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Becker’s Healthcare Podcast
Inside the Future of American Healthcare with Dr. Marschall Runge
00:23:44
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago. This is Scott Becker with the Becker's Healthcare Podcast. We're thrilled today to be joined by a very special guest. We're joined today by Dr. Marshall Runge. And Dr. Runge is both a physician and MD plus is a PhD. He had the pleasure and we were lucky to have him serve as the CEO of Michigan Medicine through a critical period of time at Michigan Medicine. He's also at Johns Hopkins Graduate and just a brilliant person. We're going to talk to Dr. Runge today about several subjects, but first and foremost we're going to discuss a new book that he authored, Marshall, before we discuss the book. One, congratulations on a fantastic career. And second, could you take a moment and introduce yourself to the Becker's healthcare audience, even though you need no introduction.
- [01:23]
B
Well, thank you Scott. It's great to be on the podcast with you and thank you for your very kind comments. I am, as you alluded to, a physician, scientist by training and spend a large part of my career seeing patients and doing research related to cardiovascular disease. I'm a cardiologist and as my career progressed I became more involved in administrative roles. In the last 11 years I completed these actually in the fall I was dean of the medical school at the University of Michigan and CEO of Michigan Medicine, which is the medical school, plus our large $9.5 billion health system. And the great thing about being here is Michigan is full of wonderful people who are passionate about health, passionate about making advances in research and providing the very best in patient care. And so I couldn't, I don't have a single complaint about my opportunities here and I have true. As I've told you before, I truly enjoyed and learned so much from the Beckers meetings that those are a real pearl.
- [02:29]
A
Well, thank you. You are as good a person and leader as they come. And, and I won't say it because I'm not a Michigan sports fan but, but for you I, I will say go blue for one moment because you're a long term Michigan person. We had a couple daughters that went to Michigan. I grew up being a rival of the University of Michigan. At least we thought they were. They didn't think they were rival of us, but, but, but a great, great academic institution. Tell us a little bit, Marshall, you've got such perspective. I want to talk about really two things, your perspective on healthcare in general and second, your book. And both those are really interesting. Let's start with talking about your new book. Tell us a little bit about that and what motivated you to write it. And tell us a little bit about this.
- [03:14]
B
Well, about two and a half years ago, I was contacted by Forbes Books, a great brand, and asked if I would like to write a, with them a book on healthcare. And I like you, I'm sure, and many of us, we get these opportunities to write, participate in writing books, both which are not very interesting. But I thought with Forbes name, this would be a book that could have some impact. I asked them what would you like me to write about about healthcare? And they said, anything you want. And so I thought, well, you don't get that option very often. So I worked with them and developed a book that really talks about both the many, many positives of American health care, but also the pressure points, the areas in which we're having the biggest problems, and then finally some opportunities for the future. So that was the genesis of the book. I so you know, for example, everyone knows the paucity we have of primary care physicians. So I talk about that. I talk about access. I also, to take a step in the opposite direction, talk about the potential for AI, AI in more mundane tasks and AI and more sophisticated tasks. I do talk about some of the amazing things that are happening in drug discovery and device discovery in healthcare that have really made our health care here what I think is the very best in the world. If I'm, if I have a significant or severe disease, there is no place I'd rather be than in the United States. But that said, we have challenges. And finally, I talk some about a topic that is of great interest these days, and that is, as we age, about longevity and what we can think about in terms of what I'll call healthy aging or measurement of healthy average life expectancy, one of these terms that the epidemiologists use where to my great surprise, the United States ranks quite poorly. We rank, when I wrote the book, we ranked 60th, 6, 0 out of all countries in the world in terms of healthy average life expectancy. So I think there's much we can do in these areas. I don't want to leave the, the my strong conviction that we have Wonderful health care, but there are things that we need to improve in.
- [05:42]
A
Thank you, Dr. Run. You've watched the healthcare environment for a long time. You've also been a leader of a great institution, plus of a medical school. What can we do to improve health care in the United States? What is practical? What can be done? I mean, we're the third largest nation in the world, so it's not easy. But, but, but what can be done?
