From Patient Care to System Change: Glenn D. Steele Jr., M.D., Ph.D. on the Future of Healthcare

🔍 Episode Summary:

What does it take to reshape the healthcare system from the inside out? In this powerful episode, Dr. Glenn D. Steele Jr. reflects on his multi-decade career—from hands-on patient care to pioneering leadership roles in academic medicine and health system innovation.

Nicole and Dr. Steele talk candidly about:

• How trust shapes patient outcomes
• The critical shift from fee-for-service to value-based care
• What really matters in patient-doctor relationships
• How high-trust systems can transform lives, especially in cancer care
• The surprising failures that taught the biggest lessons

Whether you’re a patient navigating a diagnosis or someone working in healthcare, this episode is packed with wisdom, vulnerability, and actionable advice.

📌 Key Topics:

• Transitioning from surgeon to healthcare leader
• Working with high-performing, “hard to manage” innovators
• The evolution of cancer care: from radical surgeries to patient-centered innovation
• How to advocate for yourself or loved ones in complex medical systems
• The importance of trust between patients, providers, and healthcare organizations
• Building systems that support — rather than overwhelm — doctors
• Lessons learned from failure and transformation in leadership

📝 Listener Takeaways:

• How to identify a high-trust healthcare organization
• The most important question to ask your doctor:

• “How will this test or treatment change my care?”

• Why even “routine care” deserves serious attention
• You shouldn’t have to choose between clinical expertise and compassionate care

📍 Quote Highlights:

“There's no such thing as an impertinent question in healthcare.” – Dr. Glenn Steele“If your provider gets nervous or defensive when you ask something simple, that’s a red flag.”“In the 1980s, letting women lead in surgical training was radical — now it's a given. That kind of change matters.”“You can’t expect individual doctors to keep up with everything — they need a system behin

Transcript

SPEAKER_00: 0:01

Hey guys, so today this episode of Glow Wild is brought to you by Noka Organics, a brand that's not just in my pantry, but in my heart. When my daughter Parker was battling stage 4 cancer, she literally survived on Noka smoothie pouches. And I mean, they were one of the only things she could keep down. And now I can't keep them on the shelf at home. She loves them so much, she has them every morning, and honestly, so do I. Whether I'm running errands, hitting the trail, or chasing purpose, Noka I'll see you next time. Try them out. You might just fall in love like we did. Hey guys, welcome back to Glow Wild. and the Steele Institute for Health Innovation while advising organizations on how to align care, finance, and technology. At the heart of his mission, like I said, is a simple but profound idea that healthcare should deliver the best outcomes with the least burden on patients and families. We all deserve the best and he believes that at his core. Today, we'll explore his journey, the risks he's taken, and the wisdom he wants to pass on to the next generation of leaders in this field. So please help me welcome Dr. Glenn D. Steele Jr. All right, Glenn, welcome to the podcast. I'm really honored to have you here. I gave our listeners a good intro about your history and what you've accomplished. I am just so curious and fascinated by your journey. Can you tell us more about your entire journey? I mean, Harvard educated, that's huge.

SPEAKER_01: 2:38

Yeah, right. Well, you know, it's been a long journey. journey and it's been a lot of fun and one of the great things about medicine is if you're you know if you've got credibility in medicine in one area or another you can make a lot of changes during the journey which is pretty typical of what happened to me so I took care of patients for over 20 years and that was what I call the honorable part of my career and was very gratifying and then I kind of moved into the administration and the business of medicine for the last 20 years. And that's been equally gratifying. So there's a huge amount of opportunity and it's been a lot of fun.

SPEAKER_00: 3:27

How long were you in patient care? 24 years. Okay. And what gave you the inspiration to switch from patient care into what you're doing now?

SPEAKER_01: 3:39

Well, you know, I I really enjoy working around very bright people who are extremely innovative and sometimes hard to manage. It's an acquired taste. And so when I found out early on in my career that I could actually coordinate these people and we could accomplish great goals together, I ended up having more and more business opportunities and more And I got to a point, particularly when I went to Chicago, where I couldn't give the kind of care and couldn't put the attention on patient care that I was able to do before I had more administrative challenges. So I had to make a decision, and that's when I gave up the caregiving and moved into the administration and business aspect. But I enjoy working around people who are very innovative, extraordinarily accomplished, very bright, and hard to manage.

SPEAKER_00: 4:52

So I hear that you enjoy a challenge. I mean, it's evident from your schooling, you know, the patient care for 24 years, moving into this new space where you are facing more challenges and working with people that might be difficult to work with but that inspire you it sounds like so i am just i am curious about the purpose behind it what fuels you to work in the space you are now

SPEAKER_01: 5:24

Well, again, there's a great deal of gratification in taking care of human beings and individual caregiving. But there's also been huge challenges and transformation in healthcare during my time in the field. A good example would be actual improvement in cancer care. Cancer was my particular area of focus. And when you think Think about the kinds of mortality figures that I experienced back in the 60s and 70s of the last century. Leukemias, particularly leukemias in kids. When you think about a lot of the adult cancers that were really devastating or in order to cure somebody, you had to do devastating surgery or devastating chemotherapy or what have you. The improvements have been absolutely remarkable. And so that's, you know, to be able to be in that area and to be involved in some of the transformation is so gratifying.

