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This is Alan Condon with the Becker's ASC
podcast, and I am thrilled to be joined
today by Melissa Wiebel,
who's the CEO at Guam Surgery Center. Melissa,
a pleasure to have you on your first
Becker's podcast with us today.
I'd love to turn the floor over to
you. 1st and foremost, to tell our listeners
a little bit about your role and your
background at Guam Surgery Center.
Okay. Thank you so much. It's a pleasure
to be invited.
So my, journey getting to, the Guam Surgery
Center Guam is, obviously, a territory of the
United States, but it's a it's over 7,000
miles away from the rest of the mainland.
And I started off as a nurse. I
knew in nursing school that I wanted to
be a perioperative nurse, so that was a
pretty easy fix. I've spent my year on
the floor and then transferred directly to the
operating room
and learned how to be a perioperative nurse.
Did that for many years in the hospital
setting. And then in
2010,
I was recruited,
by u USPI, actually, and,
went to work as an administrator at a
surgery center. So it was not in my
plans to be in the ambulatory surgery setting.
It's just how that worked out. And I
was there for about 4 years
and, believe it or not, was fired from
that job. It was that was an interesting
turn of events.
But it was a good thing because it
opened the door for me to be able
to explore other options. And
at the time,
the Guam Surgery Center was was posted on
ASCA. They were looking for somebody to come
and be their
chief clinical officer and do some of those
types of things, so I applied and it
it was a whirlwind. About a month later,
I was on the island, and I've been
here,
now for 14 years.
The surgery center is a a
4 4 room OR
location. It it's a beautiful place.
It has all the same things you would
expect. The rooms were actually bigger than the
surgery center that I first started out at.
And the people here are so warm and
welcoming, and they are so appreciative of anybody
who has medical
skills and training that wants to be here
to serve them.
But there are a lot of challenges with
being on an island that's very far away
from all of the supplies that you need.
Because, of course, we still have to follow
all of the US regulations, which means, you
know, making sure everything has FDA approval.
There's a lot of shenanigans
that go on with,
other countries trying to sell items to us
that don't meet
the specifications
for
US rules. So there's,
it's a challenge. It's a challenge being this
far out and away from everything, you know,
and it's expensive. This is not an inexpensive
place to live or work.
Yeah. I mean, what a what a what
a fascinating background. I think from starting out
as a perioperative nurse in hospitals, as you
said, being recruited from USPI.
And I know it's I believe you said
the last 13 years or so now with
Guam Surgicenter.
Exciting, and no doubt it has its own
specific and unique challenges as well. So I'm
kind of excited to kind of dive right
in there. But
to to your point on what you've said
in your opening remarks, Melissa, are you still
it is
Guam's obviously a US territory, but, you know,
vastly out there,
in terms of 70,70,000
kilometers away. We still have to follow a
lot of those regulations,
look, FDA approval for specific items and whatnot.
But before we get you on that, I
are there any
when we talked about the health the trends
in the health care and ASC space,
what are the 2 or 3 trends that
you're paying most attention to that most affect
you, and why?
Well, that's interesting. Right? Because, when I even
when I, looked at those questions,
prior to this meeting, I went, wow. It's
so much different.
Long, realistically,
medical wise,
especially in surgery, is about 20 years behind
what the US is doing
for multiple reasons.
You know, we don't have representatives who are
sitting on island just waiting to to serve
us. You know? That that's not that's not
possible. As a matter of fact, for the
first,
probably, 10 years that I was here, it
was very rare to see a representative of
any kind on the island. You were just
doing everything yourself
and really having to push hard to bring
new things to the island. And part of
that is because of our population size.
A big portion of it is, you know,
we don't have a lot of people who
are on private pay. Most people are in
the poverty line on the island. So
it's difficult to bring people with highly skilled
services available
that
they can do enough cases to keep their
skill sets up.
So that's a challenge. But for the for
the US, you know, I the trends that
are interesting to me are, you know, we're
seeing a lot more AI being utilized, and
that's certainly on the administrative side as well
and what they're doing with those things.
I think that there's an interesting trend for,
you know, surgeons and that's been going on
for a while. Surgeons specifically being hired. Right?
