[00:00:06] Gary Bisbee, Ph.D.: Will healthcare systems bear greater responsibility for public health, such as testing and vaccine administration? Are doctors leaving private practice for employment by health systems? These are two questions we discuss with Dr. Tom Balcezak, Chief Clinical Officer of Yale New Haven Health. Dr. Balcezak provides insight into the role of the Chief Clinical Officer, it’s place in the C-suite and evolution over time. He describes how Yale New Haven Health fared during the pandemic. Dr. Balcezak points to the benefits of scale and high integration across the health system. He credits the entrepreneurial healthcare employees who fill gaps in staffing and experience in treating COVID patients. We touch on technology in healthcare and the balance of opportunities and burdens. Dr. Balcezak predicts that we will have greater focus on turning data into usable information and fewer streams of data. Dr. Balcezak forecast future staffing challenges due to the changing demographics of the workforce, plus competition from sectors that historically have not competed with healthcare. For young leaders, Dr. Balcezak advises that opportunity favors the person who looks for it.

Good afternoon, Tom, and welcome.

[00:01:26] Tom Balcezak, M.D.: Hi, Gary. It’s great to be here.

[00:01:28] Dr. Gary Bisbee: We’re pleased to have you at the microphone. This shows about leadership, how we pursue leadership excellence, how to remain top leaders, and you’ve been a top leader at Yale for a number of years. We’ll dig into that in a moment, but first let’s get to know you a bit better, Tom. What was life like growing up?

[00:01:48] Dr. Tom Balcezak: Not that interesting. I grew up in Connecticut, which is where I am now. I’m the youngest of four children. Grew up in a middle class, suburban neighborhood. My parents didn’t have much education. Mom was a secretary. Dad, I think, he got his GED when I was seven or eight years old and was involved in the trades, moved around in jobs when I was young, ended up as an electrician. The expectation was the four of us, with me being the caboose, that we would go to college, and they had the perspective that we needed to be trained, like learn a trade, looked at engineering where v`ers went to engineering school. My sister ended up in manufacturing and, we were all expected to find something, a set of skills that would get us employment.

[00:02:34] Dr. Gary Bisbee: Well, what did young Tom think about leadership?

[00:02:37] Dr. Tom Balcezak: Not a lot, Gary, not a lot. I don’t think that that concept of leadership as we think about it today was anything I ever put any time or effort or thought into. Certainly now looking back, there’s a lot of leaders, great leaders that I met, including those in my own family. I look at stuff that my siblings and my parents and others in my family did, and I can really see the essence of leadership there. But, it was a little bit like water to the fish. It was all around, but you didn’t necessarily recognize it for what it was at the time.

[00:03:08] Dr. Gary Bisbee: When did you begin to think about medicine?

[00:03:11] Dr. Tom Balcezak: Again, I think in retrospect that’s a lot clearer to me than it was at the time. I had majored in chemistry in college with the idea that I would go on and get a degree in chemistry. And I toyed with the idea of medicine, but it wasn’t really until a summer working in a lab, in a chemistry lab doing a biochemistry project, that I decided that the hard sciences were not for me and that I would pursue a career in medicine. And again, I had always grown up working with my hands and fixing things and rebuilding cars and those kinds of things. I thought that it would be really neat to combine that interest with my interest in sports. At the time I was a competitive swimmer in college and had an interest in orthopedics and injuries and mechanics of how do you prevent or cure injuries. And so I said maybe I could merge my interest in science with my interest in mechanics and with sports, and I really toyed with the idea of becoming an orthopedic surgeon.

[00:04:05] Dr. Gary Bisbee: I have to ask the question. What strokes did you swim in college?

[00:04:10] Dr. Tom Balcezak: Well, I was a freestyler, but my go-to stroke, my strength was backs.

[00:04:15] Dr. Gary Bisbee: Ah, do you still swim?

