Latest / Becker’s Healthcare Podcast / Leading Through Change in Orthopedics and Academic Medicine with Dr. Alexander Vaccaro

Transcript

Leading Through Change in Orthopedics and Academic Medicine with Dr. Alexander Vaccaro · Becker’s Healthcare Podcast

• 0:02
  - Just five years ago, a big portion of
• 0:04
  - what's now being done in ambulatory surgery centers
• 0:07
  - wasn't considered outpatient work. The cases have changed,
• 0:10
  - the tech has changed, the patient expectations have
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  - changed, and the leaders who are thriving are
• 0:16
  - the ones who saw it coming.
• 0:18
  - Becker's twenty third annual Spine Orthopedic and Pain
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  - Management Driven ASC Conference
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  - exists for exactly that kind of forward looking
• 0:25
  - practitioner.
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  - Here, Becker's hosts more than 1,000 attendees, 275
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  - physician and ASC speakers, and three days of
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  - sessions that move between the clinical, the operational,
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  - and the strategic, and the CME credits to
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  - show for
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  - it. Join us June eleventh through the thirteenth
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  - at the Swiss Hotel in Chicago, and come
• 0:45
  - ready to think about what's next. Register on
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  - our events page at beckershospitalreview.com
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  - by clicking on the events tab in the
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  - upper right.
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  - This is Carly Beam with the Becker Spine
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  - and Orthopedics podcast.
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  - And joining me today is doctor Alex Vaccaro
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  - at Rothman Orthopedic Institute. Doctor Vaccaro, thank you
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  - so much for being here today. Oh, you're
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  - welcome, Carl. It's always a pleasure to be
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  - with Becker's. I, again, I'm a big fan.
• 1:10
  - I'm glad to hear. You know, I love
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  - chatting with you, love catching up. And, you
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  - know, just to kick off this podcast, could
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  - you briefly introduce yourself, your role, and the
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  - scope of the
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  - organization, and then also talk about what's really
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  - commanding most of your attention as a leader.
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  - You got it. So I'm an orthopedic
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  - spine surgeon. I I have a title in
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  - my university of being a professor of orthopedics
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  - and a professor of neurosurgery, but I'm an
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  - orthopedically trained
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  - spine surgeon, and I'm the chairman
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  - in the department of orthopedics,
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  - and that's at Thomas Jefferson University,
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  - in Philadelphia.
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  - I am the Richard h Rothman professor.
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  - Rothman Orthopedics is one of the largest muscle
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  - skeletal specialty groups in the country, and and
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  - what I do is I oversee the academic
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  - department with educational
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  - research and clinical,
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  - missions, and we're sort of integrated into a
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  - large urban health care system. And I can't
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  - tell you how many hospitals we have, but
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  - I think
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  - I think we're over 30 hospitals now at
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  - Thomas Jefferson University.
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  - Our particular group
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  - operates in multiple states, and it doesn't and
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  - about, I would say, we have 30 locations
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  - now. I the numb the number always I
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  - I lose track of the number, about 30.
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  - And what
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  - takes most of my time now is a
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  - complex
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  - relationship, I think, between these large independent specialty
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  - groups, which is us
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  - and the health care systems that we partner
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  - with and trying to figure out
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  - how to preserve clinical excellence, but most importantly,
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  - surgeon autonomy. Because
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  - when you're in a if you're hired by
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  - a private equity or hospital based system or
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  - academics,
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  - in a sense, you may lose some of
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  - that autonomy
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  - and then also including academic productivity
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  - while navigating the economic realities of contracting, value
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  - based care, workforce shortages,
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  - and the rapid technological shifts, you know, shaping
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  - how we deliver musculoskeletal
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  - care. And I always look at the economics
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  - of what we have, and
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  - most of my graduates, I would say seventy
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  - five percent, are leaving,
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  - and they wanna have a guaranteed revenue stream
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  - for an income. So if if someone joins
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  - me
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  - and I say, listen. I'm gonna pay you
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  - this, but, you know, I could pay this
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  - for two years and then you're on your
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  - own, they're like, well, if I join a
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  - health care system, I get an RVU.
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  - I may get a piece of the downstream
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  - revenue. They can start off at a higher
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  - price, but they always have a guaranteed income.