And big groups also being hired and brought
into
hospital settings, which that's a worrisome trend for
me.
It's happening on this island as well. If
all of our skilled surgeons
are being employed by the hospital, well, the
first thing they're gonna say is we don't
want you working for a private privately
run surgery center. So that's
the that's the trend that I'm watching closely
here specifically.
As a matter of fact, I've got a
I'm coming up with ways now on how
can I recruit potentially
surgeons that might want to rotate
out here and provide services to the people
here? The other thing would be that
I love the trend that more cases are
going into the ambulatory space.
I think we've proven to Medicare and to
a whole lot of other people
that we are much better priced,
we're much more comfortable,
we provide a very high quality outcome for
our patients.
And it's in a pleasant welcoming environment that's
easy to get to and easy to get
out of. So I love to see that
trend, continue.
Interesting trends in the states are robots and
ASCs as well and the cardiac cases that
are going in. What we find is there's
no way that this far out we could
afford to do either one of those things.
It's just cost prohibitive
for
a place like us.
But it's still interesting to watch. Maybe now.
20 years from now, maybe we'll be doing
it.
Wow. Wow. That's kind of interesting that you're
also seeing going back to, I guess, the
trend of surgeons moving more towards hospital employment,
which obviously presents a bit of a challenge
for for privately run ASCs like yourself and
no doubt we're seeing the same very much
so in the states as well. You did
say that you were, I guess, looking at
options to recruit some rotating surgeons. Could you
give us a little bit more insight into
that?
Sure. So,
we I actually have an example of that.
The we have a gentleman who is a
we have more actually than one, but there's
one that's been doing it for, you know,
20 years, who is a retina specialist.
And, he's out of Beverly Hills, and he
comes out every 6 to 8 weeks or
so.
And he's got a full time staff here
on island,
and so he's able to come out. He's
got great relationships with our cataract surgeons that
are on island.
And he sees patients
in clinic, and he's here for a week,
and he works like a crazy man that
week,
not only but also in his office. I'm
looking to maybe do the same kind of
thing
with
potentially urology
and orthopedics, specifically
sports med. We need a really good
sports med,
kind of surgeon who can come in here
and do these kinds of cases quickly and
effectively.
And I think that potentially
rotating some surgeons in a bigger group,
maybe what's needed, because maybe that's just not
enough for them to want to be here
and live here, but maybe I could convince
them that's a good thing to do.
It's a win win for them, but it's
really a huge win for the island.
Yeah. I'm sure Guam's sounds like a a
really nice place to go for 6 to
6 or 8 weeks even if you are
gonna be working that hard. Right? But,
I wonder how how does that come about?
It was specifically with the Beverly Hills surgeon
that you mentioned. Is that just a case
of you reaching out using your own personal
connections? Or have you kind of forged that
relationship and ultimately recruit some of these rotating
surgeons?
Well, that's where, you know, it is
I don't know if you'll see the kind
of,
of assistance that you see here.
So the surgery center is very good about
assisting our hospitals. There's actually 3 hospitals on
this island. 1 is the community,
hospital. There was a private hospital built here.
Oh, my word. I think maybe they've been
here 7 years now.
And then we have a military hospital. The
navy has a hospital as well.
And so our policy has always been, if
they have a need in order to serve
a patient that they can't fill, then we
will assist if possible. So if I have
supplies
that they need that I'm not in I'm
not using right now in order to take
care of patient, then we will load it
to them. If we same with medications and
everything else. If there's something that they need
in the care of a patient right now,
we will do what we can to help
support that.
We've shared instruments. We've shared equipment. We've shared
supplies.
I've even shared staff a couple of times.
And because of that, we've seen a lot,
that being returned
from our community. So it's very open as
far as that goes. The hospitals try and
help each other, which is not, I don't
think you're gonna see a lot of that
stateside
and
and try and try and assist to take
care of patients. Again, we don't have a
big, you know, there's not like a big
manufacturing plant here that's, you know, creating supplies
that are necessary. Everything is coming from off
island.
And so there's lots of glitches in shipping
there. I'm telling you, shipping has been everybody's
nightmare since COVID and that's not getting better.
