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Becker’s Healthcare Podcast
Rethinking Medical Training with Dr. Sylvester Youlo of Phelps Health
00:12:41
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- [00:00]
A
This is Scott Becker with the Becker Healthcare Podcast. I'm thrilled today to be joined by a brilliant orthopedic surgeon. We're joined today by Dr. Sylvester Yulo. And Dr. Yulo is going to talk to us about one of the issues that I am so engaged with, which is trying to figure out how do we make medical education a little bit quicker in our country. Because at this point we're running short on so many specialists, so many doctors, and, and that's going to get a lot worse. And we've got ourselves to a situation we're in our nation. Medical school plus college plus residency ends up about 12 years. People aren't practicing until they're about 30 plus and then a lot go part time by 40. We've got to try and fix this for a lot of reasons. Dr. Yulo, can you take a second to introduce yourself and tell us about what you do?
- [00:55]
B
So my name is Sylvester Yulo. I am an orthopedic surgeon, a healthcare leader and business strategist. A little bit about my graph background. I grew up in a small rural town in Liberia, West Africa. In my hometown, access to healthcare was almost non existent. The only person you would call a doctor in my hometown was a nurse. In fact, you only saw Dr. Karma when herbs that grandmother gave you did not work and you were almost to the point of death. I actually wrote about those early life experiences in my memoir the Boy from Cleveland because they shaped my view of medicine and access to medicine today. For medical school I went to Wright State University Medical School in Ohio and then completed five years of residence in Orthopedic surgery at the University of Wisconsin Hospitals and Clinics and then did a post medicine fellowship for one year the University of Kentucky. After that I earned an MBA from Indiana University Kenneth School of Business and then went on to get a Master's of Health Administration from the University of Scranton. Now these additional degrees, I earned them because I believe that improving care isn't just about operating room, it is also about designing better systems that work for patients. Today I run a very busy orthopedic practice in rural Missouri at Felthealth. Felthel is a community hospital that serves about 250,000 service areas. We are also the unofficial primary center that provide most orthopedic care for Fort Leonard, a U.S. army training installation that hosts about 10,000 plus service members, their families. Most orthopedic programs though on this topic, still follows the traditional five year model. You go to five years of residency and you have one year of fellowship. Most of the first Three years is spent doing non surgical work. Meaningful oral time does not really begin until third year of training. By the fourth year, most residents already know what they want to do. They want to be so specialized and so they go on to fellowship and that's how the system is set up. I think this is inefficient and it's a waste of time and scarce resources. That is why I argued in the op ed I wrote recently that orthopedic surgeon residents, they should be three years not sick. In our model, it will create a pathway that will produce excellent surgeons faster and help address the looming orthopedics surgeon surface that is already limiting care access in a country.
- [03:43]
A
Let me ask you a question, Dr. Yule, before we talk about that, there's something that's that much more interesting. How do you end up from Liberia here as a leading surgeon? That is an amazing life story. Can you just give us a few minutes on that and congratulations on your journey. Give us a few minutes on that and then let's talk about making residency shorter. So I could not agree with you more, but tell us a little bit about you and how you came to where you are today.
- [04:13]
B
It is a long story, obviously. And as I said, I wrote about this story in my memoir, the Boy from plo. And in that memoir, and the story begins in a small town in Liberia, small town called Plivo. I was raised by my grandmother until when I was 13 years old, there was a civil war in Liberia. That civil war lasted for about 14 years. In the early stages, there was mayhem, there was slaughter, there was death everywhere. And as a young man, at 14, I fled Liberia and went to refugee life in Ghana. I lived in a refugee camp with no parents, by myself for about six years. And then at some point I made it to the United States when I was about 24 years old. And the third goes from there.
- [05:03]
A
Well, that is literally amazing and fascinating. Thank you. And talk about, I think so many other nations that produce fantastic doctors, they do residency and medical school quicker than us. Why has ours become so elongated? And what stops us from making some of these things shorter?
- [05:23]
B
So focusing on residency, I think there are a few things. I think the first thing is we tend to live by tradition in the United States and also in most parts of the world. We try to live by tradition. Back in the 60s or maybe earlier, there was this tradition that surgeons have to study for long years to become surgeons. And so the whole residency for five years for orthopedics began. And it's been that way what was obvious at the time was orthopedic surgeons were produced to do everything. He got out of training and went out there and took care of people and did orthopedics. You did trauma, you did, you know, you did fractures, you did joint replacement, you did everything. That has changed in today's world. We've changed the way we treat people by this soft specialization. And so we are, we are almost focused on tradition. A surgeon has to go to school for ethnomal years and we can't change that.
