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About the Guest:

David H. Berger, MD, MHCM
CEO of University Hospital at Downstate

David H. Berger, MD, MHCM is the Chief Executive Officer of University Hospital at Downstate, the main teaching affiliate of Downstate Health Sciences University. Dr. Berger is also a Professor (tenured) in Surgery and Public Health at Downstate. Between 2019-2020 Dr. Berger served as the Chief Operating Officer at the University of Florida – Central Florida. Dr. Berger is an expert in patient flow, operating room throughput, quality, and patient safety. He has extensive experience identifying cutting-edge healthcare technology and implementing the technology effectively in hospitals. Dr. Berger previously served as the Senior Vice President and Chief Operating Officer of Baylor St. Luke’s Medical Center, Chief Medical Officer of the Baylor College of Medicine McNair Facility, and Operative Care Line Executive of the Michael. E. DeBakey VA Medical Center.

Dr. Berger is a native of New York, where he received his medical degree (1984) from the State University of New York Health Science Center in Brooklyn. Dr. Berger completed a General Surgery residency at SUNY-Brooklyn and a fellowship in Surgical Oncology at the UT MD Anderson Cancer Center. Dr. Berger completed a Master of Science in Health Care Management at Harvard University in 2007. Dr. Berger has over 200 publications. He is the Founding Editor of Perioperative Care and Operating Room Management, a multidisciplinary Elsevier journal. Dr. Berger is Past-President of the Association for Academic Surgery and the Association of VA Surgeons. He is a member of the medical honor society Alpha Omega Alpha. Dr. Berger is married to his wife of 38 years Adrianne Saffir-Berger. David and Adrianne have four children Stephanie, Rachel, Daniella, and Isaac. He serves on the board of the Alzheimer’s Foundation of New York City and the Association for Academic Surgery Foundation.

About the Episode:

Welcome back to another episode of Entrepreneur Rx!

This week on the podcast, John talks about physician leadership, digital health, and burnout with Dr. David H. Berger, CEO of University Hospital at Downstate and the main teaching affiliate of Downstate Health Sciences University.

Mentorship and networking have been pillars present in the opportunities that led David toward a leadership role in healthcare. Throughout the conversation, he discusses the importance of physician leaders running healthcare organizations and how he is helping other physicians in that transition. They talk about how digital tools will revolutionize the healthcare industry and relieve the current burnout, pondering on the incoming generations of physicians and highlighting suicide prevention amongst fellow colleagues.

Tune in to this episode to learn about being a physician in a leadership role who embraces the incoming change in healthcare!

Entrepreneur Rx Episode 57:

Entrepreneur Rx_Dr. David H. Berger: Audio automatically transcribed by Sonix

Entrepreneur Rx_Dr. David H. Berger: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

John Shufeldt:
Hello everybody, and welcome to another edition of Entrepreneur Rx, where we help healthcare professionals own their future.

John Shufeldt:
Hey everybody! Welcome back to Entrepreneur Rx. Today I am really fortunate to have Dr. David Berger, who is a chief executive officer at University Hospital at Downstate and the main teaching affiliate of Downstate Health Sciences University. Dr. Berger is an expert in patient flow operating room throughout, which I don't want to talk about, quality, and patient safety. He has extensive experience identifying cost-cutting healthcare technology and implementing the technology that's so effective in hospitals. David, welcome to the podcast.

David H. Berger:
Hey, John, thanks a lot. I'm definitely going to send a copy of this to my mom. She'll love that introduction.

John Shufeldt:
Well, you have such a diverse background. I was like, okay, how do I how do I pare this down? Because one of things I want to talk to you about is working with Michael DeBakey, he was like an early hero of mine, and you probably knew him well.

David H. Berger:
Yes, so I was privileged to be the operative Carolina executive at what became the Michael DeBakey VA Medical Center, which formerly was the Houston VA Medical Center. And the DeBakey VA is actually the largest VA in the system in terms of the number of patients it treats. It's actually the most complex, and we had a very, very busy surgical service. When I first got there. Dr. DeBakey, who was 90 at the time when I arrived, was still the chair of the dean's committee at the VA, and he was still extremely active. And I had the opportunity to interact with Dr. DeBakey ongoing until he passed away. I think he was 99, just short of his 100th birthday. He was just amazing, amazing individual and totally committed to patient care and totally committed to veterans' care throughout. It was just amazing to watch him.

