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Becker’s Healthcare Podcast
David Stiasny, MD, FAAP, Chairman of Pediatrics at Swedish Hospital – Endeavor Health
00:22:26
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- [00:01]
A
This is Scott Becker with the Becker's Healthcare podcast. We're thrilled today to be joined by a guest, a leader that straddles multiple different worlds. We've got somebody on today that is a famous pediatrician in the greater Chicago area. He's chair of the pediatrics group at Swedish Covenant Hospital, which is part of the Endeavor Health System. Also a little known fact is he's also a well known Jeopardy. Contestant. He may or may not be a fan of Bobby Knight from back in the day. We're going to find out. Dr. Stiazny, can you take a moment and introduce yourself and tell us a little bit about your practice and leadership and also just a little bit about being a Jeopardy. Contestant and how that went?
- [00:47]
B
Sure, yeah. I'm Dave Stiasney. I'm a pediatrician here at Swedish Hospital as part of the Endeavor Medical Group. I've been here at Swedish for seven and a half years. I was previously a pediatric hospitalist for many years as well. I'm currently the inpatient pediatric chair here at Swedish Hospital as well, but I specialize in outpatient general pediatrics. I currently am also a new children's book author. I recently released my first children's book about a month ago, and that's a new area that I've started to delve into. And I'm starting to write my second book as well. But I was previously on Jeopardy. About three years ago. It had been something I've been trying to get on since college. It took me six auditions over a period of 21 years and finally got on the show. Unfortunately, I got matched up against a guy who ended up being one of the best champions of all time. Um, but since I have been helping other people who have trained to get on the show, including the most recent Jeopardy. Masters champion who I have helped prepare for the show for the last two years. Um, so I, I still keep in with the Jeopardy. Circles very routinely.
- [02:09]
A
That is amazing. I've heard of people that are sort of, you know, tennis coaches, golf coaches, SAT coaches, act coaches. I didn't know that there were coaches for Jeopardy. And absolutely fascinating. Talk for a second about your children's book. What is it about? Where can we find it? What's the title and the process of writing and the inspiration to write it.
- [02:31]
B
Yeah. So the title of the book is called the Trivial Pursuit of Happiness and Lifelong Learning. It is about the love of lifelong learning. And I wanted to share my journey of learning throughout my process of childhood and career and continuing with trivia and wanted to share that with everybody. So the book kind of describes that and the, the illustrations kind of describe that as well. My publisher is Fulton Books and it's available through anywhere that you can do online book purchases. So the biggest ones, you know, being Amazon, Barnes and Noble, Google, Walmart, there are currently the paperback and Kindle versions are widely available and soon to be hardback versions as well. But this was a book that I, you know, had been working on over the last about two years and, you know, just want to kind of delve into a different area that I didn't feel comfortable initially and, and wanted to try something different. And it's something that I tell a lot of my families too, that, you know, as you get older, you know as your kids get older and you know, as you don't want to fully wrap yourselves around everything that your kids do. Although it is a big part of being a parent that you want to also maintain like other old hobbies and new hobbies. And I think that was part of the reason why I wrote the book for both the kids and the parents.
- [03:55]
A
That's fantastic. And let me give you an observation and I'd love to get your thoughts on this from my perspective. In having been sort of around the healthcare world for a long time, the doctors that do the best at avoiding burnout have a couple different interests. So for example, what we find is the doctor has been doing it for 34 years, that all they've done is sort of grind through their primary care patient base every single day, 30 patients a day. It's almost impossible not to be burnt out after 10, 20, 30 years. In contrast, those that have developed outside interest have pursued lifelong learning and so forth. You find a better way of ultimately trying to balance things out between their practice goals and they're just life goals and professional goals. And it helps to also avoid some of the burnout on clinical medicine. Any thoughts on that? As you've pursued leadership, you've pursued writing, you do some coaching of Jeopardy. Or advising of Jeopardy. Contestants. Any thoughts on that? Well roundedness as a way to help avoid burnout too? Sure.