[00:04:17] Dr. Tom Balcezak: No, it’s funny. That’s a really good question. And I found that once you achieve a certain level in something, it’s hard to go back and dabble at it. And so, I dabbled for a while in swimming and thought about master swimming. But I never will be as fast as I was in college, and it just didn’t feel right to go back and try to attain something that’s just at this point, unattainable, so I’ve been putting my energy more recently into learning how to row, and my wife convinced me to join a local rowing club. So that’s, that’s my current pursuit in the exercise routine.

[00:04:46] Dr. Gary Bisbee: Well, that sounds like fun. Good, good exercise. So fast forwarding after 17 years in private practice, you began to become more of an administrative leader. Was that a tough adjustment for you, Tom?

[00:05:01] Dr. Tom Balcezak: Not really Gary, because, I had, when I finished my residency, my wife made a decision to do a second residency. And that really closed the door for doing a fellowship in pursuing perhaps a more clinically focused set of roles. So for those 17 years, I was in private practice part-time and doing quality projects and, and really helping the then chief medical officer, chief of staff at the hospital work on things that were important to the administration. So I had sort of a hand in both worlds. And, as I became busier as the needs of the institution grew, and as I filled some of those needs, I found that I was able to spend less and less time with my patients. And it was really, it was a decision that I had to decide I was going to go one direction or another. And it was just a few short years ago that I closed my private practice, a very hard decision, but really I was not giving my patients the right level of service. I was not able to commit the kind of time that I needed to. And I’m very grateful for the ability to have that background and bring that to my administrative responsibility. And that’s something that I think is really important for any aspiring physician leader, which is to have a very solid clinical background and having walked in the shoes of those who are full-time clinicians.

[00:06:23] Dr. Gary Bisbee: Well, you’re now the chief clinical officer at Yale New Haven Health. Could you describe Yale New Haven Health for us, Tom?

[00:06:31] Dr. Tom Balcezak: Sure. We are what I would call, a mid-sized health system with a very large academic medical center here in New Haven. I think we were fourth or fifth in terms of size of the hospitals in the United States. We’re a 1,541 bed academic medical center here in New Haven, with 2,500 total beds across the hundred miles that’s the coastline of Connecticut, with a little incursion into the center of the state. But we really serve the Southern half of the state of Connecticut, from the New York border all the way through and into Rhode Island. We have about 30,000 employees, 6 billion of revenue, and about 6,800 or so medical staff, with 1500 residents and fellows.

[00:07:18] Dr. Gary Bisbee: Just to get a feel for it. As a chief clinical officer, what are your primary responsibilities?

[00:07:25] Dr. Tom Balcezak: So, I have responsibilities for a lot of what historically has been a chief physician executive for a hospital or now a health system. And I am part of the CEO council, in the chief physician executive for that CEO council. So I have under, in my span, I have, of course the chief medical officers, and the medical staff office functions with credentialing and privileging and the like. I have the chief nurse exec reports through me and as a matrix to her, of course, all the C&E. I have the quality and safety roles, accreditation and regulatory, clinical operations improvement, quality, safety. I have some unusual things I think for a chief clinical officer, pharmacy and supply chain roll up to me, and a couple of other functions. But really, from a strategic perspective, I really try hard to make sure that, in all the conversations that we have as a health system, in everything that we do in terms of planning, capital deployment and strategic planning, that we make sure that we focus on the clinical needs of our community and our patients. And that’s what I really try to focus my efforts around.

[00:08:30] Dr. Gary Bisbee: Well, just to follow up on that a bit. So what would you say your top several priorities are? I mean, you really cover the waterfront in terms of your responsibilities. What are your several top priorities, Tom?

