(upbeat music) - Welcome to another episode of Surgeon's Lives. I'm your host, John Monson. My guest today is Tom Varghese, who has a number of professional titles. He is the division chief of the section of general thoracic surgery at the Huntsman Cancer Institute in Utah. He's also their associate chief medical quality officer, as well as their chief value officer. He has a range of leadership positions nationally, including with the Society of Thoracic Surgeons. And he is, of course, the current president of the Society of University Surgeons. He has held and continues to hold NCI funding and was responsible for the development of the strong for surgery program with the American College of Surgeons. But above and beyond all of this professional life, he also has much more to talk about in regard to his personal life. He's a double immigrant, if you like. He was born in India, immigrated to America, moved back to India from medical school and then came back to America. So he knows all about being different in different societies. He has a lot to say about mentorship, basking and reflected glory, the development of integrated care, and what might be the next big thing in medicine. By the way, please don't forget to like and subscribe to the channel, it really helps. And send us any comments you may have about this interview or other interviews that you'd be interested in hearing. - So without further ado, let's go over and listen to Tom Varghese. I'm John Monson, and this is Surgeons Lives. - Absolutely. So my life story is very unusual. And I would start by that. I was born in India when I was, and then I came to the US when I was a year old. My dad had one year old. My dad had come over on a student visa. Remarking me, my dad was in the US, and my mom gave birth to me in India. So we were separate continents because my dad got his student visa about a few months before I was born. And you can remember how strict immigration rules were back then, and it was a lottery ticket. You got it, you went, you know, and so my dad was here and then I was born. And they took a year before me to come over here to the US. And so I laugh and that I was probably one of the most photographed kids in the world for the first year of my life because my mom was taking photos and mailing them to my dad, you know, the era before the computers and the internet and all that. And so I arrived in the US when I was a year old. And where my story became a little bit different than most people as I was came as an immigrant to this country, and then after my sophomore year in high school at the age of 16, my family actually moved back to India. And so I became an immigrant back to the India. And we'll probably get into this. I mean, it's remarkable that, you know, the immigrant story of coming from the outside, trying to make a better life for yourself and trying to connect with people. Yeah, so I'll guess I'll start there. So, yeah, so I was born in India. I came to the US when I was one after my, at the age of 16, moved back to India and I lived there for nine years. And I was saying that, you know, it's remarkable that immigrant journey of trying to go to a place and, you know, trying to fit in. And the pushback that sometimes you get is very similar, no matter what. You know, so when I came here, you know, one of the racist tropes I'd hear is you need to go back to your country. And interestingly, when I went back to India, one of the racist tropes I would hear is you need to go back to your country. And you can imagine somebody like myself going, well, where the heck do I belong? Where do I go back to? And it becomes, you know, when you see the news these days and you see the plates of refugees and you see the plates of people who get displaced as a result of war or political differences or for reasons out of their control and see the backlash people have against them, you know, I can feel what they're going through. I mean, not to just say that I've gone through all the hardships that they've gone through. I mean, some of the atrocities that they've gone through, especially in the middle of war is remarkable. But that feeling of you want to fit in, you want to assimilate, you want to become part of a community, yet the initial pushback is you are not one of us. - Yeah, you're an outsider, you know? - You're an outsider. And I think that there's something for each and every single one of us where you feel that you may not belong to the majority group or you're trying to fit in. And it becomes especially poignant when you're trying to fit in, so to speak, in this culture we call surgery. You know, after I went to college medical school there in India, but I always wanted to be a surgeon. And I knew that at some point I wanted to come back and wanted to train, to be amongst the best. And so then I came immigrated back to the U.S. and after my U.S. assembly board exams, you know, I started, you know, I did my research for a year before the surgical residency at Northwestern was very fortunate. I started as a prelim, you know, kind of a preliminary spot at Northwestern. And then they took me in and finished my training there. So I did my general surgery at Northwestern. I see T surgery at the University of Michigan. And then my first faculty position was at the University of Washington before I got recruited here to the University of Utah. So I've been kind of an academic nomad is sometimes what I call myself, you know, kind of trying to establish myself and been around and have been to many places around the world as well as here in the U.S. And I'm grateful for the experiences that I've had. But you were slightly fortunate unlike a lot of Indian graduates. I mean, I worked in the U.K. for many years. And, you know, that was the landing place for many people from the continent. And, you know, the difference between landing there and landing in the U.S. Is that many people coming from India have to are fully, almost fully trained and have to redo it all. You know, you clearly made the decision to go back almost immediately. So, you know, you didn't have time if you like. And it's not wasted time, but, you know what I'm getting at. But the question was, when you were about to go back to India, you know, when you were 15, 16, did you consider yourself American or Indian at that time? And when you went back to India, did they consider you Indian or American? Fantastic question. I considered myself American when I went back to India. And then I realized when I was there in India, I was confused for a few years. I didn't know what to identify myself as. You know, here, you know, even though I considered myself American, there were very obvious ways that I wasn't, you know. I mean, my parents were unbelievably strict, you know, growing up and, you