- [05:04]
B
I mean, like, I think the most important thing is that you want to keep your brain fresh and you have to challenge your brain in different ways because if we don't, we lose skills very quickly. You know, for example, like, you know, I used to be an inpatient pediatrician. I don't use those skills anymore. They're kind of gone. And so, I mean, like, you know, I could I ever get them back? Sure. But, you know, it's it's, you have to find new ways to challenge your brain. So things that I've done, you know, either through constant reading or now my writing, I'm learning, you know, I'm learning Spanish, you know, I find new ways to try to find new wrinkles in my brain. Because I've seen when people as they get older, either through, you know, in medicine or not, when they don't challenge themselves or find new interests, these are also things that could lead to higher risks of things like dementia. And I, I, I've seen it with family members, I've seen it with friends, and it's not something I want for myself. One of the ways that I usually advise, you know, younger physicians is, you know, if they're trying to figure out how to tailor their practice into the rest of their life. One, one thing that I, my, both my wife and I, who's also, she's a physician as well, both that we, things that we have applied to our practice is that you don't live to work. We work to live. And so we, we don't want to make sure that, you know, you know, all of our life goes into our job. We want to make sure that the job is a, is a part of our life that, you know, it doesn't fully define us. Because the doctors who let their job fully define themselves, that when they get closer to retirement age, they have nothing that they can kind of look forward to, and they feel like they just have to keep, continue working until, you know, they, they physically can't anymore. And that's not what I want for myself. Like, I want, I want to have a long career, but I also want to have a long, productive life even after my career. I mean, like, one thing that I tell people, find ways for service, find ways to give back in ways that you feel comfortable with, but also ways that will be enriching. One thing that I also typically do is I don't try to overload my practice. I see enough patients where I feel that my patients can have enough accessibility to me, but not to the point that I'm going to go crazy and feel like I have no energy when I get home. I make sure that I have long enough patient visits that I can get the communication that I need to for my patients so I don't feel rushed, but also, you know, see enough patients where my patients feel like they can get in to see me. And I think finding that balance is hard, especially in primary care, because some people just feel like they want to see as many patients as Possible. And you know, some people like that. But for me, I feel that I give my patients the appropriate attention when I feel that I can set my meeting or my visit times long enough that I get everything I need across. Because the patients, they come to see me, it's not for me to see them, it's for them to see me. And so I want to make sure that their time is not wasted as well as it's best used to the point where I feel I have a connection with my families, that I get to know them intimately, both as. As a patient and personally. And that way they enjoy coming to see me and I enjoy coming to see them. Because every day at work should be fun. As a pediatrician, it shouldn't be tiring and unfulfilling. I feel fulfilled every day I go home because I know that I've made a difference and my patients have made a difference on me.
- [08:42]
A
Thank you very, very much. And talk about that. I mean, pediatrics, people coming out of pediatrics today, they come out with a lot of loans. Often they also would they make a great living, but not the living that some of the subspecialists make. What advice would you have for sort of evolving pediatricians trying to build that life, build their practice, make a good living, but also be able to pursue life and do that with the notion of the debt they've got to pay to. Any thoughts on how do you manage that sort of trifecta?
- [09:18]
B
Sure. Well, one of the ways that I was able to manage the debt, I mean, I lucked out partially because of my wife's career, but for those who don't have that kind of setup, I strongly encourage pediatricians to look into ways that look into areas that can help pay back loans. Some people, for example, might go pursue pediatrics in a medically underserved area like working for an FQHC or, or, you know, a native. Native American reservation or an urban area that just seems to have a desert when it comes to amount of people who are actually seeing patients in these areas. Also to take advantage of certain programs that the government offers. So, for example, like, you know, me having worked here at Swedish as well as having previously worked for Lurie, those are both considered not for profits. And so the federal government did have the public service loan forgiven program. I'm not sure how in depth it is now with the current administration, but at least with the last administration that helped me actually pay off my loans. So, you know, finding the right resources from the, from the federal government, if they are available, are is definitely important, but also just try to find a balance between seeing enough patients but, but also having a life. So for me, like my, I would probably say my, you know, highly, my most highly functional zone and my, my, you know, my breadbasket would have been like 18 to 20 patients a day. That's like, that's where I seem to suit the best in being able to get enough patients in, but also give my patients enough time. There are some pediatricians who like to see 25, 30, 35 patients a day and you know, all the power to them. If they can do that and get everything that they need done and their patients seem fulfilled, fine. But I like to talk to my patients. So I have lots of conversations because what I tell new pediatricians and medical students is that especially in this area of medicine, like this is an area that people need to communicate well and it should be a conversation, it should not be an interview. And that's how I think all pediatric visits, at least in the general area, should be. Because that's how you get to know your family. Because you're going to deal with them for 18 to 21 years and you better get to know them well. No.
