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Becker’s Healthcare Podcast
Dr. Kapil Dhingra on Leadership, AI, and Value-Based Care at The Permanente Medical Group
00:19:56
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- [00:02]
A
Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year, those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies, and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit Beckershospitalview.com and click on the Events tab in the upper right.
- [00:38]
B
This is Scott Becker with the Becker's Healthcare Podcast. I am thrilled today to be joined by a brilliant physician leader. We're joined today by Dr. Capel Dhingra and Dr. Dhingra is the physician in chief and healthcare executive at the Permanente Medical Group. He serves specifically as the chief Physician executive at the Kaiser Permanente San Leandro Medical Center. He also is the chief of staff at that center. Dr. Dhingra, thank you for taking the time to join us today. I've been incredibly impressed by the Kaiser Permanente growth over the last 30, 40 years, particularly the quality that Kaiser Permanente has come to represent in the Permanente Medical Group. Can you take a moment to introduce yourself and tell us a bit about yourself and your career?
- [01:24]
C
Great. Thank you Scott and I appreciate being on this podcast. I'm a big fan of Becker's and how you connect healthcare leaders from different areas together to improve health across our communities. So my name is Capel Dingre. I'm clinically trained as an emergency physician and I'm the physician in chief and chief of staff the Kaiser Permanente San Leandro Medical center, which is a city just south of Oakland and we have multi specialty clinics and hospitals that care for a little over 375,000 patients. As you may know, Kaiser Permanente is an integrated healthcare system. We're fortunate to take care of just over 4.6 million patients across Northern California, a very diverse area. What's special about the territory that I have a privilege of leading within is that we are an incredibly diverse territory or service area and the diversity spans a lot of different ways. That makes me excited as not only a practice position but also to lead in this space. We have incredible socio ethnic diversity, socioeconomic diversity. We're on the tip of Silicon Valley, some areas and in some areas many of our patients are just above the federal poverty line. Another unique fact is that we speak over 88 different languages in the GSA. Please don't ask me to name all of them for you, but it is truly A privilege to care for such a diverse population.
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B
Thank you so much. And take a moment. Dr. Dingra, you've been a lifelong learner. You're a physician. You've also gone back and done an mba. Talk about the commitment to lifelong learning and why you've committed to it.
- [03:07]
C
Thanks, Scott. Lifelong learning for me really came from my father. I learned a lot from my father. He's a first generation immigrant from India, and he's a retired electrical engineer. Got some training in India, went to Columbia, and he was always learning, he was always reading, he was always educating and teaching me things, even when I maybe wasn't interested. But you kind of picked up on the power of not only improving oneself, but doing it for something that you really believe in. And so I've always been super passionate about healthcare and been interested in not only delivery of care, but the systems that make that easier for physicians, for nurses, for staff to do the work. And it's a challenge because healthcare in particular, when you think about just even medicine, we're always learning. There's new therapeutics, there's new ways to deliver care. And now with healthcare systems that are rapidly evolving with technology, say artificial intelligence, you really have to be alert, you have to be willing to also be humbled because things are changing so quickly and question our status quo so that we can do better for our patients.
- [04:19]
B
Thank you, no one. I love that. I'm a huge fan and can't tell you enough how much I'm a fan of people that are lifelong learners. And your dad was an immigrant from India, Electrical engineer. In the household I grew up in, you were allowed to be a doc. And this goes back a generation. A doctor or lawyer or an accountant. Those were the three choices. You ended up being a doctor. Did you have multiple choices or were your parents open to you doing anything? I came from a generation where my parents were not open to me doing anything. So I ended up having to do what they told me to do. Tell me about that with yourself.
- [04:53]
C
Yeah. Thanks, Scott. My parents were very supportive. They definitely first they preached the importance of getting a better education. I have three kids and my wife and I always think about our role is to love our children and provide a supportive environment where they can be their best selves. And I think I learned that from my parents, my exposure to health care. First off, I'm the first physician in our family, first in healthcare. And the thing that got me into healthcare was when my mother was diagnosed with breast cancer. Now, a little over 25 years ago, and I remember Being in college, hearing about the diagnosis. At the time I was an economics major and not quite sure where I was headed. And what ended up happening for me is I saw the compassion that she was treated by the nurses, by the physicians and the staff, when she had a double mastectomy, complications, chemotherapy, really a long road, as we know. Breast cancer treatment has really evolved. But what that did for me is it exposed the potential to care for others and that really made it easy to want to go into medicine. The decision to pursue an MBA really came from wanting to help systems improve. As an emergency physician, we're often at the nexus of everything that's happening in a hospital. In a system, you see patients that maybe are not receiving the most optimal care are coming to you because you're their last resort, or patients who have very complex needs are already getting tertiary care services and you're able to really see how systems come together across multiple pairs. That always fascinated me and that really led me wanting to pursue an MBA and to lead and support others to make the work better for our patients.
- [06:40]
B
That's fantastic. And what a beautiful story. What led you to medicine? I thank you so much. Fantastic. Talk for a second about Dr. Dhingra, what are you most focused on and excited about this year?