know, other than, you know, playing in the band or playing on a basketball team, I didn't really have extracurricular activities. It was just everything the focus was studying. And, you know, that was just drilled into us, you know, that education was the mechanism or the way forward. But I still consider myself American. And then when I went to India, yeah, you know, even though I look like everybody around me, in some ways, you know, skin color and they could tell the difference immediately. I mean, like even the local language, like I went back to the state of Kerala, the language there is Malayalam. Even there when I speak that night and people can tell, you know, the accent kind of comes through, they can tell, you know, by the way, I speak that, you know, I'm not from there. And so I was a little bit of an outsider there. And then, of course, coming back, just added that level of it. It was just at some point. And so I think that I started realizing that, you know, maybe the more complex your origin story is, it makes you stand out. I mean, you know, you're then trying to find places where I call it, trying to identify cultures of belonging, you know, those much more open cultures where people are willing to accept, you know, diversity. And when I say diversity, I'm not talking about the way we look for say. I'm talking about diversity and background, diversity of thought. And you realize that in this world, even though people say diversity is a good thing and we realize acknowledging there's some pushback nowadays, most people are very fearful of change. They push back on those that don't quite look like that. And I think it's a detriment, honestly, to everything. I mean, we're supposed to be the greatest immigrant nation here in the US, yet we push back on people who don't quite look like us or don't think like us or don't act like us. We see this in the world of surgery as well, you know, that we see these things where, you know, people are like, "Well, it's the way I've always done it," or, you know, and you understand where there's benefit towards standardization, but you and I both know technologies or surgical techniques that are in existence right now, 10, 15 years from now, will change. You know, we're always constantly looking to see what can benefit patients today, tomorrow and into the future. And part of that means that you can't just be stuck in the same thing you're doing over and over again. Yeah. I mean, it's, you know, the US story of racism, of course, has one unique aspect to it, which is, you know, the slavery story. Yes. That is different to the rest of the world, even though some countries such as the UK, you know, have were complicit in that in a slightly different way. But what is true is wherever you go in the world, people don't like different. People don't like different. No, and it's, you know, the obvious way of spotting different is skin color. But, you know, all you have to do is look at the Balkans, for example, you know, you know, that was a horrific war, you know, between close neighbors who look identical in some respects, but are not, you know, people don't like different. And, you know, you describe it as people don't like change, you know, one of my favorite things that I point out to, because everybody teaches, you know, people in management school, you know, people don't like change. And, you know, I would say to people is people are fine with change, as long as it's a 20% boost in their salary and a bigger office, you know, but if it, but, you know, they don't like change because they're pretty sure it's not going to involve a bigger office and a boost in a salary. And it's going to be some way that it like rains on their parade. And, of course, the other thing that you you suddenly developed when you came back from Kerala is now you're a femme gem. And that's a big issue in the US, you know. Yeah. Yeah. It's fascinating. You, I mean, you hit it right on the head. I mean, so the medical school I went to on the government medical school and the capital city of Kerala in Toronto or Thiru and Nandapuram, as it's known nowadays, at the time of my graduation, the school was, the med school was ranked seventh in the nation. I graduated the top 10% of my class. I was class president. I was captain of the basketball team. I was editor of the yearbook for five colleges. I mean, you name it. I mean, I had, but I was just lumped into the same bucket as all sorts of foreign medical grads where the thought was we were inferior. And and it's remarkable that even the most educated, most advanced people who claim that they are appreciate diversity, some of the viciousness that you face going through is is is eye opening, to say the least kind of a persona that I put on. And now I don't know if this was more of a survivalist instinct more than anything else. There's that movie of people who know me laugh when I say this. There's this movie, the Penguins of Madagascar, where people will just say smile and wave boys. That is the persona I put on. I mean, that that that was the armor I put on. I smiled, I outwardly, I didn't allow anybody to to know that they were getting under my skin. I just put on this protective armor. It infuriated people because no matter what they did to me, I just kept smiling, but it was a defense mechanism. I mean, there's only a few people like my wife is one of them that really, truly know what I went through going through all this. And I may go to my grave, not sharing all this, but it is to say it wasn't easy. I mean, I, you know, sometimes, you know, I would, you know, in a moment of, you know, maybe weakness or something like that, I would go to my parents and say, why do we go through such a difficult pathway? But then the flip side of it is that maybe I was meant to go through that difficult pathway because I have an appreciation of what a lot of people go through. And I know exactly when people say about the uphill battle or changing goalposts, where they put the goalposts and then say, okay, you reach that and they move the goalposts even further. I know exactly what you're talking about. I think it's, there's no doubt that people's life experiences inform the way they, what they mature into, you know, and some people wear it on their sleeve and some people don't. You know, they, they bottle it up if you like. And, you know, I always remember when I moved from Ireland to England, there were still signs up on boarding houses that said, you know, no black dogs are Irish. Wow, that's incredible. And that wasn't, as, as, as my, as one of my colleagues says, well, that was a previous century. Yes, it was, but it wasn't that long ago. It wasn't that long ago, right? I'll tell you one thing that you did have, which is a big advantage, you may look different, but