Transcription:
Transforming the Care Experience with Doctor-Directed Medicine

Intro: Duly Noted, a health and care podcast, is the official podcast series of Duly Health and Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners re-imagine and better understand an extraordinary health and care experience.

Dr. Christina Bratis: Hello everyone. I'm pleased to welcome you to another episode of Duly Noted, the official podcast of Duly Health and Care. I'm Dr. Christina Bratis, Vice President of the Clinical Board of Directors and the hospitalist with Duly Health and Care. I've had the privilege of working alongside an outstanding group of medical professionals at Duly for the past 14 years, including my guest today, Dr. Paul Merrick. Dr. Merrick is a highly regarded urologist, co-chair of the board and Chief Physician Executive for our organization. He's also one of the founders of Duly Health and Care, which today is one of the largest independent multi-specialty physician groups in the county.

Today on the podcast, we're talking with Paul about something that he is utterly passionate about, namely how Duly is transforming the care experience with doctor-directed medicine. I'm thrilled to welcome Dr. Paul Merrick to the podcast. Welcome, Paul.

Dr. Paul Merrick: Thanks, Christina. I'm really excited to be on the other side of the microphone and talk to you. I'm looking forward to our conversation.

Dr. Christina Bratis: Same here. And I'm looking forward to grilling you a little bit. I think this is going to be fun. So maybe to start for our audience, we can start to talk a little bit about what's unique about being a physician at Duly.

Dr. Paul Merrick: Well, I believe that over the last 20 plus years, we've assembled an extraordinary talented group of doctors that are truly committed to their craft. Here at Duly, I think doctoring is more of a verb than a noun. And I'd say there's probably three things that make us and our physicians really unique. And the first is the people. Character and the commitment and just the collegiality, the pleasantness and the sort of team-oriented approach is, unless you're hearing you experience it, it's sort of hard to imagine. I mean, just yesterday I had a family friend who is a person was diagnosed with cancer. I was able to call Dr. Ojas Shah. He was in Costa Rica on a family holiday and yet took the time to connect with a family and create a treatment plan and examples of that are just endless.

The second thing I think that makes us unique is our structure. We are a physician-owned, physician-led organization. We have wonderful business partners that help us with our mission. But physicians increasingly are sort of plugged into an employment model where they have less influence and opportunity over their practice, their service line and the healthcare ecosystem more holistically.

The third thing that makes us different is we have a mission. That mission is to help each other and help our communities and our patients flourish. And that's a very aspirational goal. And it's not just a reactive care model. It's trying to meet people where they are and genuinely try to help them be the best versions of themselves.

Dr. Christina Bratis: So, you know, I think a lot of docs would say that that's really what our secret sauce is, but what is doctor-directed medicine in your words?

Dr. Paul Merrick: Yeah. So those words have come out of my mouth for more than a decade now. And our new business team leaders when they came, they asked me what does that mean? And unfortunately, I wasn't able to efficiently articulate it. My answer was sort of overly simplistic. I said, "Well, just kind of look around, that's who we are." And over time, we've come to realize it's been "embedded and ingrained in our DNA." But that the challenge to answer that question was a really important one. And so, together with the clinical board and the advisory panel and some of the division chiefs, put it to paper and then sent it out for comment and review and it's so valuable to articulate it. So, when we're talking to other physicians in other parts of the country that are still independent groups, this list is powerful.

I think sometimes doctors say, "Hey, I don't want to lose my autonomy." But just like I was unable to efficiently articulate what exactly does that mean, but we just kind of knew that we didn't want somebody sort of in our business and sort of being prescriptive about telling us how to practice and take care of patients. And so we put it to paper and part of it's the structure that we alluded to before. So we have a dyad model. So we have business leaders that all work in partnership with us, but our physicians do not report to our business partners. In essence, I report to all our physician partners. That's the way I view it as a servant leader. So that structure matters. Physicians have influence and authority over clinical service line development, the clinical care model, evaluating physician performance.

Dr. Porcelli, the president of our organization, put together what we call a quadruple aim scorecard, which is how do we measure how we're doing individually by departments that can ratchet down to physicians. But it's physicians defining what good physician performance looks like. Physicians defined who the future shareholders and partners are. That's essentially your committee, Christina, right? And physicians invest in physician leadership development. And so, when I share that list of what is doctor-directed medicine with other physician leaders, it's exhilarating, because that's it, I agree. And there could be things that I didn't specifically mention there, but we should always be looking to add what is critically important to help us best serve our patients in our community, but that's a good start right there.

Dr. Christina Bratis: That's great. Thank you. Yeah, I think just making sure that physicians are always involved in the decisions with the company and making sure that the patient being at the center of everything that we do is paramount. So that's great, yeah, So you're a founding physician. You've been here from the beginning. So can you give us a little background of how we got here and what those guiding principles that we've operated by have been and how they will continue to lead us forward?

Dr. Paul Merrick: So our founding business leader CEO is a gentleman by the name of Darrell Stremler. And if anybody's been here prior to 2005, they know of him and who he was and what a lasting influence he has on me personally and our organization more broadly. And he was well known for saying "Take great care of the patient first and we'll figure out how to keep the lights on and keep the business going." And so the idea of our organization is physicians working together for the benefit of their patients and always doing the right thing, the five rights. You know, the right service, the right time, the right way, by the right person.

