CODE speaking with Dr. Scott Levin, MD, FACS at the 4th Interdisciplinary Conference on Orthopedic Value Based Care 2020

CODE speaking with Dr. Scott Levin, MD, FACS at the 4th Interdisciplinary Conference on Orthopedic Value-Based Care 2020

Session Topics: 

• The outpatient “evolution” in orthopedic surgery panel
• The TEAM Approach to Orthopedic ASCs

Interviewee:
Dr. Scott Levin, MD, FACS
Professor and Chair of the Department of Orthopaedic Surgery
University of Pennsylvania School of Medicine

Breanna Cunningham:
I have the pleasure of being here with Dr. Scott Levin, who is an orthopedic surgeon at Penn. He is the professor and chair of the Department of Orthopedic Surgery. He’s been there for how long?

Dr. Scott Levin:
11 years.

Breanna Cunningham:
11 years. And before that you were at Duke?

Dr. Scott Levin:
For 27 years, yeah.

Breanna Cunningham:
Which is absolutely amazing. Dual certified surgeon so he’s hand, but he does a lot of crazy cases, a lot of microvascular work and had amazing talks here at the OVBC Conference in which Dr. Kain presented. I did it. Woo. So Dr. Levin, I’m so excited to talk with you about physician leadership. You had mentioned several times during your presentation how important the transition is to Value Based Care and surgeon’s role in that. Can you talk to me more about that?

Dr. Scott Levin:
Well, the only thing constant in healthcare delivery is change. And the adage, basically every year for almost 30 years that I’ve been in practice, the adage or the feeling sometimes is depending on the political situation, the economy, the country, who’s in office, that the sky’s going to fall. And this year is going to be our worst year ever. Things are really bad, they’re going to get worse, so forth and so on.

Breanna Cunningham:
And you hear that every year.

Dr. Scott Levin:
Well, you hear it every year. And I think the attitude, because everybody in healthcare delivery, and I’m speaking as a surgeon, but for our nurses, for our ancillary health personnel, our extended providers it’s a privilege to take care of patients and like other commodities, for example, there’s no disruptive innovation in medicine. There are always going to be sick people. We haven’t cured cancer yet. There’s still going to be trauma. There are going to be motor vehicle accidents. We haven’t cured arthritis. Correct. Children are born with scoliosis. We haven’t figured out how to congenitally modify mothers so that they won’t give birth to children with congenital deformities and differences and things like that. So the one constant in what we do is there are always going to be patients. Now, if you read Becker’s every week, this hospital’s closing, that hospital’s closing.

I think there are certainly challenges in healthcare delivery, but you can choose to look at where we are right now as the worst of times or best of times. And I consider and like to look at my day-to-day work and where I am in my career. And when I look out on the landscape, these are the best of times. Look at all the things we’re able to do. Outpatient joint replacement, somebody who can’t walk because they’re so crippled into form that they can’t even stand, let alone breathe. They can be instrumented, have spine surgery, and get up and walk around.

The remarkable things we can do in trauma care. Your husband’s an orthopedic traumatologist, so the ability to operate and fix the human pelvis is taking place. Since maybe 30 or 40 years ago, people would have been confined to bed. Look at World War I, World War II, even where patients that had a femur fracture were in traction for six to eight weeks. So we have constant advances, constant change, constant disruptive innovation that provides better technology for what we do. And in terms of Value Based Care, we should all be enthusiastic about giving healthcare in today’s world. Yes, we have challenges. Reimbursement, high cost pharmaceuticals. What’s the government going to do? We’re in a political evolution now with the Democrats and the Republicans and who’s going to be reelected. But one of the things I said earlier today that’s important and what I believe in, is that if we as healthcare providers look at what will and Charlie Mayo did at the Mayo clinic, the patient comes first.