SPEAKER_00: 6:39

I can imagine you've had years of experience doing this and seeing the... the huge change. I mean, even speaking with our child's oncologist, he said their mortality rate for childhood cancer was very high in the past and it's increased or decreased significantly, which is great. We're moving in the right direction. I know that you're so centered on the patient and the patient care. What could you give people who are looking for advice on how to achieve the the patient care they need or to advocate for themselves.

SPEAKER_01: 7:18

Well, I think, you know, I think there's still a lot of room for improvement. So, I mean, the balancing act in care is, particularly if you're giving care to an individual and you're an individual practitioner, you want to make sure that the patient and the families that you're dealing with feel confident in what you're doing. But at the same time, you know that there's room for improvement in almost every aspect of healthcare delivery. I mean, There's so much basic science now that is coming down, particularly in cancer and cardiovascular disease and musculoskeletal, all of the prevalent diseases, that the ability to keep up as an individual practitioner or as a patient is almost impossible. So you have to have a system-wide way of making sure that the practitioner knows exactly what the improvements are and that the patient is confident that that practitioner has a system behind him or her that really helps them keep up. And that goes beyond just an individual practitioner making as much accountability as possible and understanding what's happening in the literature. An individual human mind can't do that and keep up in a busy practice. So there's got to be a system behind that individual. And as a patient, you need to know where to look for the best system behind an individual, whether it's in heart disease or musculoskeletal or genetic disorders or cancer or what have you. And that's pretty tough, pretty tough to keep up. You know that.

SPEAKER_00: 9:18

I absolutely do. Absolutely do. I mean, when we were down in Salt Lake with Parker, I had no idea what information they were giving me at the time. You're first in shock, so you're not really aware and you're just going to put your trust in the doctor. But I do know from my own medical experience, you have to advocate for yourself because they kept missing my diagnosis over and over. And I love that. Can you tell us more about that system that you've created? to help these patients

SPEAKER_01: 9:50

and these practitioners? out there, if you're dealing with something, the first thing you need to figure out is how to get to a high-trust organization. Because you'll never be able to make all the decisions that have to be made. But there are certain giveaways. So if you go to a high-trust organization and you've done your background search, you've gone on the internet, you understand And you ask almost any question at all. You can tell by the response to that question whether you've got a good relationship with the individual in front of you who's giving you the care or the organization. You can pick it up. And if there's any nervousness on the part of, you know, the person who's answering your questions, if there's any defensiveness, you probably ought to look for a different relationship or a different organization. Yeah, absolutely. Absolutely. They're little tip-offs. But once you have trust in that organization– and you can look at mortality figures. You can look at outcome figures. Now, one of the interesting issues is even for so-called routine care– You've got to kind of go through the same thought process because you can get screwed up. If you go for a so-called routine care and things are not systematically as good as they could possibly be, you can get screwed up. Interesting. Once things get screwed up, it gets much more complex.

SPEAKER_00: 12:01

So if you were to give a patient advice in going in, let's say, They've got either a cancer diagnosis or, you know, a very serious diagnosis. What would you give a patient? I can take that out. How would you guide your patient in asking the right questions and what would some of those questions be? Okay.

SPEAKER_01: 12:26

Well, the first question is if you're told that you need to have a blood test or if you need to have a certain x-ray or diagnostic procedure or what have you, The first question to ask is, what difference will this make? If I get a certain result, what will that lead to?

SPEAKER_02: 12:48

And

SPEAKER_01: 12:49

how will that make a difference in my care? And that sounds like an impertinent question. And some people are scared to ask the doctor or the nurse practitioner impertinent questions. But there's no question that's impertinent, basically.

SPEAKER_00: 13:10

Can we just? that relationship between patients and doctors. I feel it. I know that many people feel it. We feel beneath the doctor, so we are afraid to question them. And what advice would you give to us in that sense?

SPEAKER_01: 13:27

Well, first of all, the doctor or the nurse, practitioner, whomever you're dealing with as a caregiver is should know more than you know. I mean, that's number one. So it's an asymmetric relationship. But that doesn't mean that you should not be able to have every... answer that you need to have in order to make the right decision. And some of it is just the feeling that you've got a good relationship. I mean, I suppose if you're having a hip replaced or if you're having a coronary artery bypassed or whatever, you want to have a good technician. You want to have somebody, and even if they're, you know, on the spectrum or even if they're jerks or what have you, you know, as long as they're the best technician in the world okay. But most of the time in a relationship, whether it's a primary care relationship or whether it's a specialty relationship, a huge amount of the ability for you to do well as a patient is dependent not just on the expertise of the individual that you're dealing with, but also a good, caring relationship. And that has to do with chemistry. It has to do with trust. So it's a combination of both. Okay.

SPEAKER_00: 14:52

Now looking

SPEAKER_01: 14:53

at... I mean, when my father had his heart surgery back in the 1960s, nobody else, there were two places that were doing coronary artery bypass. One was in Cleveland and the other was in Milwaukee. And so I was just kind of starting my career in medicine, so I was able to get cared for in Cleveland. And the cardiac surgeon was a jerk a complete jerk but I was told he had the best hands in the world so we went there and I had to be the primary care physician for my father who said I don't want this jerk to be but I said do it deal with it but you shouldn't have to make that

SPEAKER_00: 15:41

choice anymore right we have so much more access now and that is just crazy to think about there being two people doing this, and you're in the best hands, your father doesn't like him, how did everything turn out? Well, it turned out fine. Great. It turned out fine, but it wasn't that optimal experience, obviously. I understand that.