John Shufeldt:
You know, I read the book Hearts, it was about him and Denton Cooley when I was literally, I think, a preteen, and I wanted to be a heart surgeon, you know, my entire life until doing a rotation. So I always admired that, and I went down to Texas on a spring break and walked around Texas heart just trying to absorb it. So it very cool experience, I'm sure.

David H. Berger:
So I was fortunate to work with both of them. So when I became the chief operating officer at Baylor St Luke's, we ran Texas heart and had the opportunity to meet Dr. Cooley in his later years. But he was amazing individual as well, and it's really unusual to have two people of that stature in two institutions right next to each other, and they really fueled each other. The competition between the two of them, and I think the Texas Medical Center and the success of the Texas Medical Center has a lot to do with the fact that they were both there throughout their careers and just amazing legacies.

John Shufeldt:
So you're the perfect person to answer this, and I've always wondered this, did they have a relationship as they got into their later years, or were they still bitter rivals?

David H. Berger:
So there was a bitter rivalry and for a while, they didn't speak to each other, but I think when DeBakey was about 95, they had a reconciliation, and both DeBakey and Cooley have surgical societies in their honor, and Cooley first made DeBakey an honorary member of his society, and the DeBakey made Dr. Cooley an honorary member of his society. So there was a reconciliation towards the end of their lives, which was just amazing to watch.

John Shufeldt:
Oh, that's good, yeah, you know, they were mentor-protege to start, and then all of a sudden, you know, it didn't work out so well. All right, so sorry I got sidetracked a little bit, but I've always wondered that. Okay, so, okay, so backing up, take people through your career, and then let's talk about kind of where how you are where you are.

David H. Berger:
Yeah, so I started out my career. I was actually going to be a pediatrician and then I had some great experience on the surgical service when I was a medical student, and I decided to become a surgeon and in fact, an academic surgeon. I did my general surgery in Brooklyn at the institution I'm now the CEO of and had the opportunity to go to MD Anderson in Houston to do my surgical oncology. And then my first faculty job was in Philly at what was MCP Hahnemann then became Allegheny and got recruited back to Houston to Baylor College of Medicine by someone I was a resident with. And when I got, came back to Houston, I was, it was called the Operative Caroline executive at DeBakey VA, and whereas I thought I was going to be an academic surgeon, have a basic science lab, and then potentially be a chairman and a dean, my experience at the VA really changed that, and it changed my focus from really basic science research to health services and outcomes research and really on patient safety and quality, and then I got the administrative bug. I really enjoyed leading the surgical service there and develop more and more of my leadership skills and really, to hone and round out my administrative education, I went and got a master's in healthcare management at Harvard. And then based on the success at the DeBakey VA, I was asked to come over to the private side of Baylor first as the chief medical officer, then the chief clinical officer, and then the chief operating officer. And then after I had the opportunity to be chief operating officer and really had the full breadth of administrative experience in the hospitals, I got called to become the CEO back at my alma mater again by the chair at Baylor, who, we worked together as residents, and then he then became the dean at Downstate, and he was the one who helped recruit me here. So the question is, how do I get through that winding path? And I think there's a couple of things to think about. I think one of the most important things that is repetitive theme during my career is the issue of mentors. I've had some amazing mentors. So the first mentor was the person who convinced me to be an academic surgeon. Then I had another great mentor who convinced me to be a surgical oncologist. Then I had great mentors when I was at MD Anderson, who helped me on my early career track. So it's been really about mentors, mentors, mentors along the way who really taken an interest in my career and help me achieve my goals. I think the second thing is the issue of opportunity. So while I thought I was going to go in one direction, there were different opportunities that came up throughout my career, and just looking at the opportunity to see how it fit with what my strengths were and what my interests were and seizing those opportunities, again led me on the path to where I currently am as the CEO. And then finally, one of the three most important things is the issue of network. It's really important to build a network throughout your career, and it's not just to benefit yourself because when I network with someone, I ask them how I can help them. But certainly, most of the opportunities I've been presented have been through my network. I got the job initially at Baylor and DeBakey VA because of my network. I got the job to be the chief operating officer at Baylor St Luke's because of my network. I got my CEO job because of my network. Networking is really critical to being able to be successful in your career and achieve what your professional goals are.

John Shufeldt:
How important was it for you to go back and get some advanced education to get your master's?

