Welcome to Becker's Healthcare Podcast. I'm Chris Sosa,
your host, and I'm thrilled to be joined
today by doctor Gautam Rao. He's the Jack
Medallie professor and chairman for the department of
family medicine and community health at University Hospitals
of Cleveland and Case Western Reserve University.
He's also the chief clinician experience officer for
University Hospitals Health System and editor in chief
of Family Practice.
Gautam, thank you for joining us today.
Thank you, Chris. Thanks so much for having
me.
Gautam, for those in our audience who may
not be familiar with you and your work,
could you just please introduce yourself and tell
us a little bit about your background?
Yeah. So first and foremost, I am a
family physician, have been one for, I guess,
twenty nine years or so. Started my career
after residency in rural Northern Ontario,
then came to Pittsburgh, Pennsylvania, where I did
a fellowship in faculty development and research methods,
and really became been an academic family physician
ever since, that point, but also practicing family
medicine regularly.
I'm also an obesity medicine physician. I was
one of the first, physicians board certified in
that, in that particular subspecialty.
I'm a health services researcher with with, with
a long well, many years in in the
field, actually. I won't tell you how many,
But, but, I've served on study sections and
received funding from major agencies.
I've I'm pretty experienced with medical editing, and
I also serve on the US Preventive Services
Task Force.
Gautam, you certainly wear a lot of hats,
and that's also very impressive and very important
to all all your colleagues, I'm sure. We've
got you on the podcast today to discuss,
recruiting physicians.
It was part of the issue of family
practice, which again, you're the editor of that
publication. So first question I have for you
on that topic is simply, what are the
challenges that university hospitals and the other organizations
for which you work? What are the challenges
you face in recruiting physicians to primary care
in specifics?
Yeah. So, you know, there are there are
unique challenges to every health care system, Chris.
There's no no doubt about it. But I
think globally, we all have the same problem.
And that's what struck me when we put
together this issue. It's not just an American
problem or a North American problem. This is
a problem in Europe. It's a problem in
Asia. It's a problem in many, many parts
of the
world. Uniquely, as the chair of the department,
I am responsible for recruiting primary care physicians
to our department.
And I realize that we face a number
of headwinds in the sense that they can
pretty much go anywhere they want. And, they've
got lots of opportunities out there. And unless
there's a really strong connection to, to our
system, and I think we do a wonderful
job in recruitment and, and
and everything else that a physician might be
looking for. It's very competitive. There's simply
so much demand and so few physicians available.
And that's common to to many other health
care systems, not just in Cleveland, but across
the country and around the world as well.
And, Gautam, when you look at how competitive
the field is,
what is it that helps university hospitals or
any other health systems stand out then?
Yeah. So I think there's there's different things,
Chris, that have come up in putting together
this issue. So when I asked when I
put together the call for papers, I was
very open minded. I didn't know what to
expect. As long as you have an interesting
idea for expanding the primary care workforce,
send me the paper. I'll take a look
at it. And if I think it's promising,
we'll send it out for review and get
some feedback and maybe and of of course,
a very small proportion are actually published
because it is competitive.
But I think that that,
some of the the things that
we found in the issue are things that
we're trying to do here at university hospitals
as well
and is to provide something that's a little
bit interesting. So there's a and, yeah, as
a chief clinician experience officer, which in other
systems, I know you're with Becker's, they call
wellness officer, but it's a it's a similar
sort of thing. There's an age old adage
that if you give a physician
the opportunity to pursue what they're truly passionate
about 20% of the time,
they will won't mind doing the other 80%.
That may be less interesting and that applies
across specialties. If you have a gastroenterologist
who loves pancreatitis
and you give him pancreatitis clinic, maybe half
day or full day a week, he'll do
all the endoscopies
and other things that may not be of
that in much interest. Family physicians are no
different. Primary care physicians in other disciplines like
OBGYN, pediatrics, general internal medicine are no different.
They have their passions. I'm very passionate about
mitigating cardiovascular risk and obesity treatment. There are
others in my department who are passionate about
addiction medicine, for example, others in geriatrics.
The LGBTQ,
health care service line is in my department.
We have a woman who's very passionate about
caring for those communities. And if she has
that opportunity
one or two days a week, the routine
primary care becomes more interesting. So that's something
we would promise people when they when they
come here, we can make your life a
little bit more interesting.
That, I think, is what distinguishes us from
other places that are struggling to recruit.
Other places can recruit
by offering larger,
financial compensation packages,
and that's great.
I think that's something that some people might
be looking for. There's loan repayments, of course.
There are other approaches that kind of, you
know, look at the pipeline of of potential
students who might be interested in family medicine
starting a little bit further back.