- [11:39]
A
And it is a really challenging situation and so much of what you say says resonate and it resonates for all professionals. If you've totally overbooked your day, you can't really enjoy or really dig into every specific conversation and visit and meeting. You're just trying to get through the day. Now the flip side is we are so short physicians that taking aside somebody's desire to see 30 patients a day, in some places you can't get in to physicians, those that are willing to see 30 patients a day. It certainly is challenging, but they also help fill a gap. So how do we deal with some of that going forward of trying to fill those gaps and where do PAs fit into that going forward so that we could have enough pediatricians seeing X amount of patients a day without being so overwhelmed. Where are some of the solutions to that? So we could actually make sure we're taking care of our whole population too.
- [12:45]
B
Yeah, I mean, I don't disagree that, you know, there are, there are ways, non physician ways to fill in the gap. So, you know, well trained PAs and nurse practitioners definitely help. We have one of each in our office. Our nurse practitioner, she's been seeing pediatric patients independently for 15 plus years. So she's been doing this in our PA. She's been seeing pediatric patients independently for almost a decade. So that definitely helps. But I think in general, we have to reconfigure what is important in the medical world, especially how reimbursement comes about. I think over the years there's been a big justice on what importance that primary care has had. And I think because of the fact that we've had so much disease in this country, we haven't done enough to prevention. The people who try to at least do the prevention aren't getting rewarded for that. And that's a big downfall, I think, of a lot of how modern medicine has gone. So I really think that there should be much more emphasis on, from insurance companies, from cms about the importance of primary care and really impacting the people who are doing that kind of medicine. And until that kind of legislation comes about, I don't think we're going to ever have a time where there isn't a big gap in primary care. I mean, we don't usually have a gap in specialty care except for certain lower paying specialties. I know, like in the adult world, for example, like they have issues with having enough endocrinologists or rheumatologists or things like that. In the pediatric world it's even further a problem because the pediatric subspecialties sometimes pay even less than primary care. And plus with the extra training that those entail, a lot of people don't want to go into them. So the areas that we see huge detriments or huge dearths of pediatrician would be developmental, which is huge, especially with the skyrocketing amount of cases of autism that we are diagnosing comparatively to the past because we're so much better at diagnosing it. We need more developmental pediatricians, we need more pediatric neurologists, we need more endocrinologists, nephrologists, pulmonologists, and there just isn't enough. Because whatever structure that insurance companies and the federal government have at reimbursement just isn't rewarding. The hard work that we are doing to help prevent illness and keep our sickest of the sick children productive. And I think that's something that needs to be done. I mean, no one lobbies in Washington for medicine better than pediatricians. Unfortunately, getting through to those in charge is very, very difficult. And other if there have been politicians in medicine, it's usually not pediatricians. Right now, in all the two major areas of Congress, there's only one pediatrician amongst all 535 of them. And although she's wonderful, she doesn't have anywhere near as much power being a congresswoman from Washington State we wish that we had more power on the primary care side, but unfortunately that's, you know, pediatricians want to take care of patients. They don't want to be in politics. And I don't disagree with that.
- [16:08]
A
Yeah, no, I think there's, there's. I think there's trouble across the board, primary care and specialties in terms of shortages, and I think they're daunting. And I don't, you know, it is hard pressed to see how they're getting better anytime soon. But. Yeah, no, just so many, so many challenges. And physicians as a whole are way underrepresented in Washington compared to insurance companies and health systems and everybody else. I think legal, everything, quite frankly, 100%, not even a question.