David H. Berger:
Yeah, so I don't think everyone who wants to be in healthcare administration needs a master's. You really have to be self-aware of what your strengths and weaknesses are and how they fit into the position you're trying to apply for or the goal and the direction you're trying to go in. So I felt there were a couple of things in my training where there were holes. That's basically they had medical training and didn't have a lot of administrative training. So in terms of financial accounting, cost accounting, really honing my negotiation skills, I thought those are things that be helpful to get an advanced degree in, and I don't regret for a day spending the time to get that done.

John Shufeldt:
Yeah, it's funny, you know, I've gone back a couple of times and it's, I'm literally always amazed at what I don't know. It's, you know, the old wise man knows he knows nothing. And boy, there's a lot I learned that I had no idea about, and have a lot left, left to learn. Let me ask you a question. How did you, one thing I had to learn is, as an EM physician like I expect things are just you know, you're probably told Gawande they found given in fact you're both surgical oncologist, but that's kind of where my brain works, but that's not where most people's brains work. How did you transition from let's get this done? You're a surgeon, you expect these results to being, I don't want to say softer but more inclusive. Is that a good way to say it?

David H. Berger:
Yeah, no, that is a challenge, and I grew up in the era of leadership with command and control, especially in surgery. So you've hit the nail on the head with that transition and it isn't easy. And I took my lumps for it because you do make mistakes, and one of the things that I think I'm pretty good at, I'm pretty self-aware. So I take constructive criticism very well, and I'm aware of my weaknesses and my strengths. So I realize that my listening was not a strength because of the fact as a surgeon, make a plan, make the diagnosis, take care of the problem, and that's not the way leadership is currently, and that's not the way you manage an institution. So I read a lot, I took feedback, and I changed the way I approach things, but still, even if I'm in a meeting now with someone, I have to remind myself, okay, be patient, don't jump in, listen, don't react. So it is a learned skill and you have to be aware of how you're coming across to other people. But you're absolutely 100% right. It's a very different mindset.

John Shufeldt:
So you may have heard, Dr. Berger, you are no longer in the operating room. You've got to slow your pace or they're always telling me, slow my roll.

David H. Berger:
You got it, it's very, very true. And even now in the operating room and you mention Gawande, if you read his work, the operating room is a different place now than it was before. It was, the surgeon was the captain of the ship. He didn't speak unless he was spoken to, especially as a nurse or a medical student. Now it's all about situational awareness, making sure all the team is empowered. So it's a very different mindset and leadership style, even for surgeons in the operating room.

John Shufeldt:
Was it difficult for you too? I'm just assuming now you probably don't spend any time in the operating room anymore. Was that a hard challenge?

David H. Berger:
Yeah, so I don't operate anymore, but I try to stay clinically busy in terms of I attend tumor boards. I do a lot of, participate in some of the peer review conferences, but it was a hard transition. It sort of was forced upon me not because of time, but because of physical issues. I've had three operations on my neck and three operations on my lower back. I was a surgical oncologist and do a lot of big abdominal and pelvic surgery, and it just took a toll on my musculoskeletal system, and that's not an uncommon factor. I think 30% of surgeons have had some musculoskeletal issues, especially spinal issues.

John Shufeldt:
Yeah, it's the same with fighter pilots, for example. They have a ton of neck and back issues and I would imagine oral surgeons and dentists do as well just for leaning over somebody. So yeah, you guys, and you guys do it for 7 hours at a time, so it's got to be very physically demanding and mentally demanding.

David H. Berger:
And it's finally been recognized by the surgical societies, and there are several papers that have come out looking at surgeon ergonomics to try to address the issue because it's such a common problem.

John Shufeldt:
Yeah, it's got to be. What are your thoughts? I mean, I've always been under the belief and I think there's some data to support it, that hospitals and hospital systems run by physicians generally do better. I mean, to me that's an intuitive, obvious answer, but I'm sure you've seen both sides. What are your thoughts?

David H. Berger:
So only a small fraction of hospitals in this country are actually run by physicians. I did write a perspective piece that got published in JAMA Surgery. I think it's in 2019 on the issue of physician administrators and at the time, 14 of the top 20 hospitals in U.S. News and World Report were run by physicians. And the other industries where you get similar data is if you look at racecar teams, the teams that are run by either drivers or engineers do much better than businessmen. If you look at basketball teams and over the course of NBA championships, much, many more championships have been won by people who were former players or now coaches than coaches who have not been players in the past. So there is something to the issue of expertise and the ability to lead a team because of that expertise. But I think there are some of the CEOs I've worked with, and worked for, are not doctors, and they were outstanding CEOs and led great institutions. So I think there's a little more to it than just whether or not you're a physician. There's the skills around being a physician.

