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Becker’s Healthcare Podcast
Dr. Tony Seupaul, Executive Vice President and Chief Physician Executive with Carilion Clinic
00:18:34
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- [00:00]
Molly Gamble
Molly welcome back to the Beckers Healthcare Podcast. I am Molly Gambleth Beckers and today I am joined by Dr. Tony Sepal. Tony is the executive vice president and chief physician executive with Carilion Clinic. Dr. Sipal Tony, thank you for being here. I'd like to start by giving our audience a sense of who you are and the great organization you lead with Carilion Clinics. Let me turn over to you to introduce yourself.
- [00:23]
Dr. Tony Sepal
Yeah, thanks Molly. Well, as mentioned, I'm at Carilian Clinic which is in Southwest Virginia, specifically in Roanoke. We are a seven hospital system with a 250 mile ambulatory footprint. Our academic health system is largely focused in Roanoke, Virginia. We have multiple residency training programs as well as a growing footprint in research and innovation. And in fact, innovation is part of our DNA. We've been named to the Forbes list three years in a row now for being an innovator in healthcare, which is something that I think is we'll talk a little bit more about in the podcast today and is certainly going to be part of the advancement of healthcare, certainly healthcare transformation for the next foreseeable future.
- [01:09]
Molly Gamble
Well, congratulations on the latest Forbes inclusion. And I know Carilian Clinic always strikes me as one of those systems that is really a regional powerhouse. And you hinted at some of the great work you're doing, which we'll dive into more deeply. But you mentioned, I mean, 250 mile ambulatory footprint just to really help orient our listeners and really picture and visualize the market Curling Clinic serves. Can you talk about that a bit more about your patient population, population, your mission and just really paint a picture, if you will, Tony, of Carilion Clinic and the footprint beyond the number of sites of care, if you will.
- [01:48]
Dr. Tony Sepal
Yeah, well, I'll start with our mission, which is something that drew me to this organization. I've been here now for about a year and a half and aside from absolutely loving being here, the mission of Crillian Clinic is to improve the health of the communities that we serve. And that very simple statement can actually be permuted into a number of understandings around who we are and what we do, from servant leadership to the very expansive definitions of what health and health care means as well as communities. And so if you think about, and if there are any geography buffs out there, what the state of Virginia looks like on the US Map, if you divide it down the middle, pretty much everything to left of middle is Carilion Clinics market share. UVA is kind of right in the middle of that dividing line. And so they have a little bit of space to the left and to the right of that. And then as you extend across the commonwealth, we touch West Virginia, pieces of North Carolina and Tennessee. And so we provide services for those areas as well. And that's going to become more and more important for this region as we will soon open our new cardiovascular Tower Cardiovascular Institute. And we've broken ground on our Taubman Cancer center, which will bring additional services to the area. Some of you may know that we were also recently approved to open our kidney transplant program, which will start in 2026. So our regional footprint and menu of services that we will provide is constantly growing.
- [03:25]
Molly Gamble
I'm sure that makes work interesting for you, so let's dive into that. I mean, this is an interesting time. It's been quite the year for health system leaders across parts of the country and all different types of care settings, as we've seen pressures compound in a number of different ways. But that doesn't slow down a lot of the great clinical innovation that systems continue to unleash. You just hinted a few Tony new cardiovascular institute, a new kidney transplant program starting in 2026. What are some trends or some issues that are top of mind for you right now? Whether it's policy shifts, evolving care models, new technologies. What have you been paying closest attention to?