- [06:21]
A
And how can we change that? Who's against changing it? Is it the health systems that are against it? Is it the government's against it? Because it just seems as though doctors, for example, from India start right out of college and medical school. They're ready to practice fully by 27, 28. We've pushed it to a situation where people aren't really ready to practice at 30, 32. We know the quality of the physicians coming out of many other countries is just as good as the quality company of our country. How do we. What stops us from making these changes?
- [06:53]
B
Oh, it's because, I mean, it's because the first thing I said was tradition. The second thing is that there is a benefit, there is a benefit of performing in most cases, free labor for residents. The first year of residency you're pretty much not doing anything. When I was resident, you rotated on every sub specialty and doing those rotations, you pretty much just did work that was not related to what you were going to do. You didn't even touch orthopedics the first year. And then in your second year in training orthopedics, you still don't do anything surgical. You pretty much do work on the flows, you discharge patients, you write orders and such, you answer the pager and things like that. And then third year you have the opportunity to kind of really hesitate the operating room. But even during that time you still have to take time off to do other things like research. So in my program you had about a 10 week block of research that you did. And so by the time you start to do surgery, you know, they take that first three years of doing work that is not related to being a surgeon in my opinion. And you know, towards the end 30 years when you already engaged into surgery, but then by the time you get to fourth year, most residents have already decided they want to become so specialized and so the attention is on self specializing in the end. In last fifth year you just sit around and waiting to go do fellowship. And that's the system we have now.
- [08:26]
A
You're fascinating. No, thank you. And Dr. Will, where can people find your book? The book that you authored, where can we find that and tell us the full title of it again.
- [08:40]
B
The book is called the Boy from Plevo. So Plebo is T L E E B O. It is a small town where I was born and raised until I was 13, 14 years old. The book you can find on Amazon and in most, most online bookstores. It's not in, you know, Italian mortar bookstore, but online you can find it. It's both. It's something you can read online and it's also a hard copy. You can get a hard copy of that book. You can also read it online.
- [09:12]
A
Fantastic. I see it now on Amazon. I'm about to buy it. The Boy from Plebo A Story of survival and perseverance. Dr. Sylvester Yullow. Thank you. Okay, I've got it now. Great. I'm about to get to the purchase. Spot on it. It's fantastic. Great. Well, that is awesome. Any advice you'd give to people trying to build a career, build a life, you know, what advice do you have for emerging leaders and for people?
- [09:40]
B
So there are a few things that I think emerging leaders should focus on. And this is very important, I mean dear and important to me. I think you should always question tradition. Respectfully. You know, residency lens is not serving the country the way it should. You should question how call is. You know, how many calls you have to take. If you run a practice and it's slow of clinic is not appropriate. Question it if your OR is wasting resources. You should always question stuff that's been done for years because it doesn't always work. And if you think it doesn't serve the patient, then you need to say something and do something about it. I also think you should. We should also focus on building systems and not just your practice. So as a young surgeon or a young leader, think about how you can improve care pathways. Think about how you can recruit and retain physicians for your health system. Find ways to strengthen access to care and not just walk on, hey, I gotta fill out my OR block schedule. Take care of people. Try to mentor the next generation. It can change people's lives. Be the mentor you wish you had and protect your colleagues from burnout. And build a place where people want to stay. Stay curious, be adaptive. In today's world, there are robotics, there is navigation, there's AI, there's value based health systems. The field of orthopedic is moving. The field of surgery moves quickly. Leaders who stay curious will always be ahead of the curve and then keep patients at the center of everything you do. Every innovation should answer one question. Does this make care efficient, safe, and more accessible? I think those are things that every emerging leader should understand and try to focus on.
- [11:37]
A
Thank you very, very much. For those listening, the book I just ordered, the Boy from Plebo P L E E B O A Story of survival and perseverance. Dr. Sylvester Yulo, just so you're aware, for anybody that's a careful shopper, a ton of five star reviews. It's got 48 reviews, 4.7 rating on Amazon. Just fantastic. I bought the 1995 one. I encourage our audience to the same. Thank you. Dr. Yulo. I can't tell you how much I appreciate your thoughts in your journey to Simply remarkable. And I can't tell you how much I agree with you on the pace and timing of residency in medical school. We've got a kid in medical school right now. I think the length of time is ridiculous compared to the shortage we have in America and everything else. Thank you so much for joining us today. Simply remarkable.
- [12:32]
B
Thank you very much. I appreciate it. The chance to be able to speak to the audience.
- [12:37]
A
A total pleasure. Thank you so much.