you sound American and that's a huge strength for somebody of an Indian or Pakistani background or overseas background, you know, because people in America again, and it's not just America, I mean, it's a, you know, they will, a voice that sounds like them is, is a huge advantage. That's a great point. John, I do appreciate that. And the credit for that really goes to, it was an early mentor in my life. It was in grade school, the principal of our grade school, sister Noreen, I went to a Catholic, Catholic school, really drilled into us the importance of handwriting, the importance of speech, the importance of communication. It was just any opportunity she got whenever she was meeting with students outside of class, you know, she was one of these people who was always constantly pushing you to look beyond where you were at or trying to get you to see what are the goals you want to achieve in life. And, you know, I was a shy kid who was very awkward and, you know, didn't, you know, where English wasn't my first language and was trying to appreciate that, but she kept saying, you have to look at the great speeches in history, look at the way people deliver, look at the way people talk. Every single word that comes out of your mouth is measured, you know, the intentionally uses the pauses and sentences. That was all of a huge credit to sister Noreen. And it was something that really came up during the pandemic I mean, she passed away a few years ago and I actually had the opportunity to talk to her probably a few weeks before she died. And it was very meaningful for me. It was kind of that full circle type of moment. But again, the importance of having great role models or teachers who at the formative age are trying to push you to be better than you can even imagine that you can accomplish is tremendous. - So it's an easy segue into mentors. You said you always knew you were going to be a surgeon. - Yeah. - Do you understand why that was and talk a little bit about mentors during your surgical career? - Yeah, great question. So the idea for this came, so there is, you know, stereotypes of Indians where most of us are either doctors or engineers. It just seems to be two of the most popular professions. In my family, we're about 98% engineers. I mean, my dad's an engineer. My wife was before she became an interior designer. My brother, you know, you name it. Armies of engineers. But I was playing basketball and I tore ligaments in my knee. And at the beginning of my sophomore year in high school, I had knee surgery. And I was just fascinated by the number of people that were involved in the care of one patient. I mean, it just blew my mind. Like I lost track of the number of people that were involved, you know, from the people who greeted you at the door to wheeling into surgery to the people in the recovery. Like that entire process just fascinated me. And I thought, you know, I'd love to be part of this team. And so that's kind of where my ideas of going to medical school and, you know, some type of surgical specialty came. And so of course I went to med school thinking about orthopedic surgery and then fell in love with pediatric surgery, you know, in med school. And then when I started in my surgical training at Northwestern, realized that it was the chest. It was the anatomy, the surgery of the chest that was really fascinated me and ultimately ended up making the decision to go into thoracic surgery. And so a lot of great mentors around the, so from the research perspective, the person who gave me my first shot was Dr. Mike Abbakassas. Dr. Abbakassas is now currently the dean of the University of Arizona Medical School in Tucson. But Mike was the one who gave me the first shot of, you know, they had an opening in the Oregon Transplant Lab and connected with Northwestern in Chicago. And, you know, I finished my boards and I knew that I wanted to do, you know, I wanted to learn the fundamentals of, you know, the scientific method, you know, hypothesis generation, designing an experiment to test that hypothesis, looking at your results, seeing if the results are reproducible and then trying to see do you need to change your hypothesis or not, going back, you know, that entire process, that methodical process, Mike was the one who really gave me that first opportunity to see that at that point. - I don't know when these, you know, sometimes these interviews come out at different times and et cetera. But last week, I just shows you it's a small world. I interviewed Scott Silvestri. - It's amazing. - Who is, you know, a good friend of mine, we spent the last seven, eight years in Orlando together. And of course, I interviewed him in his house as they were putting up internet in his house in Tucson. You know where he's just gone, been recruited by Mike Abbakassas. - Yeah. Um, et cetera, et cetera. - It is a small world. I mean, I think that is indeed a small world. But, you know, the comments-- - One question about mentors. Where you are, are you and how, what do you advise people intentional about finding mentors? And if you were, were your mentors aware that you had found them as a mentor? - Yeah, no, great, great question. It's a challenge because, you know, there's that old saying that you should open yourself up to all sorts of experiences 'til you're about the age of 40 and then you start narrowing. And so, the challenge there is, is that you think you know certain ways that your life is going to go. But if you don't open yourself out to diversity of experiences and diversity of mentorship styles, it becomes hard to make those decisions going forward. I think that one of the mistakes you make is if you, if you narrow yourself too early, maybe this is a little bit of a pushback to this, you know, it seems like the era of early specialization and we need to get done quick and we need to identify what you're gonna do really quickly. I'm not so sure about that. And so the mentors I gravitated to were really at the base people who genuinely wanted you to be do well, you know, they're not looking at, you know, so I don't look at transactional relationships as mentorship, like, oh, you work for me and the only way I'm gonna write a letter of support for you is if you do X amount of work, that's more of a transactional type of thing. I look at more mentorship as it's really coming from a source of intellectual curiosity, you know? I love, you know, as a base, you know, people always ask me what are some common themes in my own career. And for my, it's a really basic thing. I love seeing talented people perform at the highest level of their potential. I just love that. It doesn't matter what the domain is, whether it's surgery or sports or music. I just love being around talented people and seeing them reach their full