- [04:03]
Dr. Tony Sepal
Well, all the above, Molly. And as it pertains to what's happening at the national level, the first thing I think everyone understands is the one constant in healthcare is that it's always changing. And those pressures that we face are oftentimes unexpected. And I think the last couple years have proven that. And so if we've not grown in the direction of managing uncertainty, then we just haven't been doing our jobs. And as I talk to it, as the Beckers audience and you've talked to health care leaders across the country, I'm heartened by the fact that we have changed over the last several years. And so as we look at the political landscape, I think we're adept at managing the many challenges that may or may not face us. And I think that I say may not because we really don't know. And what I'm proud about my colleagues and what we've done here at Carillion as well is we've stayed the course, we've maintained our true north, which is our mission that I discussed earlier, to maintain services. We're growing and I think that growth mindset is incredibly important. And along the way, in terms of some of the other trends, obviously artificial intelligence and what it can bring to healthcare is a hot topic. You can't get through a day without talking about machine learning, agentic AI, et cetera. And we're all still figuring this out, in my opinion, across the broader scope of healthcare. At Crillon Clinic, similar to many other health systems, we've actually been using AI models for a decade. And obviously the last couple of years, we've been ramping up our assessment and utilization of those tools to include the creation of an AI Governance council at our organization so that we can help better understand what's out there, what's right for us, what's working, what's not working, when is the technology ready for the many things that we need it to do versus what we may be promised it can do? And I think that's true of many health systems because it, at the end of the day, it is all about patient care and the health of the health systems. But these are big investments that we need to make, while on the contrary, it also takes away from investments in other things because resources are finite. And so we really need to think through how we're managing that. But like many health systems, we've invested in ambient listening, and that's something we found to be incredibly helpful for our physicians for right now, that we've gone through our pilot phase and are now expanding the number of licenses, making a big difference in the patient physician relationship, the time that our physicians have to not be part of or in front of the EMR all day. And so that's something that has been helpful. We have extended that technology to also help manage their inboxes, particularly for our ambulatory physicians that are always on because they're available available to their patients. And then in the areas of radiology, for example, we can now perform a head MRI in what took 30 minutes to now less than two minutes. And that acceleration in performance is due to some AI technologies that we've taken on. And those really just kind of highlight, I think, what many health systems are using, where the use case makes sense, the investment is worthwhile, and the technology is delivering on the promise. There are a lot of great ideas out there, and we want to take them all on when the timing is right and the investment horizon makes sense for us.
- [07:42]
Molly Gamble
Yeah, I've heard, Tony, that one of the hardest parts about leadership in your space with AI is when the time comes to say no, because there are some great tools out there that are solving real problems. It's just a matter of prioritization and like you said, making sure one investment doesn't take away from something more pressing. Can you remind us how many clinicians and physicians you lead a curling clinic?
- [08:06]
Dr. Tony Sepal
Sure. So Karelian has 13,000 employees. We have roughly 1,000 employed physicians. And at last count, we're close to 600 apps, plus 350 plus residents and fellows as a complement to our total employee number. And we're growing, so we're growing our GME programs. We're continually adding physicians and apps. I would think in the next year to two, probably next two to three years, well, we're probably going to approach 1500 clinicians across our system.
- [08:41]
Molly Gamble
That's great. And so soon to be 1500 who are under the leadership of someone who seems to have a really great handle on a lot of the turbulence that you had described in the industry. How are you staying energized? What? Either looking ahead is giving you energy, or maybe it's a recent win, something in the last six to 18 months that you're still riding high on, an accomplishment you're especially proud of. What comes to mind?
- [09:05]
Dr. Tony Sepal
Well, you know, I love a challenge and I hate to lose. And so for me, I think that these challenges, the challenges that we're all facing today, be it at the federal level, the challenge of what technology can help us do, and some of the things that have remained over the COVID pandemic in terms of workforce challenges, inflation and other things, we still deal with supply chain issues, most recently with I IV fluids, et cetera. But in every one of those challenges, I think, and what energizes me and what makes me excited about what we need to accomplish, we always end up better after these disruptions. If you think about how scary times were in 2020 and where we are today. So telemedicine, for example, got its golden ticket because of the need and the way we've thought about the delivery of healthcare has fundamentally changed in this country and we needed to do that. Unfortunately, it may have taken a pandemic to do that. But as an example, we've as many health systems have been using telemedicine for many years, even before the pandemic, but certainly nothing compared to the acceleration in that technology since 2020. We've hired virtualists now we have physicians that are completely remote, that don't manage patients in person. And as it turns out now we have a very large ambulatory footprint. As I discussed earlier, 6% of our visits are virtual visits by our virtualists. That doesn't include the visits by the many other virtual visits we have on a daily basis with our Providers that also have, in person, kind of traditional clinic models. And so as I look at today and what we might look like five years later from a healthcare standpoint, the short answer is, I don't know. But what I do know is the same level of agility and flexibility and the ability to grow and transform ourselves is far better than it's ever been. And as we look at what AI can do for us and what the federal government may force us to do, and how we think about partnerships and how we think about clinical growth in uncertain times, of higher costs across labor, supplies, pharmaceuticals, et cetera, a big piece of me still really excited about how we're going to look on the other side of things. Got a lot of smart people in healthcare. We're going to figure this out, and I think we're going to be better for it.
- [11:46]
Molly Gamble
Yeah. The virtualist status is interesting. 6% of visits are virtual visits conducted by virtual lists. I just want to make sure that's clear for listeners. What's the typical profile or background of a virtualist? Can you say more about that role?
