Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Scott Soefje, Director of Pharmacy Cancer Care at Mayo Clinic

Transcript

Dr. Scott Soefje, Director of Pharmacy Cancer Care at Mayo Clinic · Becker’s Healthcare - Clinical Leadership Podcast

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  Hi everyone. Welcome to a Becker's podcast.
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  On the line with us is Scott Ji.
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  He is an amazing pharmacy expert.
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  I'm really excited to get his thoughts on the expert space. Um,
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  we're just gonna go ahead and start diving in. Scott,
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  could you please introduce yourself and tell us a bit about your background?
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  Uh, yeah. Hi, I'm glad to be here. My name is Scott Epci.
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  I am the current director of Pharmacy Cancer care services at the Mayo Clinic in
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  Rochester, Minnesota. Uh,
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  which basically means I oversee the oncology service line at,
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  at the Rochester campus in Mayo, at Mayo. Uh,
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  and then I coordinate oncology pharmacy services across the enterprise where
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  we're trying to get everything aligned and, and doing it about the,
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  the same way wherever we can. Um, I'm a hospital pharmacist, uh,
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  by training.
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  I'm one of those pharmacists that got a bachelor of science back in the
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  eighties. I worked a few years in hospitals,
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  went back and got my doctor of pharmacy degree, did a residency fellowship,
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  and I have had a breadth of experience, uh, academia, uh,
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  clinical practice. I did a little bit of industry and then, uh,
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  about 15 years ago,
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  made a decision to go into pharmacy administration and really have been focusing
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  on the administrative side of oncology care. And so that's where I am now.
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  I've bounced around, worked at Yale New Haven for a while,
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  director of Pharmacy in Austin, Texas for a while now.
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  I'm here at Mayo and I'm loving it here.
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  Great, great. I'm glad you're loving it at Mayo.
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  What opportunities or headwinds, uh, do you kind of have your eye on right now?
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  Yeah, I am, I'm really intrigued with ai,
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  whether you call it in augmented intelligence or artificial intelligence
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  or whatever. Uh, a lot of what pharmacists do,
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  particularly on that operational side,
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  that order verification side is pattern recognition.
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  And I really think we're gonna get to a point where the pharmacist doesn't have
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  to do as much work. If the thing is normal, everything looks good,
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  there's no changes to the order, uh, it meets the criteria.
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  It just flows all the way through.
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  And then the AI flags us to be looking at those exceptions. And, you know,
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  this, this is something you should take a look at, kind of thing.
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  And what I'm excited about then is it begins to get us to that point where we
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  wanted to be for several decades now of let's get you
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  out in front of the patient,
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  let's have the pharmacist face-to-face with patients, uh, shoulder,
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  shoulder with providers in the clinics. Um,
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  we're starting to do this here at Mayo where we're getting more and more people
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  into the clinic.
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  And I think it's really got opportunities and we're finding that pharmacists can
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  really help things in the clinic to become more efficient.
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  Uh, we find when the pharmacists actually are doing the chemo orders,
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  the number of changes we have to make on the backside is less, uh,
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  when the pharmacists are managing some of the toxicities and side effects, uh,
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  patients do a little better.
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  And those are the kind of things we're really excited about and want to get out
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  and do. Uh, the other thing I'm real interested in is, uh, robotics.
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  We've installed our first chemo compounding robot here at Mayo Clinic.
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  It's doing roughly 20% of our mixes, uh, every day. Uh,
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  and again, the question is,
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  could we get to the point where we don't have to have a human hands
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  touch these hazardous drugs? And I think that would be beneficial to everybody.
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  And and I don't think it's gonna replace people.
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  What I think it's gonna do is free people up to become more efficient, uh,
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  work, uh, work smarter, not harder, those kind of things.
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  And so I'm really excited about where we're gonna be over the next five or six
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  years. I think some of the roadblocks,
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  all of this is there's some cost involved.
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  There's a lot of regulatory barriers we're gonna have to overcome. Uh,
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  there's a lot of, of, that's the way we've done it kind of attitudes,
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  particularly at the regulatory level. Uh,
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  and we're gonna have to work through some of these to show that these things are
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  safe, efficient in the way to go. So I,
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  I think it's a fun time to be a pharmacist,
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  fun time to be a pharmacy administrator as you're starting to put things
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  together to say,
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  what can we do to become more efficient and show more value to people.
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  I understand the, I'm really interested in the, uh,
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  robot than you mentioned. Of the 20% of mixes every day,
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  you said it's the first chemo.
