Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Dr. Goutham Rao, Chair of Family Medicine and Community Health at University Hospitals of Cleveland and Case Western Reserve University

Transcript

Dr. Goutham Rao, Chair of Family Medicine and Community Health at University Hospitals of Cleveland and Case Western Reserve University · Becker’s Healthcare -- Pediatric Leadership Podcast

• 0:00
  Welcome to Becker's Healthcare Podcast. I'm Chris Sosa,
• 0:02
  your host, and I'm thrilled to be joined
• 0:04
  today by doctor Gautam Rao. He's the Jack
• 0:06
  Medallie professor and chairman for the department of
• 0:08
  family medicine and community health at University Hospitals
• 0:11
  of Cleveland and Case Western Reserve University.
• 0:14
  He's also the chief clinician experience officer for
• 0:17
  University Hospitals Health System and editor in chief
• 0:20
  of Family Practice.
• 0:21
  Gautam, thank you for joining us today.
• 0:23
  Thank you, Chris. Thanks so much for having
• 0:25
  me.
• 0:26
  Gautam, for those in our audience who may
• 0:28
  not be familiar with you and your work,
• 0:30
  could you just please introduce yourself and tell
• 0:32
  us a little bit about your background?
• 0:33
  Yeah. So first and foremost, I am a
• 0:35
  family physician, have been one for, I guess,
• 0:38
  twenty nine years or so. Started my career
• 0:40
  after residency in rural Northern Ontario,
• 0:44
  then came to Pittsburgh, Pennsylvania, where I did
• 0:46
  a fellowship in faculty development and research methods,
• 0:50
  and really became been an academic family physician
• 0:53
  ever since, that point, but also practicing family
• 0:56
  medicine regularly.
• 0:58
  I'm also an obesity medicine physician. I was
• 1:00
  one of the first, physicians board certified in
• 1:03
  that, in that particular subspecialty.
• 1:06
  I'm a health services researcher with with, with
• 1:09
  a long well, many years in in the
• 1:11
  field, actually. I won't tell you how many,
• 1:13
  But, but, I've served on study sections and
• 1:16
  received funding from major agencies.
• 1:19
  I've I'm pretty experienced with medical editing, and
• 1:21
  I also serve on the US Preventive Services
• 1:23
  Task Force.
• 1:25
  Gautam, you certainly wear a lot of hats,
• 1:27
  and that's also very impressive and very important
• 1:29
  to all all your colleagues, I'm sure. We've
• 1:32
  got you on the podcast today to discuss,
• 1:34
  recruiting physicians.
• 1:35
  It was part of the issue of family
• 1:37
  practice, which again, you're the editor of that
• 1:39
  publication. So first question I have for you
• 1:42
  on that topic is simply, what are the
• 1:44
  challenges that university hospitals and the other organizations
• 1:47
  for which you work? What are the challenges
• 1:49
  you face in recruiting physicians to primary care
• 1:51
  in specifics?
• 1:53
  Yeah. So, you know, there are there are
• 1:54
  unique challenges to every health care system, Chris.
• 1:57
  There's no no doubt about it. But I
• 1:59
  think globally, we all have the same problem.
• 2:02
  And that's what struck me when we put
• 2:03
  together this issue. It's not just an American
• 2:06
  problem or a North American problem. This is
• 2:07
  a problem in Europe. It's a problem in
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  Asia. It's a problem in many, many parts
• 2:11
  of the
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  world. Uniquely, as the chair of the department,
• 2:14
  I am responsible for recruiting primary care physicians
• 2:17
  to our department.
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  And I realize that we face a number
• 2:21
  of headwinds in the sense that they can
• 2:23
  pretty much go anywhere they want. And, they've
• 2:26
  got lots of opportunities out there. And unless
• 2:28
  there's a really strong connection to, to our
• 2:31
  system, and I think we do a wonderful
• 2:33
  job in recruitment and, and
• 2:38
  and everything else that a physician might be
• 2:39
  looking for. It's very competitive. There's simply
• 2:43
  so much demand and so few physicians available.
• 2:47
  And that's common to to many other health
• 2:49
  care systems, not just in Cleveland, but across
• 2:51
  the country and around the world as well.
