Latest / Becker’s Healthcare Podcast / The Business of Healthcare and Physician Leadership with Dr. Erica Rowe Urquhart

Transcript

The Business of Healthcare and Physician Leadership with Dr. Erica Rowe Urquhart · Becker’s Healthcare Podcast

• 0:02
  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
• 0:08
  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where they go to
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  - pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - This is Laura Dierda with the Becker's Healthcare
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  - podcast. I'm thrilled today to be joined by
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  - doctor Erica Urquhart,
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  - We're an orthopedic surgeon, author, and health care
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  - thought leader. Doctor Urquhart, it's a pleasure to
• 1:01
  - have you on the podcast today.
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  - Now on the side of our conversation, I
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  - know we've... I've got a lot to touch
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  - on and really are gonna dig deep into
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  - some of the things that we're very passionate
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  - about and and leadership in general. But before
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  - we do, can you introduce yourself and tell
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  - us a little bit more about
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  - your organization and and your career?
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  - Yes.
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  - Laura, thank you so much for having me.
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  - It's a pleasure to join you on Becker's
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  - Healthcare podcast.
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  - I am an orthopedic surgeon by training and
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  - a practice
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  - in an independent orthopedic surgery practice for the
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  - last
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  - twenty years.
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  - My role is a partner in the practice,
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  - and I have
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  - a direct interface with the business aspects
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  - of practicing orthopedic surgery and have watched that
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  - evolution
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  - since the early two thousands.
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  - Absolutely. That's great to hear. And, you know,
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  - definitely, a lot has happened over the last,
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  - twenty some years, and so it's just fascinating
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  - to see the evolution of the field and,
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  - you know, where things are headed too. So
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  - I'm curious. What are some of the trends
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  - that you're watching currently?
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  - Yes. I'm primarily focused on the business of
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  - health care, specifically
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  - the interaction
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  - between,
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  - practicing physicians
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  - and
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  - the,
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  - payer side of,
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  - medical practice. So
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  - I have been extremely passionate about the dollars
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  - and cents. What does it take for us
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  - to keep our practice
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  - operational
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  - and for us to be able to provide
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  - the best care that we possibly can for
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  - our patients.
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  - And I think, psychologically,
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  - that,
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  - emphasis has evolved
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  - because I've recognized that
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  - as a practicing
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  - physician or surgeon,
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  - one can't only think about
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  - the pathology
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  - and the pathophysiology
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  - of what's happening with our patients.
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  - In order to be effective
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  - as a clinician, one must be aware
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  - of what's happening
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  - on the back end on
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  - that, business side.
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  - And that doesn't mean that our decisions should
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  - be dictated,
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  - by those,
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  - that awareness
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  - or,
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  - those patterns, but
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  - certainly informed.
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  - And it's really a sink or swim ideology
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  - that, I think has come to be for
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  - me,
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  - having been in this,
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  - type of practice for such a long time.
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  - Absolutely. Yeah. I think that makes a lot
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  - of sense and, you know, it really truly
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  - to your point,
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  - as a practicing physician and and trying to
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  - learn the business and understand, you know, the
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  - dollars and cents as well as what's happening
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  - on the health care side and,
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  - you know, how
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  - to build the business as well as,
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  - treating patients and making sure they have the
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  - care they deserve is huge challenge and and
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  - something that,
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  - you know, it takes a lot of foresight
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  - and time to put into. So when you
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  - look at, you know, where the business and
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  - and practical position and core positions have evolved,
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  - what do you think are the key things
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  - that are top of mind for physicians who
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  - own their own practices and,
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  - buildings today? What what are some of the
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  - things that,
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  - you're seeing come up in the industry that
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  - would be helpful for other physicians and and
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  - our listeners to be thinking about and aware
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  - of?
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  - Yes. If,
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  - your listeners are coming from the perspective
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  - of practicing,
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  - physicians
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  - and surgeons.
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  - One of the most important things
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  - an individual
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  - must recognize
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  - is that
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  - this is a very dynamic
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  - field. And, obviously, we're very accustomed to the
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  - dynamism on the clinical side. There are always
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  - new advances,
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  - new modalities,
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  - new information.
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  - We're continually
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  - expected to learn
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  - and to grow.
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  - We can't continue to practice based on the
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  - information that we learned in medical school and
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  - residency because that information is dated
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  - and no longer applicable.