John Shufeldt:
Yeah, I agree. It's like, you know, aircraft carriers, the captains are always X pilots, they're not ship commanders. So there's certainly something to be said for that, but I also think, like you said, it's not that no one else can do it, obviously, but it's, we have a little bit of a leg up because we understand how healthcare should be practiced and we understand how physicians should act and work, which is part of it.

David H. Berger:
Sorry to interrupt, but the best non-physician CEOs that I've worked for have deference to physician leaders. So they fill that void in their training by deferring to other physicians, and they really respect the physicians and their contribution to the delivery of care.

John Shufeldt:
Yeah, I've been in some hospital systems where physicians were not only treated but were told they were a simple cog in the machine that could be replaced easily, and that just makes the hair on the back of my neck stand up.

David H. Berger:
That doesn't work.

John Shufeldt:
No, I totally agree. One of the things that you talk about and it's on your LinkedIn profile that you help physicians transition to kind of, towards your path doing more administrative leadership roles. How do you do that?

David H. Berger:
Yeah, so it really depends on the person, and I feel since I had great mentors that I have to give back to others and help them on their journey. And really when I coach someone, the main thing I do is I try to listen to them and understand what their goals are, what they think their strengths and weaknesses are, and help them fill in their strengths. The other thing I like to do as a mentor is help them build their network. Again, most of these jobs in administration are filled through networks. Yeah, there's all these recruiting firms that make a huge amount of money, but if you come down to it, usually the person being hired has some type of connection within the organization that's hiring them. So I help them build their portfolio, help them identify their leadership challenges, their personal leadership challenges, but I think most importantly, I help them build their network and help identify opportunities for them.

John Shufeldt:
Do you think from where you've been in your position now, do you see more and more physicians becoming disenfranchised with the healthcare system and are looking to do other things? I get the sense, but it may just be because of the blinders that I have on.

David H. Berger:
I think what's happened as a result of the pandemic is there's a significant amount of physician burnout. Early on, physicians were celebrated and nurses and caregivers were celebrated as heroes, but that didn't last too long. Maybe the first 3 to 6 months, everyone's a healthcare hero, and I think that helped sustain morale during the initial real challenging time. That has totally dissipated, and then with a lot of the vaccine mandates and how healthcare some healthcare workers treated, I think the whole mindset of heroes sort of disappeared, and as a result, because of the stresses of the system and the number of people who have left the system, there is a significant amount of burnout. And because the burnout, people are looking for alternatives and it's not just physicians, but nurses as well are looking to move away from direct care. The other thing that's really fueling this is society as a whole has become much more confrontational. Patients are questioning their healthcare providers and not in a, what we would regard as a socially acceptable manner. So especially the people on the front line, the emergency room staff, as you know, and the hospitalist, and people like that who have really direct patient care and direct interaction with family are in many times being victimized because of the conflict that is grown in society, and the way we interact each other is on much less friendly terms and much more confrontational. So it's a stress.

John Shufeldt:
Yeah, I've definitely noticed that. You know, I stopped asking people if they've been vaccinated because I didn't want to know the answer because I would be frustrated often and I'd say, Well, I want to go down the rabbit hole, but yeah, there's much more antipathy, I think, for these frontline physicians that I've seen over the last, and, you know, Phoenix had hit hard, but nothing like New York did. So you were obviously in the thick of it. How did you, during the thick of it, manage all your physicians? I mean, it's, it had to be hell, frankly.

David H. Berger:
So I wasn't here during the first wave in spring of 2020. This place was overwhelmed. There was, we had some challenges in our physical plant, but we were the only hospital designated COVID only and there were patients everywhere, and it was very, very stressful. I know it was stressful, but frequent communication, people rolled up the sleeves and pitched in, and early on the thought was you even putting your own life and the family's life in danger.

John Shufeldt:
Totally.

David H. Berger:
People still stepped up and did what it took. And even through the first wave and the fact that we're challenged in terms of our facilities are just with any of the other hospitals in New York. So they got through it, but it was a real challenge, but I wasn't here.