[00:08:43] Dr. Tom Balcezak: I think they’re relatively simple, Gary, and I think a lot cascades from them. I think simply put, my single overarching priority for what I do within this health system is to drive what we call care signature, which is, it should be the expectation of any person, any patient, any family that touches anywhere that we practice within our geography, that they can get the same high quality safe care, and it’s consistent no matter where we go. And we’re putting a lot of effort into that. Lots of places have loci of excellent care. Few places have that consistency. And the expectation that it’s really high quality and consistent everywhere you go, that no matter where you present within our health system with a diagnosis, you are assured of the same evaluation, the same therapy, the same outcome, I think that’s a very tall order, and it’s something that we’re very passionate about. And you can’t help but think also too that as an industry medical care is too expensive. We as healthcare providers need to be focused on providing value, and we define the value equation as the quality of care, the safety of that care, and the experience that patients in their families experience during the episode of care, as the numerator of that value equation with the denominator being the ultimate price or the cost of that care. It’s really critical for us as clinicians to focus on that value equation and have our voice be heard, because it’s not about being too expensive or less expensive. It’s about being high quality, safe, with a great experience, at a price point that is affordable.

[00:10:29] Dr. Gary Bisbee: Mm, Tom, I’m interested in the evolution of the role of the senior clinical leader in the house, and there’s been changes in titles. Used to be chief medical officer, now the senior person is frequently chief clinical officer, but how would you say the role of the senior clinical leader in these large health systems? How has that evolved over the last 10 or 15 years?

[00:10:54] Dr. Tom Balcezak: That’s a great question, Gary. And I know this institution, I spent my entire life here, and I’ve got colleagues around the country. And I think that we have evolved similarly, I think, to many of the other health systems in the United States where, first we were a hospital, then we were a group of hospitals that came together for purposes of supply chain and whatever economies of scale and back office functions that we could gather. And now we are evolving into a much more highly integrated set of institutions to drive things like care signature that I mentioned a few minutes ago. And I think that as we have evolved, it’s really important to me as a clinician, that the clinical voice remains very active in the discussion in the C-suite and in the strategic planning. Because at the end of the day, bigger, it can’t just be for getting bigger. It has to actually serve the purpose for the patients in the communities. And I think the clinician voice, whether it be embodied by a physician or some other clinician, I think is critically important. So I think as time has progressed, and as you mentioned, the role has changed from chief of staff to chief medical officer to now, on an enterprise level for an institution like ours, a chief clinical officer. I think it recognizes the importance of not just making sure that you’ve got the physician’s credentialed and that there’s some baseline safety and quality program, but that it infuses in everything that the health system does, and that it is important in the strategic planning for what the health system does next.

[00:12:27] Dr. Gary Bisbee: I imagine size, in this case was helpful during a COVID eruption basically, is that true? I mean, did you think that you were better able to respond to the community need because you had access to the resources that you do at Yale New Haven Health?

[00:12:44] Dr. Tom Balcezak: Yeah, there’s no question. That was one of the elements, not the only, but one of the elements that helped us survive the deluge of patients that we saw in March and April of 2020. Given our proximity to New York, very early in March as the pandemic swept up from New York city, we felt that down in Greenwich, and it ran right along the I-95 corridor, north right through New Haven, right up through New London in the Rhode Island border. And it was our size, but it was also the level of integration that we’ve been able to develop. And it was really incredibly obvious where we had succeeded in integrating and where we still had opportunities to continue to integrate. We have a system formulary for our pharmacy, and our pharmacy is a single function. We have a single instance of epic, for example. And so we were very easy and able to be able to place into production very rapidly a care signature pathway for the treatment of COVID on the inpatient side, on the outpatient side. And it was rapidly accepted across the entire health system because of that single instance of epic, because we had that single pharmacy, for example. We had longstanding well functioning practice groups that looked at standardization for ED practice, for ICU practice, and we were really able to leverage those so that we were very rapidly able to roll out care pathway protocols in pivot, when we needed to assess our ventilator stock or when we were changing our drug utilization or how we did proning for example. And it was really amazing to see when I would round in Westerly Hospital in Westerly, Rhode Island, a small institution with a very, very small ICU, that had never proned to patient prior to the pandemic was very able to easily assemble the team and the necessary expertise to put patients on their bellies, something that we know worked in COVID, and we did it with the same frequency amazingly with the same clinical outcomes as the rest of the health system. And that was only able because of the degree of integration. But it also pointed out areas where we hadn’t integrated but yet the need exists, because if those infrastructures aren’t the same, then we have challenges in making good on our care signature a promise. So for example, respiratory therapy had different leaders at each delivery network, and there was very little communication between respiratory therapists in their leadership across our health system, something that, you know, like many support function, feels very local, but when you get into a rapidly evolving environment, like the pandemic, you want to be able to pivot rapidly. And it’s hard to do that when you don’t have some degree of standardization and integration.

