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Becker’s Healthcare Podcast
Dr. Benjamin J. Pieters, Pediatric Anesthesiologist and Vice Chair of Clinical Operations at Children’s Mercy Kansas City
00:17:27
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- [00:00]
Laura Dardo
This is Laura Dardo with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Ben Peters, pediatric anesthesiologist and Vice Chair of Clinical Operations in the Department of Anesthesiology at Children's Mercy, Kansas City, and Associate professor of anesthesiology at UMKC School of Medicine. Dr. Peters, it's a pleasure to have you on the podcast today.
- [00:19]
Dr. Ben Peters
Hi. Thanks for having me.
- [00:20]
Laura Dardo
Now, I'm excited for our conversation because I know there's so much happening in anesthesiology right now and some really, truly cool things that you're doing at Children's Mercy. But before we dive into that conversation, can you tell us a little bit more about yourself and your background?
- [00:33]
Dr. Ben Peters
Yeah, sure. As you mentioned, I'm a pediatric anesthesiologist by training and I'm also the vice Chair of Clinical Operations in the Department of Anesthesiology at Children's Mercy Hospital. Children's Mercy, Kansas City is a large, independent, freestanding children's hospital. And we've been lucky enough to serve the children in our community for the past 125 years, actually, both in this region and even nationally. We are a level one trauma center. We're also a level one children's surgery center, and that's a designation from the American College of Surgeons, of which there's only 30 in the nation. We're also a level four NICU and we have a fetal health center. And that's allowed us to be among the first deliver high risk babies inside a children's hospital. And with all that, we have a full range of surgical services. Something near and dear to my heart as an anesthesiologist. We have cardiovascular subspecialty care. We have solid organ transplant, fetal and neonatal surgery. In terms of scope and size, we have some 390 inpatient beds and 9,000 employees. Our anesthesia group within the hospital. The department has evolved quite a bit in the last five years. We've gone from private practice and worked successfully in that model, provided good care. But about five years ago, we had the opportunity to become employees of the hospital, and I can talk more about that later. But we've gone through that transition and seen both sides of it come through successfully. My current interests include anesthesia, staffing, business analytics, reducing variation in care and compensation models.
- [02:12]
Laura Dardo
That's amazing to hear. What a journey that you've been on, seeing so many different aspects of the health care system and now really having a passion for the data, the analytics, so much more. So given all that, what are Some of the trends that you're watching currently.
- [02:29]
Dr. Ben Peters
Sure, there's several trends that I'm watching closely, and all of us are in anesthesia. One of the big ones is physician employment in general and then anesthesia employment within that. If you look at the trends over, well, the last several decades, if you look at the AMA data, American Medical association data from, say, 2012 to 2024, you can see that private practice, which was the dominant model, has declined from about 60% to 42%. And during that same time period, we've seen an increase in hospital employment situations, whether directly employed or contracted. And then the other trend is private equity, and I'll talk a little bit more about that in a minute. But in terms of the anesthesia employment, we still represent some 46% are in private practice, so probably a bit more than the physician group in general. But we're certainly trending towards employment, and that's becoming the norm as people come out of training. Now, private equity is an interesting trend to follow. If you look at physicians in general, you can see that from about 2018 to 2024, it went from, say, 4.5% to 6 and a half percent. But within anesthesia itself, we've gone from less than 5% to over 15%. Some surveys say 20%. So that's a 200% increase that we've seen from, say, 2009 to 2019. And so that's. That tells you that PE is a significant player in the anesthesia space. And the implications of that, we don't really know at this point. There's been some antitrust issues. There are large national anesthesia groups, and they're coming in and telling hospitals, we can staff, we can provide all your staffing needs. And sometimes that works out and sometimes it doesn't. But that's certainly a trend that we're following along with employment in general among physicians and anesthesiologists.
- [04:40]
Laura Dardo
That's fascinating to hear, you know, and certainly, as you mentioned, pros and cons for both and trying to figure out and navigate what's going to be possible as time goes on from your perspective, you know, when you're seeing how the field has evolved and then looking ahead to read some of the tea leaves there, how do you see that impacting the way anesthesiologists operate and then how anesthesia evolves as a specialty.
- [05:09]
Dr. Ben Peters
Sure. And part of what we do is try to predict the future.
