medicine, and adolescent health.
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Another priority is access.
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We are thinking through all the ways that
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we can expand,
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grow
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and iterate on roots of access to our
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services.
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We're trying to modernize our approach and
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incorporate many of the tools that we've learned
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to use in the last few years, particularly
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digital tools like telemedicine
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and virtual visits, but we're also trying to
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think of ways to utilize our fixed resources
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so that we can quite literally get more
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patients
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into our clinics, into our hospitals,
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into our operating rooms, into our procedural suites.
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The third priority that we have is thinking
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about how to manage
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populations and this is a really key area
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in pediatric care
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where traditionally
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we tend to be focused on the patient
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in front of us, the patient who's there
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to see us for a clinic visit
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or for
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procedural
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episode
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or possibly for a hospitalization,
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we need to think differently today. We need
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to think about how to manage not only
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the patient who is sitting in front of
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us but also
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the patient as he or she exists within
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a community of other patients.
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We need to think about the broad health
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of populations
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as they are impacted by socioeconomic
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challenges,
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by changes in things like climate,
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by changes in things like the way health
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care gets funded and paid for.
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So it's a shift in focus from the
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individual to the community and to the population.
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It's an exciting challenge, but it's one that
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requires many different stakeholders to come together,
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strategize together,
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in a way that is very different than
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how we used to provide care.
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Thank you for laying all out all of
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that, doctor. Obviously, those are challenges, as you
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mentioned, that are being faced across the health
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care spectrum right now. As we look further
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ahead,
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how do you anticipate your role and your
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teams is gonna evolve over the next 18
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months in particular as it relates to the
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challenges that you just laid out?
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I think all of us who are leaders
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in medicine need to become chief experience officers.
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And I mean that from the perspective of
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the experience of the patient and the family,
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but also the experience
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of the person providing care, whether it's a
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physician or an advanced practice provider
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or a medical technologist
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or a nurse or another valuable team member.
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We need to make sure that people who
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come to work in health care have a
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great experience
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of work.
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We saw in the last few years of
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the pandemic many people exiting health care.
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Pediatrics was not immune
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to that phenomenon.
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We need to make sure that our children's
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hospitals,
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our offices,
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our operating theaters,
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our procedural suites
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are designed
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with the needs of the patient in mind,
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with the preferences of the patient in mind,
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but also with the needs of the providers
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and the clinicians in mind. We want people
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to come to work every day wanting to
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be happy to see their patients.
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A key challenge and particularly over the next
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18 months
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is building structures around our physicians, around our
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advanced practice providers so that we can relieve
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them of some of the administrative burden of
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care. This is a top challenge for my
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institution and many others. We're beginning to incorporate
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some new tools,
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things like
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artificial intelligence assisted visit transcriptions,
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things like
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triage teams,
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which work remotely
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to review
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the endless stream of messages that are coming
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through our electronic portals from our patients, whether
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they need prescription refills
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or medical advice or appointments.
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So building
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these really thorough, these really
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heavily
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resourced
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structural elements around our personnel who are providing
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care, that's something that we are working on
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right now.
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Of course, with the shifting economics of care,
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paying for these things is always a challenge.
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But what we find
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in many cases is that
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the return on investment is quite high, both
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from the perspective of
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sustaining the mission of the organization, perhaps more
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importantly, however, from the perspective of keeping our
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people happy at work.
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Thank you again, doctor, for
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outlining all those challenges and how they can
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be addressed.
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Looking forward to even more.
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What are you excited about right now? What
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makes you nervous? It's a 2 part question,
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and please feel free to answer it in
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whichever order you find appropriate.
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I'm a little bit nervous about some of
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the changes that we will be dealing with
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in academic pediatric health care that are structured
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around
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changes to our training programs.
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And what I mean is that, you know,
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we train the next generation of pediatricians in
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our residencies and in our fellowship programs.
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These exist all across the country at all
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of the major children's centers, including mine here
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here at Duke. And what we are about
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to undergo
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and this happens every several years as the
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curriculum of these programs gets reevaluated.
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We're about to undergo another seismic shift
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in the division of labor.