potential. And so for me, mentorship is about unlocking your potential. And it really comes down to is, if I engage with the student or if I'm connecting with a mentor, you know, it's like, are they putting you in situations where you can unlock your potential? You know, pushing yourself to do better than what you, you may or may not be aware that you're capable of, but unlocking that potential to get to that other side. - Kind of a surprisingly rare characteristic, the ability to bask in reflected glory. Maybe it is. And it's sad to say that because, you know, part of it is I get the world has a lot of problems going on. Don't get me wrong. I mean, I'm not minimizing any of the hardships where the problems going on. But at the same time, we are living in the greatest time in the history of the world. You know, it's like the fact that you and I right now are doing this, you know, recording for this podcast, we're not physically near each other right now. We're at different places in the nation and the technology is available, information is available on our fingertips, people are trying to grasp what the role of artificial intelligence is. But even now, I think mentorship is needed now more than ever. People just saying, hey, you know, maybe that's a good idea or, you know, I did a couple of those type of experiments years ago and it failed miserably, but maybe you may have a good different result, but you should go in with your eyes wide open. These are the missteps I did in guiding. But, you know, the basking and the reflective glory, it's an interesting thing. I mean, I'm astonished that more people aren't appreciated. You know, somebody, you know, I was recruiting a talented, you know, junior faculty member a few years ago. And somebody made the comment of Tom, you know, what would your thoughts be if that individual won like the Nobel Prize? And I was like, well, then I'm the genius that recruited the Nobel Prize winner. I don't get it. It's like, you know, you don't need to be jealous. I mean, it's just, I reflect, yeah, I think it's great, but you're right. It is a rarity, shockingly, in this day and age of people being able to bask in the reflective glory of others. - It should, it reminds me, as you say, about repeating research. It always reminds me of the late, great Jim Thompson. You remember who was chair in Galveston? - Yes. - Said. He used to say, you know, repeating other people's research is like dancing with your sister. He said, it's perfectly safe, but there's no future in it. (laughing) - So, to clarify, reproducibility, I mean, more of like, if you have an experiment, I mean, that was Mike's thing is like, you gotta be able to reproduce the three times. But I get what you're saying about, you know, reproducing others' thoughts or ideas. I mean, really the goal is to put a spin on it. - So, if you get a chance, you can look back at one of the previous interviews I did with actually a classmate of mine called Vivian McAllister. And Vivian is a very wise individual who has recently retired as a liver transplant and catastrophe surgeon in Canada. And he set up a lot of the transplant program and some of the provinces. And one thing, you know, just was awarded the order of Canada and stuff like that. - Oh, extraordinary guy. If, in his early years, Vivian was a failure in terms of the traditional training model and went backwards and forwards from Ireland to Canada and one thing or another. But he comments in that interview said, you know, everybody's CV when you look back at it makes sense. Even if it didn't make sense at all when it was happening, you know, when you look back at it, for some reason it makes sense. The other thing I was gonna say to you is you say, you know, we're living in the greatest time in the world. Hasn't it always been that correct to say that? - It should be. - Mine, do you say it? - It should be. I mean, now maybe people who are going through the depression or, you know, the black plague or something like that may feel differently, but theoretically it should be that you should have the greatest. - Well, you know, we have versions of the plague and the black death coming. And we just went through COVID, you know. - We went through COVID. - You know, so that was pretty bad. But nonetheless, you know, wherever you are in the world at that moment, there's stuff happening that never happened before in terms of technology or, you know, but you know, the pace of change right now, you know, is truly extraordinary. So let me ask you a question. You know, you've been very successful. And by the way, congratulations on the SUS presidency and great honor. - Thank you, her. - And I'm sure a great privilege. And I'm privileged to be an honorary member of the SUS. You probably didn't know that. - No, I did know that, I was going to ask you afterwards to make sure that we can get you even more engaged but that's a good congratulations. - When did you realize, when did other people realize that you were above average? - Great, that's an interesting question. I think it was, you know, there's book smarts, street smarts, and tying it all together. I mean, book smarts, you know, it was interesting. I mean, I always had great grades. I mean, it was just like even in the very beginning when, you know, when I was in kindergarten, where, you know, at that, in kindergarten, English wasn't my first language. Even then, I was somehow able to grasp concepts. And then by the time I hit first grade, you know, I was always at the top of my class. I suddenly realized though, when I, you know, with these different moves, you know, that I was put in situations where I would have to try harder, you know, just because of moving to a different country, moving to a different, you know, scholastic system. It just, you just, when you're in a new situation, you just have to do, or be better. And so from the grades perspective, I knew that I was above average. But I think that the belief in myself came much, much later, you know, because I think that aspect, you know, the street smarts was, I always had a doubt of myself because I was, you know, I was the outsider, right? And you're trying to fit in. And somehow, somewhere along the line, it was probably in the middle of my surgical residency where I just realized that if I wasn't comfortable with myself, or I believed in myself, that that was the first step. It just took a while, you know, just, now I'm fortunate I have a great family, you know, I'm an amazing spouse, I have great kids. And so I had these pillars that kind of help reinforce that. But it was still, it had to start with myself. I had to know that, you know, where every time people said, well, nobody's ever done that before, or, you know, that's not possible. You know, when I first came from