- [05:12]
Laura Dardo
Right.
- [05:15]
Dr. Ben Peters
Another trend that relates to that is anesthesia. Just the numbers of people available and the anesthesia Shortage. As you probably are aware, there's a shortage of physicians nationally and other providers, and that's certainly true within anesthesia as well. The reasons for that are multiple. You've got an aging population and an increased demand for services. At the same time, you have an aging workforce. Among anesthesiologists, 44% of them are 55 years or older. And so, you know, they're cutting back, they're thinking about cutting back, they're thinking about retiring, and they're going to be leaving the workforce. Now, as I said, the reasons are multiple for this. But if you go way back to 1997, the number of residency spots was fixed due to the Balanced Budget Act. This has prompted organizations such as the American association of Medical Colleges to advocate for adding anesthesia spots to residency programs. They advocated for adding 3,000 of those spots in 2017, and that has yet to materialize. So what can we do? What we do on a personal level is advocate through our national societies, political action committees within institutions. We get people interested in the specialty. We go to medical schools. I know I personally go to one of the local medical schools every year, talk to large groups of medical students, get them excited about pediatric anesthesia, which is what I do. Tell them stories about being in the operating room and, you know, hope to inspire them to go into the field. And part of that and related to that is providing opportunities within our hospital. And we've done that by increasing the number of shadow opportunities and rotations here at Children's Mercy Hospital. The other thing we've done in the last five years is start a fellowship program. So as you know, you go from residency to fellowship to. To get subspecialized in pediatric anesthesia. Unfortunately, the pendulum is swinging away from that nationally, and those spots are not filling. We hope that it swings back, and most pendulums do, but currently we're seeing fewer pediatric anesthesiologists. At the same time, there's an increase in demand. But we did start a fellowship program here. It's been very successful, and that's due to a high quality fellowship as well as a really good experience that the residents have when they come to rotate with us so that we can attract those local residents into the fellowship. We've also attracted people nationally into the fellowship program, and we've managed to match at 100% and in fact, grow the fellowship program from one spot to three. And so we're really going against the current trend by just having a really high quality fellowship program. And that's helping us to also Employ some of those fellows later on. Lastly, I'd say we advocate for increasing financial support for residency and fellowship opportunities. If the federal government is not providing that, then it does fall to local institutions to provide that support.
- [08:27]
Laura Dardo
That makes a lot of sense. And you know what a great opportunity you have there in order to start that fellowship program, bringing more students in and then having the opportunity for them to stay within the organization. It seems like a really innovative way to solve a big problem within the healthcare space and especially trying to ensure that there's access to care for those pediatric patients. I'm curious, what are you most focused on and excited about right now as well as, you know, what have you been proud of over the last six to 18 months or so?
- [08:55]
Dr. Ben Peters
Yeah, those are great questions. As far as the last six to 18 months, what I'm most proud of. And you know, we all ask ourselves these questions. What, what motivates me, what gets me up in the morning, what gets me excited about this job? And usually it comes down to being a servant leader, helping others. And that's certainly the case for me. What I'm most proud of the last six to 18 months is the increase in opportunities that we've provided for leadership within our department. We've gone from a private practice model with really very little structure to it, if you will, to a well organized, well structured department. We have division directors in general, anesthesiology and cardiovascular anesthesia and in pain management. And so we've expanded horizontally that way to provide those opportunities as well as increase the number of medical directors. And all of this allows for advancement in your career and the opportunity to lead. So we've continued that journey from private practice to employed academic physicians and anesthesia providers. And that's what I'm most proud of the last six to 18 months. So we are looking for good people. We've got a dynamic and inspiring new CEO, Dr. Alejandro Quiroga. And his goal is nothing less than reinventing the delivery of medicine, reimagining our institution from the top down. And one of his mandates is investing in people. Doug Rivard is our physician in chief and he has supported this desire to get good people and bring them into our hospital. But we're doing that in the face of a shortage, as I mentioned before. So how can we be competitive? And that means knowing what the surveys are showing in terms of fair market value, having an idea what your competitors are offering. How do we look at baseline salaries in terms of adding to that baseline, a specialty incentive, after hours and call pay practices? We Want a flexible arrangement. Work life balance is really important to people, especially coming out of training. And so how do we value all those parts of the work we do? Unfortunately, we