Sam Rhee shares a plastic surgeon’s perspective on healthcare during this interview with Rob Oliver. He brings a Generation X perspective to the Perspectives on Healthcare Podcast. His private practice operates in northern New Jersey. In addition to his medical practice, he is also a CrossFit trainer.
Here are 3 things that stood out to me from Sam Rhee as he shared a cosmetic surgeon’s perspective on healthcare:
· Of all the parameters involved in quality healthcare, being “Patient Centered” stands out
· Breast cancer will affect 1 in 9 women.
· Improved health and quality outcomes go hand-in-hand. It’s about holistic care.
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Here is the transcript of the interview:
Rob Oliver: Thank you and welcome. Today my perspective comes from Sam Rhee. He is a plastic surgeon and a CrossFit enthusiast who lives in Northern New Jersey. He is a member of Generation X and Sam, welcome to the show.
Sam Rhee: Thank you. It’s an honor to be here.
Rob Oliver: Absolutely. So we’ll start right from the beginning and tell me a little bit about yourself and your role in healthcare.
Sam Rhee: Thanks. So I am a plastic surgeon. I’ve been board certified for 16 years. At this point, I’ve sort of seen health care on a couple different sides. When I first started as a plastic surgeon, I work in a large institution. So my first job was at University Hospital in Newark, New Jersey, and I saw a very, I guess you could say, urban gritty, part of what health care is about. I saw a lot of trauma. It was it was very eye opening as a young surgeon to be exposed to that. And I did a lot of craniofacial care. So I trained originally as a pediatric plastic surgeon. Did cliff lifts, facial trauma, anything sort of related to children and the head for the most part. And I worked in large teams. So most of those types of care required geneticist, neurosurgeons, ENT specialists, pediatricians. After a couple of years working there, I worked at New York Presbyterian pretty much in the same role, but this time in Manhattan. So it was a little bit of a different demographic, for sure. And I was there for another couple of years. And at that point, personally, I love this type of medicine and this type of care. But if you want to be in that intense academic setting, you really have to spend a lot of time there. And I was living in New Jersey in Northern New Jersey and the commute. I had two young kids and I had to make some choices, and I ended up leaving and then switching pretty dramatically into a single practice, single solo practice environment. And, you know, once you leave that large academic or institutional environment, you can’t really do the same types of surgery. And most plastic surgeons who are in single practice environments end up doing primarily cosmetic surgery, which is what I basically transitioned into. So for the past, what is it, like, nine years or so I’ve been doing primarily. So whatever stereotypical things you might expect a plastic surgeon to do on TV, faceless, breast, augmentation, liposuction. So I’ve seen it from multiple aspects.
Rob Oliver: Okay. I’m just interested to hear just a little bit more about your taking when you’re in the big hospital. It’s a team setting. Are you able to generate any type of team setting as a solo practitioner, or it just kind of you on your own. What would you classify as kind of the difference between those two opportunities with team building?
Sam Rhee: So when you’re in a large academic institution, you have resources provided for you very smart people, all working in their specialties. So you have a pediatric ophthalmologist, but really, really, on top of the line pediatric ophthalmologist. You have geneticists who are working at the forefront of their field. And so when you meet about these very complicated patients with complicated issues, you can sort of put that together. And you have institutional funding typically to do that. They want you to. If they’re an elite institution, they want to perform elite level care. When you’re in your own private practice, you’re no longer salaried by the hospital. You’re now based on your own revenue that you make. And most of these procedures are, although they’re very complicated, they don’t reimburse. Well, we’re at the mercies of insurance, and when I first came out to Northern New Jersey, I did try to work in that setting, but it’s without some sort of infrastructure. It’s really difficult.
Rob Oliver: What does quality health care mean to you?
Sam Rhee: Yeah. That’s a good question. So thinking about this, I pulled what a traditional definition is, and I wanted to pull some aspect out of that. So the definition often used. And we see this in hospitals all the time. Is quality healthcare safe. It’s effective. It’s patient centered. It’s timely, it’s efficient. It’s equitable. Well, for me, as a plastic surgeon, especially when I was performing a lot of reconstructive care, I usually would see patients well, our specially usually sees patients in a couple of different settings. We’ll see them in the Er for acute trauma, either complicated soft tissue lacerations or facial fractures. And and or we will often work with other specialties, such as orthopedics for other reconstructions, like limb reconstruction or hardware revisions, or will work with the surgical oncologists for reconstruction of the breast after mastectomies. So in most of these situations, the one aspect of quality health care that stands out is patient centered. Because we are surgeons, we are very focused on. Our techniques are generally safe and effective and timely and efficient and equitable for the most part, those are not the decisions we’re making as clinicians. But each patient in these situations is very unique. Whether you’re working with a 17 year old or a 77 year old or 50 year old mother of two versus a father who is 25. Like, these are all different situations. And how you tailor your treatment plan for that patient entails a great understanding of what that patient’s situation, their needs, their goals are and not. And that’s what we take pride, as in plastic surgery is if a patient has a blocked artery, there’s really one treatment for it. Right. But when a patient is absent, abreast or if they have a hand, a laceration, are they a Workman? Do they work with their hands? Is it their left hand? Which finger is it? What type of goals are these patients seeking in terms of their function versus aesthetics afterwards? And so I think for us, as plastic surgeons, quality health care depends on patient centered care.