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  - Or similarly,
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  - on the business side of health care,
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  - the information that I had
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  - as someone who is entering practice
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  - is no longer applicable.
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  - The dynamics are evolving as quickly as
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  - language models are evolving or AI is evolving.
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  - It's so dynamic that
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  - one must constantly be
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  - in contact with and communication
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  - with, strategizing
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  - with those individuals who do the billing and
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  - the collections or the financial side of your
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  - practice. Because what you will see is that
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  - the strategies that were effective one year ago
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  - are no longer effective today.
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  - And the
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  - attacks that are coming in terms
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  - of obtaining reimbursement for the work that your
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  - practice has already done,
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  - they are new and evolving,
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  - and one must constantly be assessing and problem
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  - solving
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  - and growing and changing
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  - real time.
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  - So,
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  - being delinquent
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  - on your billing or being delinquent
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  - on assessing
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  - reasons for
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  - denial of claims,
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  - only allows the algorithm to then target you
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  - as a practice, your practice
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  - that does not necessarily pay attention to those
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  - things. And once practice, we'll continue to see
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  - more denials.
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  - So that is just one example of the
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  - idea that
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  - one must continually be growing, not only clinically,
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  - but also
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  - in terms of strategy
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  - and
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  - assessment,
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  - constant assessment
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  - of the business side of one's health care
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  - system or practice.
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  - Absolutely. I think that's such a powerful example
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  - of, you know, how quickly things are changing
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  - and... But how important it is to stay
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  - on top of those trends and really, you
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  - know, be close to the business and dig
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  - deep into it. Yeah. So I... I'm curious.
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  - What are you most focused on and excited
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  - about right now?
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  - I'm excited because I published my first book
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  - this year, this calendar year,
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  - and it is about the business of health
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  - care, the invisible hand wielding the scalpel,
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  - the hidden cause of America's health care crisis.
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  - And,
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  - although the title is very doomsday ish,
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  - it really does shed light as I learned
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  - through practice
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  - on the fact that much of what we
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  - do in health care
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  - is affected
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  - by
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  - those,
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  - players, those stakeholders
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  - in the health care system that
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  - are responsible
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  - for payments.
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  - Because, ultimately,
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  - if you can't buy the supplies that you
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  - need, if you cannot afford to pay your
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  - staff, then you
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  - cannot, remain in practice,
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  - or your health system cannot remain open, and
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  - you will see closures.
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  - So,
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  - that's what I'm really excited about, putting that
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  - experience, those ideas
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  - to paper. It was cathartic, but it was
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  - also,
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  - I think, very invigorating because of the conversations
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  - that I've been able to have like this
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  - one
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  - about this issue to really bring to light,
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  - the practice
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  - dynamic for someone who is in independent practice.
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  - And I'm most proud of the fact that
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  - our practice has continued to problem solve and
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  - that we still remain independent
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  - with all the pressures
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  - to join larger health systems or become employed
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  - or to
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  - look to private equity
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  - for
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  - backing.
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  - We're still able to
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  - maintain our autonomy.
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  - And we don't know for how much longer,
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  - you know, we will be able to do
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  - that. But currently,
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  - our practice is doing well, and so, you
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  - know, I'm most proud
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  - of applying
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  - the strategies that I learned in business school.
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  - I went back to school to get an
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  - MBA.
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  - Actually, it happened right before COVID started. So
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  - I was in business school during COVID,
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  - across the pond at the University of Oxford,
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  - But I'm extremely happy that I was able
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  - to take that knowledge and,
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  - use that to help our practice.
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  - That's amazing to hear. And, you know, no
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  - small feat to keep the independent practice running
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  - and thriving. To your point, I know it
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  - takes a lot of energy and resources and
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  - your time, and passion to,
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  - of that be a huge part of what
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  - you're doing. So,
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  - very, very commendable. And, you know, to your
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  - point, when you think about this process of
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  - pointing out of the book and and taking
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  - the lessons that you've learned and ensuring that
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  - perspective, what has it been like? Can you
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  - shed some insight into that process and,
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  - how much of you is reflected in those
• 10:12
  - pages as well as, on kind of a
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  - broader scope of what's happening in health care
• 10:16
  - today?
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  - Yes. So that was a challenging
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  - decision for me as I was writing the
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  - book. How much of it was going to
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  - be about me? How much of it was
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  - going to be about what was happening in
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  - health care at the time. And
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  - I sort of straddled the two. So some
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  - chapters
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  - are very dense with,
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  - data and details pertaining to
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  - what is happening on the financial side and
• 10:44
  - and with the payment side of
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  - health care. And then other aspects are more
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  - reflective.