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  It it's the first chemotherapy compounding robot in the state of Minnesota. Now,
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  there, there are others across the country. We're not the first in the country,
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  but uh, we're the first in the state of Minnesota. Um,
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  and so it's set up that it will actually compound the chemotherapy for us.
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  Uh, so the technician loads the robot with the appropriate supplies,
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  and then the robot uses barcode technology, optical scanning,
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  uh, graver metric weighing and actually prepares the chemotherapy,
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  uh, and is very, very accurate. Uh, the, the number of rejections is very,
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  very tiny. Uh, and so it's,
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  it's one of those things we really think are safe and effective and it frees our
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  technician.
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  They can load the robot and then they can go off and do something else while the
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  robot's compounding. You know,
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  those are the kind of things that we really like to see more and more of as we
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  go. The question is how do we make the robots more efficient also, um, you know,
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  it it, can we get to the point where we're doing 50% or something like that.
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  That's where we'd like to be over time.
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  And how far or close in the future do you think that, you know,
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  20% to 50% changes?
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  Uh, I don't think it's as far off as we think it is. Uh, we've seen some,
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  some demos at some of the,
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  the national meetings of robots that are doubling the volume,
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  the capacities that we do now. Um,
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  and I think it's just getting those robots to market,
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  getting 'em in and set up and ready to go. Uh, and then I,
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  I suspect there's another wave coming behind that. And so there,
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  there's gonna be a diminishing return,
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  there's gonna be a point where it can't mix any faster that physically. Uh,
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  but I think, uh,
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  how do you build these robots where you've got multiple arms doing multiple
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  things at the same time and it makes it an efficient process to
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  move the drugs through the system. Um, again,
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  the faster we compound things, the faster we get drugs out the door,
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  the faster we can treat patients and maybe we can move that patient
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  through the system just a little bit quicker.
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  And if we do that for all of the patients that come in today,
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  maybe we treat more patients and we have better access, that kind of stuff.
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  That's the long-term goal when we're trying to make the clinic more efficient.
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  You also mentioned kind of regulatory, uh, barriers and,
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  you know, an attitude of, well, that's the way we've always done it.
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  Can you kind of delve more into, you know,
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  what might kind of halt or pause these advancements?
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  There are regulatory boards like the Board of Pharmacy,
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  those kind of things that are reluctant to make
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  radical jumps because they're concerned with safety,
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  population safety, et cetera. Um,
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  and so what you have to do whenever you're making these technological jumps
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  is show to the regulatory agencies,
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  this process is safe. We can do this process as well,
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  if not better than if a human does it and prove to them that
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  these systems work. It takes time to do that.
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  And so when you're sitting there talking to someone who's never seen a robot
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  before, try to do the work, you're, you're having to,
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  you're having to explain to them, this is effective, this is safe,
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  this is not something we have to worry about.
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  And then sometimes you even have to go to the legislators to get the laws
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  changed because there's a law that may prevent you from doing that.
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  All of that process takes time. Um,
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  and it's just one of those things that we have to,
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  we we're constantly having to deal with and healthcare as
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  technology evolves, I think one of the,
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  one of the issues we're facing right now is technology is evolving faster than
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  the regulatory and policy agencies can keep up with.
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  And so we're just gonna have to work through those processes over time.
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  Eventually they'll come around,
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  eventually the law will change or the re regulatory policy will change.
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  It's just gonna be able to show,
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  it's gonna require us to show that this is the appropriate change to make and
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  this is the appropriate time to do it.
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  And I'm sure many other hospital pharmacy leaders, um,
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  would like to see regular regulatory changes made soon. Um, you know,
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  if it is bringing up ISTs and pharmacy technicians times,
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  um, so they can work smarter, not harder, like you said, um,
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  could help kind of alleviate some of the workforce shortages, I'm sure.
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  Yeah, and unfortunately,
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  most pharmacies are regulated at the state level. So, you know,
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  across the country we almost literally have to do this 50 times.
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  You have to convince each state that this is the right thing to do.
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  Now there'll be a momentum, there'll be a wave as more and more people,
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  and then more and more states adopt it. It gets easier for the, the, the,
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  the later states to adopt it. But if you're sort of in that front waiver,
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  so sometimes it takes you a while to get things changed, to get things adopted,
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  get things ready to where you want them to be.
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  Right, right. Um,
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  just to kind of move it out of the robot AI topic for a bit,
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  you said it's a fun time to be a pharmacy administrator right now.
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  Are there any other, um, kind of trends that excite you right now?
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  Um, I, I really, there,
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  there's a shortage of oncologists in the country right now. Um,
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  there's a shortage of oncology nurses.
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  There's a shortage of advanced practice providers.