So, you know, we have to rely on
each other
for the best outcomes for everybody's patients. And
so that's
it's interesting.
It's
it's also heartening that, you know, we can
we can be competitors,
but we can also be highly compassionate for
the people that we live and work with.
Yeah. Absolutely. It all comes down to the
patient and patient outcomes at the end of
the day. Right? I'm I'm curious to hear.
You talked a little bit about so you
have the the privately the privately owned hospital
that was recently built. You've got the military
hospital and then I believe a community hospital.
Hospital. What does the ASV landscape look like
in Guam? I noticed yourself. There are many
other competitors or ASVs on the on the
island?
Yeah. So there is actually another
listed ambulatory surgery center that is on the
island. It's much smaller. They have a
a one room. It it was owned by
a surgeon. He he started it. He's recently
sold it to another surgeon, so that's good.
I mean, we wanna continue to have the
capability for patients to be utilized. Now I
will also say, am I the best ambulatory
surgery center on island? Yes. Am I the
best,
surgical place to be, period? Yes. I I
put us up against anybody.
Fantastic. Love to hear.
You've mentioned earlier in the conversation we talked
a little bit about how you plan to
grow the surgery center. You talked about recruiting
some of these rotating surgeons. You've touched on,
the trend with AI maybe on the administrative
side. But,
whether you wanted to when you think about
the future of the ASC space, you you
from what you said earlier, on the Guam,
on the island maybe is 20 years behind.
But the future of the ASC space for
your service center in particular, what are you
most excited about?
You know, I'm always excited about the opportunity
to continue to grow and bring new things
to the island, actually. We've been pretty instrumental
in in being the first in things. We
we brought lasers here for urology. We brought,
you know, new,
new towers to help the physicians who are
doing either laparoscopy
or arthroscopy.
You know, we've we've always been normally the
the ones who start doing things before
the hospitals do and then the hospitals will
follow the trend. So I'm looking forward to
always looking for things that work in our
space that
are good for our patients,
obviously, that we can afford and support because,
again, we're not going to have
representatives on island who are gonna be helping
us to maintain and take care of these
things.
On the island, you have to be very
self sufficient. You have to learn to do
things for yourself, to fix things for yourself.
Our
facility, years ago, knew that we would need
biomedical.
And so we found a gentleman who was
highly skilled, but did didn't have certification and
was eager to learn and to do more
things. And so nobody else on the island
and he worked at the hospital at the
time. Nobody would help him to do that,
so we did. We paid for him to
go and get those things done, which has
benefited not just our facility, but everybody else
on the island. So that's the other thing.
You have to not be selfish
when you work this this far out.
Other trends that I think that, you know,
we're gonna continue to see more things,
finding their way into the the surgery center
space,
which I think is exciting, what new
procedures are gonna move into our space, what
new
equipment's gonna be made to make things faster,
better, easier.
Realistically, for me, it's the bigger issue is
keeping surgeons. Right? Keeping
highly skilled surgeons and getting those individuals out
here
to work,
and maybe they don't wanna live here. So,
again, I think that
thinking outside the box and finding
surgeons that would maybe be willing to to
come out here, work for a week, work
really hard for a week,
then maybe do some jumping off, you know,
travel a little bit in Asia, and then
return home feeling refreshed and ready to go,
and potentially be willing to do that, you
know, on a monthly or every other month
basis is gonna be a win for the
island and certainly for my surgery center and
my staff. Those I've got great people
and they work really hard and they're highly
skilled
and they deserve the opportunity to be able
to do all the new cutting edge exciting
things that are being done stateside and frankly
our people deserve the same.
Yeah. I think that's absolutely fascinating
story, fascinating to hear the background, how you
ended up as the the leader and the
CEO of Guam Surgery Center, and also some
of the trends and some of how you're
looking to grow that center as well in
the coming years. Well, it's a fascinating conversation.
Thank you so much for taking the time
out of your busy schedule to speak with
us. We look forward to connecting with you
again down the line. Alright. Thank you so
much, Alan. You guys have a great time,
and enjoy the mainland.