do provide coverage 24 hours a day and so somebody has to be here. And, and anesthesia is a very labor intensive specialty. We need a person really sort of in front of that anesthesia machine providing the anesthesia care for each patient. So fair market value is something I'm following closely. The other trend, somewhat related, is quality and standardization. How do we reduce unnecessary variation in our field? And the way we do that is through evidence based practice. And we actually have an evidence based practice department within the hospital here at Children's Mercy. One of our anesthesiologists is the medical director for evidence based practice, Dr. Todd Glensky, and he's helped us develop multiple protocols and guidelines, especially enhanced recovery after surgery or eras protocols, so that we can deliver the best possible care and reduce unnecessary variation. And part of that has been not only developing the protocol, but then having a way for our frontline staff to know that the protocol could apply to this situation for this patient. And we've leveraged technology in order to have our frontline staff have availability of that immediately so that they know that the patient qualifies for a protocol. And then also how do we measure compliance and outcomes, all of these quality protocols, guidelines, if they don't change outcomes, then really it's probably not worth it. But we want to tie that to improvements in outcome and we've been able to do that. We're actually also leveraging the transition to EPIC for our electronic health record. And we're going to have an even better system of being able to flag and measure those outcomes and compliance and have increase data analytics capabilities with that.
- [13:07]
Laura Dardo
That's amazing to hear and you know, certainly amazing to see how you're reinventing the delivery of medicine within the organization, leveraging technology as well as expertise and insights from your broad team. And so that's really cool to hear and definitely it seems like a really strong way to proceed with the future of medicine. Well, Dr. Peters, what are you most focused on right now and excited about?
- [13:32]
Dr. Ben Peters
Yeah, well, we've got several projects going on. One of the things I'm really interested in is answering a seemingly simple question, which is how many people do we need? Traditionally we would develop a spreadsheet. These are the locations we have, and this is the number of people we have, and there's their time off. So how does that translate to the number of people actually available on A daily basis. The problem really in medicine is that we have variable demand and so we don't know the number of operating room cases on a daily basis, the number of locations. And so how do we go from that static model to a more dynamic, flexible model, more predictive model? And we're working with several people on economic models related to this, something called the news vendor model, and ways to take variable demand and translate that into optimal staffing. And if applied nationally, that could lead to considerable efficiencies. So I'm excited about that project. Like I said, as far as what I'm most proud of are the opportunities that we've provided for other people to serve within our department.
- [14:40]
Laura Dardo
Now, I'm curious, before we wrap up here, what advice would you give evolving leaders today, especially those who are looking to make an impact on the clinical as well as operational side?
- [14:51]
Dr. Ben Peters
Yeah, great question. So advice for new leaders. You know, I would have people who are just coming out of training, I would ask them to think about leadership and just to be aware that there are opportunities to lead and whether that's in quality administration clinically or in research. There was a recent article at Becker's bemoaning the lack of interest in physician leadership. The exception within that article was actually a pediatric hospital. We found that to be our experience here that people do want to get involved, they do want to be engaged, and they just need the opportunity to flourish. Once you engage and go beyond the day to day work that you do and find other ways to be engaged, I think you'll find that your career satisfaction goes up, the longevity of your career goes up. And so that's something I would ask people coming out of training to think about and to be aware of. I would also advise them to consider additional education. You know, having a master's degree, whether it's a master's in public health, mba, MHA is becoming sort of the norm if you want to do additional leadership with any of those areas. So consider that master's degree, whether it's during residency, fellowship or later, and that can help. I would also let people know that anesthesiologists are uniquely positioned to improve patient experience and flow throughout complex systems. It's what we do all the time. We see patients preoperatively, intraoperatively, postoperatively. We interact with a tremendous number of different services within healthcare. And then a couple of other thoughts form those dyad and triad relationships. So leadership is really about relationships. And within the perioperative space, if you can have anesthesia nursing and surgery as a triad working together, you can do incredible things. And finally, I just tell people that the future is bright, the water is warm. Step up and be part of something great.
- [17:13]
Laura Dardo
I love that. Dr. Peters, thank you so much for joining us on the podcast today. This has been a really inspiring conversation, and I look forward to connecting with you again soon.
- [17:21]
Dr. Ben Peters
Thanks for having me.