SPEAKER_01: 16:00

And now, because there's so much more expertise that's more widely distributed, you don't have to deal with

SPEAKER_00: 16:06

that decision. That's great advice. I think that's so important. Looking back at your entire career, what is... something that stands out for you that has been the most impactful, not just for you, but for the medical industry as a whole?

SPEAKER_01: 16:26

Well, you know, there were three leadership segments in my career. And the first leadership segment was leading a surgical training group that was part of the Harvard complex. And the two things that were impactful there were had to do with us leading the way in getting women involved in surgical leadership. So, and this sounds crazy now looking back on it, but in the 80s, we were one of the first really great surgical training programs that accepted women. And over a 10-year period in leading that, 50% of our graduates were women, and they all went on, the men and the women, both went on to create programs great leadership, but we, we led the way and actually accepting women into surgical training. If you could believe that. That is great. Yeah. And, you know, and it was looking back on it, it seems stupid that, you know, that it didn't happen because the bigger your denominator is for anything, you know, the better your numerator is. But, but back in the day, you know, just, it was unheard of. So that was a big change that, that we helped to lead. The other, the other thing is, In GI cancers, there was just the beginning of a move away from huge, huge disabling surgery. For instance, in colon and rectum cancer, we used to remove huge areas of the body and have ostomies and colostomies and what have you. And over the period of the 70s, 80s, and 90s, we actually were involved, a number of us in leadership positions were involved in actually modifying the kind of therapy that was necessary to cure people without necessarily causing a huge amount of disruption to their bodily function. So that was very gratifying.

SPEAKER_00: 18:33

That is. I have experience with two different ostomies. They are hard. They are life-changing. They are embarrassing. It's just a constant daily thought, you know, all day long about what's going to happen. Where can I go without having issues? And so that's huge that you're able to modify the treatment there and change people's lives because it, it really, it does affect you and your identity, I can say.

SPEAKER_01: 19:05

So the second, the second leadership job was at University of Chicago where I was Dean of Biological Sciences. And almost everything I tried there failed. So we tried to change the curriculum of the medical school. It didn't work. I mean, there was cultural and regulatory issues, and it was just impossible. The second thing we tried to do there, and when I say we, there were three or four of us that kind of traveled together from Boston to Chicago and then to Pennsylvania. We tried to create a business model where instead of having what's called a deep means dowry where you negotiate for a lot of resource and then you use it up and then you renegotiate. We tried to actually create a sustainable business model. That didn't work either. But I learned an awful lot. It was a great group of people I worked with, some of the brightest people in the world at University of Chicago, both on the clinical side and on the basic side. But almost nothing that I tried there actually worked. So I learned a lot from that. And then the third segment was this really interesting place called Geisinger Health System, which was in the middle of rural Pennsylvania. And there we actually transformed the relationship between the insurer and the provider. We had both an insurance company and a large provider group with hospitals and outpatient facilities and what have you in the same fiduciary. And back in the day, and this was back even in the 2000s, there was an enmity between the payer side and the provider side. They would battle each other. The providers wanted to get paid more for all the work they did, and the payers wanted to pay the providers less. That's tough. That's kind of the way it was. Yeah. And what we did at Geisinger, which was transformative, was to say, is there a way of having the payer side, the insurance company side, and the provider side actually working together to the mutual benefit of the constituencies? Because a huge number of our patients were also people that we provided insurance for. And that began, you know, a whole national experiment on what's called value-based care as a to fee for service. And it meant that the insurance and the providers were actually trying to do better for patients to decrease the total cost of care and keep people with chronic disease, because we had a huge old population with a tremendous amount of chronic disease. And in rural Pennsylvania, it was Appalachia, basically. Keep them in better shape and keep them out of the hospital. So we would save money. They would And our insurance company would actually do better. And then the insurance company could transfer part of that financial benefit over to the provider. So it was transformative. And it started a series of national experiments called accountable care organizations and what have you that have been trying to scale that. And it also started the movement, which is now, you know, continued with Medicare and with Medicaid programs. And a lot of commercial insurance as well to be paying people for outcome rather than just units of work. So that was very gratifying.

SPEAKER_02: 22:54

I can

SPEAKER_01: 22:54

see that. Those are the three components. So two out of three were really interesting. One was a dud, but I learned a lot from the dud. So

SPEAKER_00: 23:02

I want to talk about that. Tell me more about your challenges that you've had through this whole process and any failures that you look back and say, I learned a lot. We just spoke about one. You learned a lot. Tell us more about that.

SPEAKER_01: 23:20

Yeah, well, you know, I think if you achieve a lot in life, you also fail a lot. And your aspirations, if your aspirations are very, very high, you generally never achieve those aspirations. Most people don't know that. You know, my kids don't know how much I failed because I've really achieved a lot. I've been very lucky. But you're always, you know, you're always stretching. And, you know, you have to figure out how to deal with failure but you accomplish a lot as well and a lot of it particularly in rural Pennsylvania when I went to Geisinger they were just coming off of a three year failed merger with Penn State, Hershey Penn State and everybody the morale was really low it had been a disastrous marriage and the people, you know, had great engine size, great engine size. And what, you know, what was really gratifying was if we set ambitions that were very high, there were things we could do at Geisinger that other really great institutions couldn't do because we had a huge patient population that loved us on both the insurance side and the provider side. But setting goals very high and having the individual people who had been beaten down with three years of an unsuccessful merger and watching them actually accomplish a huge amount and having everybody realize over a period of time that they weren't limited by their engine size or their capabilities. They were just limited by their aspirations. And if you could get group aspirations moving together, it was amazing what could be accomplished.