• 2:53
  And, Gautam, when you look at how competitive
• 2:56
  the field is,
• 2:58
  what is it that helps university hospitals or
• 3:01
  any other health systems stand out then?
• 3:04
  Yeah. So I think there's there's different things,
• 3:06
  Chris, that have come up in putting together
• 3:08
  this issue. So when I asked when I
• 3:10
  put together the call for papers, I was
• 3:12
  very open minded. I didn't know what to
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  expect. As long as you have an interesting
• 3:16
  idea for expanding the primary care workforce,
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  send me the paper. I'll take a look
• 3:21
  at it. And if I think it's promising,
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  we'll send it out for review and get
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  some feedback and maybe and of of course,
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  a very small proportion are actually published
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  because it is competitive.
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  But I think that that,
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  some of the the things that
• 3:34
  we found in the issue are things that
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  we're trying to do here at university hospitals
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  as well
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  and is to provide something that's a little
• 3:43
  bit interesting. So there's a and, yeah, as
• 3:45
  a chief clinician experience officer, which in other
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  systems, I know you're with Becker's, they call
• 3:49
  wellness officer, but it's a it's a similar
• 3:51
  sort of thing. There's an age old adage
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  that if you give a physician
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  the opportunity to pursue what they're truly passionate
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  about 20% of the time,
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  they will won't mind doing the other 80%.
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  That may be less interesting and that applies
• 4:05
  across specialties. If you have a gastroenterologist
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  who loves pancreatitis
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  and you give him pancreatitis clinic, maybe half
• 4:12
  day or full day a week, he'll do
• 4:13
  all the endoscopies
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  and other things that may not be of
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  that in much interest. Family physicians are no
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  different. Primary care physicians in other disciplines like
• 4:22
  OBGYN, pediatrics, general internal medicine are no different.
• 4:25
  They have their passions. I'm very passionate about
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  mitigating cardiovascular risk and obesity treatment. There are
• 4:31
  others in my department who are passionate about
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  addiction medicine, for example, others in geriatrics.
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  The LGBTQ,
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  health care service line is in my department.
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  We have a woman who's very passionate about
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  caring for those communities. And if she has
• 4:45
  that opportunity
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  one or two days a week, the routine
• 4:48
  primary care becomes more interesting. So that's something
• 4:50
  we would promise people when they when they
• 4:52
  come here, we can make your life a
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  little bit more interesting.
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  That, I think, is what distinguishes us from
• 4:58
  other places that are struggling to recruit.
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  Other places can recruit
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  by offering larger,
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  financial compensation packages,
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  and that's great.
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  I think that's something that some people might
• 5:11
  be looking for. There's loan repayments, of course.
• 5:15
  There are other approaches that kind of, you
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  know, look at the pipeline of of potential
• 5:20
  students who might be interested in family medicine
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  starting a little bit further back.
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  I think all of those are great. Some
• 5:26
  of the ideas we came that came through
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  the issue
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  reflect those fundamental ideas that have been around
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  a long time. But I will say this,
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  the definition of insanity is doing the same
• 5:37
  thing over and over again and expecting different
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  results. Right? So I think we have to
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  make primary care more interesting.
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  You know, not paying more because that doesn't
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  seem to really do much and will never
• 5:48
  pay as much as some of the other
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  subspecialties
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  or not trying to convince people at a
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  very young age that this is the direction
• 5:54
  they need to go in because they may
• 5:55
  not choose to. But how about just making
• 5:57
  the actual job more interesting? That that's that's
• 5:59
  my approach.
• 6:02
  Gautam, the 20% number that you hit on,
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  and I'm I'm glad you mentioned the emotional
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  components
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  of
• 6:10
  recruiting
• 6:11
  physicians. So how did that number, come about?
• 6:14
  Well, that's been that's been around for a
• 6:16
  very long time. So I I circulate
• 6:18
  in in the wellness,
• 6:21
  communities of every health system. As you know,
• 6:24
  burnout became a big issue about six or
• 6:26
  seven years ago, and it really accelerated during
• 6:28
  the pandemic.
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  And, you know, you can remember the scenes
• 6:31
  from New York City where health care workers
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  are really, really working far too hard and
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  and suffering some psychological
• 6:38
  crises.