Rob Oliver: Well said, can you give me an example of quality health care?
Sam Rhee: Yes. I think one of the ones that touches most patients, and I don’t do this anymore. But I did was breast reconstruction. So one in nine women will eventually be diagnosed with breast cancer. It’s one of our most prevalent care issues in America and around the world. And when a patient undergoes a mastectomy where they are removing a breast for breast cancer, there are many, many reconstructive options, and it is certainly not cookie cutter. And not one option fits all. It can range from no reconstruction, which has been an option for patients. And there’s a vocal subset of patients who believe in that all the way up to very, very complicated multistep micro surgical reconstructions and everything in between implant reconstructions or a combination of such. And each option has a range of sub options. So when you talk to patients and you put them in a situation, a great plastic surgeon will be able to honestly offer all of these options fairly to a patient who can then decide for themselves what it is that they want. And it can be overwhelming, almost too overwhelming. And so a big part of quality health care in that example, is being able to present this to a patient in an easily understandable, digestible way, which helps them decide what they want to do. And that’s a tough thing to do the best breast care. Plastic surgeons that I know are not just technically great, but they’re really good at connecting with patients and helping them guide them through all of their options.
Rob Oliver: There is an element of medical knowledge. But then there’s also the communication intelligence to be able to talk about it and bring folks onto that page. What do you wish people understood about your role in health care, about being a plastic surgeon?
Sam Rhee: Wow. Well, I mean, it’s sad to say, but I’m really no longer. I can’t really call myself a health care provider right now at this time. I mean, if I’m doing primarily aesthetic procedures, I’m not really performing health care because these are not needed procedures per se. But I will say in my experience, I’ve seen both, like I said, large institutional as well as small, single surgeon type situations. And I would say that improved health and positive outcomes go hand in hand. I think the further long I’ve gone, the more I see that I think it’s really hard for us as surgeons not to focus on a specific issue. And I think for many, many years I did that I focused that the issue at hand, and I would try to help manage that issue at hand. But I think what’s even more important now is and this is something we’ve espoused for many years, but it’s really hard to implement holistic care, where we truly understand what our patients need, not just from what they need today or next week from us, but what do they need in general? And I think that’s in part why I became a CrossFit coach is because I had been interested in what is involved in making patients healthy, not just fixing problems that they had. And that can be as simple as exercise, or it can involve nutrition. It can involve other aspects of patients lives, like stress or management of stress. And I think the farther along I’ve gone, I see how as healthcare providers, we could probably work a lot more on that aspect of them.
Rob Oliver Okay. I would just want to kind of parse through what you said there because you gave me two impressions. One way is you said I’m not delivering health care per se. And then the other way is to look at people holistically. And in some ways I’m thinking, even when it comes to cosmetic surgery, you are changing the way that people look at themselves or feel about themselves, which is a self image concept that changes their psyche. And in that way is kind of peripherally linked to health care because it’s looking at them not just as body, but like mind body so kind of thing. And it’s more holistic. What’s your reaction to that thought?
Sam Rhee: I would appreciate that, because that puts a very positive spin on what I do. And I like that. I would say that’s been a process for me, especially as I’ve come along when I have to say when I first started in cosmetic surgery, you want to build your business, you want to make money? Definitely. At first it was listening like, what do I think the patient wants? Can I fulfill that technically and then achieve that regardless of what the overall improvement in that patient’s life is at this point in my career, I definitely do think about whether or not this will affect a positive change in the patient’s outcome because that makes me happy. But I have the luxury at this point of being in practice for long enough that I can work with my patients. I don’t have to honestly take every patient in the door. I actually Consul patients a lot more now about not necessarily doing surgery at this point. For example, I will have a lot of patients for body contouring, and if I see a patient and their 5′ 3″ and 270 pounds. Well, what I can do cosmetically is not going to impact them very much, nor will it effectively impact their self image much other than very temporarily. I really work with those patients. I never say no to anyone, but I do say for us to really get to the point where I think you want to be. These are some of the things that need to happen, and I’m willing to I’m not a weight management specialist. I’m not a nutritionist, I’m not a psychologist, but there are resources that can help, and I’m here to, you know, support. And if at some point you get to that point where you are a candidate, then absolutely, we can do some things for you. And I have had a couple of amazing success stories with patients where they really took that to heart. They got super motivated, and they really made positive changes. I mean, of course, change is really uncomfortable, and not a lot of people necessarily will do that. But at least it starts to put the thought into their head. And maybe not this year, but maybe next year or the year after they’ll think about some of these things, and maybe they will affect some change in their life. So those are the kind of things that, yes, you’re right. There are some oblique aspects to improving health care that I might be involved in.