You go to the Mayo clinic and you ask the parking attendant when it’s 30 below, what’s your job? What he or she would say to take care of the best care of patients I can. Not go park in space X on the third floor. So if we think about what we’re here for, and the question is, what’s the mission, right? What’s the mission? Is it to make a lot of money? Not necessarily. Is it to get out early? No. Is it to take care of a patient in need, take care of their family. That’s what we’re here for and we have to figure out the best way to do it, given some of the constraints, we have some of the changes in health policy, we have changes in reimbursement. But doctors, nurses, anesthesiologists, health policy gurus, we’re pretty intelligent people and it’s up to us to make the difference.

A legislator or a politician is the worst person to tell us how to do our jobs. Now, what we’ve seen in American healthcare for the last 30 or 40, 50 years is that the doctor-patient relationship has been impacted or eroded by things like the electronic medical record, policies, restrictions, things like that. But if we hold onto, and this is the job of the leader that I was talking about, what are the core values that make us good healthcare providers? Why did I go to medical school? And I’m not trying to be melodramatic. I took the Hippocratic oath, do no harm. And so in my institution at University of Pennsylvania, my adage is, we take care of princes and paupers and everybody in between. We don’t do wallet biopsies, we don’t do fiscal credentialing to patients. What I’m interested in is access and good care.

Breanna Cunningham:
I love that. But I want to ask you a question about the practicality of this too.

Dr. Scott Levin:
It’s a long answer.

Breanna Cunningham:
So here’s the thing. As a surgeon, especially as a new surgeon, you want to take care of patients. So, and you’re emphasizing that we heard over and over in the talks that physician leadership is key and that we need physicians involved in this design, right? How do you carve out time? I mean, you’re busy doing vascular surgery. You’re busy really taking care of patients on a one-on-one basis. What do you do to make that happen?

Dr. Scott Levin:
I’ll quote my teacher, the late Jay Leonard Goellner, who was the chairman of orthopedics at Duke for many, many years. “Medicine is a lifestyle. It’s not a vocation.” You want a vocation, be an assembly line worker. Nothing wrong with that. Be a shift worker. Work at a car wash. Nothing wrong with that. I was a brick mason for two summers before I went to medical school. Okay. But medicine is a lifestyle, not a vocation.

So that is the change that concerns me about health delivery. The curtailing of training, the 80 hour work week, the shift work of care providers. I became a surgeon. I didn’t become somebody who worked shifts like anesthesiologists or let’s say neonatal intensivists that are 24 on, 24 off. ER physicians who have shifts. Say I work four shifts a week. Four eights and I’m done and I can ride my mountain bike or do other things. That’s fine, and we need those people, and I value and respect them. That’s not who I am. And so like Golnar said, “it’s a lifestyle, not a vocation.” I don’t have a vocation. It’s a trade of sorts to be a surgeon. It’s an art and a science. And then the other adage about that is if you love what you do, you never work a day in your life.

Breanna Cunningham:
Valid point.

Dr. Scott Levin:
Right?

Breanna Cunningham:
Absolutely. So you’re an expert when it comes to contract negotiating ASCs all kind of the nuance, more legal business side of things. Was that something that was innate for you or is it something that just became something that you had to learn, that you love to learn? Tell me about that journey.

Dr. Scott Levin:
Well, I think that brings up the issue of business acumen and training outside of medicine for evolving leaders, current leaders in our residency. We have a whole leadership in business of medicine, a module that we teach as residents go through. So they’re prepared in any arena they go to, to be effective leaders, to be introspective, to know how to lead and also know something about the practice of medicine. I don’t think that every orthopedic surgeon has to have an MBA. Those that have pursued that, and a good case in point is my dear friend Alex Vaccaro, who is my strongest competitor in Philadelphia. But Alex-

Breanna Cunningham:
I was just going to say, really, your dearest friend, hmm.

Dr. Scott Levin:
Well he’s a really good guy. Alex, you can quote me and show this video to me-

Breanna Cunningham:
Alex, I’m interviewing you tomorrow. You better say the same thing.

Dr. Scott Levin:
No, he probably, well I don’t know what he’ll say, but I think when you’re confident in your enterprise and you’ve been successful as you just defined it, you’re not threatened. And I think, the Rothman Institute and their legacy of Dick Rothman and the model of care is very entrepreneurial and they have great, great surgeons there.

