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Becker’s Healthcare Podcast
Dr. Mike Guertin, Professor of Anesthesiology and Chief Perioperative Medical Director at Ohio State University Wexner Medical Center
00:22:54
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- [00:00]
Scott Becker
This is Scott Becker with the Becker's Health Care Podcast. I'm thrilled today to be joined by a remarkable leader. We're joined today by Dr. Mike Guertin. Mike is a constant, lifelong learner. He's with the Ohio State University Wexner Medical Center. Mike, can you take a moment and tell us a little bit about yourself and your career? Take a moment and give the audience a good introduction on Dr. Mike Guertin.
- [00:30]
Dr. Mike Guertin
Well, thanks, Scott. It's nice to be here today. I am, as you said, a physician. I went to undergrad and medical school at Wayne State University in Detroit. I then came to Columbus, Ohio to do my internship and residency in anesthesiology at the Ohio State University. I stayed on faculty for the first six years as a faculty member and then I, I didn't leave the university completely. I stayed an adjunct faculty. But I helped to start the first physician owned surgery center in central Ohio back in 1998. We were an ENT surgery facility. We had five ORs, we did adult and pediatric patients and we did over 7,000 cases per year. We were very successful. We had a big focus on quality, efficiency, patient satisfaction. And it was really a great experience to be able to be in the beginning stages of that industry, which has obviously grown tremendously since that time. So after that I was on the board there. I became the medical director and then I decided that, as you said, I'm a lifelong learner. My youngest daughter was finishing high school, so I decided I was going to go back to school as well. And I went back to Ohio State Fisher College of Business to get my mba. And about midway through that, I then went back to the university as the medical director of ambulatory surgical services. And that was a time when we were starting to build more facilities. We had one surgery center at that time was an hopd. And since then we have built another hopdot, actually two more if you include our cancer hospital building one, and two ambulatory, freestanding ambulatory surgery centers. It has been a wonderful journey. Then during the COVID pandemic, when that started, I became involved in creating a lot of the processes for closing down things, restarting things, creating a lot of the policies and a role was created that I now occupy, which is chief perioperative medical director. So. So I oversee the operations and really work on every part of the entire enterprise for perioperative services at Ohio State, which right now includes 11 pavilions and approximately 90 ors. We are also in the process now. Yeah, we're in the Process of building a big new inpatient tower. It's about 1.9 million square feet. We will have 24 more ORs in that facility. And again, you know, really an interesting journey getting to this point. Something that if somebody had told me 30 years ago or 35 years ago, this is what I'd be doing, this would be my career path. I never would have, never could have believed them because it just again, life is what happens when you're busy making plans. The other thing that I think.
- [03:42]
Scott Becker
But I'd love to like I'm gonna, I'm gonna stop you for a couple questions, but I do want to focus on a couple of things today. One, I want to focus on this career evolution. So I remember from back in the day from the first surgery center, from stuff with the ambulatory Surgical centers of America and things are Ambulatory Surgical association of America now, fasa. I remember from back then. And then you've built this incredible career. And I want to talk to you about the career and about anesthesia shortages at some point. Quickly. First question, though. First, first you spent time at Wayne State University. Great, great place, great school in Michigan. Then you spent a lot of the latter parts of your career at Ohio State University. So the first question I have for you is when Ohio State plays Michigan, where your royalties lie, where are you a Michigan person or you're an Ohio State person?
- [04:36]
Dr. Mike Guertin
Well, Scott, I'll answer that very easily. Go Bucks. I am a convert and very happy to be a Buckeye. And it's a long story that I won't go into, but I'm very happy. Most of my family are Michigan fans, grew up there, obviously. But now we all have an evolution. And you say, as you said, lifelong learner. I've learned to root for the team that is the national champion. No.
- [05:08]
Scott Becker
And you've matured into a Buckeye fan. And I love that talk for a second about leadership in Ryan Day because Ryan Day lost four times in order to University Michigan. They're arch rival in the Michigan Ohio State game. If you're not a sports fan, it's the biggest football game every year other than the national championship. It's that big a rivalry. Ryan Day lost four times in a row, including this year to Michigan. Then came back and went won the national title. Did he have to win the national title to keep his job or would he kept his job anyways? And any leadership lessons you get from that kind of resiliency or from Ryan.