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  - And that sort of entrepreneurial
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  - mission driven
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  - autonomy is lost. So that's my biggest challenge
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  - now, and the only way to maintain that
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  - is I have to show them that the
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  - life that we can make as an independent
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  - practitioner
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  - is something that they're gonna look forward to.
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  - And you're not working for someone. You're working
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  - for yourself. And if you wanna be totally
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  - clinical, you're totally clinical. If you wanna be
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  - academic and clinical, you could be academic clinical.
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  - But if you work for a health care
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  - system,
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  - you're what they want you to be.
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  - But they do have the benefit of a
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  - guaranteed salary. So
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  - Yeah. It's an interesting I can imagine it's
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  - a it's an interesting balance to
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  - decide
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  - which path you
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  - wanna take, especially when you're, you know, just
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  - getting out of, medical school, fellow fellowships, residencies,
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  - etcetera.
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  - Yeah. I'd love to hear, you know, obviously,
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  - in this year, it's marked by rapid change.
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  - Can you talk about a
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  - recent decision or a pivot that real that
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  - really required
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  - the most leadership conviction
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  - from you, especially thinking, you know, in these
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  - areas, like, aligning people, resources,
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  - capabilities? I know you're doing all this across
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  - a, you know, wide breadth of,
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  - states, cities, etcetera.
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  - Sure. Sure. So I think the pivot that
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  - demanded the most conviction over the last year
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  - for me involved rethinking
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  - how our department or at Rothman
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  - aligns the academic mission
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  - with the operational and financial structure of a
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  - high volume specialty practice.
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  - Historically,
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  - the two worlds, the university department and our
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  - private group, ran in parallel tracks. Each had
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  - a their own incentives, governance,
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  - and culture. And and in our hospitals, we
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  - have other private orthopedic groups, so we have
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  - to sort of work along with them.
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  - The decision to more deliberately
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  - integrate them, redirect
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  - resources towards shared research infrastructure, and retool how
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  - we recruit and develop young surgeons
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  - and asking the senior partners to accept these
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  - changes
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  - and how their time and effort are valued,
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  - that was not popular. I mean,
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  - you hear it all the time where the
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  - the young versus the old.
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  - The older surgeons were more into academics. The
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  - younger surgeons said, listen, I've got tremendous debt,
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  - 500,000 of my educational so they were sort
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  - of intel, I gotta go out. I have
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  - to work hard. I have to make money.
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  - So aligning people
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  - behind our mission, which is teaching academic and
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  - research,
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  - required a willingness to be transparent about the
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  - long term threats
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  - facing academic orthopedics and independent specialty groups and
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  - to make the case that neither one of
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  - us survives in its current form without the
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  - other. And that kind of pivot
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  - was less about a single
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  - announcement and more about repeatedly showing up, explaining
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  - the rationale, absorbing the friction
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  - into the logic of the new direction became
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  - more self evident, and that's and that's what
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  - I do. And I think if I can
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  - get these young surgeons to participate in the
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  - academy, to go to specialty societies,
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  - to see the joy
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  - of doing research,
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  - presenting the research, publishing the research, and having
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  - that research become part of a clinical practice
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  - guidelines, it makes
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  - sense. But
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  - the older guys had it a little bit
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  - easier because insurance companies didn't put so much
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  - pressure on reimbursement, and there's so many more
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  - rules and regulations now. So it's a constant
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  - battle, but, we're going in the right direction.
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  - I I think people have bought off and
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  - constantly as the president, as the chairman,
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  - I have to let them see the benefits
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  - of being independent,
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  - teaching,
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  - doing research,
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  - and developing that model that works for both
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  - of us. Yeah. So it sounds like you're
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  - really leading by your own example in all
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  - of this.
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  - Yep. And that's and that's and that's what
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  - I I mean, I spend a lot of
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  - time on an airplane.
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  - To let you know, this weekend, I went
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  - to the AOA meeting, and then I had
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  - to go to another meeting in another city.
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  - I had to take seven airplanes in eighteen
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  - hours. And Oh my god. And every every
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  - airplane
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  - had a mechanical problem and was laid. And
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  - I just made it. None of the flights
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  - were canceled, but it was so painful. That's
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  - the pain of academics.