- [06:58]
C
Well, there's a lot happening in healthcare. You know, I had recently had an opportunity to attend the J.P. morgan Healthcare Conference. And, you know, there's a lot of focus certainly on the cost of healthcare and, you know, whether that's looking at, you know, the CMS is looking at how to eliminate fraud, waste and abuse such that it improves the cost of care. The total, total spend on our GDP. Obviously GLP1s are still continuing to be an area of focus given the cost of pharmaceuticals, but the great potential that they have in improving chronic disease. And this other piece that I think all of us are talking about in any industry, including my own kids, all the time, is artificial intelligence. And how is that going to show up? And I recently read a book that described artificial intelligence as almost like electricity. We didn't quite know what it was, but when, when it came out. But then soon it became something that all of us relied on all the time. And so there's so much that healthcare is learning with this evolution of AI. What I'm excited about is that I think our practice is going to look different in just a few years. And I think that patients are going to receive better care because we're going to have richer information, more nuance that is going to be supported because it's hard to be a clinician. You have so many pressures on you. And technology has such an amazing potential to help us. An area that I'm very proud of is in the Permanente Medical Group, our CEO, Dr. Maria Ansari. She had the prescience to unleash ambient listening technology to all 10,000 of our physicians in Northern California. And the uptake has been amazing. We're able to now chart more effectively, more quickly and accurately in a way that allows us to spend more time with our patients. So that's an example of an application. Many of you have heard of these technologies and more are coming. And that's what excites me, is to make it easier to do the right thing.
- [08:58]
B
Talk for a second about technology. Doctors, you started a few minutes ago with some of the challenges in oncology or your mom's breast cancer. Talk for a second about, if you don't mind, about oncology and information overload and AI because it seems like oncologists in our country with the aging population are just overwhelmed. They have information overload. At what point will that turn a corner to where AI is really helpful to oncologists versus just right now, people sort of feeling like oncologists, particular specialists, oncologists, just overwhelmed. Any thoughts there? And I know it's a not planned question and a little bit off base, but I'm curious your thoughts on this. AI versus oncology and AI in some specialties where you see this evolution, you
- [09:46]
C
know our oncologists are doing heroic work. They are constantly reacting to changes in data, changes in the science, the new peer reviewed articles that come out almost all on a daily basis or you know, another way is to think about off label therapeutics that can really improve cancer care and they need to sift through this information on a daily basis. When I speak to my oncology department and my chief, you know, he is talking about how there's there is this information overload, yet there are systems that are out there that can really look at multiple nodes of care. So whether it's care here in Northern California or care across the country about where those best practices live, how we can pull all that information together and put at the fingertips of an oncologist so she can make quick and rapid decision for our patients. At Kaiser Permanente, we have one of the largest oncology groups in the country. And one thing that we're very proud of is that we bring in multidisciplinary teams, whether it's oncologists or surgeons or radiologists. And look to make the most effective decision as personalized. And that's the potential that we have with artificial intelligence as well, is we can personalize care, much like we're doing with many of the precision medicine, to have the right treatment that you may need, but also do it in a much quicker way. Reducing that cycle time from diagnosis to treatment to recovery is critical, especially in cancer care. And what that will do for us is it'll improve health. Spanish for our patients.
- [11:25]
B
Thank you very, very much. And take a moment. Sort of trends you're watching right now. We talked about technology, some. You talked about the, you know, your multicultural area, obviously, shortages of doctors. What are some of the trends that you're watching currently that you're most focused on, Dr. Dhingra?
- [11:46]
C
So, Scott, I'm thinking about our workforce all of the time. And, you know, I think one of the benefits of being a clinical leader is you get to see and experience what our people are experiencing 24 hours a day and then have the privilege of understanding those issues and putting in systems that make you successful. And so I think about our 800 physicians, I think about our over 3,000 staff here and the work that they do. And I think about, you know, we talked about the complexity of being a clinician in this day and age and the requirements and the potential of the technology. And so what I. What I think a lot about is this, is how do we make that work more seamless, more easy? How do we reduce waste that doesn't add value to the patient's journey? And I think there's a lot of potential, certainly in artificial intelligence. But I also think there's a human component that I wanted to spend a little bit of time on, which is the power of listening. Ultimately, you know, as healthcare leaders, we have lots of great ideas, we have experience, but truly, to get to the most effective solution, you have to listen. You have to constantly be listening to your people, what their ideas are, and really, they're going to provide the breakthrough performance for us to be successful. I always say our people point us in the direction we need to go. Our job is to make the pathway smoother.
- [13:09]
B
Thank you. And Dr. Dingrell, let me ask this question you had mentioned. The first name is Capell, like David Chappelle, but Capel. And so I guess the question for you is, is he funnier than you or do you win that award?
- [13:25]
C
So I would say that it depends on who you ask. If you ask my kids, they would say, Dave Chappelle's a lot funnier, because my dad jokes to hold a candle, but yes, my name does rhyme with Dave Chappelle.