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Increasingly,
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our trainees are being asked to do more
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outside of the hospital, which may be very
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appropriate for their training, but it leaves gaps,
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real gaps in coverage inside the hospital, whether
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it's in our emergency department,
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our critical care unit, our neonatal intensive care
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unit, our cardiac intensive care unit, or one
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of the number of other areas where we
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take care of patients
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in our hospital platform. That's gonna be a
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huge challenge. We're gonna have to think about
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how we leverage the skills of our advanced
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practice providers, so our nurse practitioners
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and our physician assistants. But it's also gonna
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mean that
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more work is likely to fall on attending
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physicians.
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I think most of us understand this is
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to be the case and I think most
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of us are willing to pitch in and
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do what we can, but at the same
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time, we need to be really careful.
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We need to protect our professional autonomy as
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much as possible. And again,
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kind of going back to my previous answer,
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we need to make sure that we've designed
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the work so that people feel really satisfied
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at the end of the day. It's an
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incredible challenge
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and something that I think we're all nervous
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about. In terms of what I'm excited about
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is related to something I mentioned before,
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we have some amazing tools that we're beginning
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to incorporate into practice and yes,
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people have heard a lot about digital tools
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in healthcare,
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people have heard a lot of buzz about
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artificial intelligence.
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And to some extent, like any new technology,
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there's sort of a haze of uncertainty
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and maybe some overhyping of these things. But
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at the core, what I like about our
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approach here at Duke is we're getting physicians
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involved in the way these new tools are
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disseminated and rolled out. So for example, we're
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about to launch
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a really interesting study where we're gonna test
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2 different kinds
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of artificial intelligence
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enabled systems,
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which can help physicians
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and other clinicians
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transcribe their visits, their clinic visits in real
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time, generating
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a office letter that can later be reviewed
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and edited.
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This sounds like
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the modern version
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of the medical transcriptionist, but it actually has
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the potential to be much more
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because embedded in these technologies
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is some ability
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to incorporate outside information, whether it's patient educational
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information, whether it's clinical decision support, that's the
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really exciting promise of this technology. And, again,
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the theme here is the more we can
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build
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support systems around our physicians,
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around our advanced practice providers,
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around our other team members,
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the more satisfying the work becomes.
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And I actually believe that translates into better
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care for patients and families.
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So lots to be excited about, some things
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to be nervous about,
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but, this is how it goes in academic
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medicine, and we are all looking forward to
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thinking through these challenges.
11:55
Lastly, doctor Milazzo, what issue or aspect of
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children's health care do you believe deserves a
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brighter spotlight than it's getting at the moment?
12:03
I think we need to shine a spotlight
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on the position of children in society in
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general. I think pediatricians can be really strong
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advocates for children. But when we think about
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the
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value or sometimes the lack thereof that we
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place on children across other areas of our
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society,
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whether it's in
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advocacy
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for the rights of children,
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whether it's in advocacy for the safety of
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children,
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whether it's in advocacy for the way children
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are educated,
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all of these things are really important.
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And I think in some ways,
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a society can be judged
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by how
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it deals with and how it supports its
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most vulnerable
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members. And to some extent, our children are
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quite vulnerable.
12:51
Pediatricians
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tend to, as I said, they tend to
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advocate for their patients, they tend to advocate
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for young children and families. I think that's
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a really important role for
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pediatricians, for pediatric health systems
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like mine and like other children's hospitals, really
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important role for them to play in society.
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The more we can
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invest today
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in children, whether it's their health, whether it's
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their education,
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whether it's their
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ability
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to be supported by society in general,
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greater the dividends will be in the future.
13:27
It will, I think,
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pay dividends in terms of,
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a spectacular workforce.
13:33
I think it will pay dividends in terms
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of what children are able to achieve when
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they move on to higher education.
13:39
I think it will pay dividends in terms
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of just an overall brightening
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of our future
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for
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these young kids who will grow up and
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go on to do presumably
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amazing and wonderful things.
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So this is an area where I think
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we can all pitch in regardless of what
13:57
we do, whether we're physicians,
13:59
whether we're podcasters,
14:00
whether we're, people like the great people at
14:03
Becker's who are thinking about administrative challenges in
14:05
medicine and and related issues. I think we
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all have a role to play here.
14:09
Doctor, thank you for being so generous with
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your time and your insights today. We absolutely
14:14
cannot wait to share them with the rest
14:15
of our audience. I look forward to connecting
14:17
with you soon.
14:19
Chris, thank you so much. As always, it's
14:21
a great pleasure
14:22
to speak with the team at Becker's,
14:24
and I look forward to joining you again
14:26
in the future for further conversations.