- [05:43]
Dr. Mike Guertin
Day, you know, Scott, I, first of all, I don't Know whether he, I would assume he would have kept his job. And I think our current athletic director, Ross Bjork already had said that during the season. And I gotta tell you, there are a lot of people would argue that that Michigan game is more important than even a national championship. Now, clearly that's not really the case, but that is that important here. And it's that important in Michigan, too. Growing up. I remember growing up and how big that was. JP McCarthy was a very big radio personality in Detroit back when I was growing up. And every year that whole, that whole Ohio State, Michigan week was just huge. And from a standpoint of how do you recover from something like that, I think that really does demonstrate. And it's really a lesson in life. When things get bad, sometimes you don't succeed, but you have to continue trying to figure out what are the things that I can do or our organization can do to overcome the adversity that we face. And I think one of the big things, clearly the players really took that loss very personally, very personally. And here in Columbus, that gets a lot of press. And, you know, if you, if you listen, some of the players really took a lot of heat for that. And so I think it really was a motivating factor for them. And they used it rather than putting their tail between their legs and saying, oh, we didn't make it. They really strapped it up and decided they were going to put an even bigger, harder effort into their coming games. And you saw what that did. And I think that's a great lesson for where we all have been since the pandemic. That was a very big challenge for us, and we had to come back from some very big challenges. And I think as a, as an industry, we have done a really good job. There are still a lot of challenges ahead of us, but I think we've worked hard. And so I think that's really the lesson, is that you have to accept the challenges and. Except that you're not always going to win, but that you have to continue fighting and trying to become better so that you can move forward.
- [08:07]
Scott Becker
No, I think that's right on. It reminds me very much of what we're sort of. We're off subject one bit. But that resilience that you saw in that Ohio State team reminds me when the Beers went into Miami during the super bowl year, when they won the super bowl and got crushed by Miami after thinking they were gonna have a perfect season. They're such a good team. And that provided the wake up call, the motivation to go and win the super bowl that year, just like for Ohio State. I really do feel like this provided a lot of the wake up call to then get back after this and win the national title. And you're absolutely right. In Michigan, Ohio State, it's almost more important. Nothing better than the national championship. But the closest thing, and it's in a very parallel course when you're Michigan, Ohio State fans is winning that game. So absolutely that rivalry game. Couldn't agree with you more about that comment. Also, Michael, let me ask you this question, Dr. Garten. Give us some reflections on lifelong learning and what lessons you'd give to your children and emerging leaders. I mean, you went back when you were your MBA at Fisher School, Ohio State, was it mostly people you were middle aged at that point or not middle aged, but you were no longer a kid either. Was it mostly people that were middle aged or it was mostly the people right out of school or a couple years out of school? What was that demographics like when you were doing that?
- [09:17]
Dr. Mike Guertin
So the I was in the working professional program and actually I spent four years and I loved the fact that I did that working professional program because it really is a parallel to the standard mba. And the cohort was people that were younger than me for the most part, or many of them were, and many of them in business and in the industries that we were learning about, accounting, finance, operations. And so it was really a great learning experience that way. And I always, I've always said I'm not going to grow old gracefully. I'm going to go kicking and screaming. So I really enjoyed the fact that I was able to, to really learn alongside some people who are still right in that very formative part of their careers. And I thought it was a great experience. And I really could never look back on that with anything other than just so grateful that I had that experience. And that whole leadership journey is really an important thing, particularly for physicians.
- [10:28]
Scott Becker
No, that's literally amazing. And it's been an amazing leadership career that you've had. And I love that. Going back to school and doing it and being with other professionals, I mean, a daughter that studies international affairs and she learns just as much as she does in the field in different parts of the world as she does in her master's program. And I think that combination of learning and doing and engaging in the world is so, so important. Leadership and learning. I love that. Dr. Girton, talk to us about the anesthesia shortage. How much does this do to explosion in surgeries? How much does it do Just having too many sites where we do surgery. I've never been a certificate of neat fan, but it's part of the problem that we do surgery at too many different places. Why is there such a shortage of anesthesiologists and how did this happen?