That’s the other thing about leadership and one of my mentors, Jim Urbanik taught me this. If people are talking about you, either good or bad, that’s a good thing, right? Don’t worry about what they’re saying. If they’re talking about you, they’re interested. They never talk about you, then you feel discounted. But coming back to, leadership and business, I’ve had 25 years of “learning on the job”. The other thing I do is I study leadership. I read books on business. I manage a large budget. The role of a department chair or a leader in academic medicine today, you have to be involved not only in clinical care education and research, but you have to be an administrator and you have to be a business person to succeed.

So it’s not the so-called triple threat anymore. There are actually five components of management and operations as well as business. And then clinical care, education and research.

Breanna Cunningham:
Wow. That’s a lot.

Dr. Scott Levin:
So it’s evolved.

Breanna Cunningham:
That’s a lot. But learning on the job sometimes is a great way to do it, right?

Dr. Scott Levin:
It is.

Breanna Cunningham:
It’s very real and practical.

Dr. Scott Levin:
And you learn by failing. We learn by failing in surgery. We learn by failing in life, and we learn by failing running a department or an enterprise. If I would sit here and tell you everything I’ve done has been successful, I’d be lying and have no credibility. So I’ve made a lot of mistakes.

Breanna Cunningham:
But you fail forward.

Dr. Scott Levin:
Well, yeah, sometimes you fall back and it’s the hallmark of a leader is to be introspective. Say I’m honest about what I’m capable of and what I’m not capable of, asking for help, and then the other factor is to empower others so that you have, not only yourself that’s leading, but you have people that you trust and you build relationships so that you can lead with a group, a small group, and people you trust and don’t tell you what you want to know, but tell you the truth. And truthfulness is a very important characteristic in any organization. And I have often my vice chairs in even my faculty say, “I don’t agree with you.” And I respectfully say, “You’re right. You have a point there. We shouldn’t do this. Even though I said we’re going to do it, we’re going to change and we’re not going to do it.”

Breanna Cunningham:
It’s nice to have people challenge your thinking.

Dr. Scott Levin:
Yeah.

Breanna Cunningham:
So I have one final question for you.

Dr. Scott Levin:
Final question, yeah.

Breanna Cunningham:
And also thank you for all these great insights on physician leadership. It’s really amazing. I don’t think that we talk a lot about that at conferences. There’s a lot of things about Maco and all the new widgets and tools out there.

Dr. Scott Levin:
Yeah that’s going to be, the different story every week.

Breanna Cunningham:
But this is so important, transcends time.

Dr. Scott Levin:
Yeah and if you read books on business, “Good to Great” by Jim Collins, Stanford business professor. How good companies become great. Level five leadership. And if you have those characteristics in it-

Breanna Cunningham:
Covey? Are you a Covey fan?

Dr. Scott Levin:
Well, Seven Habits? Yeah, I have a lot of habits. Not all of them are good. You can ask my wife, but at any rate, yeah. Jim Collins is a very insightful guy.

Breanna Cunningham:
Absolutely. Absolutely. So I have one final question.

Dr. Scott Levin:
Yes.

Breanna Cunningham:
What is your favorite… I have an outcome data company, so I love PRO tools. What is your favorite upper extremity PRO tool?

Dr. Scott Levin:
I would have to say for validity, and it was written by a friend of mine, Kevin Chung. It’s the Michigan Hand Questionnaire. There you have it.

Breanna Cunningham:
Okay. I like it. Not a DASH fan?

Dr. Scott Levin:
I’m plus minus on DASH. DASH is the current, the quick DASH and all that kind of stuff. It’s the coin of the realm, but if you look at the Michigan Hand Questionnaire.

Breanna Cunningham:
I’ll have to look into it, I’m not an expert on this one.

Dr. Scott Levin:
Kevin C. Chung, University of Michigan.

Breanna Cunningham:
I’m on it. I’m going to check it out.

Dr. Scott Levin:
Okay.

Breanna Cunningham:
Thank you. Dr Levin, so much for your time. It was a pleasure.

Dr. Scott Levin:
Pleasure. Good to see you.