[00:15:29] Dr. Gary Bisbee: Right. Well, you’re talking really about the benefits of abscale and the benefits of integration and the benefits of a common data system across all your delivery sites. What about the burden on doctors and nurses of our data systems? It seems really in the history of delivery of institutional care, the data systems are pretty new, so we’re just really now getting used to it. But where do we stand in terms of this burden on doctors and nurses of the data systems?

[00:16:04] Dr. Tom Balcezak: Yeah, it’s something that we hear about every day, isn’t it? I mean, I’m in this role partly because when we went live with our first computerized physician order entry, and you remember that back in the early days of the quality movement, that every institution was expected to have CPOE because it was going to drive down errors, and it was going to improve quality of care and efficiency, and it’s going to reduce the burden on physicians. And I think it’s done some of those things. I think the improvement in quality and our ability to standardize, I think, is unassailable. I think we’ve been less served in terms of the burden on clinicians. And that’s something we need to pay attention to. I think I mentioned to you some time ago, that it’s really amazing to me that while automation, technology, and other kinds of advancements have helped reduce the burden on virtually every other workforce in every other industry, while simultaneously reducing costs, I think healthcare may be unique in that technology, the layers of technology, while improving care and perhaps some degrees of efficiency, have added the workflow burden to the clinicians and increased expense because of the cost of that technology. And I think that we need to go back and re-engineer ourselves, help other vendors and things help re-engineer so that we can actually gather some of those benefits that right now, I think, feel like deficits.

[00:17:32] Dr. Gary Bisbee: It feels like last year really was the first kind of year of of full data integration in a lot of our health systems. And it feels like this decade, if I said last year, I meant last decade, and it feels like this decade will begin to realize the benefits along the lines of what you’re talking about. To that end, you’ve got a great analogy about your old cars that you have them built and the controls there and how that’s changed over time. Can you share that analogy with us?

[00:18:02] Dr. Tom Balcezak: I know that that made you laugh the first time I mentioned it to you, but it’s not just the EMR. It’s really all technology. It’s the technology of imaging. It’s the technology of laboratory availability. If it weren’t for the technology of polymerase chain reaction, we wouldn’t have a good test right now for COVID. I mean, all these technologies have given us so much additional information have contributed to so many healthcare advances, but just really in just my lifetime, I feel like we’ve gone from small amount of technology to overwhelming amount. And as you say, I have an analogy that I use sometimes. I have a number of antique automobiles. The oldest car I have is a 1914 Model T. It has no gauges. There’s no indication of speed or oil pressure temperature. I don’t have an odometer on it. If I want to know how much gas is in the gas tank, I have to pick up the seat and put a stick, literally a yard stick, into the tank, which is underneath my seat tell them how much gas is in it. And, that was sort of technology. That was high tech circa 1914. My next car is a 1931 car that actually has a speedometer. And that’s it. The gas tank is actually a cork on a piece of a wire that has an indicator. So that shows you in 25 years or 20 years how much technology improved. And then I have a 39, 1939 car, so only eight years later, that’s got six gauges. And, the last car I owned was from the early 2000s. And it was a turbocharged car, and it had every kind of gauge to the point where you never even knew what those gauges meant or what to do about them. It would measure exhaust temperature, and how much turbo boost there was, and oil temperature, things that you don’t even have any idea what you would do with. And I feel like that’s where we are with medicine today, which is, there are so much data coming at you, much of which is noise, or you don’t know what to do with it, or you need special expertise to interpret. We need to move beyond that phase to where, I have a Tesla that all it has is a television screen, and I can look for data, but really, it just tells me whether my battery is okay or not. And when I decide that I’m going to go get a supercharge top up of my battery, it doesn’t ask me how far the supercharge is away, or what I need to do to prepare the battery. It does all of that. It senses when the supercharge is near when I’m navigating to it, it preps it all for me, so all I have to do is plug it in. And I think that’s where I think the promise of technology can really make good on what we need as clinicians, which is to take all those disparate inputs. And, my Tesla could do what my old turbocharged car did, which is to give me all of this data, which I didn’t understand and couldn’t take action on, but instead what it does is it uses technology in the background that I don’t necessarily see, but it takes the data and turns it into information. And I think that’s where we are today. We need less data that our brains can’t process, but we need more actionable information. And I think maybe as you said, the last decade is different than this. And I think the promise of AI, and I think the promise of where technology is going can get us there, but we need to embrace it. We need to be smarter about using it, and we need to be part of the solution and we need to help guide where it’s going. If we sit back and just complain about where we are, I don’t think we’ll ever make meaningful progress.