- [11:15]
Dr. Mike Guertin
You know, Scott, it's really multifactorial. And as we look at really the industry as a whole, I think one of the big things. So I will share. My mother was a nurse anesthetist for 44 years. She was really one of those pioneer career mothers. And she really. I helped. I learned a lot about how you work together as a collaborative team, because back then, particularly that team model was very important. They had two or three anesthesiologists in the group and many CRNAs, and they worked as a team, and it was really a big family. And I think that's an important part of anesthesia. I think that during the pandemic, a lot of people who had the opportunity to leave healthcare, retire or whatever it was, they took advantage of that. And as you said, I think we've had an explosion. I think really, particularly coming out of the pandemic, a lot of people had surgery that was not as urgent or emergent that it needed to be done during the pandemic, but they waited on those things or sought care and then found out they needed surgery. So we had an explosion of people needing and wanting to have surgery. One of the things that we've noticed, and as I talk to a lot of people, I think a lot of places are noticing that some of that plateau has now declined a little bit, and people are particularly holding off on elective things. And we found new modalities for reducing the need for surgery. For example, the impact the GLP1s have had on bariatric surgery, reducing the number of people who need bariatric surgery. And now we see things like PRP and other orthobiologics reducing some of the orthopedic surgeries that need to be done. So I think, you know, we're seeing some of that real explosion starting to decline a little bit. And part of the anesthesia conundrum with this is the reimbursement. And Scott, I was on for asca, which you mentioned already. I was on their political advisory board or committee, and I did some lobbying in Washington on behalf of ambulatory surgery centers, because, as you may remember, ambulatory surgery centers were given their increase in the past based on the consumer price index, the cost of bread and butter, whereas hospitals had their Increases every year based on the hospital market index, which is a much steeper curve. At one point, it was to a point where ASCs for the same procedures were getting about 51 or 52% of the reimbursement that hospitals were. And so when we went and we lobbied on that, that was one of the factors. But the other thing that goes into that too is that anesthesia is very much impacted by government payers and the reduction and the current pay reimbursement per RVU for anesthesia services. And so I think that has driven some people to, as I say, leave the industry potentially or not come into anesthesia. And that has led to some of those opportunities for that for people that remain to then try to find how can they improve the. Their staffing and their reimbursement and their ability to bring people in. We've been very fortunate in our organization at Ohio State to really be able to keep up with a lot of the trends and recruit people into our department. Of course, agency use of agency professionals has been very important during that time. And I think we all know that those costs are higher and as hospitals really look to control their costs, because again, that's the one thing that we can really do. And when reimbursement is relatively, it's contracted or it's controlled by the government, for government payers, controlling costs and being efficient are the biggest things we can do. So with those kinds of costs, you have to look at how can you really keep up with trends and reduce some of those agency needs, but also be able to staff your ors enough? I hope that answered the question for you. It was kind of a roundabout because I don't know that there is really an absolute direct answer as to the cause.
- [15:55]
Scott Becker
No, I mean, there's so many different challenges to it. There's an explosion of sites. There's none of anesthesia residencies. There's not a big anesthesia. There's. There's reimbursement challenges, for sure. But what an amazing thought that your mother was one of the first CRNAs, and how much influence was that on you to become an anesthesiologist? And that's an amazing. I never hear about somebody whose mom was a CRNA or whose dad was a crna. That's, that's, that's literally amazing. It's supposed to be back in the day when CRNA is on top of it being a CRNA and also being a woman, we had to fight for every bit of ability to have authority to do what you wanted to do and to treat patients.
- [16:30]
Dr. Mike Guertin
You know, Scott, it's interesting. I actually wanted to be a surgeon. And when I was in medical school, I had a really tremendous chief resident. His name is Scott Dolchavsky. He's actually at Henry Ford Hospital in Detroit and has been a leader there as well. He became a cardiothoracic surgeon. But he saw how I'm very focused and I wouldn't leave the hospital quite often. And he really sat down with me and said, you've really got to think about things if you want to become a surgeon. You may be giving up your personal life to a very, very large degree because you may not ever leave the hospital. And it made me start to think, and I love the environment of the or. I thought that that was really where I needed to be be. And when I did an anesthesia rotation as a medical student, I realized this is really what how I want to be in the OR and have the capacity to care for patients very fully. But when my time was done, when I was out of the or, I could leave. I didn't have clinic to worry about things like that. And it really then became that, that driving force for me going to anesthesia. And I really couldn't be happier that I went to this, this route because I've thoroughly enjoyed everything I've been able to do in anesthesia.