The right service done the right way is critically important. And that is quality medicine. And so, one of the things that keeps us together is very few organizations have figured out a way to have a disparate group of people and commonly it's specialists and primary care doctors that seem to get on different sides of opinions. But our organization is structured where we have primary care, have specialty in our leadership team, and it's so collaborative. And the way that we work together is inspiring. And I think our patients feel it, appreciate and benefit from it. It is so integrated and so collaborative and that's kind of the secret sauce to what you said earlier. And the program that you helped found, Christina, our hospitalist program, is a great example of that. So, we were basically an outpatient practice, but as we increasingly take risk, we need to have the most engaged, truly integrated, truly aligned in-patient physicians to help serve our acutely sick patients. And I'm so grateful that you and Mathew Philip agreed to blaze the trail with a lot of headwinds, by the way. I mean, not easy to be a DMG or Duly physician in inpatient care units and yet you guys are the model for all others to sort of follow.

Dr. Christina Bratis: Well, first, I mean, that's tied to the fact that Darrell Stremler remains a huge impact and source of inspiration for you, and that has infiltrated the entire organization and has persisted over time. It's really kind of amazing how that right thing, right time, doing everything right for the patient is still the foundation of how we approach what we do. So for physicians that are totally on board with our mission and they're excited to do more than just come into work and take care of patients, which is a huge undertaking in and of itself, how could a potential future physician leader get more involved and start to build their leadership career?

Dr. Paul Merrick: I think we're a group of leaders. Virtually, every one of our physicians leads in one way or the other. And I think we just have this positive selection bias where people are interested, engaged, want to come here because there's more opportunity; faster, sooner to do more than just your day-to-day clinical practice. That's obviously to your point, critical gating step foundational beginning. And I think that's how you lead at first, is you lead your clinical care team. And then you help in your department. We've got plenty of examples of people who are interested, solve problems and they just get more and more responsibility. And personally, you and I are both examples of that. So I was a junior board member on the founding organization. I was sort of known for asking questions and follow up questions and had some thoughts and opinions and, overtime, that put me in a position of having more thoughts and opinions, I guess. And I think that's true for everybody. And when you are given a little responsibility and you deliver on that, it's super common that you're going to get additional and broader responsibility.

And so one of the questions that I always ask, we have board elections annually, and so if I'm interviewing somebody who wants to serve on the board, my first question is why? It's not what have you done. It's why do you want to serve and what you want to accomplish? And when the answer is mostly about the group and helping patients, then I think I'm super excited to work and serve along with that person. Rarely, but occasionally the answer is, "Hey, because I want to grow, and I..." and those individuals, I think we have to work more closely with to sort of broaden their thought process. But there is just an abundance of leadership opportunities. We have leadership courses and classes. We just actually had 16 of our fine physicians come back from the Center for the Future in Palo Alto, California last week, where they had the privilege of brainstorming about what healthcare could look like together. And so we're increasingly investing in people who want to invest in their leadership skills, because doctoring and the way we're taught clinically and leadership, there's some overlap, but there's definitely some distinct differences as well. So learning leadership is an additional competency on top of our clinical acumen.

Dr. Christina Bratis: Yeah, it's definitely a skill and it takes time to develop. And I really like the idea of making sure that you're leading from a place of service and not from a place of personal gain. I think I agree that that's where the best leadership comes from.

Okay, so I've got one last question for you. And this is more of a broad overarching kind of a question. But when you say that our best days are ahead of us, how do you think that our physicians can remain inspired to persevere when there's headwinds that are making reaching those best days more difficult?

Dr. Paul Merrick: You know, interestingly enough, I think people who go into the clinical side of healthcare that include doctors, nurses, APPs, everybody on the clinical care model. It's almost like we're wired to try to be helpers and healers and lean in to help and solve problems for people. And so I think that, you know, obviously, the pandemic was a brutal stressor to all of us. And I think we navigated through that graciously and, most importantly, together and talk about physician leadership people like Mia Taormina and, again, Matt Philip and Don Hoscheit and others were so critical in safely navigating through that, informing our partners and our patients about the risks of the pandemic and how to respect the virus, but not fear it. And I think that, truthfully, I had two of the toughest years of my entire career in '19 and '20, and began to see some investments in the organization, investments in resources last year. And those things will only build on it. And so we're continuing to make EMR investments and technology investments, and patient experience investments.

And I think that as we do a great job of taking care of our patients when they're in front of us, we're going to get better at is everything in between and making appointments and doing internal referrals and billing and collecting, and all those other sort of tough business side of things that people have to navigate through. We're committed to getting better at those things. And when you engage an elite clinical workforce and you solve those patient-facing nonclinical experience issues, that's an unstoppable force for good in healthcare. And we have such a dedicated group of people who are just so jazzed to get out of bed every morning and try to make the healthcare environment a better place for all of us. But if it was easy, it would've been done already and somebody else would be doing it.

But what I'm super excited about is I think we are leaders, not just locally, but nationally in this thought process, in this approach, in this mindset and, as a consequence, that's exhilarating. And so when you know you're part of something special when those headwinds and those really difficult things happen clinically, or whatever circumstance makes it difficult, knowing that it's part of something that's so important, it helps you get through those bumps. I hope you feel that way. I know I do, and I do have some challenging days from time to time, but I'm excited again today.

Dr. Christina Bratis: Well, thanks. It has been really fun. And I just want to thank you for your vision and your exceptional leadership and dedication to Duly and to our growth and our success. And of course, I also want to thank all of the outstanding Duly docs that are out there delivering extraordinary care to our communities. To learn more about Duly's commitment to helping humans flourish, visit us on the web at www.dulyhealthandcare.com. Thanks for listening.