- [12:02]
Dr. Tony Sepal
Sure, yeah. So we started off, first of all, not sure if it was the right thing to do. And is it truly something that we want to invest in? There's a tremendous market. There are a large number of physicians that are interested in diversifying their portfolio of what they do. And so we started off, we have a very strong family community medicine department here. That said, you know what? I think we can do this. And okay, so we started off with family physicians. We hired two initially out of our Bluefield office, which is kind of what would be considered their home base, even though they're not physically present, although they can be, to deliver telemedicine services from that location. Bluefield is a rural location, and for those of you that understand the geography here, we have a large rural footprint here in southwest Virginia. Well, the response from our patients and the success of that model has been substantial. We've added pediatrics. Now we have a pediatric virtualist. I think we're looking at more options. I think the next step for us may be not only building out those primary care specialties, but I think we're going to have subspecialty coverage in this virtualist model. As an example, something like things you might not think about, like rheumatology, neurology, endocrinology, women's health, other women's health initiatives, prenatal care, et cetera. I think these are all prime areas for virtuous care. And that list is not exhausted by Any means.
- [13:35]
Molly Gamble
I love it. I think to understand how big it could become, especially in a rural population, there's been so many attempts, even from. I'm thinking about retail clinics coming in and think you may hail the ticket to improving care delivery in rural settings. So it's great to see how health systems like yours are continually testing the boundaries and realms of limitation as we see it and challenging that status quo. It sounds like there is a bright future for that program.
- [14:01]
Dr. Tony Sepal
Yeah, I agree, I agree. I think we're probably just scratching the surface, quite frankly. Even though so much telemedicine is occurring certainly in independent industry, Teladoc and others who have had successes and failures over time have monetized the ability to deliver telemedicine. I think health systems are uniquely positioned because of the brand strength and the loyalty that the patient populations have to their health system. It just makes sense. It's what they want and need. And certainly in rural areas where we worry about not just access but health equity and health justice, it's another bridge to help us get to where we want to be for those populations.
- [14:48]
Molly Gamble
Well, let's see. Tony, I wanted to wind down here. We've talked about the need for adaptability and vision from healthcare leaders like you. I want to see on that note what advice you might have to those who are either stepping into expanded leadership roles, maybe new leadership roles, or maybe just trying to figure out their next chapter as leaders if they've been at this for a while. Is there a piece of advice that has been especially relevant to you as of late?
- [15:16]
Dr. Tony Sepal
I would say be yourself, lean on your team, maintain transparency, honesty, even in the face of failure, or maybe didn't answer the bell the way it should have been answered, that's okay. Your team will respect and resonate with that because none of us are perfect. But providing a clear vision that is mission driven I think is the key. And at Crillian Clinic, I tell you, you can wake an employee up out of a dead sleep and they'll be able to tell you what our mission is. I don't know, out of a dead sleep. They'll get all the words right, but they will get the message across. And I think that that is a powerful message in healthcare. Unity in health systems in any industry is critical to the success of what we need to do. And the currency that we deal in is patients lives, quality of life and well being. And that's something that I and we take very, very seriously. And so the moral imperative is pretty and for those of you that are thinking about a career in healthcare leadership. Go for it. It is incredibly rewarding, but make sure you're prepared. It's not smooth sailing. In fact, it's rocky for most of it. But the reward for what we do, at least for me, is what gets me up in the morning every day. I love coming to work. I love being part of this health system because we're making a difference. And I think that, and thanks to you at Becker's and this podcast, we get to make a difference for more than just this region and the communities that we serve at Curling Clinic, but for others who can learn from us, as well as me learning from them and us learning from the others that participate. So it's a wonderful community of leaders. We're all in it together. Although at times we may have to compete with each other, at the end of the day, we all support each other. And I think that's just a wonderful aspect of what we do in this industry as a global team for US Healthcare. And I'm also thankful to you guys at Beckers. I was at the national meeting, most recently is the first time I've been to a Beckers meeting. And I was just blown away by the collegiality, the depth of information, the support and the commitment that Beckers has that is aligned with leaders in healthcare. So, Molly, thank you for all that you do and what Beckers does for us in sharing the message and the information to make us all better.
- [17:47]
Molly Gamble
Tony, thank you so much. I mean, I think we are fortunate to be in an industry where people can't help but share. You know, they're so pleased and proud of the work they're doing and they just want to ensure that system to system, that best practice knowledge, know how is being shared. So it's a good spot to be. We're very fortunate and we thank you for your participation. Listeners, this has been Dr. Tony Sepal. Tony is the executive vice president, chief physician, executive Thrilling clinic. Tony, so great to have you for the first time on the podcast. I hope you'll return.
- [18:17]
Dr. Tony Sepal
Molly, it was a pleasure. I am really thankful that I was invited. Happy to come back anytime.