- [13:38]
B
So fantastic. And talk a little bit about you've had this great career, emergency physician by background and then physician in chief leadership career. What was the transition like from straight practice to transitioning to leadership and practice? Talk about that for a moment.
- [13:57]
C
So Scott, you know, in the permanent medical group, we are a physician led and physician owned medical group, our CEO is a physician. We have a board of directors that are physician led, that partners closely with our Kaiser foundation hospital and health plan. And one thing that attracted me to this opportunity, because you come out of residency and there's so many choices. You could be in an academic practice, you could be in a large integrated healthcare system like ours, you could go into a smaller private practice. But one of the things that attracted me to the permanente medical group was mentorship. I really appreciated the ability to be around physician leaders that were passionate, supported by administrative leaders who saw the mission of what value based care is that our incentives are truly aligned around improving outcomes because everything else follows the derivative from that, including finance. And so when I think about that in my journey, you know, one thing that I still feel strongly about is maintaining my clinical practice. Now it is smaller than when I first started as a new emergency physician. Yet what it, what again does is it strengthens your leadership. And the transition initially was challenging in that, you know, you're trying to balance really two full time jobs, but over time you realize that your clinical role really supports your leadership practice. And I still enjoy seeing patients. It's, it brings me a lot of joy and a lot of times I get less text messages than I might get when I'm seeing my same patients. But it really is a joy and really what drew me into medicine in the first place.
- [15:35]
B
Thank you very, very much. No, I absolutely love that. Thank you. Any advice to emerging leaders wanting to have impactful careers?
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C
Yeah, I would say there's probably two things that I think of. The first thing is surround yourself with mentors and start asking the question of who are my mentors? Because whether those are people that you work shoulder to shoulder with or maybe those that are outside of your practice, or your discipline is really having that feedback loop and circle because as you ascend in leadership, it can sometimes feel lonely. And you may not always get that feedback that's important for you to be a better person, be a better leader. But when you create that mentorship circle and you get to know people across healthcare, you really get the feedback that helps you be Frankly, a better person, too. The other advice I give emerging leaders is the power of yes. Consider saying yes, and particularly say yes when you're not sure of yourself. Oftentimes when I approach an emerging leader and I have a project or an idea or a need, and they, you know, we've all been there, I've been there before, experiencing that sense of imposter syndrome. Am I good enough to do this, this big audacious task I was asked for? Well, oftentimes you are, because that's why someone asked. And it's taking that leap of faith and learning and understanding that it may not go as well as you planned, you might fail at it, but ultimately you're going to grow through that. And so my two pieces of advice, get mentors, just say yes.
- [17:09]
B
No, I love that. And there's this great concept, particularly as you're evolving your career, to constantly say yes to new experiences, new opportunities, not be scared to. When you almost have to stretch yourself to grow and figure out what you're going to be great at, what you're going to love. And then at some point in your career, you have to learn to say no, too. But I think this concept, it's probably not until you're 50 that you start to say no all the time. I'm not sure that that's the right timing or date. But I think saying yes to opportunities, not being scared of them, and you're as good as anybody else, do it and try it and go for it, you know, and. And if it doesn't go great, you move on to the next thing that you love. But I think that advice is such important advice, and it gets so mixed in the busy world today where people are taught so much, oh, you got to say no, you got to protect your time, you got to do this, you got to do that. And I think that's saying yes. Most of us got to where we got to. We've had success in being an emergency physician, being a physician in chief, you teach at Berkeley, by ultimately saying yes to opportunities and not viewing yourself as so closed off that you can't take on those opportunities. And I think it's great, great advice. Dr. Dingra, thank you so much.
- [18:12]
C
Thanks, Scott. And I appreciate the opportunity to be with Beckers. And really, I do think this is such an amazing forum that you all have created because you get to hear from healthcare leaders across the country that offer such amazing perspectives and grow the. Grow the health of this entire community.
- [18:29]
B
Well, thank you. It's amazing to me to watch over the 34 years I've been doing this, the evolution of Kaiser Permanente into the quality that Kaiser brings to the health care, to the health care world. Just literally amazing culture that's been developed there. So thank you for taking the time to join us and share your experiences and share your experience with Kaiser. I think you've been at Kaiser 15, 20 years now, right?
- [18:51]
C
That's correct. That's correct. Actually, my little story on that is as my professional career as an attending physician and physician leader is just over 16 years, I actually trained at a joint Kaiser permanent day and academic program at UC Davis. And when I was a college student at UC Berkeley, my first part time job was working at the permanent day medical group where I supported access and service assessment in the econometrics department. And so I've been fortunate, like you said, to be part of an organization that has a rich history over 75 years of mission driven, value based care. And you know, we've had our ups and our downs. But what's been consistent, what keeps me here, why my own family and friends get care at Kaiser Permanente is our mission. We truly care about our patients and the communities we serve.
- [19:42]
B
Thank you so much. And Dr. Dingre, what a pleasure to visit with you. And tell the kids you're funnier than Dave Chappelle. I don't take it. I don't believe it. Thank you so much.
- [19:52]
C
Thanks, Scott.