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  So for me,
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  I'm sitting there thinking about what can a pharmacist do in clinic to provide
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  their clinical expertise on drug therapy to help
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  our pharma, our, our, our provider colleagues to reduce burnout,
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  to help them get patients through, to see more patients,
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  to do those things we need to do to meet the demands of a growing cancer
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  population. Um, cancer is a disease of old age,
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  and so as the population increases, as it gets older,
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  we're gonna see more and more cancer patients. So we've,
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  we've got this perfect situation set up where pharmacists can step in
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  and be almost providers,
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  primary providers or providers to help make sure the therapy is being
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  done, uh, appropriately. It's being done effectively.
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  And it really excites me to see what we can do from a pharmacy perspective as
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  we're put in these, uh, clinic positions. Um, I think it's gonna be very,
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  very interesting. Uh, we're also in that we're,
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  you know, we're starting that transition of moving from quantity to quality
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  and how does reimbursement follow that process? And that's a tricky,
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  that's a tricky situation as we start looking at changing reimbursement
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  models, evolution of, of the economics of cancer.
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  Uh,
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  and then you combine that with cancer drugs that are just skyrocketing in price.
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  Uh, we have to sit back and say,
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  what are we gonna do to show value to make sure this whole process works?
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  And to me,
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  I think pharmacy can shine with that because we can show value by making sure
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  we're using the right drug, right time, right patient,
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  and doing it in the right way so that we get the best outcome.
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  You put that all together, you're optimizing quality,
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  and when you optimize quality, then you improve the value to patients.
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  And that's something that we're really,
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  we're really looking at to try to optimize at this point in time.
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  Right, right. Something else that I wanted to kind of poke your brain about is
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  because of the, you know, pharmacy oncology angle, and there are a lot of, uh,
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  cancer drugs that I know are in pretty severe shortages right now. Um,
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  what, what are your thoughts on that?
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  Drug shortages have been a significant problem for the last decade,
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  decade and a half. Uh,
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  and they continue to be shortages just about the time you think you've reached
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  the point where you're not gonna have to worry about a shortage,
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  another one pops up.
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  And so we have constantly had to deal with drug shortages again over the last
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  10 to 15 years. And we're not, I would, I would say we're getting better at it,
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  but it is still a constant headache.
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  It's one of those things when you start talking about burnout in,
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  in healthcare providers, when you're constantly having to juggle,
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  can I treat this patient the way they needed to need to be treated?
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  Or am I gonna have to find an alternative because we can't get the drug,
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  that creates a significant, uh, significant pressure.
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  And that pressure leads to burnout.
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  And then particularly when you run into one of those severe shortages where
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  you're having to say, I can treat this patient but not that one.
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  And you're starting to have to decide, this patient's curable, this one's not,
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  I'm gonna give the patient this drug because that's the best use of the drug.
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  That's a tough situation to be in. It's a tough situation to put anybody in.
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  And, um, you know, at,
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  at Mayo we have a great team that stays on top of this.
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  And so we're,
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  we're trying to prevent getting into that situation to the best of our
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  abilities. Uh, but we're always worried about it. We're always looking at it,
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  we're always trying to figure out how do we stay ahead of the shortages. Uh,
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  and I think that's something that everybody across the country's having to deal
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  with. I wish there was a way to fix it,
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  and I don't know the way to fix it other than
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  incentivizing, uh, generic companies to make some of these cheaper drugs,
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  uh, and incentivize them by, maybe we have to pay more for them, uh,
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  which means then the reimbursement has to go up and all these other things.
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  But that may be the only way we can figure out how to make this process work.
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  While I still have you for a few more minutes,
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  is there anything else you'd like to add?
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  I, I just think that as oncology continues to grow, you know,
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  we're getting, we're getting better drugs, we're getting more treatments,
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  we're getting interesting drugs. Uh,
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  we're on the wave of cellular therapy and gene therapy.
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  I think it's a great time to be an oncology pharmacist because, uh, we get to,
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  we get to work with the cutting edge technologies, uh,
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  both on the drug side and now even on the technological side. Uh,
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  and we can be right there frontline to help patients.
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  And so it's one of those things that I'm excited to be an oncology pharmacist at
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  this point in time, and I think that's something that we can really,
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  really take a step forward in helping the overall value
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  to patients, the overall value to the institutions,
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  and ultimately the over overall value to society as we improve healthcare
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  globally across, you know, our country.
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  And I think that's one of the things that's really fun to think about as a
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  pharmacy administrator. And I think that's why it's fun to be, uh,
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  at this point in time.
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  Great. Well, thank you again so much for your time, Scott.
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  That's all we have for today. Um, yeah. Thank, thank you. Thank you. Thank you.
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