India here, or, you know, or coming back from India here, you know, now again, I'm trying to pursue surgical, many people saying that for the foreign medical graduate to get into academic surgery, that's like mission impossible, it wasn't possible. Don't even dare to dream that. But I was like, well, I'm gonna take a chance at myself. I mean, that's why I was ecstatic to get a pre-limbed position at Northwestern, because it got my foot in the door. Yeah, so it wasn't a guaranteed position, but my foot was in the door. And so it was like, I'm going to work on it. And fortunately, I had, you know, there were professors there and academic faculty and mentors there that realized what my potential was and they believed in me. And so whether that was luck, grit, you know, hard work, combination of all those, probably. But it all started with the belief in myself. I had to believe in myself first. Well, plus, you know, I mean, it's just a reality that there's a difference between getting a prelim at Northwestern and getting a prelim in somewhere in the boonies and no offense to Nebraska or wherever, you know, I mean. Sure. But that was an intentional choice by me. For sure. Yeah, it was, you know, but you make a great point. And this is not to disparage any other programs in everything. Exactly. Your path, which is already hard, is going to be even more harder if you're coming from programs that aren't as well connected. You know, at least at what my goals were. Like I knew that I wanted to do some sort of specialty training, you know, fell in love with thoracic surgery. And so then I knew it was CT surgery and specifically with the focus on thoracic surgery. I knew I wanted to be an academic surgery. Like once you realize what your goals and your aims and your missions are, then you have to look at the situation in a hand and say, okay, what are the paths forward? If needed, like a lot of people, you needed that lucky break. Yes. Absolutely. I get to be the argument there. Well, you know, you make it. No, no, I'm the first person to admit, I have had breaks in my life that others are not. But some of it is making your own luck, but there's no question about that is to do that. Now, things that have probably benefited me is, yes, I do have a belief in my own abilities of my own self. I mean, if I don't have a certain skill set, I will go out and make sure I get that skill set. You know, the current leadership positions I have right now, you know, like one of the, you know, in addition to being chief of thoracic surgery, I'm in charge of quality for the Huntsman cancer right now. That last skill set, I went and did an executive, a master's in business administration a couple of years ago. That wasn't easy either, but I was like sitting there going, you know, I'm looking at budgets, I'm trying to put strategy for the organization. You know, I want operational skill sets. I wanted to make sure that I wasn't just talking it, that I really knew that. And so I made the fundamental decision to say, I'm going to go and get that skill set. Now, others may have said, why bother? You don't need to do that. - So you've, just like a witness on the witness stand, you've just opened the door for me to ask the question. - Go for it. (laughing) - You know, what are you going to be in 10 years? - Great question. Yeah. - This is a great question. - This is the, these are the small acorns that lead to a CEO, you know. - Yeah, no, great question. I'll be honest with people out there. I mean, I'm going through a little bit of soul searching right now of, you know, would I love to be a chair of surgery one day? Yes. But I'm not sure, you know, a little bit of doubt is crept in because I'm actually enjoying a lot of the hospital level leadership roles that I have had recently. And so you can imagine that that's two different pathways, right, that, you know, go, you know, becoming a chair and going through the traditional school of medicine pathways, one pathway versus the other pathway of becoming, you know, a hospital leader or CEO or a leader of a health system is a different pathway. And there are all these universities where there's a merger of both. But I'm having a lot of fun right now, John. Honestly, I mean, I love my job. I absolutely love my job. And right now I have the best of all worlds. You know, I have a role in the C-suite, you know, I'm helping teams as part of being the leadership of the thoracic surgery program, helping to train the next generation, doing academic research. I mean, like I'm having a blast right now. - And that's, it sounds like a definite maybe. - Hedged a little bit, but, but I think part of it is, you know, is being able to capitalize at the, with the opportunities at hand. It is just to see where the opportunities arise. And then if it's a great one, go for it. - So a good friend of mine will be known to you, a guy called Tom Watson. - Tom, yes, no Tom very well, yes. - So Tom and I left Rochester at the same time. And he took a job in D.C. that had a significant leadership role to it. Regional administrator role. And as you know, he's no longer there. You know, he moved on from that. And as he was moving on from that, he said to me something, which, you know, I've done quite a few leadership things in the past, but he articulated something that I think is interesting. He said, you know, I, you know, I became a name in esophageal surgery. I was well known, you know, USC background. And you know, I could, I could hold more than hold my own in any company having a conversation about that, that side of my life. He said, but now I find myself sitting in a room with people on the administrative side who have no knowledge, appreciation, understanding, or interest in the fact that I may or may not have been a player in the world of esophageal surgery, for example, or thoracic surgeries. And, you know, I'm sitting beside, you know, young administrators who are following an administrative pathway and I'm in their world. - Yeah. - And it's, you know, it's really quite challenging to, you know, how do I convince people that, you know, that I'm worthy in their world as I was in my previous world? - Yeah, it's a, I mean, yeah, I mean, Tom's a great guy. And I mean, as you correctly pointed out, I mean, obviously I know Tom well from multiple circles, including he's a fellow thoracic surgeon, but he articulates it well. I mean, I think it's one of the downsides of this, what we call the corporatization of healthcare right now, right? And I think it's the healthcare has always been a business. Don't get me wrong. It's just, it's more upfront and pervasive now than it was in years past. And part of it is the margins are getting very, very tight. And a lot of the times the decisions organizations are making may or may not be