SPEAKER_00: 25:29

Yeah, team powers is so extraordinary. What advice would you give to people who have these high aspirations, but they fail once and they just give up?

SPEAKER_01: 25:44

Yeah, well, a lot of it, you know, is personality and a lot of it's just resilience. And, you know, some people have it and some people don't. But I find that, you know, I found certainly in, well, in Boston it was different because everybody thought the world was perfect. And, you know, if you made any change at all in Boston, people worry that you would screw things up because everything was already perfect. Oh, got it. Yeah. You know, that's hard to work with. Yeah. But certainly in, you know, in Pennsylvania where we created a national and an international model for, you know, for value-based care and, you know, for how the payer and the provider could work together, you know, I just found that if you could create initial success in certain areas and celebrate it, then the group would respond. And some of the people, you know, wouldn't respond. Some people are just negative no matter what. You know, it could be genetics. It could be, you know, early environmental issues, who knows what. But, you know, what we were able to do was, you know, either change their minds or replace their minds, one of the two. Yeah. And then it built up a lot of momentum. So individuals have an incredible capacity to do really great things or really bad things. And a lot of that is influenced by leadership and is influenced by the environment. Right. I mean, it's amazing the plasticity of human capabilities, either on the good side or the bad side.

SPEAKER_00: 27:26

I agree. So you've been around the block. Do you mind sharing your age with us? You know, I'm 81. 81, and you are still working. Do you see yourself ever fully retiring, or because this is such purposeful work for you, do you see yourself just going and going until you can't?

SPEAKER_01: 27:50

Well, you know, everybody builds up a reputation and what have you, and I'm still running on the reputation, and so I still haven't brand. Um, and so, you know, I'm still asked to be a part of, of a number of organizations, uh, and I can pick and choose now. That's nice. I mean, you know, living in Jackson hole ain't all bad. Um, and luckily, you know, we started here in 1969. So I was able to ride, you know, ride this obscene equity increase up. Right. Uh, and, uh, and, and it's been, it's been great. Um, and i can pick the organizations that i want to be a part of the organizations have to be you know have to be consistent with my mission basically most of them are trying to do transformative things some success some failure and i pick the people that i want to be around i i enjoy being around interesting chance-taking people um and i'm still learning i you know i i think I think that my attention span is relatively short, so every one of these leadership jobs was between 10 and 15 years, and then I got a new learning curve, and I'm still on a learning curve. My learning curve now is private equity, venture capital, a lot of startup stuff, which is really kind of chancy, but I'm not in it for the money now. I'm in it for the mission. It's fun. It's

SPEAKER_00: 29:31

fun. Right. I keep drilling into you guys, you listeners, that you've got to keep going no matter what. If you fail, get back up. And you're right. It does kind of come down to the personality type of the person. But to see someone who has been successful for so long, has their brand, has the name. Can we talk about your personal life and how that worked together with your professional life? You You have two daughters and a wife of how many years now?

SPEAKER_01: 30:02

47. 47

SPEAKER_00: 30:04

years. She's my second wife, too, so give me credit for that. I didn't know that. Okay. I'm learning something new about you all the time. Well,

SPEAKER_01: 30:13

yeah. Well, my son, you know, my son, Josh. Oh, right. So you have three kids. Yeah. He came from my first wife. That's right. That was at Mulligan. And that was in a time when I sacrificed all things personal for my professional life. So that was a learning curve, too. I mean, that was a learning curve. I was a real jerk. And so I learned from that.

SPEAKER_00: 30:34

And tell us what you learned and how you brought that into your relationship with your current wife.

SPEAKER_01: 30:41

Well, you know, I just... you know, balance in life back in the 70s and 80s, if you were going into leadership in healthcare, was a joke. In fact, I can remember one of the places that I was thinking about doing my surgical training in, which was Columbia PNS in New York, would not even consider you as a potential surgical resident if you were considering getting married. Wow. They wouldn't consider you. And the women, forget about it, they wouldn't consider any women. But they expect you to go into the hospital at the beginning of your residency training and stay there until the end, which is usually five or six years later. So there was a lot of social affirmation of, you know, no balance in life. So a huge amount changed socially, obviously. And as I mentioned before, we were a part of that with accepting women and, you know, having 50% women in our surgical training program at Harvard, which was incredible. But I learned a lot as well. And once you've had a failure, and my first marriage was a failure, not because of my first wife, but because of me, and you've had a child and you're no longer with that child, it affects you emotionally. And so the second time with Lisa was different. And we've been a great partnering team. And I got to tell you that for all three of my leadership jobs, they were not just my job, but they were our job. I could not have done my job without Lisa's participation as a part of that leadership team, a huge amount of business socializing. And most of the jobs that I've done, not so much Chicago, but certainly in Boston and in rural Pennsylvania, in Geisinger, not Most of the people that I work with who were key members of the team enjoyed each other, not just professionally, but personally. So it really, it was kind of, and everybody has a different style in terms of leadership, but we really got close to people. And I could not have done that alone. That was because of me and mainly because of Lisa.