- [16:38]
B
One area where I think that definitely needs to be addressed is just they have not changed the amount of residency spots that are sponsored by CMS in 30 years. And we have. Yet we have more medical students graduating. We have more foreign medical graduates who are trying to come to this country, yet we haven't changed the number of residency spots. And that's just a crime. We're getting all these people who are going to medical school who are no longer matching because there's no spots for them, and then they, they accrue all this debt and they have nothing that they can do about it. And I don't think that's something that, that we can let go on any longer. I mean, I think we, we have to be able to open up more residency spots to allow more people to train or else we're going to continue to have a further shortage. And I don't know how that can change without, you know, further lobbying Congress to be able to change that.
- [17:26]
A
No 100%. And one of the big, big mega bills, it was 4,000 additional residency spots. But of course, Washington is so broken. It was tied into just a big, big bill, so it never got passed. Even though standalone on both sides of the aisle, people pretty much recognize the need for this. I think you're right on. On it. Let me ask you one final question. When you look at this year coming up, what are you most focused on and excited about? Dr. Stiasney?
- [17:53]
B
Well, the one thing that I'm excited about is that pediatricians have come together this year like no other, comparatively. Whether it's because of past problems like lead crisis or autism or other chronic illnesses, that's always been an issue. But with the current issues that we are seeing potentially with disruption of vaccines, you will never see pediatricians come together more than trying to prevent Vaccine preventable illnesses. And if anything gets in the way of that, you will see pediatricians band together and probably become involved politically more than ever. Because if we see outbreaks of disease that were preventable based on decisions that people above us are making, then.
- [18:47]
A
You.
- [18:48]
B
Will see probably a big blowback from the general public. Because, you know, pediatricians have been warning about this for years that if you change any of these mandates or change any governmental recommendations, especially into research of chronic illness, then you're going to see newer diseases or older, sorry, older diseases in newer presentations pop back up. And that's going to be scary, but it's going to teach the general public of what life was like 100 years ago very quickly. And we don't want that as pediatricians. I think that's what's energizing a lot of pediatricians to, to become more involved socially, politically and professionally. And I see a lot more of that happening in the future. And I'm going to try to get a glimpse of this when I go to the AAP national convention next week. So we'll see how it goes.
- [19:41]
A
No, I think you're right on. I mean, there is a whole mix of feelings throughout the nation that's much more. Oh God. Evenly dispersed around the COVID vaccines and all things about it and so forth and so on. But one of the things that's getting overshadowed by that is the fact that the percentage of people that are the scientific community and the percentage of people that generally believe in this, in the childhood vaccines is overwhelmingly high. And so you've got this, you've got this mudding of the waters by this mix of opinions on the COVID vaccines that is causing real damage to the community of us that believe very strongly in childhood vaccines. And it is just a, it is just a mess. We've got some states that have the lowest rate of childhood vaccinations in decades. And you then see the, you know, the slow beginning outbreaks of measles in some communities. Something that was almost gone for a very long time. And could not agree with you more about this war on childhood vaccines from certain corners. And it is just ludicrous. And thank goodness it energizes the pediatric community because it's very, very important. Dr. Stazing, tell us again the name of the book so people could find the book and tell us how we find the episodes of Jeopardy. You were on so we could look at those as well.
- [21:07]
B
Sure. So the book again is titled the Trivial Pursuit of Happiness and Lifelong Learning. It's available online through Amazon and Barnes and Noble, Walmart, Google, anywhere that usually has on books to purchase online. The Jeopardy. Episodes are available streaming now. I think you can find it on Hulu season 39, episode 52. I know, I know that Jeopardy. Is now starting to stream on multiple networks. I think on on Peacock and and Hulu you're going to start to see new episodes as well but the old episodes should still be on Hulu and yeah, feel free to check it out. I, I look a little bit different then. I was about 30 pounds heavier then so it's, it's, it's okay. I, I'm happy being seeing myself back then.
- [21:57]
A
No congratulations and fantastic work on every, on every angle. Just fantastic. I love the lifelong learning pursuits. I love the balancing practice with life. I think there's so much to learn from you. Dr. Stasny, thank you for joining us today on the Becker's Healthcare Podcast. What a pleasure to visit with you.
- [22:14]
B
Thank you for having me, Scott. Thank you.