- [17:51]
Scott Becker
And we love that. Take it. It's so important in terms of life planning. If you put yourself in an area where it's hard to set boundaries, or you won't be able to set the boundaries because of how you're wired, then you end up being very narrow. And that's also a prescription for burnout. Whereas if you take a profession that you did and you could shift in on the care, you also have the ability to also do so many other things professionally and had multiple different careers then. I mean, what a great way to look at things and what great advice from your mentor back in the day. I mean, that's really remarkable.
- [18:24]
Dr. Mike Guertin
Yeah, it really was. And Scott, you brought something up earlier about really the. What are some of the things that really motivate you or drive you into certain directions? And I've told this story before. When I was in private practice, we were very focused on efficiency and really doing things at a very high level, quality wise, everything. Well, one day I was working in a room and apparently there was a delay getting back the next patient. And the nurse in the room put anesthesia delay. I don't remember what I said to her, Scott, that's one of those things, I have no idea. But that evening I got a call from my good friend who was also on the board. He happened to be the chairman of the board. And he asked me, he said, mike, are you okay? And I said, well, yeah. Why? Why you ask? And I remember where I was when, because that was so important to me. And he said, well, you know, today you really made your good friend, this nurse, feel really bad about what she did because of the way you reacted. And I remember at that moment thinking to myself, there's two ways I could approach that. One, which was the kind of traditional way to say, well, you know, tell that person to really get broader shoulders and do their job right and not be take, you know, not get so upset by what somebody says. But what I chose to do, Scott, I really thought about this in the moment. And since then, I chose to realize that as leaders, and particularly as physician leaders, we have a higher calling and we have a tremendous impact on all the people that work with us and with our patients, obviously. And I had a higher responsibility. And that really led to me getting a very, very effective, effective professional executive coach and really changing my entire perspective. And that really led to me then ultimately becoming the Director of leadership for the center of Faculty Advancement Mentoring Engagement in the College of Medicine at Ohio State. And that's a role I've been in for six years now. It has been so important to me to give that insight into so many other faculty members and allow people to recognize how important their self awareness and the way they treat others impacts those people and how important it is to the entire culture that we create.
- [20:59]
Scott Becker
That's an amazing story, because what happens is, and I just love this take you just gave us, there are a handful of critical conversations, whether from that person or chief resident or whatever, they may be a handful of critical conversations throughout your life that you'll remember forever and that will really have an impact on your direction in life. And it is very likely somehow or another that conversation might have been had somehow or another, or you might have come to that, that education. But it is so meaningful that it did happen, because you might not have, you might not have without that conversation, changed your management, changed how you manage and led to a much broader and more successful management career. It's a fascinating take, isn't it, on critical conversations?
- [21:47]
Dr. Mike Guertin
It really is, Scott. And you know, not only did it lead to a better career, it led to a better life. Because I think we realize that we're under a lot of stress and pressure sometimes, and we have high responsibilities, high training, and, and people really do hold physicians in a very high esteem. But with that comes responsibility and an opportunity to really be better people. And that's led to a better life. It's been led to a happier life.
- [22:13]
Scott Becker
That's fantastic. Well, a happier life's a good thing. I'd call that a better life, too. Michael. Dr. Guertin, what a pleasure to get to visit with you again. I am so happy we had a chance to visit today. Thank you for joining us on the Beckers Healthcare podcast. Just a remarkable professional career and, and so many insights as well. What a pleasure to visit with you.
- [22:31]
Dr. Mike Guertin
Thank you, Scott. Great to talk to you again. We'll talk again soon.
- [22:34]
Scott Becker
I'm sure looking forward to it. Thank you.
- [22:37]
Dr. Mike Guertin
Thank you.