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  So when you when you attend meetings, you
• 6:41
  will generally find
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  that,
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  that that twenty percent number is is thrown
• 6:47
  about. Now there's no evidence that it's actually
• 6:49
  actual number. And when you meet with a
• 6:51
  potential recruit, they might ask for more, or
• 6:53
  they might be absolutely thrilled and say I
• 6:55
  was only expecting a half day where I
• 6:57
  could pursue something
• 6:59
  that that brings me more joy than my
• 7:01
  regular job.
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  And I've tested that 20 number among our
• 7:05
  recruits, and it seems to be about spot
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  on for people.
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  It's not possible, Chris, to allow someone
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  obesity medicine is a good example because I
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  I as I said, I do I do
• 7:17
  that 20% of the time, my myself personally.
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  And there are some physicians out there who
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  say, I really like this.
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  Can I do that full time? And the
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  answer as a department chair is no because
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  we we need you to do regular family
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  you know, regular primary care as well. But
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  for a lot of the people who are
• 7:35
  have that particular board certification, they're happy with
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  a day, perhaps a little bit more a
• 7:39
  week. So so that's that's that's that's my
• 7:42
  experience with it.
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  Got you. Thank you, Gautam, for laying out
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  how that experience has gone in your
• 7:49
  circles. Right? I think it helps to, our
• 7:51
  audience to relate to all of that.
• 7:53
  You've mentioned a little bit about how your
• 7:56
  role will evolve, but is there anything else
• 7:58
  you want to mention about how it's going
• 8:00
  to change over the next eighteen months or
• 8:02
  so?
• 8:03
  Yeah. There's a lot of things. So as
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  I as I mentioned at the outset, I'm
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  a health services researcher. I'm passionate about improving
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  how we deliver care.
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  We started all kinds of innovations here even
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  here at University Hospital. One is an on
• 8:17
  demand primary care clinic.
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  It's an old, old fashioned idea. I can
• 8:22
  remember in when I was a resident in
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  Toronto, there were some very much older physicians
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  who were experimenting with and that is there's
• 8:29
  no appointments.
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  If you arrive before a certain time, your
• 8:33
  doctor will see you. You might have to
• 8:35
  wait, but the doctor will see you. And
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  people say, well, what if see someone's waiting
• 8:39
  for two hours? He goes, well,
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  that's okay as long as they know they
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  have to wait. I mean, they're they're they're
• 8:44
  going to be a little annoyed. But they're
• 8:46
  really annoyed if you're running behind and they're
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  waiting for two hours. They had an appointment
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  at 03:00 and you don't see them till
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  five.
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  So that was just one very simple idea
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  that we started. So how we deliver care
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  is something I'm passionate about. So over the
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  next eighteen months, Chris, I think that what
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  we are trying to do is incorporate more
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  artificial intelligence based tools into primary care, and
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  you hear a lot of hype around it.
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  The most useful tool is the one that
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  people actually use.
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  So in our medical obesity treatment program, for
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  example, where we are very much overloaded with
• 9:19
  patients,
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  we can't see them often enough, we can't
• 9:22
  support them in between appointments, we have developed
• 9:25
  an AI based health coaching tool that substitutes
• 9:29
  counseling for me and and the behavioral counselor
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  as well. In addition to that, even just
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  in routine primary care, there is AI based
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  scribes, for example,
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  AI based tools that can help summarize provide
• 9:40
  summary notes, And, also, this the same sort
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  of counseling tool that can provide reminders and,
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  you know, if you have a patient who's
• 9:46
  trying to quit smoking, for example, they can
• 9:48
  provide counseling and guidance there. So that's definitely
• 9:51
  within the next eighteen months is going to
• 9:52
  be a big part of what we do.
• 9:55
  We also want to
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  formally
• 9:58
  create a new primary care center
• 10:01
  at university hospitals.
• 10:02
  And this is in the works. We have,
• 10:05
  the physical space is being renovated right now.
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  And what I would expect is those physicians
• 10:13
  who choose to work there
• 10:15
  will have that 20% opportunity.