[00:21:38] Dr. Gary Bisbee: Now here, here. That’s so well said. Tom, let’s get back to COVID for a minute, which many of us feel that the real heroes in the last several years have been our caregivers, just under a lot of pressure that those of us that haven’t really been close to it, I think, can’t appreciate. But how do you describe that? How do you think about that, Tom?

[00:22:03] Dr. Tom Balcezak: Yeah. I mean, there is nothing in my career so far that has given me as much hope for the future of healthcare as this past pandemic. And the way that our staff, I’m sure other staffs across the country, have turned out in support of our communities and our patients, it’s nothing short of absolutely remarkable. And it wasn’t just the direct clinical staff either, Gary. When we were rolling out testing, we made it available to everyone who worked for the health system. When we were rolling out vaccination, we did the same. Because it was in recognition of the fact that even those who worked outside of clinical realms lent whatever hand they had possible to keep our enterprise open functioning as a Haven for care in our community. And I really, really mean that it has been truly remarkable. Very one quick story. In the early spring of 2020, when our ORs were essentially empty, when people weren’t seeking care, because they were afraid, we had all this OR staff that basically had nothing to do. And we base, we said, we’re not going to lay people off, we’re not going to furlough, and they sought out opportunities to figure out where they could help. This is just one anecdote among thousands. And our CRNAs and anesthesiologists opened up extra ICUs, given their critical care skills, in our postoperative care units. Our scrub techs, this is a fun one, our scrub techs realized that many of our staff didn’t know exactly how to properly don and doff PPE, remember of those terms, don and doff.

[00:23:41] Dr. Gary Bisbee: Yep.

[00:23:41] Dr. Tom Balcezak: And they term themselves doff-icers. And they went out there, and they made sure that people truly understood how to put on and take off the personal protective equipment. And then they actually taught classes. And then they walked around and provided assistance, and they observed. And it was just amazing to see all of the different nooks and crannies, where we had opportunity for help, and then they organically our staff, whether it be the OR staff or others, that didn’t have immediate see-needs, found ways to help. And then of course, there are the folks that we always talk about that were on the front lines, in our ICUs that felt the brunt particularly in the first wave, they were just truly heroic in how they faced this pandemic with just the steady resolve that they were going to get it done, and they were going to be able to take care of patients.

[00:24:32] Dr. Gary Bisbee: A number of the CEOs that I’ve spoken to have used the term battle when it came to that period of time and those people, and it said it was just remarkable. The downside is that some of them gave so much that it seemed to have burned themselves out. Is that still kind of lingering as an issue that you’re having to work with, Tom?