SPEAKER_00: 33:04

That's great to have such support in the career. And I want to know, I know that both of your children are, or all three of them, three of your children are very successful. What do you think that you passed on? Was it through words or really through action that inspired them to become so successful in what they're doing?

SPEAKER_01: 33:26

No, I don't think it was words. I think they, first of all, you know, I believe in genes. So, you know, the genetics were good. On both, you know, both my marriages, it was terrific. And then, you know, and then the kids, you know, the kids saw a lot of success around them and they saw high aspirations, they probably weren't as aware of the failures as, you know, because I would hide the failures.

SPEAKER_00: 33:56

Do you think that was to their detriment or to their benefit? Because, you know, it does take that failure because, you know, climbing to success is not a straight shot up. You know, you peak, you valley, you go down, you go back up.

SPEAKER_01: 34:12

I think they're they were subconsciously aware of some of the failures, but I mean, you know, I've had a pretty blessed career and, you know, so I don't think they were aware of the failures, but they were chance takers. And I was a chance taker. Lisa was, my wife is a real chance. I mean, could you imagine moving from Chicago to rural Pennsylvania? Could you imagine that? I figured if I could recruit her to that, you know, that high chance, stakes deal. I could recruit anybody. So the kids saw us. They saw us do really well in Boston, which is a great place. They saw us do seemingly very well for the six to seven years I was in Chicago. They went to lab school and what have you. It was great. And then they actually saw us do well in rural Pennsylvania. So I think they must have at least limbically understood that no matter where you are, if you've got the right aspirations and you've got the right group around you, you can enjoy yourself and do well. And of course, the backbone to the entire family trajectory was Jackson Hole. So that wasn't bad either. Not bad at all. It is beautiful here. The kids learned to ski here. It took us like 30 years before we realized how wonderful the summer was here. As you know, we would always come out in the winter and never come out in the summer. And And then we suddenly discover, wait a minute, the summer is really pretty good too. It's wonderful

SPEAKER_00: 35:46

here. I will say, I've known you for a long time. I vividly remember almost every single dinner that we would have. And I really got excited because my parents... They're great people. have inspired me as well. Those dinner conversations were always deeper than I was used to, and I really appreciated that.

SPEAKER_01: 36:42

Well, it's nice to hear. I don't like to talk about myself, as I told you before we did this podcast. I enjoy doing things. I'd enjoy the change in how we train surgical residents. When I was in Boston, I enjoyed trying to change the medical school curriculum at Chicago and the business model there. I really enjoyed creating a new model of how insurance companies and providers work. So I enjoy real life experiments. I love people who are operators, who are successful operators, particularly if they're operating in systems that are under a huge amount of challenge and have to change. And so I don't like to pontificate about things. I don't like to write commentary. I like to do things. So even this is a little bit, you know, it's a little bit anxiety producing because I don't like to talk about myself.

SPEAKER_00: 37:45

I understand. It's very hard to talk about yourself, but I love that you are just driven by helping others and serving a purpose. And that's huge. I see here, we're sitting in your beautiful office and your beautiful home. You read a lot. So have you read any books, and I know this comes up a lot in all the books I read, is you are who you surround yourself with. So it sounds like you like to surround yourself with doers and really smart people that are changing the world. Do you think that's really true? And what advice would you give to people that maybe have these relationships that aren't serving them and how to get rid of them?

SPEAKER_01: 38:26

Well, I think you have to enjoy yourself. You really do. And I can't tell you how many people during the 24-year I was taking care of cancer patients, would come to my office and say, you know, I was waiting until I retired until I, you know, and then I could really do some fun stuff with my family and my wife. And then all of a sudden they're looking at, you know, some terrible physical challenge.

SPEAKER_03: 38:50

So I

SPEAKER_01: 38:51

don't think you should wait. I really do think you need to enjoy yourself and have fun. And enjoying yourself does not necessarily mean, at least for me, does not mean, you giggling 24 hours a day, seven days a week. It means having stress, achieving goals, failing, being resilient, what have you, but really having meaningful relationships and enjoying yourself along the way because you never know when it's going to end.

SPEAKER_00: 39:19

I know. You never know. I recently listened to a podcast from one of my favorite podcasters, Ed Milet, and it was titled QTR, Quality Time Remaining. It doesn't mean the years that you have Thank you so much.

SPEAKER_01: 39:58

Well, you know, again, I don't look backwards, you know, except for something like this podcast. I'm always looking forward. Now, when you're 81, you know, you're not going to buy wine. It takes 20 years to mature. So you've got to be realistic. You don't want to be delusional. But I'm always looking forward. And so I'm always trying to learn. And, you know, again, I just– I'm addicted to stress. I'm still addicted to stress. Some people are less addicted to stress. They're probably more normal than I am. But I look for organizations that are stressing themselves to try to change, to try to change the environment around them, what have you. So everybody's got a different set of inputs that turn them on and keep them motivated. And you just, you know, again, you just have to use those inputs. I think a lot of, you know, a lot of, you know, I have a close circle of friends, some of whom are here physically, a lot of whom are, you know, in other parts of the country because of my networking and what have you. And I'm still, you know, I'm still interactive with them. I'm acutely aware of the fact that at 81 years of age, a lot of my values and a lot of the things that I've experienced are no longer meaningful to younger people who I'm around. So I try to listen to younger people and learn from them, even though it occasionally makes me nervous and aggravated. I get that. I mean, you know,

SPEAKER_00: 41:44

it's just the way it is, right? I love to hear that. Something I keep hearing in our conversation is that you love to learn. Can you tell our listeners how important it is, in your opinion, to continue to learn because I know a lot of us stop. It's critical. I agree. And if

SPEAKER_01: 42:02

you're not in the game, you know, at my age, I've got a lot of, you know, I've got a lot of depreciating assets, you know, because people that I knew who were leading organizations are either now dead or insensate. But that's a joke. But, you know, they're retired.

