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events page. See you in Chicago.
This is Chris Sosa with the Becker's HealthCare
podcast.
I'm thrilled to be joined by doctor Angelo
Milazzo of Duke Health, where he is vice
chair of practice and clinical affairs in the
pediatrics department and a professor in the pediatrics
division. Doctor Milazzo, thank you for joining us
today.
Thank you, Chris. It's a pleasure to be
back with Becker's and speaking with you today.
As you just mentioned, you are a frequent
guest on our podcast, which is wonderful. But
for our listeners who are not familiar with
you, could you please introduce yourself and tell
us a bit about your background?
Happy to do it. So I am a
pediatric cardiologist
by training, so I take care of children
of all ages who have
either acquired or congenital cardiac problems,
and that keeps me very busy.
I'm also
the administrator at Duke Children's Hospital here in
Durham, North Carolina.
I serve as the vice chair
for clinical practice.
So I have the opportunity
to work on
strategic growth and operational management for our clinical
practice, which includes
primary care, specialty care,
procedural care, emergency care,
inpatient care, outpatient care and a variety
of variations of all those things.
And what's
so gratifying
is the opportunity to
speak with the Becker's team because I know
that you guys are constantly
thinking about, how we can iterate and improve
and advance the ball, so to speak, in
what we're doing.
And that's what I try to do on
a daily basis in my role as the
vice chair of the department.
I'm constantly thinking through how we can advance
the care,
of children here in the central part of
North Carolina.
Doctor, thank you for setting up the rest
of this podcast so beautifully.
Where we're gonna start is what are your
top priorities today at Duke Health?
At Duke Health, we are
wrestling with many
of the challenges that our colleagues,
our sister institutions, our like minded institutions
across the region and across the country are
wrestling with,
we are looking at workforce challenges. And that's
probably one of the top priorities
in pediatric care because,
as you may know, the pediatric workforce,
particularly in the last couple of years, has
been challenged, challenged both at the level of
our trainees where we're seeing
less people choosing pediatric residencies and pediatric fellowships.
We're beginning to see shortages in many
critical and important areas of pediatric practice, including
some very important
sub specialty areas like endocrinology,
rheumatology,
behavioral medicine, and adolescent health.
Another priority is access.
We are thinking through all the ways that
we can expand,
grow
and iterate on roots of access to our
services.
We're trying to modernize our approach and
incorporate many of the tools that we've learned
to use in the last few years, particularly
digital tools like telemedicine
and virtual visits, but we're also trying to
think of ways to utilize our fixed resources
so that we can quite literally get more
patients
into our clinics, into our hospitals,
into our operating rooms, into our procedural suites.
The third priority that we have is thinking
about how to manage
populations and this is a really key area
in pediatric care
where traditionally
we tend to be focused on the patient
in front of us, the patient who's there
to see us for a clinic visit
or for
procedural
episode
or possibly for a hospitalization,
we need to think differently today. We need
to think about how to manage not only
the patient who is sitting in front of
us but also
the patient as he or she exists within
a community of other patients.
We need to think about the broad health
of populations
as they are impacted by socioeconomic
challenges,
by changes in things like climate,
by changes in things like the way health
care gets funded and paid for.
So it's a shift in focus from the
individual to the community and to the population.
It's an exciting challenge, but it's one that
requires many different stakeholders to come together,
strategize together,
in a way that is very different than
how we used to provide care.
Thank you for laying all out all of
that, doctor. Obviously, those are challenges, as you
mentioned, that are being faced across the health
care spectrum right now. As we look further
ahead,
how do you anticipate your role and your
teams is gonna evolve over the next 18
months in particular as it relates to the
challenges that you just laid out?
I think all of us who are leaders
in medicine need to become chief experience officers.
And I mean that from the perspective of
the experience of the patient and the family,
but also the experience
of the person providing care, whether it's a
physician or an advanced practice provider
or a medical technologist
or a nurse or another valuable team member.
We need to make sure that people who
come to work in health care have a
great experience
of work.
We saw in the last few years of
the pandemic many people exiting health care.
Pediatrics was not immune
to that phenomenon.
We need to make sure that our children's
hospitals,
our offices,
our operating theaters,
our procedural suites
are designed
with the needs of the patient in mind,
with the preferences of the patient in mind,
but also with the needs of the providers
and the clinicians in mind. We want people
to come to work every day wanting to
be happy to see their patients.
A key challenge and particularly over the next
18 months
is building structures around our physicians, around our
advanced practice providers so that we can relieve
them of some of the administrative burden of
care. This is a top challenge for my
institution and many others. We're beginning to incorporate
some new tools,
things like
artificial intelligence assisted visit transcriptions,
things like
triage teams,
which work remotely
to review
the endless stream of messages that are coming
through our electronic portals from our patients, whether
they need prescription refills
or medical advice or appointments.
So building
these really thorough, these really
heavily
resourced
structural elements around our personnel who are providing
care, that's something that we are working on
right now.
Of course, with the shifting economics of care,
paying for these things is always a challenge.