John Shufeldt:
Yeah, well, you still got the second wave, I'm sure, which was a little bit better because we're all used to it at that point. We all had COVID fatigue but still managed through it. Let's switch subjects here, if you don't mind. Digital health. You're an expert in digital health. Where is the world going to go with digital health?

David H. Berger:
So I think you have to, when you, looking at that question, look at other industries and how digital has transformed, how you bank, how you make a hotel reservation, how you make an airline reservation. So digital has transformed just about every other industry in the world and healthcare has lagged behind significantly. So I do think over the course of the next 5 to 10 years, we will see a market transformation, how healthcare delivery is delivered. Just look at the pandemic and the rise of telehealth. We talked about telehealth and we actually started telehealth in 2012, 2014 when I was in Houston, but the, because of the pandemic, the use of telehealth really exploded. The other thing that is becoming very, very important is the issue of remote monitoring. We can now monitor all kinds of, the vital signs, regardless of where you are, which is now leading to the movement of hospital at home. So digital tools are going to totally transform how we deliver healthcare. It's going to be a bumpy road because there are so many different apps and solutions and companies trying to get into this space, but I think it will all sort out and we'll see very, very different healthcare system ten years from now.

John Shufeldt:
No, I agree, I started a digital healthcare company in 2010 and literally use their ... call. We can do it in banking, makes total sense and we all trust it. Why can't we do it in healthcare? And so it was slow as hell for about four years and started to pick up, and then the pandemic hit, and as we all know, it just went through the roof. You know, as a surgical oncologist, where do you see the world going for personalized medicine as it relates to the genetic variants we all carry that may make us more predisposed to different kind of cancers? I mean, Brock is obviously the classic one, but there are I'm sure there are literally hundreds.

David H. Berger:
So we're already seeing personalized medicine in the, in cancer therapy right now. So most cancers, they will do genomic analysis and looking at the most frequent mutations and cancer and tailor the chemotherapy specifically to the genetic mutations that any tumor has. So we're already seeing that, and that's just going to continue to explode. I think we're going to have more and more personalized and individualized type of therapies as it moves forward. But we're there already, but it's going to continue to grow.

John Shufeldt:
Do you think, though, ever, and this is a way out there question, do you think you'll ever be a day when we're using gene therapy to prior to diagnosis, say, look, you've got a risk of X, We're going to clip out that gene using CRISPR CAS nine technology and, so you don't have X anymore?

David H. Berger:
Yeah, so I was, when you started the question, I was going to cite CRISPR technology, and that finding has revolutionized our ability to edit the genome. And there's a lot of issues around the ethics of what we should do in terms of our ability to edit the genome, but certainly, if you have someone who has the Li-Fraumeni Syndrome, which is inherited p53 mutation, and you can correct that with the CRISPR mutation by cutting out p53, I think that's going to happen.

John Shufeldt:
Yeah, why not?

David H. Berger:
And clearly, we're already there with our trials going on now with sickle cell disease to treat sickle cell with CRISPR and incredible success, but I think the finding around CRISPR is going to totally revolutionize how we do gene therapy.

John Shufeldt:
Yeah, the only question I have, I agree with you, is there's obviously an ethical component to I want to be 6'4'' not 5'4'', you know, let's fix that. Obviously, that's going to be a stretch, but I worry about if we can get past the ethics, which we'll be able to get past, but then comes how is it going to be, who's going to pay for it? I think that's going to be the next big challenge even as prices come down.

David H. Berger:
Well, in China, there was a scientist who used CRISPR in.

John Shufeldt:
He's ended up in prison.

David H. Berger:
He ended up totally ostracized by the entire scientific community and was, ended up in prison in China.

John Shufeldt:
Yeah, but he was celebrated when he went back home first.

David H. Berger:
Initially, he was, but once the scientists figured out what he actually did. Huge amount of pressure and he was totally ostracized.

John Shufeldt:
Yeah, and I actually feel bad for him. He was way over his skis. However, the people that he did it was basically to prevent children from getting HIV from their HIV parents. So his intent was good, just out over skis.

David H. Berger:
It sounds like you read the Isaacson book.

John Shufeldt:
I did, yeah, how could you tell? How important is entrepreneurism for physicians these days to prevent burnout? Because that's what I mean, that's how I use it. I, you know, I'm still practicing, but it's been three decades plus, but for me, entrepreneurism was always a crutch against burnout. What have you seen?