- [06:03]
B
Well, what you hear in the media is true, and that is the cost of health care is much higher per capita in the United States than anywhere else in the world. It's twice as high, about $12,000 per person per year in the United States as the, the next, the runner up is about half that much. And it, and it goes down. And that is without demonstrable solving of some of the, the challenges that we face. And I think that there is one overall concept, and that is our focus in the United States has been on health care, which is important, but it has not been as focused on health and preventive health and keeping keeping people healthy. And I think that were we to put much more emphasis on that aspect of health, we would dramatically reduce our healthcare costs and people would be living longer, living healthier and happier. So what does that mean? Well, I think there are two large deficiencies in the United States that are partly related to the freedom we have in the United States. One is unlike most of our peer countries, we do not have some sort of global, in global health care coverage for everyone. So I'm not talking about universal health, I'm not talking about any of the models that came along, health for everyone, Medicare for everyone. But I'm talking about is some level of health care so that everyone has access and we, we don't have that. Now it's interesting when I talk about that, on one side of the political spectrum, people say, well, that's just way too expensive. We won't do that. On the other side, they say, this is unacceptable. We can't have two or three tiers of healthcare. To which I respond, in the first case, of course we can afford it. If we make people healthier, there's less impact on our budget. When people get very ill, they don't get so sick before they come to the hospital. On the other side, I say, well, let's not kid ourselves. We have at least three tiers of health care. We have commercial insurance, we have government insurance, Medicare, Medicaid, et cetera, and we have no insurance. And that is just not the case with our peer countries around the world. So that's one. The second is many peer countries require that you have a primary care physician. And people critique that. They say, well, wait's too long. Why do I need that? I like to coordinate my own care. But in reality, primary care providers, and I have many of my best friends and some relatives are primary care providers. And they're dedicated and they want to look at each of us, each of their patients, holistically. And I think that's something that is lost in our current environment, where we may go to five specialists, but no one of those people is really looking at our health in totality. So I think those two things highly controversial. Some sort of baseline health care and some sort of requirement that we all have primary care to obtain that baseline health care. And there. And there's some very good examples in the United States that work really well. For example, federally qualified health centers, the Indian Health Service, both of which I've worked in. And I'm just getting ready. I just finished all my credentialing for the VA hospital. There's one here in Ann Arbor. And I'm looking forward to practicing cardiology in the VA hospital as part of my clinical commitment.
- [09:41]
A
That is fantastic. And I think that more and more people on the right and left would like to see coverage for all. And I think that one of the great problems is that we can get to coverage for all, but we actually have to have health care for all. And they're very different things because we've increasingly got. We're up to about 90% of people covered, something like that. But access is incredibly challenging because of supply and demand problems and so forth. And we almost have to do both. We gotta figure out coverage and enough supply, enough demand to provide what you're talking about, which is this, at least some baseline level of healthcare for everybody. And I couldn't agree with you more that that is needed. Agreed. The other thing you mentioned about the tiers of healthcare, I would break it down to say we've moved towards a fourth or fifth tier. You've got commercial Medicare, Medicaid, no coverage. Now, on the other side of the equation, on the commercial side, you've also got this whole evolution of concierge practice, which makes healthcare even more tiered out between the haves and the have nots. And that seems to be getting worse. And a lot's based on supply and demand. There's just not enough doctors. You have more and more doctors moving towards concierge. And you see it in. It used to be just Primary care. Now I see near us a dermatology practice that charges an access fee. There's a cardiology practice in Chicago that's going concierge too. And you've got this incredibly tiering of health care. And I don't blame the doctors at all. But it does speak to a problem we have and just not having enough physicians to take care of the demand. We just have a supply and demand problem too. Dr. Runge, let me ask you another question. Didn't you also write a fiction book? Did you write a fiction book at one time too?
