Leaders in Medical Education: Dr. Larry Kaiser, Dean of the Temple University School of Medicine

Screen Shot 2016-10-02 at 12.57.00 AMAn internationally renowned thoracic surgeon, researcher, author and academician, Larry R. Kaiser, MD, is the leading health sciences executive at Temple University in Philadelphia, PA. He serves as  CEO of the Temple University Health System, Senior Executive Vice President for the Health Sciences, and Dean of Temple University School of Medicine. Prior to joining Temple University Dr. Kaiser was the President of UTHealth, the University of Texas Health Science Center at Houston from 2008 until April 1, 2011.

Dr. Kaiser graduated from Tulane University School of Medicine in 1977 and completed his internship and residency in General Surgery as well as a fellowship in Surgical Oncology at the University of California (Los Angeles). He then completed a residency in cardiovascular surgery and thoracic surgery at the University of Toronto.

Dr. Kaiser’s research and clinical interests include lung cancer, malignant mesothelioma, and mediastinal tumors.  He is the author or co-author of 14 books and over 250 original papers.

How did you decide on a career in medicine?
I never considered anything else. Since I was very young all I ever wanted to be was a physician and specifically a surgeon. I was greatly influenced at a very young age by a general surgeon who lived up the street from us. I admired his calm demeanor and his seemingly ability to always have everything under control. He operated on me when I was 4 and came to the house to suture my eyelid when I sustained a laceration. He welcomed me to his operating room when I was 14 or 15 to witness my first surgical procedure. I was working as a hospital orderly when I was 15.

What were a few key steps in your journey from an aspiring medical student to your current position as Dean of the Temple University School of Medicine?
I set out to be a surgeon who was interested in an academic career and thought only about how developing both a research and clinical expertise. Early on I became very busy clinically as one of the earliest thoracic surgeons doing lung transplants but also with an interest and expertise in thoracic oncology. I was recruited to a number of different institutions interested in developing lung transplantation but the real turning point was my recruitment to the University of Pennsylvania where I was given the opportunity to lead the development of a thoracic surgical program that included the initiation of the Thoracic Oncology Research Laboratory with my colleague Steve Albelda, a superb clinician/scientist. Starting a lung transplant program from the ground up gave me tremendous leadership experience since a program of this sort requires a well integrated team of multiple specialists in addition to support from the institution. I very rapidly became very busy clinically and was given some additional leadership responsibilities along the way. I am convinced the opportunity to take on even small leadership roles is key to developing as a leader. In addition we were successful in our efforts to obtain a program project grant for the laboratory and thus were publishing some important work in addition to a large volume of clinically related papers. I began to receive offers to look at leading surgical departments around the country and came close to taking a chairmanship job at another institution until I realized I didn’t think I could reproduce what I had been able to accomplish at Penn and was willing to take my chances and wait until the chair of surgery at Penn would become available. Once I become the chair of surgery at Penn I became very interested in the finances of running what really was a business since the non-physician employees actually worked for the Department separate from the hospital or University. With the help of a very experienced chief operating officer who I had hired we were running a fairly large business and from him I learned a great deal. We also worked closely with faculty at the Wharton School at Penn setting up a number of courses and seminars. After several years I began hearing from search firms regarding Dean’s positions and I looked at a number of these as I clearly was interested in stepping out of my comfort zone and really stretching as a leader. Having seen closely how senior leadership was working I became convinced that I could exist quite well in that realm. Leadership is something surgeons exemplify every day. Simply putting a team together to take a patient to the OR requires tremendous leadership skill. I also realized that I could make decisions based on the available information and didn’t hesitate to act once I’d made a decision. The opportunity to be the President of the University of Texas Health Science Center at Houston was truly the perfect fit for me to really exercise my leadership “chops”. Going from department chair to President of a major institution certainly could be considered a big leap but I was very comfortable in my leadership skills at that point. The ability to really listen in addition to being able to communicate are two skills that really may be the most important. Needless to say after the Houston stint I was well prepared to take on the current challenges here at Temple.

What is the greatest difference between the clinical side of medicine and the administrative side?
The people skills that allow one to succeed in clinical medicine are the same skills that need to be brought to bear on the administrative side but they need to be honed somewhat. Whereas taking care of patients often leads to “feeling the love” from grateful family members as well as the patient, especially in surgery, there is little “love” directed to those in administrative positions. Jobs in administration are not for those who have a desired to constantly be “loved”. No matter what decision I make someone will be unhappy. On the administrative side we are constantly being asked for something specifically money to support a recruit or a particular project. On the clinical side the only “ask” is to provide high quality care to patients and get along with one’s co-workers. By the way I’m still involved clinically to a limited extent so I still occasionally get to feel some of “the love”. Whereas the satisfaction on the clinical side comes from taking great care of patients the satisfaction on the administrative side comes from being able to facilitate the success of others and experience their success. My job is to create an environment where everyone has the ability to succeed to their full potential.