mission aligned anymore. And I think that we're all struggling to figure out how to do that. And the young talented, the business administrative folks, they're very cutthroat in their approach. They're looking at the bottom line for everything. And many of us over the years who may or may not have been paying attention to the bottom line as astutely are realizing that those old ways are not gonna cut it anymore. And I think that it's just a culture shock. And I think it's just immersion in different cultures. And part of it, you start asking yourselves, I'll give you an example of one struggle academic medical centers have right now. The patient who doesn't have resources who has had so many disadvantages in their life, shouldn't they deserve the best of healthcare out there? And the answer of course for all of us should be yes. But if you look at the disparities that are emerging in terms of access and variability in outcomes, and just having a conversation with a specialist, those disparities are widening. And academic medical centers who are struggling to try to be safety net hospitals, for example, it's sobering. Hanuman Hospital going under should have been a wake-up call for every single one of us. And if it's not a wake-up call, it should be. I mean, it's just that was a tremendous institution with phenomenal leaders and physicians and healthcare teams that provided great work for their communities that just went on. And I was shocked that more of an outcry wasn't had from people like that can happen anywhere. I mean, if all the people who think that they're in a great situation right now, it doesn't take much for your financial situation and your landscape to change. And I think it's something that we need to think about. Like should, you know, there's fundamental questions. Should for-profit industries exist in healthcare? I don't know what the right answer is, you know, but I mean, I mean, maybe we're gonna, you and I are gonna open my doors box, but there's a lot of fundamental questions to ask. - There is the classic phrase that says, you know, not for profit is a tax designation not a business model. - Correct, correct. But the reason, if you go back to the origin of not for profit, the reason they're supposed to be not for profit is politicians way back when realized that there are gonna be certain parts of their business that are gonna lose money because of helping the poor, helping those don't have resources. They need to do that. That's why they got the not for profit designation in the first place. And the biggest travesty that's happening right now is they're not for profit organizations not doing their job serving the community. I mean, if they don't wanna do that, if they wanna go through the lens of, we're not gonna help certain segments of the population, great, give up your not for profit status. That should be an easy decision to make. - Yeah, and I'll say this, no names, no practical, no names, but. - I know, we're trying to get put it above board over a time. - You know, my observation as a humble surgeon practicing is that, and you described it as a widening disparity, it's my observation that the conglomerate systems, that have shifted from a private model to what people have called a privateemic model, you know, more of a group practice, an employed model versus a traditional academic model that perhaps has become a system. If you don't have resources, it's gonna be much easier to get care in the academic medical center than those corporate systems that have developed because their bottom line is their bottom line. And as in, you know, they behave in, they behave to all intents and purposes as for-profit organizations, even though they have not for-profit designation. Now obviously, that's a generalization. And, but I think, you know, I've worked in institutions where it was not a problem dealing with the indigent populations without healthcare resources, and I've worked in institutions where it was not easy. - Right, I mean, I think- - Lots of them are classified as not for profit. - Not for profit, yeah. I think that the tricky part comes to, I mean, just fundamentals says, what is the area that you serve? Who are the communities you serve? I think that's where you start the conversation first, which are like, we need to change the conversations towards, like even in surgery, and we're starting to see this because the surgery intervention should not be independent of the long-term trajectory or care of the patient, correct? I mean, so there's this concept called integrated care. And what that means is when you look at the domains of quality, you know, there's traditional six domains everybody talks about. You know, the traditional things is, is the intervention effective? Is it safe? Is it patient and center? Is it timely? Is it efficient? Is it equitable? These are the six everybody talks about. But there's a seventh domain, and that seventh domain is integrated, meaning that if I perform a surgery on you, do you recover enough that you are able to live a productive, healthy life that it goes on? It's integrated longitudinally with all of your care. So that's a fundamental thing that people don't pay enough attention to. And I think that we're starting to change that conversation in the world of surgery by looking at longer outcomes. It's not just 30-day outcomes anymore. It's 60, 90, a year, two years, five years. And we're starting to shift that conversation there. But it's just highlighting that care should not be siloed, care should not be independent of each other. And especially when more and more diseases are becoming chronic diseases, you know? Traditionally right now, we have chronic diseases of things like high blood pressure or diabetes. HIV right now is slowly and yours in my lifetime has become from a death sentence to a chronic problem. Cancer, that's what we're leading towards. Cancer right now, I'm a cancer surgeon. Cancer now is slowly becoming one where we're getting with more and more advances where it's becoming a chronic disease. And if it becomes truly a chronic disease, this is even more important about integrated care. And when you're thinking about integrated care, it's very, very important that you need to make sure you're doing the best care for the community, the patients at large. You have to build that system. We're not designed that way right now. Right now, healthcare is still that, you know, transactional fee for service, independent, oh, I did my surgery after 30 days it becomes somebody else's problem. That's where we're reimbursed for right now. But that's what's got to change. And so it's an opportunity, I think, for all of us as we start thinking about the changing paradigms and what it is that patients need and what, but it's got to be longitudinal