SPEAKER_00: 42:22

And

SPEAKER_01: 42:24

when they get out of the game, if they're out of the because they choose to be out of the game. The change in terms of vitality and robustness and what have you, it occurs very quickly. So I think, and if you're in the game, you've got to be positive. If you're in the game, no matter what your age is, and if you're negative about responding to all the challenges, I mean, there's never been a time in my leadership career there hasn't been a challenge

SPEAKER_02: 42:58

And

SPEAKER_01: 42:59

most of the time, those challenges are viewed by the people who are meeting them as, this is the worst challenge, the biggest challenge in the world ever. But that's not the case. And so now we have a huge number of challenges, both domestically and internationally. But if you get to the point where you just don't think those challenges could lead to something better, then you've got to get out of the game. And if you get out of the game, then I've just seen over and over again a lot of quick disintegration.

SPEAKER_00: 43:37

That is such a great message, not just in your field, but for everyone. Any field. Everywhere. Just personally, if you don't think that these challenges can be solved, fixed or can be better, then you're not going to get anywhere and you're right. You need to step back and let someone else figure it out or whatever it may be. I want to go back, think about your life as a whole. What do you think your best, what was the best advice someone ever gave to you that sticks out?

SPEAKER_01: 44:14

Um, Well, I can remember having some real... emotional challenges when I was in the middle of my residency training. And then making decisions to leave the residency for almost three years and get what was comparable to a PhD in microbiology. So I left the country and went to Sweden in the 70s and then I came back to finish my residency. And And I almost left my residency and almost went into another field in healthcare. But, you know, and I got advice from a lot of people. And I had a lot of mentors who, you know, who I looked up to over the years. And I think the best kind of throughput theme of advice is enjoy yourself. If you're going to go into a field of, number one, just make sure you're enjoying it as you struggle. And then, again, personalities are different. And I was either genetically predisposed or I had a lot of support around me to take chances. I took a lot of chances in changing my career path. Wow. Yeah, you have. But I've always enjoyed what I've done. And again, it's not giggling 24 hours, seven days a week. You're kidding me. You don't giggle all day long? No. I mean, a lot of it's stressful, but your basic fundamental feeling is to enjoy yourself along the pathway, don't Don't wait till some time in the future to enjoy yourself and saying, I'm just going to grind this out until I get to retirement or until I get to my 50s or whatever. You have to enjoy yourself. And again, for me, enjoying is to some extent self-induced stress. I enjoy stress.

SPEAKER_00: 46:35

I'd like to talk about that a little more. It was my next question. You had mentioned, I don't know if you said I'm addicted to stress or I thrive in stress. But what do you think is behind that? Probably genetics.

SPEAKER_01: 46:49

I mean, I don't know. I mean, you know, I just... And some people have accused me during some of my leadership of inducing stress too. Uh-oh. Yeah. But, you know, again, you know, if you have a certain kind of personality and you're, you know, you're aspirational and, you know, you set your goals so that you're really achieving a lot but you never quite achieve your goals, that, you know, that just, again, but that's something that can't be generalized. I understand that. Everybody has a different personality. and I'm not making value judgments about

SPEAKER_00: 47:26

that. No, no, no. I don't know if you know, and I mentioned this in another podcast I did recently, but Steve Jobs said, I don't know if it was in a speech or something, he wrote, if we aren't constantly stressed, we are going to be taken over. We have to worry, not worry constantly, but we always have to make sure that we don't just glide through. Because we're so successful now, we need to make sure that we feel that anxiety of maybe losing. So I don't know if that resonates

SPEAKER_01: 47:57

with you. No, I agree with that 100%. But again, you have to caveat that a little bit because how many people can be Steve Jobs, right? Oh, I get it. Yeah. So when Steve Jobs says that or when I say I'm addicted to stress, a lot of that cannot be generalized to everyone. Everybody has a different personality and everybody... But there is a theme. You do have to... You have to feel good about where you are in life because you just don't know what's going to happen tomorrow.

SPEAKER_00: 48:29

Right. And we don't want it to be bad stress. Like, if you're in a bad place in life... you know, maybe that stress would be something. You've got to change. You've got to change. You've got to change.

SPEAKER_01: 48:39

And some people, and again, you know, 99% of accomplishment in life, whether it's personal accomplishment or group accomplishment is not limited by the engine size. I mean, most people, you know, have a pretty good engine size. It's just that, you know, they're not, you know, their RPM isn't high enough for various reasons. And most of the time it's because, you know, They're nervous about

SPEAKER_00: 49:08

change. Yeah. I mean, change is scary for everyone. And what you've done is take the chances, change. I know you're very uncomfortable. I can see it talking about yourself here today. But you're doing really well, and I really love it. I see, again, that you read a lot. Is there a book that stands out for you that would be helpful to people who maybe– in a challenging place in their lives and they need that, you know, guidance to change.

SPEAKER_01: 49:38

No, I mean, I read so many books and I'm always reading a couple of books at one time. And so the, you know, what happens is the latest book I've read is top of mind.