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  - I
• 10:54
  - had our first child when I was in
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  - residency, and so I reflect on just the
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  - dynamic of
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  - coming into practice with small children
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  - and trying to do, you know, both things.
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  - But the emphasis is really on
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  - the evolution of our practice and the evolution
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  - of, again,
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  - my discovery
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  - of what makes medicine tick because I came
• 11:19
  - into medicine thinking
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  - I'm relatively smart. I was able to, you
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  - know, pass,
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  - the MCAT and get into a good medical
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  - school. I just want to do,
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  - good work
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  - for my patients
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  - with a clean conscience,
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  - and I found that
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  - that ideal is only a fraction
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  - of what it takes to be a successful
• 11:45
  - practitioner
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  - in medicine.
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  - And,
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  - so I reflect a lot on on that
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  - aspect. And that's why the invisible hand is
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  - wielding the scalpel because one would think the
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  - surgeon should be wielding the scalpel. The clinician
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  - should be making the decisions for,
• 12:04
  - his or her patients, but, ultimately,
• 12:08
  - financial decisions will affect the predisposition of a
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  - patient, whether or not they want to even
• 12:14
  - pursue health care in a given moment.
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  - It will affect
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  - whether or not a patient can have their
• 12:20
  - care timely
• 12:22
  - or it will be delayed
• 12:24
  - or whether a patient will walk away feeling
• 12:26
  - as if they cannot afford care because the
• 12:28
  - care that they thought they would get with
• 12:31
  - their insurance policy
• 12:33
  - was denied.
• 12:35
  - Absolutely. I think that's such a great point
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  - and, you know, it definitely,
• 12:39
  - hits home for a lot of our clinicians
• 12:41
  - in the audience and and those who really
• 12:43
  - are thinking about the patient first. They wanna
• 12:45
  - make sure that the patient gets the care
• 12:47
  - that they need and it is thinking through
• 12:49
  - the right things when they're,
• 12:51
  - in pain or in crisis and and, you
• 12:53
  - know, need the health care system in order
• 12:55
  - to help them. So,
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  - I I think that makes a lot of
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  - sense. It's just really exciting to
• 13:01
  - have those
• 13:02
  - insights and lessons from your own career,
• 13:05
  - reflected on those pages too and shared with
• 13:07
  - a a broader audience.
• 13:09
  - I'm curious now that you're at the point
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  - you're at, you're in your in your career
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  - and,
• 13:14
  - have spent some time reflecting, what advice would
• 13:16
  - you give to evolving leaders today, especially
• 13:18
  - those who are, clinicians,
• 13:21
  - orthopedic surgeons, and more as they're thinking about
• 13:23
  - what it will take to build their career,
• 13:25
  - whether they're... Wanna be an independent practice or,
• 13:28
  - in an employee situation? What do you... Advice
• 13:30
  - do you give, and how do you think
• 13:32
  - about all of these things?
• 13:34
  - Yes. That is a tremendous question. I think
• 13:37
  - that's where having that MBA really helped me
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  - because
• 13:41
  - we talk a lot in medical school about,
• 13:44
  - again, the diagnosis
• 13:46
  - and
• 13:47
  - communication,
• 13:48
  - helping a patient to get buy in with
• 13:52
  - what needs to happen for their care. But
• 13:54
  - there's so much more that is involved in
• 13:57
  - practicing.
• 13:59
  - One cannot practice
• 14:00
  - alone or in isolation.
• 14:04
  - You have staff that you interface with. You
• 14:07
  - have physical therapists
• 14:09
  - or other tertiary care individuals who will be
• 14:13
  - involved
• 14:14
  - in your patient's treatment plan.
• 14:16
  - And so I like the the phrase evolving
• 14:20
  - leaders because
• 14:21
  - leadership is a huge component
• 14:24
  - of being able to practice effectively.
• 14:27
  - How do you get your staff to show
• 14:29
  - up every day and to
• 14:31
  - buy into
• 14:33
  - your motto, your approach
• 14:35
  - to patient care?
• 14:37
  - How do you make sure that you're getting,
• 14:40
  - you know, all of the information,
• 14:42
  - the messages, the the communication
• 14:44
  - between the hospitals and your practice or the
• 14:48
  - patients
• 14:49
  - and your practice and, ultimately, you... That that
• 14:52
  - information is getting to you timely,
• 14:54
  - that it is accurate, and that you are
• 14:56
  - able to respond as well timely.