David H. Berger:
Yeah, so that's a good question. I haven't thought about it in the context of burnout. I think encouraging physician entrepreneurism regardless of what it is, so even if you're fixing a minor thing in the electronic medical record to be able to take care of patients better, I would lump that in terms of entrepreneurism. So I would think encouraging those kind of things and presenting physicians, those opportunities potentially can give them personal satisfaction at their job and maybe decrease the issue of burnout, but I haven't, I can't speak to it directly in terms of, yeah, if we do that, it will decrease burnout. But I think, so we are engaged with the Greater New York Hospital Association in a program to reduce burnout, especially in our hospitalists and our emergency department, and one of the things that has been made clear, burnout has a lot to do with the work environment. So making the work environment better and making it easier for the docs to do what they were trained to do probably has a significant impact on reducing burnout. So it's not that docs aren't resilient all of a sudden, it's that the work environment has become so difficult that they can't function within that work environment.

John Shufeldt:
Yeah, and I think it is true, but as a physician CEO, I mean, I would feel much more comfortable going to you and saying, Hey, David, this isn't working down here. You know, my colleagues and I are really struggling here. To a non-physician who just, although they might intellectualize it, they just don't get it because there is some things that you, just like you describe, you just have to be in the game to really understand what it means.

David H. Berger:
Yeah, I'm not arguing with you about the point of having physician leadership. I think it's important. Obviously, I wouldn't have done this if I didn't think being a physician leader was an advantage. I think I bring a lot to the table because I've been a frontline physician, i've taken care of surgeons, surgical patients, I've been in the operating room. I think that's an inherent advantage I have over a non-physician. I don't disagree with that, and certainly some of the things you pointed out, emphasize why it is important to have physician leaders running healthcare organizations.

John Shufeldt:
You know, you mentioned resilience a little bit ago. And one of the things I always talk about with physicians is, you know, I think we have all the tools, we physicians have all tools to be entrepreneurial because one of the things that's involved is resilience. And I think probably all generations say this. I mean, Michael DeBakey probably said it, Oh, these new guys are not as resilient as our group was, but I'm starting to sense that now, again, as I'm interviewing some of the medical students, I worry about their resilience. What have you seen as this new crowd coming out? You know, has the 80-hour workweek been too easy for them?

David H. Berger:
I think it's hard to generalize across a generation. So for full disclosure, I have a daughter who's a chief resident in surgery and she says to me, and she works 80 hours and she works sometimes more, and she won't complain, she's not the type to complain, she will get the job done. But she says to my wife all the time, she goes, No, I have no idea how dad did it, right? And there were weeks I worked 120 hours. So she, and she and my wife said, well, she had a spouse, he had some help. And she goes, No, no, no, no. I understand those things. I'm not talking about those things. How do you stay at work and do good work and take care of patients and work in 120 hours a week? So I think she appreciates it. I don't think there's an inherent lack of resilience in this group. I think social expectations have changed. The expectations around work-life balance have changed, but I don't think it's inherent that this generation is just lazy.

John Shufeldt:
Yeah, I think you actually probably hit it on the head. You know, I was listening to a podcast by Peter Attia and he talked about, it was about in sleep, and I'm a huge sleep proponent and I wasn't for two-plus decades, and he said, you know, when I when he was a resident, he said we would often work 120-hour weeks. And he was told early, he was like, there's 168 hours in a week. So what you do with that other 48 hours in seven days matters, and so if you want to waste it on sleep, go for it. So he was, I'll sleep when I'm dead, you know, theory is what I always used to tell people, clearly not the right way to be. But I think you're right, I think it's probably become much more humane, and it really needed to be. 80 hours is still a hell of a long week.

David H. Berger:
It is twice what anyone else works. It's still a huge burden and especially if you're single and you're working 80 hours. When do you go to the doctor? When do you clean your apartment? When do you get your laundry done? It just, 80 hours is a long time.

John Shufeldt:
It is a long time. Thank God it's, thank God we were young when we did it. And, you know, general surgery residency was a lot more difficult than emergency medicine residency. So I have nowhere to complain. Well, David, this has been excellent. How can people get a hold of you? Because I think you're in some people to reach out and say, look, you know, I need a mentor because you're where I want to be.