[00:24:54] Dr. Tom Balcezak: Absolutely, Gary. And I think like any battle, I think the aftershocks are going to be felt for years to come. We’re already in the midst of a demographic change. Our employees are getting older. The number of individuals going into our profession, or entering the workforce in general, that number is smaller than those that are aging and retiring. So this against the background of that demographic shift, I think we have this new challenge, which is the stress that people have felt, how it’s disrupted their lives, and I think we’re only just seeing the beginning of that. The question is what do we do with it? We can’t choose our circumstances, I think what we can choose is our reaction to it. We were already, we’ve been in the discussion ourselves and other organizations like ours, about how do we handle the demographic shift? How do we handle the aging workforce? And I think this is going to accelerate and add a new dimension to those discussions. I think it’s an incredibly important discussion. We’re in the people business. We take care of people in their communities. In order to do so, it’s highly person intensive, and that’s not changing anytime soon. We’re not an industry that can outsource to a computer or AI large swabs of what we do. I think we need to look for those opportunities, but at the end of the day, humans-in-need need human touch, and we’re always going to be that way. So we have to figure out how we are going to approach this new set of challenges and make sure that our staff are feeling that we’re supporting them, that they have the tools that they need. And look, one of the biggest challenges we have now is competition. As wage pressure hits we’re now competing with parts of the economy we never thought we would compete with. Amazon opens a warehouse and all of a sudden, we find ourselves in a real shortage of individuals. That’s a surprise. We were always a good steady employer that provided a livable wage. And I think that the competition has changed. And we’re going to need to respond.

[00:26:53] Dr. Gary Bisbee: Tom, another thing that came up was a little bit of the blurring of our care institutions like hospitals and health systems and a public health infrastructure. I’m thinking of all the testing that Yale Haven did, all the vaccinations that you gave. Do you think going forward that there will be closer proximity between public health and institutional care deliver?

[00:27:20] Dr. Tom Balcezak: Well, I certainly hope so, Gary. I think that’s very location specific. The other thing that happened was, as our governor would say is that, there was really very little coming out of the White House in the early part of the pandemic, and it really looked towards the states and we were one of the states, that we got together as a group of hospitals across the state together with the governor’s office and his team. And we put together a plan for how we would load balance, if need be, how we would respond together. And it was really, I think, heartwarming for many of us, particularly those of us who live and work in the state for many years, to see how all of these competitive organizations came together to make sure that we didn’t leave any of our cities or towns behind. As you say, we provided a network of testing sites. And then when vaccinations were available at the end of 2020 into 21, our health systems with some help from some of the local health departments really vaccinated the state. I don’t see that changing anytime soon. I don’t feel that there’s a real mandate to develop a public health infrastructure. I think that’s really going to continue to fall to, depending on what state you live in, depending on what locale you’re in, to us as organizations. I think that’s something that we’re going to continue to have to pick up.

[00:28:38] Dr. Gary Bisbee: Yeah. Another thing in kind of that line is the whole role of the epidemiologist and the health systems, particularly in terms of data prediction and anticipation of waves and so on. Did that happen at Yale New Haven? Did that whole role of the epidemiologists kind of up its level of visibility in the institution?

[00:28:59] Dr. Tom Balcezak: Yeah, it’s one of the places where I think the interesting and unique crucible that is our community, I think, really served us well. Being a small town in New Haven, with a world class university and all those resources. It was an incredible boon for us to have the College of Engineering, the School of Public Health, of course, the School of Medicine, and all those resources associated. To be able to do wastewater analysis, to be able to do predictive modeling in the School of Public Health to have that capacity, and a research laboratory to do sequencing to identify variants, all of that right here in this city of 100,000 people within three blocks of one another, all of that was incredibly useful for us for not just modeling what would be coming, but also trying to deal with the pandemic in the middle of it, and have all those resources together. And, as you saw in the national literature, there was a huge amount of work that came out of the school, the university, that helped inform how to respond and what should be done nationally. But certainly we felt it here in New Haven and across our health system.

[00:30:12] Dr. Gary Bisbee: I’m thinking of now of the independent physicians. And what’s been reported around the country is that the economics of COVID really has caused a number of the independent physicians to try to find employment in health systems. They just don’t think they can make it as independent docs or small groups. What do you think about that, Tom? Do you see that trend unfolding?

