Becker’s Healthcare Podcast: Interview with Dr. Michael S. Smith

Date: December 14, 2025
Guest: Dr. Michael S. Smith, Associate System Chief of Gastroenterology for Clinical Operations and Strategic Planning, Mount Sinai Health System
Host: Scott Becker

Episode Overview

This episode features Dr. Michael S. Smith, an accomplished gastroenterologist and leader at Mount Sinai Health System. Dr. Smith discusses trends shaping gastroenterology and broader healthcare, operational and financial challenges, the critical importance of provider and patient satisfaction, and effective leadership strategies for emerging leaders. Throughout the conversation, Dr. Smith shares practical wisdom from his dual role as a clinician and administrator, offering both high-level insights and tangible, real-world examples.

Key Discussion Points and Insights

1. Dr. Smith’s Background and Mount Sinai Health System

[00:50 – 02:52]

• Dr. Smith provides an overview of his role and the scope of Mount Sinai:
  • Seven hospitals, 400+ care sites, 50,000 employees—9,000+ physicians.
  • Describes the system’s expansion via acquisitions (Mount Sinai Queens, Continuum Health Partners, South Nassau Communities Hospital).
  • Highlights Mount Sinai’s GI team: ~100 employed gastroenterologists, supported by many voluntary and associated faculty.
  • Points to dual missions: patient care and research, with a strong academic and training program (two GI fellowship programs, NIH-funded research).
  • Focus on transforming the department from “a bunch of different fiefdoms” into a system working collaboratively.

2. Current Trends and Pressures in Gastroenterology

[03:02 – 07:50]

• Late Cancellations:

  • Shift in patient behavior post-COVID, with an “epidemic” of late cancellations for elective procedures jeopardizing both care and revenue.
    • “We are really dealing with an epidemic of what we're calling late cancellations.” — Dr. Smith [03:11]
  • Problem impacts both academic and private center practices.
  • The challenge is exacerbated by lengthy insurance authorization windows, making it impossible to refill canceled slots in time.

• Reimbursement Challenges:

  • Persistent issue with ASC reimbursement trending down; only slight hospital reimbursement increases that don’t match cost escalation.
  • Telehealth’s future is in flux: patients love it (especially elderly and those with travel difficulty), but reimbursement is uncertain, especially with budget changes.
    • “Patients certainly seem to love it...but the reimbursement may not be there. And that uncertainty...is certainly something we’re trying to figure out.” [04:19–04:37]
  • Telehealth also allows more efficient use of expensive Manhattan real estate.

• Role of Data & Analytics:

  • Emphasis on workflow optimization, scheduling, and the importance of actionable data.
  • Importance of collaboration with the C-suite and IT: “Having good and actionable data is really, really important...”

• Patient Experience and Technology:

  • Increasing demand for timely communications (“even in off-hours, nights, and weekends”).
  • Balance between high-touch service/communication and physician/provider well-being.
  • Role and promise of AI: as a tool for improving both patient and provider experiences, especially by automating documentation and communication tasks.
    • “AI can really help drive success across all aspects of the patient journey. But perhaps we need to focus just as much on relieving some of the burden from providers...” [06:44]

3. Sustaining Positivity Amid Burnout and Staff Shortages

[07:50 – 11:40]

• Dr. Smith’s personal approach to staying positive:
  • Admits the difficulty but credits his ongoing clinical work as an “esophageal specialist,” helping desperate patients as a fundamental motivator.
  • Teaching and mentoring upcoming physicians is a “real satisfier” that keeps him committed to academic medicine despite administrative pressures.
  • Relays a mentor’s wisdom on the importance of cherishing time spent in direct patient care and teaching.
    • “Knowing that I can have that piece of what I do make a difference in those patients' lives every day is a real satisfier for me...” [08:47]
    • “It would be really tough not to have that clinical grounding and try and do the work that I do...” [11:02]

4. 2026 Priorities and Opportunities

[11:50 – 17:06]

• Financial Pressures & Growth:

  • Ongoing mandate for GI departments to maximize their bottom-line contributions.
  • Despite challenges, Mount Sinai’s endoscopy caseload has achieved “over 10% growth year over year coming out of the pandemic.” [12:23]
  • National average GI ASC utilization is just 59%, suggesting significant room to increase efficiency and case volume.