David H. Berger:
Yeah, so I'm pretty active on LinkedIn. So it's just David Berger and it's, actually, it's David H. Berger on LinkedIn. And also my personal email, I'm happy to give that out. Is DH.Berger1002@Gmail.com. And I want to finish one thing since we talked about burnout and resilience. September 17th is Physician Suicide Awareness Day. This has become a huge problem in the field, and certainly, it's being recognized more. The pandemic has increased the number of physicians that are taking their lives, and we really need to recognize the signs in our colleagues of people who are suffering from depression and potentially are contemplating suicide and take action and not ignore it. So I just wanted to put that plugin.

John Shufeldt:
I'm so glad you brought that up because I've been reading a lot on this. There is a, as I recall it, as an orthopedic surgeon on the East Coast. They call him Dr. Smiley, he was this great-looking, late forties, early fifties orthopedic surgeon who took his own life and it crushed everybody, they said no one saw it coming. So since you brought it up, what should we be looking for? Because apparently everybody missed it in this great physician.

David H. Berger:
Yeah, so any change in behavior. So most of the time physicians have a set routine and set way of acting and interacting. Any change in behavior should be recognized. Potentially, if you've see examples of substance abuse, people who are dealing with difficulties in terms of their marriage, any evidence of depression, you need to call it out and try to take action.

John Shufeldt:
One of the challenges, we go off script here a little bit, but one of the challenges I think people have is the second that gets reported or the second you self-report, you seem like you're all of a sudden, this was described as a snowballs rolling and you have no control what it's going to run over. And, you know, I've had colleagues say, yeah, I'm struggling, but I don't want to see a psychiatrist because it's reportable. I don't want to go to my medical board because it's reportable, and I'll have this, quote, black mark. And so I think we don't take care of each other or ourselves because we're all afraid that this will stick with us, like Catholic school. It's like the permanent, it's on your permanent record. I heard that in my eight years there.

David H. Berger:
Yeah, I think that's changed a lot.

John Shufeldt:
Oh, good.

David H. Berger:
I dealt with, as a CMO, I've dealt with physicians having substance abuse issues and it's not reported if a physician takes action themselves. If we recognize it and take action, first good thing to do is go to the physician and ask the physician to voluntarily take action on their own. At that point, it's not reportable. If they refuse to take action and they continually are problematic and display disruptive behavior, then it's reportable, but it is not reportable if a physician steps forward and takes action on their own.

John Shufeldt:
Good, I've just, I've seen hospital staff applications where you, where they'll ask you if you've had any substance abuse, behavioral or mental health issues, and it's a, you know, yes/no checkbox. If yes, describe here and I'd always be in, you know, knock on wood, although the day is young, I've yet to experience that. But I'd always be afraid if I had to write yes, and then write down, Well, you know, I suffered for depression for six months. I was on an anxiolytic and an antidepressant medication. However, now I'm better.

David H. Berger:
So sitting on multiple credentialing and privileging committees, I'll tell you, if you say no and they find out, you'll either be kicked off the medical staff or ... If you say yes and you have a reasonable explanation and there's time between when the event happened and when you were going for privileges, and you can supply documentation from your physician saying this has been resolved and now on this medication, you will still get your credentials and your privilege.

John Shufeldt:
Great, that's good to hear. I've always been, have this gut instinct. I've done a little work with the medical board that folks would are afraid to disclose things that may jeopardize their career later on, as ... You're sunk, yep, totally agree. Well, David, thank you so much. We'll put your contact information in the show notes. This has been, I know we had, we ended on kind of a very appropriate but somber note, but thank you very much for this. This has been great.

David H. Berger:
Yeah, my pleasure, John.

John Shufeldt:
Thanks for listening to another great edition of Entrepreneur Rx. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. Thanks for listening.

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Key Take-Aways:

  • Networking and mentoring are really critical to have opportunities to be successful in your career and achieve your professional goals.
  • In any industry, there is value in the issue of expertise and the ability to lead a team because of that expertise.
  • Digital tools are going to transform how we deliver healthcare.
  • Making the work environment better and making it easier for physicians to do what they were trained to do has a significant impact on reducing burnout.
  • The pandemic has increased the number of physicians that are taking their lives, and it is important to recognize the signs of people who are suffering from depression and potentially are contemplating suicide to take action and not ignore it.

Resources:

 

  • To find out how to start a business and help secure your future, go to JohnShufeldtMD.com