But what we find
in many cases is that
the return on investment is quite high, both
from the perspective of
sustaining the mission of the organization, perhaps more
importantly, however, from the perspective of keeping our
people happy at work.
Thank you again, doctor, for
outlining all those challenges and how they can
be addressed.
Looking forward to even more.
What are you excited about right now? What
makes you nervous? It's a 2 part question,
and please feel free to answer it in
whichever order you find appropriate.
I'm a little bit nervous about some of
the changes that we will be dealing with
in academic pediatric health care that are structured
around
changes to our training programs.
And what I mean is that, you know,
we train the next generation of pediatricians in
our residencies and in our fellowship programs.
These exist all across the country at all
of the major children's centers, including mine here
here at Duke. And what we are about
to undergo
and this happens every several years as the
curriculum of these programs gets reevaluated.
We're about to undergo another seismic shift
in the division of labor.
Increasingly,
our trainees are being asked to do more
outside of the hospital, which may be very
appropriate for their training, but it leaves gaps,
real gaps in coverage inside the hospital, whether
it's in our emergency department,
our critical care unit, our neonatal intensive care
unit, our cardiac intensive care unit, or one
of the number of other areas where we
take care of patients
in our hospital platform. That's gonna be a
huge challenge. We're gonna have to think about
how we leverage the skills of our advanced
practice providers, so our nurse practitioners
and our physician assistants. But it's also gonna
mean that
more work is likely to fall on attending
physicians.
I think most of us understand this is
to be the case and I think most
of us are willing to pitch in and
do what we can, but at the same
time, we need to be really careful. We
need to protect our professional autonomy as much
as possible. And again,
kind of going back to my previous answer,
we need to make sure that we've designed
the work so that people feel really satisfied
at the end of the day. It's an
incredible challenge
and something that I think we're all nervous
about. In terms of what I'm excited about
is related to something I mentioned before,
we have some amazing tools that we're beginning
to incorporate into practice and yes,
people have heard a lot about digital tools
in healthcare,
people have heard a lot of buzz about
artificial intelligence.
And to some extent, like any new technology,
there's sort of a haze of uncertainty
and maybe some overhyping of these things. But
at the core, what I like about our
approach here at Duke is we're getting physicians
involved in the way these new tools are
disseminated and rolled out. So for example, we're
about to launch
a really interesting study where we're gonna test
2 different kinds
of artificial intelligence
enabled systems,
which can help physicians
and other clinicians
transcribe their visits, their clinic visits in real
time, generating
a office letter that can later be reviewed
and edited.
This sounds like
the modern version
of the medical transcriptionist, but it actually has
the potential to be much more
because embedded in these technologies
is some ability
to incorporate outside information, whether it's patient educational
information, whether it's clinical decision support, that's the
really exciting promise of this technology. And, again,
the theme here is the more we can
build
support systems around our physicians,
around our advanced practice providers,
around our other team members,
the more satisfying the work becomes.
And I actually believe that translates into better
care for patients and families.
So lots to be excited about, some things
to be nervous about,
but, this is how it goes in academic
medicine, and we are all looking forward to
thinking through these challenges.
Lastly, doctor Milazzo, what issue or aspect of
children's health care do you believe deserves a
brighter spotlight than it's getting at the moment?
I think we need to shine a spotlight
on the position of children in society in
general. I think pediatricians can be really strong
advocates for children. But when we think about
the
value or sometimes the lack thereof that we
place on children across other areas of our
society,
whether it's in
advocacy
for the rights of children,
whether it's in advocacy for the safety of
children,
whether it's in advocacy for the way children
are educated,
all of these things are really important.
And I think in some ways,
a society can be judged
by how
it deals with and how it supports its
most vulnerable
members. And to some extent, our children are
quite vulnerable.
Pediatricians
tend to, as I said, they tend to
advocate for their patients, they tend to advocate
for young children and families. I think that's
a really important role for
pediatricians, for pediatric health systems
like mine and like other children's hospitals, really
important role for them to play in society.
The more we can
invest today
in children, whether it's their health, whether it's
their education,
whether it's their
ability
to be supported by society in general,
greater the dividends will be in the future.
It will, I think,
pay dividends in terms of,
a spectacular workforce.
I think it will pay dividends in terms
of what children are able to achieve when
they move on to higher education.
I think it will pay dividends in terms
of just an overall brightening
of our future
for
these young kids who will grow up and
go on to do presumably
amazing and wonderful things.
So this is an area where I think
we can all pitch in regardless of what
we do, whether we're physicians,
whether we're podcasters,
whether we're, people like the great people at
Becker's who are thinking about administrative challenges in
medicine and and related issues. I think we
all have a role to play here.
Doctor, thank you for being so generous with
your time and your insights today. We absolutely
cannot wait to share them with the rest
of our audience. I look forward to connecting
with you soon.
Chris, thank you so much. As always, it's
a great pleasure
to speak with the team at Becker's,
and I look forward to joining you again
in the future for further conversations.