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