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  - Yeah. I can can imagine probably just running
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  - back and forth across all these airports and
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  - everything.
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  - Yep. So it was challenging.
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  - And, I mean, just, you know,
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  - thinking more about what you're telling me, can
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  - you talk about,
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  - you know, how this moment, how these challenges
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  - really how how these how this moment challenged
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  - your assumptions,
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  - and what it how does it change, you
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  - know, how you approach
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  - decision making
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  - and talent and organizational
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  - readiness?
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  - That's a great question. So
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  - what it changed in me was sort of
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  - a deeper
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  - appreciation for the gap between
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  - an intellectual agreement or understanding
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  - and actual behavioral change. I'd assumed
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  - that if the strategic argument was sound and
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  - the data supported, it alignment would follow quickly.
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  - That smart, accomplished you know, I mean, orthopedic
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  - surgeons are top in the class. They would
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  - simply see what I saw and follow, and
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  - what I came down to realize
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  - is that conviction at the top does not
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  - translate into readiness across the organization
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  - unless you invest
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  - almost disproportionately
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  - in communication
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  - and in developing the next layer of leaders
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  - and in creating structures that make the new
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  - behavior easier
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  - than the old ones. It it made me
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  - far more disciplined
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  - about talent, about identifying the people who can
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  - carry change forward rather than simply executing tasks
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  - and far more patient
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  - about timeliness.
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  - I now spend
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  - much more of my week on succession, mentorship,
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  - and deliberately
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  - constructing teams that I that I once did
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  - in the past because I've learned that organizational
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  - readiness is built quietly over the years and
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  - not in the moment a decision is announced.
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  - So when I come up with a decision
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  - jointly with the board
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  - and then we say we sort of wanna
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  - present it to the shareholders. We have to
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  - figure out a way of doing it, making
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  - the argument, showing the data, being transparent,
• 9:34
  - getting buy in. And it's like it's like
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  - that
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  - Kotter's rules that you read in Harvard Business
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  - Review that the the seven the seven steps
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  - you have to do to be successful, you
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  - know, getting buy in, small wins, and so
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  - forth. But that's what
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  - I've really learned over the last decade as
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  - being a leader,
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  - really, really, really communicating and selling, not not
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  - what
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  - I think is right, but these are things
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  - that, you know, things that you should do.
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  - Like, we should get into ASC development. We
• 10:02
  - should get into ancillary development, and some people
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  - don't wanna invest. But I know if we
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  - don't invest, we're not gonna do well. We're
• 10:07
  - not gonna be competitive. So I know that's
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  - the answer, but I just can't instrument it
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  - by being a benevolent dictator. I have to
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  - sit down and make everyone understand it and
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  - follow along with it.
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  - I got it. Got it. It's really interesting
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  - too. And it's kinda like that transparency
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  - and communication aspect of it all.
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  - Yeah. Yeah. And then you just can I
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  - guess, you know,
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  - thinking, you
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  - know, more on, you know, you talk about
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  - some forces,
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  - you know, with all these different forces reshaping
• 10:34
  - health care, where do you think leaders need
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  - to be more,
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  - decisive? I know you've touched,
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  - some on on this, but I thought if
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  - you could just elaborate more. For sure.
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  - I think in my view, health care leaders
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  - need to be considerably more decisive about workforce,
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  - technology adoption,
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  - and the structural relationships between physicians and the
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  - systems they work within.
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  - Right now, we're in a period where the
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  - cost of indecision waiting another budget cycle to
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  - invest in artificial intelligence tools, deferring difficult conversations
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  - about surgeon compensation and productivity,
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  - or postponing decisions about which service lines we
• 11:10
  - will actually
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  - lead in versus participate in is higher than
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  - the cost of moving and adjusting. At the
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  - same time,
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  - decisiveness cannot mean recklessness. I say that all
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  - the time. Because you wanna do a timely
• 11:22
  - decision doesn't mean you you you you're okay
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  - to make a bad decision. And that's particularly
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  - in clinical environments with a margin for error,
• 11:30
  - as you know, Carly, is small, and the
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  - consequences of a poorly executed change land directly
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  - on patients and the frontline staff.