[00:30:38] Dr. Tom Balcezak: You know, Gary, I think that it has accelerated some of those physicians to try to seek a safer harbor or haven. What we’ve tried to do within our health system is to be agnostic to physicians’ desire for how they would practice. And of course we have a faculty practice plan. Some physicians choose to join the faculty practice plan, particularly those with academic research, education interests. We’ve got a not-for-profit physician foundation as part of our health system, another avenue for employment if a physician chooses. But still, still around 50 to 60% of our admissions are coming from community based physicians that as you point out are increasingly struggling, partly because of COVID in the reduction in some of the ambulatory elective revenue that happened particularly back in 2020, but also the cost pressures of inflation and wage and acceleration. So we’re seeing some of those physicians seek employment, and we’re struggling hard with how to make sure that our communities remain well served by them. I think our job as a health system is not to tell physicians how or where they should practice or how they should be employed, but instead try to make sure that we’ve got an adequate physician and medical staff across all of our hospitals and provide the most beneficial environment, no matter what, that type of arrangement that physician seeks. Doing so with the community docs because of Stark and other rules, as you know, can be a real challenge. But there are certain things we can do. But actually sometimes just listening to those physicians what their challenges are and trying to come up with creative solutions is an important first step that I think is often overlooked.

[00:32:26] Dr. Gary Bisbee: Yeah, and thinking about academic medical centers and their financing, there’s a lot of discussion about the fact that we really don’t do enough to make sure that financing medical education and our academic medical centers is sufficient. What thoughts do you have about that, Tom?

[00:32:46] Dr. Tom Balcezak: No, I think you’re right, Gary. The academic medical centers in the United States are the really the crown jewel, one of the crown jewels, of the healthcare system in the United States. And historically, there have been funding mechanisms, whether it be dish payments, in some instances, certainly GME and IME payments and others, that actually have helped recognize the important role that teaching institutions play in American medicine. And as an academic, we’ve seen an erosion of a lot of those Medicare line item funds for a lot of those circumstances, I worry about that. I think it’s relatively short sided to continue to erode that sort of support. And I think that, in large, the United States, through those mechanisms, through the NIH and other funding mechanisms, has supported medical advancements across the world. And we export those medical advancements as an international good. I think when you’re sitting down and trying to put together the fiscal year 2023 budget like we’re doing right now, and you’re looking at the cost of education, in many of the unfunded mandates, you know, we ourselves across our health system, we are over our GME cap for residents. We know that we receive substantially less funding for residency training then it costs us to provide that training. Every year it seems that the ACGME adds an additional expense that we can’t get reimbursed for, add additional demand for supervision or coordinator, what have you, that there is no additional reimbursement for, it feels a little bit think I’m crying in my soup a little bit, but it feels a little bit like it’s not valued in the United States. Look, we’re expensive. What are we now? 18% of GDP. And we need to find a way to not be the GDP hog that we are. I just think that underfunding or cutting the funding of education and research I think is relatively short, is very short side for us. But again, when someone comes in to have a cholecystectomy, a gallbladder removal and says, why do you command a premium as an academic medical center? I think all of us are, I think we’re challenged to be able to answer that question. Now if you’re sick with a rare disease, if you’re sick with a disease that’s hard to diagnose, think the equation’s very clear. But for routine care, which we provide a lot of, I think it’s hard to justify. Yet the outcome, particularly the outcome beyond the patient, I think is completely unassailable.

[00:35:19] Dr. Gary Bisbee: Well, there’s clearly problems across the system. We all know that, but I agree with you that going after medical education is not the way to do it. I think part of the problem is that we just are so used to excellent training for physicians that we’re kind of accepted that, and we don’t value it as highly as we ought to. It’s my personal opinion.

[00:35:44] Dr. Tom Balcezak: No, you’re right. I mean, look, we’re an international magnet for graduate medical education training. As many people have said, not only are we probably the best medical educators in the world, we’re also the best sick care system in the world. If you’re sick, if you’re truly ill with something that’s hard to work on, diagnose, treat, then there’s no other place in the world you want to be other than the United States.