care. It's integrated care. And surgery has to have this, you know, you know, hallelujah moment where we start realizing that we need to start designing interventions that way. And so then once you start thinking about that way, then you can start answering thoughtful questions, you know, the most recent social media conversation that was happening this weekend. It was a very thoughtful conversation that, you know, Justin Dimick, who's the chair of surgery at Michigan, for example, started and he talked about it. He was like, hey, we have all these GLP1 agonists right now and the drugs are available. But what about the role of bariatric surgery? And then somebody actually thoughtfully came up and said, hey, look at what happened to peptic ulcer disease and all the surgeries, right? I mean, there were textbooks, you and I, when we were in training, there were chapters dedicated to different types of peptic ulcer surgical interventions. And now all of that is all it's, yeah, the surgery is still there, but it's an extreme case that maybe medications is the best way of doing it. And maybe that's what's going to happen with weight loss. We don't know, but surgeons need to be involved in doing the research and trying to figure that out. It's for sure, you know, I interviewed Neil Mortensen recently, who in his early career worked with a guy called Professor David Johnson, who was in the world. There were, seemed to be three people that could do a highly selective begot for me, you know, the one in Denmark. - And he was one of them. - The American one in the UK and said, and you know, David's academic career was based on highly selective begot for me. And as Neil points out, he was working for him at the time when Tagumet was introduced. And, you know, as he said, literally overnight, his, you know, his practice disappeared. And you know, he became a pouch surgeon because it just disappeared. And now, of course, you know, following the work of, in Australia, the disease disappeared. Never mind that. - Disease dissipation. - But even antibiotic treatment for ulcer disease. Remember that that paper was rejected. - Sure, yeah. - So different organizations, and people were ridiculing them. And now look, it's like, of course, for each pile, or it's an infection, you, of course, you give the antibiotics part ahead. It does. - Yeah, well, I think, you know, ultimately getting the Nobel Prize is the-- - It's the way to find a middle finger, you know. (both laughing) - Sure. - It's amazing. - So tell me this. You know, everybody says, you know, oh, I don't really care how I'm remembered and that one thing or another. But how do you think you'll be remembered, or how would you like to be remembered? They're not necessarily the same thing. - Great question. I think that, you know, whether you want to call it luck, whether you want to call it circumstances, I have gotten my foot in the doors of many places that traditionally people like myself weren't allowed into. And I'd like to be remembered for two things. I'd like to be able to say is, not only did he get his foot in the door, he really widened it, allowed other people to come, people who were even way better than myself. I always say that when sometimes people say, well, Tom, you're the first born grad who ever graduated from Northwestern's surgical training program, or I was also the first thoracic track CT surgery fellow at the University of Michigan. You know, whatever the first I've had, I always tell people, have you seen the second, third, four people that follow behind me? They're way better than me. And that's a pride point for myself, is to say that I'm hoping the people who may have benefited from me opening a door are way better than myself, because that's what allows our field to thrive or get better, is when talented people from all over the world are allowed to come in to the house of surgery, our field just gets better. - And the second thing? - And the second thing is, you know, I hope that I was a good person to be around. I mean, I just think that I try to learn from my circumstances. I try to approach things with a sense of humor, but I'm hoping that people who I've interacted with never left saying, man, that was a terrible time. I just hope they had a good time when they were around me. You know, and I think that I might spend on the world this, yes, there's a lot of problems, but I also wanna appreciate the fact that we have a lot of opportunities. And I think that all of us together, working together, building that better world for all of us, I think that's a good thing. And so I'm hoping that's-- - Yeah, no, very good words. And echoed by many of the people that I've interviewed, actually, that, you know, all of the number of papers or the grant income read doesn't matter. It's the other stuff is much more fundamental. - It's much more fundamental in everything. I mean, I think that, you know, my social media profile, I always introduce myself as a dad, a husband, a thoracic surgeon. And in that order, you know, I think that I'm fiercely proud of my two kids. You know, I've been an amazing wife, a great family, but I've had a lot of great, you know, students and trainees. And I've learned a lot from them, you know, just again, it's kind of the touchstone in my life 'cause I love to be around talented people. - You're a pretty high profile. I mean, you're, it's all variable, you know, or relative, I should say, in terms of, you know, social media profile. I mean, you're, you've, I don't know, you've 35, 40,000 put our followers, which, you know, for someone like me is a big number, but, you know, my son is a football commentator and he had like a hundred and something bad, you know, so it's all relative. - Back into the bump, yeah. - But did you set out to do that deliberately or intentionally or was it just-- - Great question. No, no, the answer is no. So one of the programs we built was strong for surgery, which is now the official quality program of the American College of Surgeons. - Yeah. - So that was building on optimizing patient health before surgery. And so we had started as a public awareness campaign in Washington state when I was on faculty at the University of Washington. And so I, I engaged on Twitter in 2013. And my intention at that time was really, I was just trying to learn from people around me. That was, that was the reason. The follower count and I remember the first couple of years. I mean, yeah, I would put out tweets or put out things. Nobody paid any attention, but it was just kind of this, you know, it's, it's a principle of common interest, right? The more you do it and you add one follower, then you add two and so now, you know, 11 years later, you have what the social media presence is. But it's really, it's still