Rob Oliver: There you go. And to get back to what you talked about earlier on, that is the the team building concept in which it’s like, I’m not the only solution to our other resources. Let’s work out to see what works best for the patient. So what excites you about the future of healthcare?
Sam Rhee: What excites me in a positive or in a concern manner, because there’s a lot on the concern side, but there is probably some stuff on the positive side, too. We can take both of them. So I think a lot of people have concerns about health care in the future, and there’s no doubt there are a lot of issues. I think the biggest thing that I’ve seen is is how the financial aspects of health care are increasingly front and center. And I see that obliquely just in how things are in the healthcare landscape. I see hospitals emerging and very large groups of hospitals merging to the point where they are being blocked for anti trust violations for monopoly creation. And these are sort of things that you never saw hospitals do before. This is what big business used to be cited for. And so it’s really unusual that this is happening, but it’s happening because people are looking at health care financially as a commodity. I have had my colleagues had their practices bought out by venture capitalists, and they are purchasing large groups of specialty practices in order to try to consolidate and get a hold on a market. For example, dermatology in our area, there are larger and larger groups being consolidated, and I think that these are the consequences of these aspects. The financial aspects of health care have not been fully understood, and I don’t think anyone really knows what’s going to happen in the future. In this regard, I think everyone thinks bigger is better. But as we all know, the deeper you get into the system, the less personal responsibility people have, the more the system takes over, so to speak, the really difficult it is to find quality health care in those situations. Often times you just get really, really lost. And it’s very frustrating. So that’s probably one of the concerned excitements I have.
Rob Oliver: I live here in Pittsburgh, and we have UPMC, which is the health care system that seems to have just taken over and is growing exponentially. So were you going to share something that excites you positively?
Sam Rhee: Well, I think I think the thing that heartens me is that individuals still matter within healthcare. I think if you’re a provider and you care, that’s why you’re going into health care. I don’t think and I talk to young people all the time. They should not be getting into health care unless they really care about caring for others. And I think that that’s really important. And I think as long as we have people for which that is the driving and motivating factor, no matter what we do in health care in the future, that sense of dedication to others, the service for others is going to save us as a system and as a specialty. And it is the care part of health care that you’re saying is kind of the essential nature of what it is.
Rob Oliver: Absolutely what is one thing medical professionals can start doing today to improve the quality of healthcare?
Sam Rhee: It’s always personal responsibility. I would have to say it’s very challenging sometimes when you’re working within a system to feel like you have personal responsibility time and time again. I’ve seen ICU nurses. They certainly care about their patients. There are some that are amazing superheroes, and yet the system so I don’t want to say break you down, but it gets so challenging the way they set up work hours or the way they set up staffing or the way they set up other issues. And as a provider, you can often feel like what you do doesn’t make a difference, or it breaks you down to the point where you’re burnt, burned out. And so I would encourage us to find ways to look above it. And unfortunately, that often means not necessarily doing focusing on what you’ve been trained to do, which is to provide quality health care, but to look into influencing management or becoming management or taking a leadership responsibility on some level, even though I am no longer doing reconstructive surgery, I do serve as share the credentials committee, and I’m associate director of plastic surgery at Valley Hospital, the local hospital in our area in Ridgewood. And this is not for any reason other than I want my hospital to provide the best possible care, to evaluate our providers in the best possible manner. And it’s for no other reason than to try to say we, as physicians do have a role in management and also in trying to make sure that the stuff that comes down from top is is truly patient centered. And so often times I think the physicians on we hate to be on committees. We hate to be part of these types of time consuming processes. But I really applaud anyone who is involved on that level, helping to create policy, helping to, you know, figure out how to make the best systems based practice for for patients and that’s where we, as advocates, have to step above ourselves, take our personal responsibility and to do those things we hate to do but that ultimately make such an important impact on all our patients.
Rob Oliver: A very powerful way to end our interview. Sam Rhee, thank you so much for being here. I appreciate your perspective on health care.