[00:36:08] Dr. Gary Bisbee: Right. Yeah. That’s for sure. Thinking about clinical practice and you were commenting on this earlier, but let me ask the question directly. And that is, as we make progress, precision medicine comes to mind, you made reference to the data systems and AI and whatnot, will we over the course of the next 10 or 20 years, will we begin to attract different type of people into medicine than we have in the past? Do you see that happening, Tom, or not?

[00:36:39] Dr. Tom Balcezak: I don’t know, Gary. I think the human body and the human condition is so central to who we are it will always attract the smartest, brightest, most compassionate people. I don’t see that changing. I think that the bigger question is what’s the skillset. Once you’ve got the mindset, what’s the skillset you need, and is medical education right now appropriately set up to give those brightest, smartest, most compassionate individuals that will be attracted to medicine, the right skillset to be the caregivers for the next generation. I think that’s the question we should be asking.

[00:37:19] Dr. Gary Bisbee: Yeah, that is a question we should and devote some resources to it. Fundamentally important. Tom, this has been a just an awesome interview as expected. Thank you very much for your time. I’ve got two questions for you just to wrap up. One of them is for those young people that come to you and say, “Dr. Balcezak, I think I’m interested in a career in medicine.” What advice do you have for them?

[00:37:45] Dr. Tom Balcezak: Well, first of all, I’d say, “Congratulations.” As I mention. If you are smart, and you care about the human condition, I think there’s no better thing to do than pursue a career in healthcare. And by the way, that doesn’t have to be a physician. There are lots of different ways to pursue a career in healthcare. I think people get locked into tracks, and I think they should think about what it is that motivates them. What are they interested in? And if you’re interested in healthcare, go for. If you’re closed out because of an MCAT score or admission to a school, that’s fine. There’s lots of other ways to contribute. And personally, and my wife and I have had this conversation innumerable times, even if I didn’t go into healthcare, I think a medical education is incredibly interesting from an intellectual perspective, it’s gratifying from a personal perspective, the human body is an amazing machine to get to know. And I think the rigors of an education can serve you well no matter what you want to do in your career. So, the reason why I say that is if you are going down the pathway of a medical education and decide at some point it’s not for you, there’s no time lost or wasted there, cause I think the education, the rigor with which you’re applying yourself to get that education, that’s useful. So I would say, go for it. It is a noble profession. I think you should be proud to serve in that capacity to try to make human life better. And so I would encourage anyone who wants to pursue it. It’s a great place to be.

[00:39:21] Dr. Gary Bisbee: Yeah, well said, final question, Tom. Somewhat similar, but what advice do you have for up and coming leaders?

[00:39:29] Dr. Tom Balcezak: Well, people who are interested in leadership seek those opportunities out. Say, “Yes.” Folks will come to me and say, “Well, how do I get involved?” My answer is, “Say yes to the things that are being offered you.” Opportunity favors the person who looks for it. And, I’ve had so many examples where I’ve talked to physicians and I’ve said, well, you know, we’re really interested in working on, well, pick your least favorite topic, length of stay, or reduction of serious safety events. Well, I’m not really interested in that. I’m interested in this. Well, you can’t really pick what the opportunity is. I think opportunity will find you if you’re the person who will always attracts that opportunity. So, raise your hand, say yes, be enthusiastic and be genuine. I think if you’re interested in leadership, then you’ll be able to choose where you go, but you may not be able to choose what the challenges you face. And you always have to realize that you have to take the challenges as they arise. You can’t say well, that one I’m not interested in and I’ll take the next one.

[00:40:36] Dr. Gary Bisbee: Wisdom from a very experienced and really terrific leader. Tom, thanks so much for your time today. Much appreciated.

[00:40:44] Dr. Tom Balcezak: Thank you Gary. It’s always really, really enjoyable to talk to you.