• 10:17
  And if they have an innovative idea for
• 10:20
  how to improve primary care, let's say it's
• 10:22
  somebody who says, you know, why don't we
• 10:24
  bring in all of our older patients who
• 10:26
  need Medicare wellness visits in on the same
• 10:28
  day?
• 10:30
  That way, we all get experience with it.
• 10:32
  They all have the same expectations, and some
• 10:34
  of the counseling we provide could even be
• 10:36
  provided to them as a group.
• 10:38
  Okay. Well, that's an interesting idea. It's not
• 10:40
  my idea, but we'll see. We'll give it
• 10:42
  a try. And if it works, we'll try
• 10:44
  it again and try it again, and that
• 10:45
  becomes a new innovation that we,
• 10:49
  that we incorporate into our daily routine. So
• 10:51
  the innovation center, you would have to be
• 10:53
  an innovator. You can't just come in, see
• 10:54
  your patients go home, and forget about it.
• 10:56
  It would it would have that. And I
• 10:57
  think that will appeal to a small but
• 11:00
  important subset of potential recruits as well.
• 11:04
  And, Gautam, you mentioned how
• 11:07
  not just
• 11:08
  health systems and hospitals in The US are
• 11:11
  dealing with this issue but
• 11:13
  globally. Right? Yes. So what and not everyone
• 11:15
  has the same resources. Not everyone has the
• 11:18
  same sort of, patient makeup etcetera.
• 11:21
  But what advice would you give to peers
• 11:23
  who are struggling with similar challenges?
• 11:26
  Yeah. It's a it's a great question. And
• 11:27
  you're right. The challenges are are unique in
• 11:30
  different parts of the world. I'm originally from
• 11:32
  Canada, and the challenges are pretty similar to
• 11:34
  here. But,
• 11:35
  we heard through our,
• 11:37
  special issue
• 11:39
  from, for example, physician working in Gaza right
• 11:41
  now,
• 11:42
  others working in Eastern Europe and in The
• 11:44
  Middle East and and in Sub Saharan Africa.
• 11:48
  I think that the challenge they face in
• 11:50
  recruiting in those environments, sometimes it's just a
• 11:53
  matter of resources,
• 11:55
  a very limited number of educational facilities,
• 11:59
  schools.
• 12:00
  And those physicians, they want the biggest bang
• 12:02
  for their buck, so they often will leave
• 12:04
  or they won't practice primary care, or they'll
• 12:06
  they'll come to they'll leave the country, which
• 12:09
  happens quite often. So that's a huge challenge
• 12:11
  we heard about as well. But I think
• 12:13
  that what
• 12:15
  stood out to me in some of our
• 12:16
  submissions, Chris, is a lot of people are
• 12:18
  struggling to I wanna make this interesting. When
• 12:20
  I have a student in my office who's
• 12:21
  seeing how I practice primary care,
• 12:24
  I think that,
• 12:25
  you know, I can make it interesting for
• 12:27
  them to show, for example, I I had
• 12:30
  a student who was interested in in primary
• 12:32
  care, and now she's definitely interested. But, you
• 12:34
  know, I I I met with
• 12:37
  a a a woman who had lost her
• 12:39
  son. The son was 60, and and and
• 12:40
  the lady in question was in her early
• 12:42
  eighties. And she completely broke down.
• 12:45
  And I felt for her. And my young
• 12:47
  student said, is this what you do every
• 12:49
  day? And I said, that's an important part
• 12:51
  of what I do. I do a lot
• 12:52
  of things. I do a lot of things
• 12:53
  I don't necessarily like to do, signing off
• 12:55
  on refills and that sort of thing that
• 12:57
  nobody especially likes. And that really struck her,
• 13:01
  that sort of human connection that we have.
• 13:03
  So what stood out to me is if
• 13:04
  you can show that, and that's the the
• 13:06
  most the simplest and easiest and most inexpensive
• 13:09
  idea
• 13:10
  that I think our colleagues overseas can can
• 13:13
  probably,
• 13:14
  promote.