intentionally, I actually call myself more of a curator than anything else. I just look to see, you know, I have enough followers now that they're always posting amazing things. And so I'll look to see where directions of conversations are going or I'll assimilate things together in this presidential year that I have for the SUS, you know, one thing we just did. So every Saturday under the hashtag, the SUS press Saturday, what we do is what I'm doing right now is I'm just showing glimpses of lives of the past SUS presidents. And it's actually been a lot of fun because you realize, like this past Saturday, we just posted on Dr. David Sabison at Duke and for all his accolades, what his biggest pride point was is the people he is teaching. The people he trained, that was his biggest pride. It wasn't the thousand plus peer review publications he had. It wasn't the fact that he had 35 years worth of continuous NIH funding. Like all those things pale in comparison to the people he taught, like that was his pride point was. You'll hear that from Scott Sylvester. He was a Duke, you know, had it was on both sides of Sabison's tongue, you know? [LAUGHTER] So in the last few minutes, just a few really quite serious questions for you now. So what is your favorite food? [LAUGHTER] Great question. Pizza. And this is where I always start. I mean, it's Thai. I love food of all types. I love Indian people. It has to be, yeah. Pizza is always followed by the second question, you know. Which type? Yeah, that's where I get in trouble. [LAUGHTER] I still, in the US, I still consider my hometown Chicago. So I love a deep-toed Chicago pizza. But I also love New York slice. Don't get me wrong. No, no, no. But this is where I always get into problems. You can't choose. What's your favorite movie? Ooh, that's a good one. That's a tough one to answer. Because I love-- I actually-- so I clarify this by saying, I love going to movie theaters and watching movies, you know? And the reason why this is a throwback to the years I've lived in India. So in India, when a popular movie comes out, the most popular time of the show is on opening day. They call it the second show, which is at night, the 9.30 PM at night show. And it's tough because everybody's-- there's throngs of people coming through. And my friends, since I was bigger than most people, they would use me as the battering ram in front to go and sit and everything. But I love movies of all type. I mean, and so I think it changes. Of course, I love movies like Gladiator and Apollo 13. But I love watching-- not the old top gun, the new one, Maverick in the movie theaters, just because I love watching the action sequences, loved all the Marvel movies. But it's tough. It's hard for me to pinpoint one, because I just love the experience of going to the movie theater and watching it at the big screen. Handsome dogs. Dogs, definitely. I've had both of my life, but I'm a dog person. Can you predict for me the next biggest thing in 10 years? [LAUGHS] Wow. Here, I'll narrow it. I think a lot of academic medical centers are going to either go under or get emerged as part of bigger systems. That may be a bad thing for us, because I think competition is good. If you think about something as simple as your cell phone, when they broke up, you know, mob bell, that's the reason why cell phones exist right now. Because if they hadn't done that, if the government hadn't broken that up, there wouldn't be the competition and all that we see right now. With these murders, I don't know if that's a good thing or not. When people say competition is good, I always say to people, that speaks-- their speaks somebody who doesn't have any competition. [LAUGHS] No, we always have fierce competition. In my environment, we have great organizations in our backyard. I learn from them. Sometimes they'll do something, and I'm like, wow, that's a great thing. We should do that, too. Friday night, you are having an inner party, and you have two spare seats. You can invite anyone from history. Oh, geez. Anybody from history, I would say one is Nelson Mandela. And the other one is very similar is Mahatma Gandhi. And the reason why the two of them is-- the question I would ask both of them is when you were facing all that adversity and all that oppression against you, how did you keep your temperament cool? Or what did you do to think of the bigger picture? Because remember, they're celebrated now, but in their lifetime, neither of them were celebrated. Just the irony of inviting Mahatma Gandhi and Nelson Mandela to a dinner party and a fight breaking out. Political difference. But those may be the two off the top of my head. But that's just figures of that. But again, there are a lot of surgical heroes that were flawed human beings. Oh, for sure. You and I both know that you'll hear about their accolades about the advanced surgical technique. And then you learn later on that maybe there weren't the best human beings to be around. And you struggle with that a little bit. The human entity is a flawed model. I mean, you just did. What is your favorite book? Oh, I have a lot of books. Yeah. One of my favorites is a drive by Daniel Pink. And he talks about how human beings, the motivation for them to go forward is based on three principles. It's autonomy. Are they doing something that the more and more they do, they get better at it? I mean, sorry. Autonomy is about the principle of, you know, having independence and chasing something. Mastery is the more and more you do it, the better you get at it. And then purpose. Are you doing something bigger than yourselves? Autonomy, mastery, and purpose. And he says that most of the ways that you motivate people is by trying to identify those three areas. There's no question for me. That's one of the reasons why I went into the field of surgery. Because surgery is, by definition, you have all those three things. I mean, you have autonomy in terms of the patients you choose to operate on or don't. You decision making mastery. The more and more you do it, you do get better at it. Especially if you're doing it at a high volume and purpose. We're, of course, doing it on something bigger than ourselves, doing it for our patients. But yeah, drive has been one of my favorites over the years. Last question. Rest of your life in five words. Yeah. Wow. That's a tough one. Doing better. Two words. Okay. I think that whatever I choose to do, or I'm fortunate to be able to be part of. Do we leave that in a better place than we started doing better? I think it would be. Two words to finish on, Tom, thank you so much for spending time talking to me. No, John, this has been a very fascinating interview. Thank you for the opportunity. And looking forward to the final version of this podcast when I release. [MUSIC]