- [11:34]
B
I did. I wrote a novel called Coded to Kill. And first of all, Scott, let me just say I agree with your, your take on this. We don't have enough providers and I do have some ideas about how we can try to supplement that and reduce some of the unique overhead costs in the United States that just aren't present elsewhere. Administrative costs for insurance companies, pharmacy based pharmacy benefit managers, et cetera. But back to the novel. So this was a novel I started when I was at the University of North Carolina. It's based in North Carolina and the premise is that there's a very progressive hospital there that thinks that they have developed the world's greatest electronic medical record and it's going to sweep the United States and be the record of choice and endorsed by everyone. And in the background there are some nefarious forces, let me just put it that way, who are all over that medical record and doing really terrible things. Not just, not just getting digging up dirt on patients, but actually interfering with their health care. And when people ask me about the book, they say what? Well, could that even happen? What I tell them is that yeah, my IT friends tell me it could happen. Hopefully, hopefully we have many protections against any of those things happening. But in the novel, this nefarious group has figured out actually how to kill people using orders surreptitiously entered into the electronic medical record.
- [13:08]
A
Fascinating. Well, congratulations. What a multifaceted person you are. Dr. Runge, you had mentioned thoughts on helping to bridge the gap between supply and demand. Let me tee up on that. A couple thoughts on how we can make some progress there.
- [13:24]
B
Well, several. One is we just don't have enough doctors and the same is true for nurses, as you know. Well, and so we need to open the spigot some and there are lots of different ways to do that. One of the one that ones that intrigues me most, I'm not endorsing this in its fullest context is Michael Crow, who is the president of I should remember it's either University of Arizona or Arizona State has been developing these massive online curricula for various things. And the result is that the students who go through those, instead of being an on campus resident, are equally well prepared and do just as well career wise. He suggested having medical school classes of a thousand people. When I suggested anything like that to our medical educators, you know, they blanched. I thought they were going to fall over because it's just such a different model. But I do think today, with some of the learning tools that we have available, and I will particularly call out in a very positive way AI and the ways in which AI can be used to accelerate learning, I think we have the ability to train many more physicians than we currently do. The second is somehow or another we got to get at this problem of why people are going into concierge care. I don't think any of those people or many of them started off as a child thinking, oh, I want to start a concierge medicine practice. They started out wanting to help people and what they found was with the many roadblocks and the many administrative responsibilities in being a physician, it was just torment. And it's, and it's worst for primary care physicians. And so I think we have to kind of cut through that and figure out how can we make this much more rewarding. And I will tell you just a very short vignette about the Indian Health Service. I had the chance to go to the Indian Health Service operation that's on the Navajo Nation in Shiprock, New Mexico. Beautiful place by the way, and I worked with the internal medicine group there. But I think about 15 people trained, well trained, three had Michigan connections, several had, one was from the University of Chicago, some were from other top tier places. And what was different is first of all the environment. There were no RBUs, no expectations that you had to see a new patient every 15 minutes. They had plenty of time and they had much lower documentation requirements and, and, and they worked in teams and they worked in teams of physicians and non physician providers and they were happy. And it reminded me of practice back when I was getting started in after medical school. People were really happy and felt rewarded. And I think we can create those environments, but they're a different environment than what we've evolved to. I'll make one last comment about this. As, as you well know, the RVU system was developed back in the, I don't know, 60s or 70s as a way to quantify work for Medicare billing. And it's now so far out of control and so rules regulated, that I think it's. It makes it very difficult to have that experience that you're just practicing medicine. But that's a commonality among FQHCs. The doctors there and the staff there, so dedicated, so committed to their mission. And that's not for everybody. Some people would like to make, you know, optimize their financial opportunities. But many people, I think, and even more today going into medicine, want to do it for the reasons of providing care and making a difference in people's lives.
- [17:10]
A
No, thank you. And there's. You can do both, can't you? You could be a great care provider and make a nice living. And particularly at the cost of medical education today, it's almost incumbent. You almost have to. But it's. But I think your point is so well taken. Expanding greatly the med school classes, finding residency spots, would really help a great deal if we could do that. And it seems so doable. I mean, certainly you know this better than anybody else. So much of medical education was developed prior to the Internet. And so we, we. We have. So much of it is. We have, we have a. One of the kids is in med school now and four years of college, four years of medical school, three to four years of residency, maybe a fellowship. People aren't practicing until they're 30, 32. And it's. And so much of it, there's so much wasted time and energy, which is, to these bright young people or at any age, it's just very frustrating.
- [18:06]
B
I'm sure not in small part due to your experience with your daughter. Daughter who's in.
- [18:12]
A
Stepdaughter. Yes, stepdaughter.