SPEAKER_00: 49:50

Yes. So I

SPEAKER_01: 49:50

wouldn't.

SPEAKER_00: 49:51

Okay. So what are you reading right now?

SPEAKER_01: 49:54

Well, I'm reading a book that's called, or I just read a book, which is called Everything is Predictable. Oh, I haven't heard of this one. Tell me more. happens and you change your fundamental proposition and there are various mathematical formulas to show. But what it means is you take account of all the things that are happening and then you change your formulation. And I think most of life is Bayesian statistics. I mean, if whatever is happening around you, you input and then you create a different set of aspirations and a different statistical model So, I mean, that's all BS, but you know, I'm just, I'm into

SPEAKER_00: 51:05

it. I'm interested in it. So I'm going to check it out. It sounds interesting. It's called everything is predictable. Okay. I love it. Yeah. So when you look back kind of on this big legacy that you've left, what do you hope continues to happen in your absence?

SPEAKER_01: 51:26

Well, let me be concrete. Um, Pre-Obamacare, there were 60 million, approximately 60 million people who are uninsured in this country. And, you know, through the expansion of Medicaid and through the Obama networks and what have you, we got that down to 15 million. Wow. Mm-hmm. as if you can have some sort of a longitudinal relationship with the primary care and then the expertise that you need with specialty care. So my argument was we're taking care of people regardless of whether they have insurance or not. The ones that don't have insurance are getting worse care. And guess what? Those of us who have insurance are paying for it anyway. Absolutely. Yeah, we are. So... Now with the new bill that came through, there's some evidence that we're going to expand, again, the number of people who are uninsured. So what I'd like to do is to see an evolution towards everybody in this country having some coverage. Not because of the ethics. I mean, I happen to believe that ethically that should happen, but just in terms of the economics of it. Because I'm paying for it anyway and so I soon have that efficient so I don't have to pay as much. I mean, you know, just make the financial argument. So I think that's number one. Number two, I'd like to see a continued evolution to paying for outcome. I'll give you an example. So for chemotherapy, for instance, for lots of kinds of cancer, you know, you give the drug to a hundred people it works in fifteen people and all hundred pay for the drug

SPEAKER_00: 54:02

right yeah that's a good point that's the way it's socialized

SPEAKER_01: 54:06

that's the way it's socialized what I'd love to see is an evolution towards you only pay if it works oh I

SPEAKER_00: 54:15

never even considered that that would be great I mean you're paying for essentially a service so and the pharmaceutical

SPEAKER_01: 54:22

companies make less money but trust me they make enough money Yeah. They're doing okay. Yeah. They're doing okay. The other thing I'd like to see is that insurance providers, whether they're Medicare or Medicaid, the public payer, whether they're commercial insurance providers, get closer to the providers in working together to increase the efficiency and increase the caregiving outcome for chronic disease. Yeah. We have a huge amount of chronic disease in this country, and I don't think RFK Jr. is going to fix it.

SPEAKER_00: 55:01

I was just about to ask you. I didn't want to get too

SPEAKER_01: 55:04

political. No, no. But we do have a huge amount of chronic disease, and it's due to lots of different things that are out there. And I don't think there's like a bad actor who's putting poison in that. Some of it is toxic and some of it is weak. But there's a huge amount of improvement in chronic disease. Now, the GLP-1 agonists Right. to outcome-based care and outcome-based payment and value-based care. So I'd like to see that continue. And I guess I'd like to see the ability of more caregivers in different areas, not just docs, but nurse practitioners and psychologists and other kinds of caregivers so that there's a better supply of people who can give care for not just physical diseases but emotional diseases as well because there's a huge lack of resource for people who have behavioral issues. Absolutely. That's actually one of the companies that I'm working with now. That's great. So again, there's just a load of opportunity out there, a huge amount of opportunity.

SPEAKER_00: 56:47

How do you think we will recover and how long do you think it will take from all the cuts to Medicare happening right now to going back to that number? You said$60 million were insured, and we're going to go down to about$15 million. And

SPEAKER_01: 57:04

now we're projected over the next 10 years to increase by$17 to$20 million. Well, look, in a democracy, things are messy, right? Right. And so we may have to wait for another three to four years to change. And again, the good thing about a democracy is people get what they want. The bad thing is things change and they go back and forth. So we'll have to wait and see.

SPEAKER_00: 57:36

Yeah. It's too bad there's not just a trajectory towards, especially in healthcare, the benefit of the patient like you're talking about. But it sounds like you're doing a lot of work with that.

SPEAKER_01: 57:50

I've had the pleasure of turning down... positions in the government under Obama I, Obama II, and Trump I.

SPEAKER_00: 58:02

No

SPEAKER_01: 58:02

way. Tell me more. So, no, I just knew myself well enough to realize that I would probably be an HR nightmare after a long weekend, regardless of whom I worked

SPEAKER_00: 58:15

for.

SPEAKER_01: 58:15

Absolutely. I can see that

SPEAKER_00: 58:17

being pretty intense. Okay, so you mentioned GLP-1s. Have you done much research on them? How do you feel about them being so widely used now? And these are drugs like Ozempic or Wagovi. Well, the

SPEAKER_01: 58:31

ones

SPEAKER_00: 58:31

that

SPEAKER_01: 58:31

are really going to be revolutionary are the pills that are coming out. There are a couple of companies, including Lilly, that have finished clinical trials showing that instead of having injections, you can take pills. And there's going to be two probably that come through the FDA in the next year. And when people can take a pill and lose 12% to 20%. That will really be revolutionary. So I think there's two or three different levels. Number one, I think there's so many obesity-related chronic diseases.