What does an “average” day look like for you?
With responsibility for both a medical school and a health system as well as being a University officer on any given day meetings might encompass all three areas. I may deal with a medical student issue in the morning, be at the University for a meeting with the President at noon, and deal with health system financial issues in the afternoon. On any given day I have very little downtime to actually sit in the office usually only between meetings.

What was/were the most memorable experience(s) during your medical education?
The dissection in the anatomy laboratory, and back then we actually did the dissection and not just observed prosected specimens, was one of the real highlights for me. That is when I really realized I was going to be a physician especially as you begin to acquire the language of our profession. My physical diagnosis course at the VA with a great resident as an instructor whose name I remember to this day was another highlight. During clerkships I especially remember my time on Ob Gyn since we were given incredible responsibility in the labor and delivery unit. I did over 50 deliveries during that rotation having never even seen one prior to my arrival on that rotation. I remember the first one very well. As I was scrubbing, with no resident in site, the nurse is yelling at me to get in there as she literally was holding the head at the introitus. By the way the nurse was so experienced she easily could have delivered the baby but I think she was having more fun yelling at me to get in there. On that rotation I did my first surgical operation as the resident actually let me perform a C-section. I do remember the incision I made went through skin, subcutaneous tissue, muscle and right into the uterus. Truly a memorable event. I used to hang around the emergency room during my first year and they were thrilled to let me sew up lacerations. It got to the point I only wanted to do the complex ones. Needless to say there were many highlights.

What do you think is the biggest challenge facing physicians today?
The changes occurring in how medical care is delivered clearly is the biggest challenge facing us today. The move from volume to value is a huge paradigm shift with the centrality of medical care no longer being the inpatient setting with more moving not just to the outpatient area but into the home. The way physicians practice will be different. Alternative payment models will continue to push physicians in much closer alignment to hospitals and health systems. Taking care of more patients with better quality at lower cost truly is the greatest challenge we face today.

In a time where technology is rapidly advancing and there is a push toward “precision medicine” initiatives and moving medical records to electronic databases, how can we best streamline this process while keeping in mind patient privacy?
The implementation of the EHR with the mandate to do so coming from the federal government has forced us to streamline all of our processes. Unfortunately in many cases patients have suffered with less face time from their physician and medical education has suffered as there is less time for teaching. The challenge to protect patient privacy has become more difficult as cybersecurity still is lacking somewhat. We need to be constantly vigilant in protecting patient privacy and it is only through this vigilance that will allow us to be successful. 

There is an enormous debate these days as to whether resources should be primarily allocated to fighting diseases or the distal causes of diseases. What are your thoughts on this issue of proximal causes versus distal causes?
We need to move our emphasis away from just treating disease to, in addition, promoting wellness. This includes continuing to emphasize prevention in both the micro and macro domains, if you will. On the macro level I’m referring to interventions such as smoking cessation, obesity “prevention” (ideally starting at an early age) by instilling healthy eating habits, use of sunscreen, etc. At the micro level such interventions as colonoscopy for those over 50, routine mammography, digital rectal examination for men, routing Gyn care, and screening spiral CT for smokers at risk. These are interventions that in the long run could have a significant impact on the health of society if implemented successfully but individuals will have to take more responsibility for their own health. Appropriately applied incentives has been shown to influence behavior when it comes to individual health-related decisions.

What are most the important facets of an undergraduate’s application to medical school from an admissions perspective?
Applicants are looked at holistically. There is so  much more than simply grades and MCAT scores though these objective measures are far easier to judge than some of the other “softer” qualities. Demonstration of some medical-related experiences to really know what the practice of medicine entails is important. Passion and discipline applied to some other craft, athletic pursuit or job also is an important determinant. There needs to be some objective evidence that the applicant can be successful in tackling the broad based curriculum of a medical education. And perhaps as important as anything is the compassion and empathy required to take care of one’s fellow man. The ability to communicate effectively also is a critical criterion and thus the importance of the interview. It is safe to say no one has yet come up with the perfect way of assessing applicants but we keep trying.

How do you foresee medical education changing in the next few years?
Many of the changes already are occurring. Small group problem-based sessions have replaced many of the large lecture format presentations. With lectures on-line students have an opportunity to look at the material prior to coming to the small group discussion sessions. The use of technology will continue to make inroads with simulation becoming even more important. Interdisciplinary education recognizing the importance of the team aspect to successfully promoting wellness as well as intervening in sickness will take on even greater significance. I believe that more emphasis will be placed on outpatient experience sacrificing some of the inpatient time as more is being done in the outpatient setting. We also may see some of the 4th year being devoted to more specific “prepping” for the postgraduate experience. With all medical information available on one’s smart phone what we really need to teach students is how to use the material, how to think critically in using the available information and how to practice using available evidence.

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