by Vik Reddy, MD
That is the normal response I receive when I inform someone that I am the Medical Director of Quality at a 349-bed community hospital and also practice plastic surgery. I do not take umbrage with the response as most physicians in an administrative role come from an Internal Medicine background; the few surgeons I have come across are typically general surgeons. Rather than seeing my clinical background as an aberration in relation to my administrative position, I see it as an asset. Moreover, I believe the discipline of Plastic Surgery is ideally suited for individuals interested in taking the leap into health care leadership.
‘The skin and all its contents’
My father, a plastic surgeon (who happens to be my partner), loves that quote and has adopted it as a mantra for his own practice: he is as comfortable performing a sural nerve graft as he is a face lift. That quote also signifies the breadth of plastic surgery which lends plastic surgeons a kinship with almost all surgical specialties. Clinically, this can lead to excellent collaborative relationships with breast surgeons (breast reconstruction), general surgeons (abdominal wall reconstruction), cardiothoracic surgeons (sternal wound management) and orthopedic surgeons (exposed hardware). These collaboration can be leveraged into developing relationships built on mutual respect; they have allowed me to have engage the very same specialists in difficult conversations when it has come to improving quality in our hospital.
Additionally, because plastic surgery contains a significant amount of overlap with other specialties, we have long dealt with what is known as ‘turf wars.’ As a specialty, we have come to accept that otolaryngologists, dermatologists, and oral surgeons will continue to perform procedures in a shared scope of practice. As issues over referrals and privileges flare up between interventional radiologists vs. vascular surgeons or neurosurgeons and orthopedic spine surgeons, plastic surgeons can serve as arbiters.
“Improving the US health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Don Berwick, The Triple Aim
Patient satisfaction has come to the forefront in health care. Physicians, and health systems, cannot escape patient ratings whether they come from on-line rating companies, like Healthgrades, or from Hospital Compare, a website produced by the Center of Medicare and Medicaid Services (CMS). For the individual physician, patient ratings can have a direct impact on potential new patients. For hospitals, patient ratings do have a direct impact on reimbursement. Through the Value-Based Purchasing program, CMS penalizes certain hospitals based on how they perform on patient satisfaction ratings.
Plastic surgeons have been invested in patient satisfaction for years due to the large footprint that aesthetic surgery has in our field. Unlike other specialties, patients, not physicians, are often the referral sources that are critical for plastic surgery practices to thrive. For this reason, a patient’s experience in the office, the operating room, and the hospital is top-of-mind for plastic surgeons. Many of the ideas behind the patient-centeredness paradigm have been utilized by plastic surgeons for years.
“Imagination sparks innovation.” D Ralph Millard, Jr., MD
The above is taken from the late Dr. Millard’s Commandments of Plastic Surgery. It points to what I believe is the most important element that can allow plastic surgeons to thrive in leadership positions. Almost every plastic surgeon has had to become an innovator in the lab that is their practice: a complex reconstruction is required and the surgeon is left without the normal armamentarium of flaps for whatever reason. This is what keeps surgeons up at night trying to come up with a plan that can be executed in the operating room–this is also what drew so many of us to become plastic surgeons.
This same sense of innovation is what excites me about my administrative position. Whether it means coming up with a way to improve transitions of care for patients being discharged from the hospital or decreasing infection rates in central lines, the challenge of how to engage the right stakeholders, develop a sustainable process, and measuring how that process does is what excites me. Just as not every flap I have ever done survives, not every project I have taken on has been a success, but I am still drawn to the challenges, both in the operating room and in the hospital conference room. I invite my fellow plastic surgeons to jump in with both feet–I think their training will serve them well.