SPEAKER_00: 59:10

Yeah, there are. It's not

SPEAKER_01: 59:11

just diabetes, but it's heart disease, it's hypertension, it's kidney disease, you name it, it's incredible. So I think there's a huge opportunity to make a big effect on chronic disease. The second thing is the cost.

SPEAKER_00: 59:27

Yeah.

SPEAKER_01: 59:28

And the more product that they have out there, the more competition and the costs will go down, particularly if and when we start to get generics and biosimilars and what have you. Right. And I think capitalism is a way of putting pressure on the companies to get the costs down. That's a really good point, yeah. Yeah, and a combination of regulatory and capitalism. And the third thing, which is always troublesome, is most of these things that have an effect. And now they're combinations of GLP-1 agonists and there are other kinds of physiologic effects that are being built into new regimens to take care of obesity and diabetes. You know, these things have to be taken forever, right? Yeah. So there's a little bit of worry that I have that there could be other effects that come up over a period of time. So the idea, as far as I'm concerned, would be if people could take these for a period of time, lose weight, and then change their activity level so that the calories in are more balanced with the calories out so that they don't have to take these pills or take subcutaneous injections forever. Because I worry about the long-term effects.

SPEAKER_00: 1:00:55

Do you? And we don't know what they are yet. We don't know what they are. They haven't been around long enough.

SPEAKER_01: 1:00:58

Yeah, exactly, exactly. But I think they are now being, I mean, it's revolutionary, but I think as soon as there's a pill that's available or a couple of different brands, it's really going to be revolutionary.

SPEAKER_00: 1:01:11

That's great to hear. What are your feelings about the people who are thin, but they want to maintain their weight and they're taking these? I mean, it is all

SPEAKER_01: 1:01:21

over. I would advise against that.

SPEAKER_00: 1:01:23

Yeah, tell us more what your thoughts

SPEAKER_01: 1:01:25

are. Well, I just, you know, look, I'm not an expert in this area, but I worry about the long-term effects. Because some of it affects the pancreas, some of it affects the brain, and who knows? That's good to know. Good advice for everyone.

SPEAKER_00: 1:01:41

That's not a medical expert advice. I understand. But we don't know. It hasn't been around long enough for us to see the side effects that could come later. It's really good advice right now because I am bombarded on All of my social media platforms, everywhere I look, take a microdose of semaglutide and just maintain your weight. So they're really pushing it towards so many people. There are so many companies out there doing this right now. So I'm glad to hear that from you. I've heard it from another physician that we don't know the long-term effects. So be really wise when you're taking these GLP-1 drugs. All right, so we all have one person that really believed in us growing up or later on in life that sticks out in our mind. Is there someone who... really made an impact on you, maybe said something to you when you were young or believed in you that you think kind of like started your trajectory in life?

SPEAKER_01: 1:02:53

Yeah, yeah. I had three great mentors. One was a history teacher in high school, great guy. One was my mentor in surgery when I got my first job. And then one was the chairman of my board when I was at Geisinger. And all three were great mentors. They're all gone now because I'm so frigging old.

SPEAKER_00: 1:03:25

Young at heart and young in the

SPEAKER_01: 1:03:27

mind. But I actually had the opportunity to write to them before they died and thank them for their mentorship.

SPEAKER_00: 1:03:37

That's great. What did your history teacher in high school instill in you that resonated with you? You

SPEAKER_01: 1:03:43

know, when I went to college, I thought I was going to be a history teacher. I went to college and as you know, I concentrated in history and literature. When I was an undergraduate, I thought I was going to go to graduate school in history. And I think he just, you know, he just really turned me on to, you know, to the world of the mind and asking really interesting questions. looking at primary data and, you know, it was early on and unusual, you know, to be exposed to somebody who said, go to the primary data and, you know, ask questions about it at the high school level. And his name was Kari, Paul Kari, great guy. And we had adult conversations, you know, before I was an adult, you know, which was kind of amazing. Subliminally, that was a big deal. It was a big deal. I

SPEAKER_00: 1:04:39

think that is so true. I have heard from so many people that something in their younger life really stands out to them and we all remember it to this day so I love to hear that we're almost done here but is there anything else you would like to share just about a purpose driven life because you really have achieved that

SPEAKER_01: 1:05:01

yeah well again I think the theme is to really enjoy yourself as you move along because you never know what tomorrow is going to bring. Number two, depending upon your own personality traits, I mean, set goals that are not achievable, but really create a huge amount of forward motion. And number three is always think about your next challenge. Don't look back like we have been for the last hour.

SPEAKER_00: 1:05:40

Right, you guys. We're just going to delete this episode. This was worthless. We want to look forward to the future. But I do agree with you. I saw something today. It said there's a reason your windshield is bigger than your rearview mirror. We need to look forward with bigger eyes than focusing on the past. So that's a great message for everyone. And yeah, thank you so much for spending the time with me today. It's really meaningful. And I think people will get a lot out of this conversation.

SPEAKER_01: 1:06:11

Well, it's my pleasure, Nicole.

SPEAKER_00: 1:06:13

Thank you.