• 13:16
  They, they will they will be able to
• 13:18
  meet the challenges. They actually do a more
• 13:20
  successful job in Britain, for example. They have
• 13:22
  less trouble recruiting, primary care physicians
• 13:26
  than we do. So, and that has to
• 13:28
  do with some structural issues. But they still
• 13:30
  have that issue of, gosh, boy, wouldn't it
• 13:32
  be great to be an interventional radiologist or
• 13:34
  something else? Isn't that interesting? Well, this can
• 13:37
  also be interesting. You just need the right
• 13:39
  exposure.
• 13:40
  Yeah. I think that's really powerful, Gautam, what
• 13:43
  you just pointed out that it it seems
• 13:45
  as a very simple thing, but just being
• 13:48
  able to show colleagues, potential colleagues, how interesting
• 13:51
  that your job is, it's obviously goes a
• 13:54
  long way. Thank you for sharing that.
• 13:56
  Lastly, Gautam, I simply wanna ask you, and
• 13:58
  this is a two part question, at insert
• 14:00
  in whatever manner you see fit. Sure. What
• 14:02
  are you excited about right now, and what
• 14:04
  makes you nervous?
• 14:06
  Yeah.
• 14:07
  Well,
• 14:09
  I think what makes me nervous, I think,
• 14:11
  is is the uncertainty that we as physicians
• 14:14
  and academic physicians and as researchers face in
• 14:17
  general
• 14:18
  with,
• 14:19
  changes,
• 14:21
  in in in the federal,
• 14:23
  system overall in terms of funding for Medicaid,
• 14:26
  for example.
• 14:27
  The vast majority of my patients have Medicaid,
• 14:30
  and I fear that they're going to lose
• 14:32
  their insurance or they're not gonna qualify,
• 14:34
  or they're not gonna submit their paperwork in
• 14:36
  time. Most of my patients are elderly.
• 14:38
  They live in poor areas, poor communities here
• 14:41
  in Cleveland.
• 14:42
  Their potential to keep up with things like
• 14:44
  that is is pretty limited. So I I
• 14:46
  fear that they're just gonna fall through the
• 14:48
  cracks.
• 14:49
  And,
• 14:50
  many of them have chronic illnesses which will
• 14:52
  simply get worse. So that is that is
• 14:54
  something I anticipate. And similarly, I think, Chris,
• 14:57
  in terms of as a researcher, funding on
• 14:59
  the federal level has been very uncertain. So
• 15:01
  I'm the incoming chair of the health information
• 15:04
  technology
• 15:05
  research study section at AHRQ,
• 15:07
  and our meetings have been on hold for
• 15:09
  some time just because the the future is
• 15:11
  so uncertain this year. I'm hoping we come
• 15:14
  to some sort of resolution on some of
• 15:16
  those key issues.
• 15:18
  That those are things that I fear. Now,
• 15:20
  what gets me excited is a lot of
• 15:21
  other things. I told you about the potential
• 15:23
  for AI
• 15:24
  health coaching, not just for obesity, but for
• 15:27
  a large number of other other problems as
• 15:29
  well. I've had a lot of exciting conversations
• 15:34
  with potential recruits
• 15:36
  who kinda fall into the same,
• 15:39
  same categories I spoke to you about. They're
• 15:41
  excited about one thing in particular. I I
• 15:43
  we're recruiting this one woman who's very excited
• 15:45
  about caring for the poor
• 15:47
  and especially,
• 15:48
  poor children with disabilities. And that's that's her
• 15:51
  she's an advocate in that area. And I
• 15:52
  said, wow. Okay. Of course. Yes, please. You
• 15:55
  know? And she that's those are the kinds
• 15:57
  of people that I think are emerging.
• 15:59
  And if you put the word out there
• 16:00
  that there are exciting things going on at
• 16:02
  and I think that's definitely true, we'll be
• 16:05
  able to recruit some additional people as well.
• 16:07
  So those are some of the things that
• 16:08
  that really excite me going forward.
• 16:11
  Both. And we covered a ton of ground
• 16:13
  in just what seemed like a very short
• 16:15
  conversation to me.
• 16:16
  That's all the time we have for today.
• 16:18
  But thank you again for allowing us to
• 16:21
  to have your insights and share those with
• 16:22
  our audience, and I can't wait till the
• 16:24
  next time our pass goes. Alright. Thank you
• 16:27
  so much, Chris. Have a wonderful afternoon.