David Lubarsky, MD, MBA, on Leadership and Changing the Status Quo
As the new Vice Chancellor of Human Health Sciences and Chief Executive Officer for UC Davis Health, David Lubarsky, MD, MBA, is in the top echelon of healthcare leaders.
For the last 6 years, Dr. Lubarsky was the Chief Medical Officer and Systems Integration Officer at the University of Miami Health System (UHealth), and before that was the first CEO of UHealth’s 1,100 physician practice. He was chair of Miami’s department of anesthesiology from 2001 until he left this past July.
From an early age, Dr. Lubarsky was interested in operational economics. Whether it was inventing a solar energy project in high school during the oil embargo that was adopted by the district school board or reconstructing the entire NYU anesthesiology staffing plan as a second-year resident, you would find Dr. Lubarsky taking the lead in improving operations.
Throughout his years of leadership, Dr. Lubarsky has positively affected the healthcare system since the early 90s and hopes to make even more of an impact in his new role.
This interview, which was condensed and edited for clarity, was conducted by CSA President Sam Wald, MD, MBA, FASA.
Did you have any leadership positions in your life as a child, teenager, or early on in college?
From an early age, I have been interested in improving operations and not accepting status quo. In my senior year of high school, I invented a solar energy project. I then sold it to my school board and got approval to install it during the oil embargo back in the 70s. Following high school, I enrolled in a scholars program in medicine which was a combined undergrad medical school at Washington University. The program was designed to create leaders in medicine. I got to meet a lot of prominent faculty and university administrators during my years there and they had a great influence on me. Long before there were duty hours, I reconstructed the entire NYU anesthesiology staffing plan when I was a second-year resident, so no one would have to work more than 24 hours without increasing costs. We used to work 36 straight hours.
How did you bring that forward given that you were a resident?
After having been up for 30 straight hours administering anesthesia, I fell asleep for 5 minutes in the operating room. Still to this day, it is the scariest moment of my life and I vowed it would never happen again. You can’t put people past their limit of endurance just because that’s the way it’s always been done. I got people to sign onto the fact that we could come up with a better way to deliver better care without increasing costs or adding more personnel and still achieve our goal. It’s about fixing things in a way that doesn’t break the bank and finding optimization strategies that allow you to do a better job within the given constraints of a system.
How did you get others to buy into it, who may have not had the same experience?
It turned out that many people had the exact same experience but were too afraid to come forward to talk about the limits of human endurance. This was medicine in the old days. People would say that’s how it’s always been – residents work 36 straight hours. Sometimes it takes someone to stand up and say hey this isn’t right. It turned out that many people believed it wasn’t right - even people in power, but since no one complained they didn’t do anything about it.
Is that a theme that you’ve used more and more to inspire change?
I did. When you have an open and transparent culture in whatever organization you work in, people will feel free to bring their concerns up and there is a genuine desire for both transparency and problem solving as opposed to blaming someone. You get a much better healthcare system.
Do you think the abilities of a physician and maintaining your clinical practice correlates to being a successful administrator?
The answer is yes and no. Making decisions with a “doctor’s heart” cannot be overstated. In the long run, administrative decisions checked against the obligation to patients and trainees that we caregivers have at our core, is always good for an institution. However, I think it is no longer enough to give physicians managerial oversight or directorship roles based solely on their excellence as a physician. Healthcare is a very big business. We don’t pay enough attention to assuring that an administrative skill set is mastered prior to being given administrative responsibilities. We continue to promote people based on their doctor skill sets, which are incredibly important but not always the best match for what they need in terms of optimizing how an organization provides care.
How do physicians gain those administrative skills especially since they are so busy clinically?
I had a great boss, Dr. Jerry Reves, who believed in me, who sponsored me when I went to get my MBA, in terms of both time and money, so I didn’t have to take a pay cut or pay for tuition. He just expected me to come back and work for the organization at a higher level. He invested in me as an employee and as a mentee and I think that is the right way to do things. You can’t expect people to know how to do things by magic. It’s as if you have a very talented person who is capable in terms of digital skills, but they don’t become a surgeon just by saying I’m a surgeon. There is a lot of training and knowledge required to augment a natural skill set. That is the key – find people who are adept. Most of the skill sets for administration are learned skill sets, and you must be willing to put in the time and effort to see that through. We fool ourselves into thinking that people can run things because they’re smart people.
Has it been a big change for you going from a clinical position to the leadership role of managing an entire organization?
It has been a gradual change for me. The last 10 years, I have gradually rotated more of my time away from the clinical arena but not away from my focus on clinical excellence. Similarly, you can’t just have an administrator run a healthcare operation. They don’t always have the requisite skill set around the commitment that physicians and nurses bring to delivering healthcare. In my opinion, that is why it’s hard to find good administrators who can run organizations with the right amount of judgement. Data shows that systems that have healthcare professionals, especially physicians leading the health system, tend to do better from a business point of view because the decisions that are made are consistent with the long-term goals and strategies of a healthcare organization.
Now that you are CEO, what is your recommendation for anesthesiologists in the best way to approach the hospital?
The key is to understand that anesthesiology is an integral part in the surgical operation. The problem for anesthesiologists is when you do a great job, no one notices because nothing goes wrong. The ORs run seamlessly, the patient’s pain is controlled, and complications related to anesthesia are few to none. If your CEO isn’t an anesthesiologist, you should make it clear that you can’t have high-quality surgery without high-quality anesthesia and pain control. There are now five major CEOs of health systems who are anesthesiologists, which makes us one of the most represented specialties in the c-suite.
Do you feel that anesthesiologists as physicians are a good group to get into administration?
Yes, I think we are going to see more of that. The nature of our specialty is one that requires working with a host of different subspecialties and working to find compromises without ever compromising safety. I believe we are more selfless than some other physicians in the sense that we are always a part of a team, which I think is the key to leadership. It is never about you, it’s always about the patient and focusing on the best outcome for the patient.
What is the most surprising thing about UC Davis?
The fact that the organization is actually better than it was sold to be! It is a bastion of high-quality care and research (#27 in NIH funding). We recently found out that of all the academic medical centers, we are number one for academic centers in quality and efficiency for ambulatory care across the United States. We have some of the best quality outcomes for all of the in-patient measures, which is why U.S. News and World Report has us ranked just out of the top 20. We’re hoping to break into the top 20 hospitals of the United States soon. The organization really is an unparalleled gem and I think you will be hearing a lot more about us in the near future as we change the way healthcare is delivered all across Sacramento and Northern California.