I think all of those are great. Some
of the ideas we came that came through
the issue
reflect those fundamental ideas that have been around
a long time. But I will say this,
the definition of insanity is doing the same
thing over and over again and expecting different
results. Right? So I think we have to
make primary care more interesting.
You know, not paying more because that doesn't
seem to really do much and will never
pay as much as some of the other
subspecialties
or not trying to convince people at a
very young age that this is the direction
they need to go in because they may
not choose to. But how about just making
the actual job more interesting? That that's that's
my approach.
Gautam, the 20% number that you hit on,
and I'm I'm glad you mentioned the emotional
components
of
recruiting
physicians. So how did that number, come about?
Well, that's been that's been around for a
very long time. So I I circulate
in in the wellness,
communities of every health system. As you know,
burnout became a big issue about six or
seven years ago, and it really accelerated during
the pandemic.
And, you know, you can remember the scenes
from New York City where health care workers
are really, really working far too hard and
and suffering some psychological
crises.
So when you when you attend meetings, you
will generally find
that,
that that twenty percent number is is thrown
about. Now there's no evidence that it's actually
actual number. And when you meet with a
potential recruit, they might ask for more, or
they might be absolutely thrilled and say I
was only expecting a half day where I
could pursue something
that that brings me more joy than my
regular job.
And I've tested that 20 number among our
recruits, and it seems to be about spot
on for people.
It's not possible, Chris, to allow someone
obesity medicine is a good example because I
I as I said, I do I do
that 20% of the time, my myself personally.
And there are some physicians out there who
say, I really like this.
Can I do that full time? And the
answer as a department chair is no because
we we need you to do regular family
you know, regular primary care as well. But
for a lot of the people who are
have that particular board certification, they're happy with
a day, perhaps a little bit more a
week. So so that's that's that's that's my
experience with it.
Got you. Thank you, Gautam, for laying out
how that experience has gone in your
circles. Right? I think it helps to, our
audience to relate to all of that.
You've mentioned a little bit about how your
role will evolve, but is there anything else
you want to mention about how it's going
to change over the next eighteen months or
so?
Yeah. There's a lot of things. So as
I as I mentioned at the outset, I'm
a health services researcher. I'm passionate about improving
how we deliver care.
We started all kinds of innovations here even
here at University Hospital. One is an on
demand primary care clinic.
It's an old, old fashioned idea. I can
remember in when I was a resident in
Toronto, there were some very much older physicians
who were experimenting with and that is there's
no appointments.
If you arrive before a certain time, your
doctor will see you. You might have to
wait, but the doctor will see you. And
people say, well, what if see someone's waiting
for two hours? He goes, well,
that's okay as long as they know they
have to wait. I mean, they're they're they're
going to be a little annoyed. But they're
really annoyed if you're running behind and they're
waiting for two hours. They had an appointment
at 03:00 and you don't see them till
five.
So that was just one very simple idea
that we started. So how we deliver care
is something I'm passionate about. So over the
next eighteen months, Chris, I think that what
we are trying to do is incorporate more
artificial intelligence based tools into primary care, and
you hear a lot of hype around it.
The most useful tool is the one that
people actually use.
So in our medical obesity treatment program, for
example, where we are very much overloaded with
patients,
we can't see them often enough, we can't
support them in between appointments, we have developed
an AI based health coaching tool that substitutes
counseling for me and and the behavioral counselor
as well. In addition to that, even just
in routine primary care, there is AI based
scribes, for example,
AI based tools that can help summarize provide
summary notes, And, also, this the same sort
of counseling tool that can provide reminders and,
you know, if you have a patient who's
trying to quit smoking, for example, they can
provide counseling and guidance there. So that's definitely
within the next eighteen months is going to
be a big part of what we do.
We also want to
formally
create a new primary care center
at university hospitals.
And this is in the works. We have,
the physical space is being renovated right now.
And what I would expect is those physicians
who choose to work there
will have that 20% opportunity.
And if they have an innovative idea for
how to improve primary care, let's say it's
somebody who says, you know, why don't we
bring in all of our older patients who
need Medicare wellness visits in on the same
day?
That way, we all get experience with it.
They all have the same expectations, and some
of the counseling we provide could even be
provided to them as a group.
Okay. Well, that's an interesting idea. It's not
my idea, but we'll see. We'll give it
a try. And if it works, we'll try
it again and try it again, and that
becomes a new innovation that we,
that we incorporate into our daily routine. So
the innovation center, you would have to be
an innovator. You can't just come in, see
your patients go home, and forget about it.
It would it would have that. And I
think that will appeal to a small but
important subset of potential recruits as well.