- [18:14]
B
It, it is a frustrating situation. It hasn't changed. In a sense, we're our worst enemies. We have various regulatory groups that regulate medical school experience, residency experience, and they just have not modernized. And in today's world, with today's resources, is there any reason that a person needs to go to four full years of college, four full years of medical school, and four years plus fellowship time? I don't think so. I think that all of that can be dramatically reduced without a single bit of loss of quality of training. And actually, I think keeping our young people who are going into healthcare energized, as you said correctly, somebody's 32, 34 years old. I mean, they're worn out and they haven't even started their career, and they may be deeply in debt. And so, you know, the debt is another issue. And we have increased the cost of tuition because most medical schools are aligned with universities. And it's a very common topic that university tuitions have just gone through the roof, way past inflationary rates. And the same is true for medical schools. And. But I think in medical schools, they're small enough that we can think about ways to reduce that cost.
- [19:35]
A
You couldn't agree more. And I think the proof is in the pudding in that many other countries educate doctors on a much faster timeline. And we are the beneficiaries of those doctors in this country. We are fortunate that many of those immigrate here, and many of them are done with medical school, done with their training by 27, 28 or so. And they're some of the leaders of our health care system. So it's doable. We just haven't done it. No. Dr. Rung, I love getting a chance to visit with you. Let me with one more thought. You've had this remarkable career as a physician, as a leader, as an author. Now fiction and nonfiction. A great thinker, a great person. What advice to an emerging professional? What advice do you give somebody who's an emerging professional trying to have a fulfilling career?
- [20:21]
B
Well, as you might imagine, I've been asked this question innumerable times by medical students, by residents. What, what do I think they should do with their career? And my advice, which I was given, oh, Golly, more than 40 years ago, is do what you love to do and you'll be happy. And so in my case, for my research during my PhD, I was really intrigued by neurology. I mean, all this fascinating brain knowledge. But then once I did some neurology rotations, I realized, well, I didn't really so much enjoy the academic process, which is all it was at that time, of making diagnoses. I wanted to do something where I felt like I could be helping people. And cardiology. I did. I did one cardiology rotation. It was just when thrombolytic therapy was coming out for treatment of acute myocardial infarction. There wasn't any treatment, really, except for put them in the CCU and hope for the best. And that was followed by so many innovations over that next 20 years that that was my passion. And my passion was in clinical areas, and my passion was to try to help students and residents find their passion. But. But I think it comes from within. And I think there's, I mean, people are. Some people love the idea of primary care. I have a daughter who's a pediatrician, general pediatrician, and she loves what she does. And other people really want to do the, the high tech work, and that's great. We. We need everyone. So I think. I think following your passion is the best advice I can give somebody. And in my case, I got asked to do administrative roles or participate in administrative roles. It turned out, much to my surprise, that I actually enjoyed that. Other people hate it, and so if you enjoy it, that's good. If you don't enjoy it, don't do it. I mean, you just have to take a little trial of these things and find out whether it's your cup of tea or not.
- [22:24]
A
But I think that's such great advice. The concept of you have to test different things to see what you really think and to see if you really love them. You just have to test different things and there is some trial and error involved, and I love that. Dr. Runge, thank you as always, for joining us. Can you take one more moment and tell everybody the exact title of the. Of the latest book? All right.
- [22:44]
B
The latest book. Thank you, Scott. And again, thank you for being on your podcast is the Great Healthcare Disruption Big Tech, Bold Policy in the Future of American Medicine. And it covers. Has 10 chapters. It covers what I felt and I could easily be wrong were the most important topics for the next five to ten years in American healthcare. And it's written to be accessible. I have enough. Enough data in it to be of interest to any healthcare provider, but also to be accessible to people who are not primarily healthcare providers but are interested in healthcare.
- [23:19]
A
Marshall. Dr. Runge, what a great career. What a great pleasure to visit with you. I love to see you still thriving, doing clinical work back at the va. Simply remarkable. Thank you so much for taking the time with us today on the Becker's Healthcare Podcast. You're as good a person and leader as they come. Thank you very much.
- [23:36]
B
Thank you, Scott. And keep up everything you're doing. It's been a lifeline for me.
- [23:39]
A
We're trying. Thank you so much.