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  - I think the leaders who will do well
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  - over the next several years are the ones
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  - that can move faster on strategy
• 11:43
  - and capital allocation while being unusually careful and
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  - deliberate
• 11:47
  - about putting the right clinical and operational teams
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  - in place to execute,
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  - speed at the top,
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  - precision at the point of care that that
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  - balance is what I think most organizations
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  - are still trying to find.
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  - Just this week,
• 12:02
  - we've had I won't get into details, but
• 12:04
  - multiple
• 12:05
  - multiple
• 12:07
  - issues that came up with our health care
• 12:08
  - partners,
• 12:09
  - and we needed to be responsive.
• 12:11
  - And making a phone call to an attorney
• 12:13
  - and waiting a week and a half for
• 12:14
  - their letter to come back is not acceptable.
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  - So we have to discuss with our
• 12:19
  - partners, our counsel,
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  - figure out what we need, and then we
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  - write the letter. We sit down, and we
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  - we we move forward. And and I tell
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  - people,
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  - delaying
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  - making
• 12:30
  - a timely decision makes your decision for you.
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  - I say it all the time. If if
• 12:35
  - you can't if you can't come up with
• 12:36
  - a decision now that doesn't mean strategy has
• 12:38
  - to be done right away.
• 12:39
  - Strategy is basically
• 12:41
  - understanding what not to spend your time doing
• 12:43
  - or what not to invest in. I hope
• 12:45
  - people say, well, the strategy should do this,
• 12:46
  - this, and this. And I go, most importantly,
• 12:48
  - how to how to allocate resources
• 12:51
  - in areas
• 12:53
  - and don't waste time
• 12:55
  - where you don't have to waste time. You
• 12:56
  - know, focus I mean, we all have such
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  - limited time. So I think that's that's the
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  - most important thing health care leaders have to
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  - do now.
• 13:03
  - Yeah. Absolutely. And, you know, are there any
• 13:06
  - other big leadership habits or minds us have
• 13:09
  - been especially critical things that you would recommend
• 13:12
  - other leaders adopt as well?
• 13:14
  - Yeah. I think that a leader needs to
• 13:16
  - have, and this is gonna sound weird,
• 13:19
  - disciplined
• 13:19
  - consistency,
• 13:21
  - showing up,
• 13:23
  - communicating clearly,
• 13:25
  - making decisions in a predictable rhythm even when
• 13:27
  - the external environment is anything but predictable.
• 13:30
  - People and the people that work for us
• 13:33
  - can tolerate an enormous amount of uncertainty about
• 13:35
  - the world around us
• 13:37
  - only if the leaders in front of them
• 13:39
  - feel like they're being steady, accessible, willing to
• 13:42
  - engage honestly
• 13:44
  - with what is and what is not known.
• 13:46
  - I try to resist the temptation to either
• 13:48
  - overreact to each new headline
• 13:50
  - or to retreat into silence when waiting for
• 13:52
  - clarity that may never come. Instead, I try
• 13:55
  - to keep the cadence of the organization
• 13:57
  - moving,
• 13:58
  - regular conversations with partners and faculty,
• 14:01
  - frank discussions about what we are seeing, and
• 14:03
  - a willingness
• 14:05
  - to sort of make provisional decisions and communicate
• 14:08
  - them clearly and revise when the facts change.
• 14:11
  - I I think in a period when much
• 14:14
  - of health care feels reactive, that quiet discipline,
• 14:16
  - being reliable, present, and intellectually honest has probably
• 14:19
  - been the single most important
• 14:21
  - thing that we as leaders bring to this
• 14:23
  - work. That that that would be my my
• 14:26
  - take on that.
• 14:27
  - It's very well said. And, doctor McCarroll, thank
• 14:30
  - you so much for taking the time
• 14:33
  - to chat on the podcast. It's been,
• 14:35
  - great talking, and I look forward to seeing
• 14:37
  - you in June for our conference. I can't
• 14:39
  - wait to meet you face to face, and
• 14:41
  - we're gonna have a lemonade together. Is that
• 14:43
  - okay? That sounds great. That sounds great.
• 14:46
  - Well, you have a great rest of your
• 14:48
  - day, and I'll be in touch. You got
• 14:50
  - it. You take care.