• 15:00
  - So the advice that I give to evolving
• 15:03
  - leaders is
• 15:04
  - you have to, number one,
• 15:08
  - be amenable to the dynamism
• 15:11
  - of
• 15:13
  - the sector.
• 15:14
  - Health care is an...
• 15:16
  - A a tremendously
• 15:17
  - dynamic
• 15:18
  - sector.
• 15:20
  - And as such,
• 15:22
  - you have to be willing to
• 15:25
  - evolve,
• 15:26
  - to change,
• 15:27
  - to
• 15:27
  - strategize,
• 15:29
  - to
• 15:30
  - continue to learn and grow.
• 15:33
  - So leaning into the fact that health care
• 15:36
  - is dynamic,
• 15:38
  - as well,
• 15:39
  - be humble enough to be open to constructive
• 15:43
  - feedback, not only from those that are on
• 15:46
  - par with your level of training, but with
• 15:48
  - your staff and with your patients.
• 15:52
  - Having a degree of humility and an openness
• 15:54
  - to constructive criticism and information,
• 15:58
  - recognizing that, again,
• 16:00
  - one cannot be dogmatic
• 16:02
  - or stuck in a fixed pattern of approaching
• 16:06
  - things.
• 16:07
  - I think also in the spec... In the
• 16:10
  - sphere, in the sector of
• 16:12
  - evolving leaders, there's always the focus on work
• 16:16
  - life balance and,
• 16:19
  - payment. So one might consider,
• 16:23
  - pursuing an employed position. But even in an
• 16:25
  - employed position,
• 16:27
  - again, one must be flexible
• 16:30
  - and recognize that work life balance for you
• 16:34
  - could very well mean a loss of work
• 16:37
  - life balance for your partner
• 16:39
  - or your associates.
• 16:41
  - And so not being so
• 16:45
  - self consumed that
• 16:47
  - you don't recognize
• 16:48
  - that,
• 16:50
  - sometimes by
• 16:52
  - minimizing or taking,
• 16:54
  - 5%
• 16:55
  - away from your plate, you're adding 5% to
• 16:58
  - someone else's plate. So having that ability to
• 17:01
  - communicate and that awareness to recognize that
• 17:05
  - everyone is looking for work life balance,
• 17:07
  - and you're not the only one.
• 17:09
  - I could go on and on, but
• 17:12
  - those are just a few tips
• 17:14
  - and tricks that I would suggest for those
• 17:16
  - that are in that evolving position.
• 17:19
  - Absolutely. I think those are are great tips,
• 17:21
  - great advice, and and really truly could apply
• 17:24
  - in so many different areas,
• 17:26
  - whether you're an evolving leader, emerging leader in
• 17:29
  - the surgeon space,
• 17:30
  - leadership
• 17:31
  - in other
• 17:32
  - aspects of the health care system too. So
• 17:34
  - I think it's definitely not a lot,
• 17:37
  - to think about when you are looking at
• 17:38
  - personal growth, continuous learning, staying humble, and more.
• 17:42
  - Doctor Urquhart, thank you so much for joining
• 17:43
  - us on the podcast today. This has been
• 17:45
  - such a fun conversation.
• 17:47
  - Really, really helpful to understand where you've been
• 17:50
  - and how you're thinking about the future. And
• 17:52
  - could you tell us just one more time
• 17:53
  - the name of your book and where to
• 17:54
  - find it? Oh, yes. Thank you for asking.
• 17:58
  - So my book is entitled
• 18:00
  - The Invisible
• 18:01
  - Hand
• 18:03
  - Wielding
• 18:04
  - the Scalpel,
• 18:05
  - and the subtitle is The Hidden Cause of
• 18:07
  - America's Healthcare Crisis.
• 18:09
  - And it can be found anywhere books are
• 18:11
  - sold, Barnes and Noble, Amazon,
• 18:15
  - some wholesale booksellers,
• 18:17
  - but definitely
• 18:18
  - online at Barnes and Noble and Amazon.
• 18:22
  - Fantastic. Thanks so much, doctor Urquhart, and congratulations
• 18:25
  - again on,
• 18:26
  - publishing the book, Amazing Career, and look forward
• 18:28
  - to connecting with you again soon.
• 18:31
  - Thank you.