• Operational Innovations:

  • Dr. Smith’s focus is on scheduling optimization to reduce waste without sacrificing provider satisfaction or increasing burnout.
    • “The easiest thing to do is to double book...but really coming up with the way that we design schedules...so that we can do more...still maintains that work-life balance...” [13:37]
  • War for talent: emphasizing the importance of working conditions to recruit and retain gastroenterologists.

• The Future and Limits of AI:

  • Exploring how and where to effectively integrate AI—from scheduling, analytics, and business ops to the patient experience.
  • Cautions about impersonal, AI-driven interactions, citing consumer frustration with non-human customer service, and questioning when patients will “draw the line” in healthcare.
    • “If you add on top of that healthcare woes and not feeling well...where are patients going to say enough is enough here?” [15:53]

5. Leadership Advice for Emerging Leaders

[17:17 – 22:06]

• Building a Toolkit and Mentor Network:

  • Seek mentorship not just in your discipline, but more broadly—“across fields, across industries.”
  • Mentorship needs change with career stages; maintain a “stable of mentors” and don’t lose touch with former ones.

• Tailored Communication:

  • Leaders must adapt their communication style to match different audiences (from supervisors to team members).

• Embracing Collaboration:

  • View teams as partners, not subordinates—success is collective.
    • “These are not people who work for me, these are people who work with me and I can't be successful without them.” [19:06]

• Recognition & Retention:

  • Actively credit your team, especially when reporting up.
  • Small actions to show value can have outsized financial and operational impact—losing one gastroenterologist can cost over $1M in lost revenue and even more in time-to-replacement.

• Lead by Example:

  • “Don’t be afraid to get dirty”—work beside your team during crunch times builds respect from both subordinates and superiors.

Notable Quotes & Memorable Moments

• On Late Cancellations:

  • “We are really dealing with an epidemic of what we're calling late cancellations...that becomes a lost opportunity both to provide the patient care, but also to collect on the revenue.” — Dr. Smith [03:11]

• On Telehealth and Reimbursement:

  • “Patients certainly seem to love it...but the reimbursement may not be there. And that uncertainty...is certainly something we’re trying to figure out.” — Dr. Smith [04:19–04:37]

• On Maintaining Positivity:

  • “Knowing that I can have that piece of what I do make a difference in those patients' lives every day is a real satisfier for me...” — Dr. Smith [08:47]

• On the War for Talent:

  • “Quite frankly there’s a war for talent in gastroenterology...a really good provider, even a brand new one fresh out of training, is going to be highly coveted...” — Dr. Smith [13:56]

• On the Limits of AI and Healthcare:

  • “I think about the phone trees now...it takes forever to get to a human...If you add on top of that healthcare woes...where are patients going to say enough is enough here?” — Dr. Smith [15:53]

• On Leadership and Teams:

  • “These are not people who work for me, these are people who work with me and I can’t be successful without them.” — Dr. Smith [19:06]

• On Recognition and Value:

  • “It’s probably over a million dollars of lost revenue...just in the time it takes to fill the empty position...So, you know, to me, investing in ways to make those people feel valued...is important.” — Dr. Smith [20:06]

Timestamps for Key Segments

• Background & Mount Sinai GI System: 00:50 – 02:52
• Biggest Trends & Challenges – Late Cancellations, Reimbursement, Telehealth: 03:02 – 07:50
• Provider Well-being & Positivity: 07:50 – 11:40
• 2026 Priorities – Financial Goals, Efficiency, AI: 11:50 – 17:06
• Leadership Advice: 17:17 – 22:06

Conclusion

Dr. Michael S. Smith’s interview is a concise, insightful look at the operational realities and culture of academic gastroenterology in a post-pandemic era. His perspectives on innovation, patient and provider satisfaction, and especially leadership highlight both the challenges and the opportunities facing healthcare administrators and clinicians. Listeners gain practical strategies for team management, technological adaptation, and sustaining professional fulfillment in a dynamic healthcare landscape.