And, Gautam, you mentioned how
not just
health systems and hospitals in The US are
dealing with this issue but
globally. Right? Yes. So what and not everyone
has the same resources. Not everyone has the
same sort of, patient makeup etcetera.
But what advice would you give to peers
who are struggling with similar challenges?
Yeah. It's a it's a great question. And
you're right. The challenges are are unique in
different parts of the world. I'm originally from
Canada, and the challenges are pretty similar to
here. But,
we heard through our,
special issue
from, for example, physician working in Gaza right
now,
others working in Eastern Europe and in The
Middle East and and in Sub Saharan Africa.
I think that the challenge they face in
recruiting in those environments, sometimes it's just a
matter of resources,
a very limited number of educational facilities,
schools.
And those physicians, they want the biggest bang
for their buck, so they often will leave
or they won't practice primary care, or they'll
they'll come to they'll leave the country, which
happens quite often. So that's a huge challenge
we heard about as well. But I think
that what
stood out to me in some of our
submissions, Chris, is a lot of people are
struggling to I wanna make this interesting. When
I have a student in my office who's
seeing how I practice primary care,
I think that,
you know, I can make it interesting for
them to show, for example, I I had
a student who was interested in in primary
care, and now she's definitely interested. But, you
know, I I I met with
a a a woman who had lost her
son. The son was 60, and and and
the lady in question was in her early
eighties. And she completely broke down.
And I felt for her. And my young
student said, is this what you do every
day? And I said, that's an important part
of what I do. I do a lot
of things. I do a lot of things
I don't necessarily like to do, signing off
on refills and that sort of thing that
nobody especially likes. And that really struck her,
that sort of human connection that we have.
So what stood out to me is if
you can show that, and that's the the
most the simplest and easiest and most inexpensive
idea
that I think our colleagues overseas can can
probably,
promote.
They, they will they will be able to
meet the challenges. They actually do a more
successful job in Britain, for example. They have
less trouble recruiting, primary care physicians
than we do. So, and that has to
do with some structural issues. But they still
have that issue of, gosh, boy, wouldn't it
be great to be an interventional radiologist or
something else? Isn't that interesting? Well, this can
also be interesting. You just need the right
exposure.
Yeah. I think that's really powerful, Gautam, what
you just pointed out that it it seems
as a very simple thing, but just being
able to show colleagues, potential colleagues, how interesting
that your job is, it's obviously goes a
long way. Thank you for sharing that.
Lastly, Gautam, I simply wanna ask you, and
this is a two part question, at insert
in whatever manner you see fit. Sure. What
are you excited about right now, and what
makes you nervous?
Yeah.
Well,
I think what makes me nervous, I think,
is is the uncertainty that we as physicians
and academic physicians and as researchers face in
general
with,
changes,
in in in the federal,
system overall in terms of funding for Medicaid,
for example.
The vast majority of my patients have Medicaid,
and I fear that they're going to lose
their insurance or they're not gonna qualify,
or they're not gonna submit their paperwork in
time. Most of my patients are elderly.
They live in poor areas, poor communities here
in Cleveland.
Their potential to keep up with things like
that is is pretty limited. So I I
fear that they're just gonna fall through the
cracks.
And,
many of them have chronic illnesses which will
simply get worse. So that is that is
something I anticipate. And similarly, I think, Chris,
in terms of as a researcher, funding on
the federal level has been very uncertain. So
I'm the incoming chair of the health information
technology
research study section at AHRQ,
and our meetings have been on hold for
some time just because the the future is
so uncertain this year. I'm hoping we come
to some sort of resolution on some of
those key issues.
That those are things that I fear. Now,
what gets me excited is a lot of
other things. I told you about the potential
for AI
health coaching, not just for obesity, but for
a large number of other other problems as
well. I've had a lot of exciting conversations
with potential recruits
who kinda fall into the same,
same categories I spoke to you about. They're
excited about one thing in particular. I I
we're recruiting this one woman who's very excited
about caring for the poor
and especially,
poor children with disabilities. And that's that's her
she's an advocate in that area. And I
said, wow. Okay. Of course. Yes, please. You
know? And she that's those are the kinds
of people that I think are emerging.
And if you put the word out there
that there are exciting things going on at
and I think that's definitely true, we'll be
able to recruit some additional people as well.
So those are some of the things that
that really excite me going forward.
Both. And we covered a ton of ground
in just what seemed like a very short
conversation to me.
That's all the time we have for today.
But thank you again for allowing us to
to have your insights and share those with
our audience, and I can't wait till the
next time our pass goes. Alright. Thank you
so much, Chris. Have a wonderful afternoon.