The Shepard: Steven Reames

 

[0:00] And I felt very convicted that when I left the job that I did, this phrase, don’t work for Pharaoh ever again.
Because what I believe is Pharaoh is a mentality of slavery.
It’s a way of keeping people working for somebody for their own benefit, not for the benefit of the workers.
And so you ask this question, will people eventually throw off their overlords?
Yeah, I believe that they will when they have the strength and the moral courage and the ability to band together to do that.
Paging Dr. Cooke. Paging Dr. Cooke.
Dr. Cooke, you’re wanted in the OR. Dr. Cooke, you’re wanted in the OR.

[0:44] Music.

[1:08] Dr. Randy Cooke.
Hello everyone, and welcome to Prescription for Success. I’m Dr. Randy Cooke, your host for the podcast, which is a production of MD Coaches, providing leadership and executive coaching for physicians by physicians.
To overcome burnout, transition your career, develop as a leader or whatever your goal might be, visit MDCoaches on the web at mymdcoaches.com because you’re not in this alone.
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[1:50] My guest today is not a physician, but he plays a very important role in the lives of many physicians in and around Boise, Idaho, where he is the executive director of the Ada County Medical Society.
So let’s hear my conversation with Stephen Reams. We have a really different type of guest on Prescriptions for Success today, and I’m very excited about that.
As physicians, although we like to be very self-sufficient and independent, we know that, we need support here and there. And my guest today, Mr. Stephen Reams, provides exactly that service as the Executive Director of the Ada County Medical Society in Boise, Idaho. So.

[2:42] Steve, I’m so excited to have you on the show today, and welcome to Prescription for Success.
Well, thank you, Dr. Cook. It’s great to be here and glad to get some time with your audience.
Well, I’m glad that you’re happy to be here and I just want to make sure to remind you that we’re on a first name basis here so we can dispense with the doctor stuff.
And we’ll go ahead and get into the conversation. And Steve, as we always do, I really am curious about how people get to where they are in life.
And so I want to delve into your past as well.
Can you tell us a little bit about your early life?
Have you always lived out toward the West Coast, or did you have other origins?
What’s the story there?
Yeah, so I was actually born here in Boise, Idaho. And then my mom and sister and I, we end up moving to the Portland, Vancouver area, Portland, Oregon, Vancouver, Washington, which are right across the river from each other.
And so I grew up most of my school years in Washington. And probably by about my junior year in high school, I had kind of decided that I wanted to go into broadcasting.
And so I was always very Pacific Northwest bound.
And when I talked to one of my teachers, she had gone to Washington State University in communications.

[4:07] And so by golly, I made my decision that I was going to be the next Tom Brokaw.
And I was very excited about that. Because you know what I would do in high school is I’d run around with a camera on my shoulder and videotape people.
And we’d edit these dumb little news videos together. and things like that.
So you really had the bug.
I did. And it was quite clear about that. But yeah, always based here in the Northwest and spent some time, of course, with my dad during the summer times here in what we call the Treasure Valley, the Boise metropolitan area.
But for the most part, grew up on the West Coast and really didn’t do much traveling outside of that, save a six-week, I wouldn’t call it a vacation.
It was an exchange student program we had in Japan with our high school.
So I did that for six weeks as an exchange student, learning Japanese in high school.
So aside from that, just kind of a good old Northwest boy.
Because I have an ancient interest in broadcasting myself, there is one area that I want to get some more details upon.
It is my understanding that you are a graduate of the Murrow School of Communication.
And.

[5:17] I’m just wondering if at the time in your youth, when you were there, were you aware that the namesake of your school was just an absolute icon of what broadcast journalism should be like?
Yeah, you know, going to college, I didn’t know that.
I was, like I said, I was a Tom Brokaw or a Dan Madden fan or what have you.

[5:41] When I got to college, of course, then all of the legacy of Edward R. Murrow was something that I learned more about. And in fact, as part of the honors program, we were assigned, you know, basically summer projects. And one of the things I did is start reading biographies of broadcasters.
And so, I read Edward R. Murrow’s biography and his time in London, of course, as a reporter.
And then, of course, when he came back stateside in the 50s and had his broadcast then and the influence on McCarthyism and, you know, all of the different things that he explored.
So that was like a really cool thing. Darrell Bock So you really dug into the history.
Kevin Chiles Yeah. I dug into all these different guys who had done this.
And I’m pretty proud of the fact that I graduated from a college that has such a namesake.
And when you wrapped up your degree, did you feel that the next step was going to be a career in broadcasting?
I think that what happened to me is I began that summer reading project and I began to read and think about what were the trade-offs for that kind of a lifestyle.
I mean, if you’re going to grow in your career in broadcasting at all, it’s going to be something that you’re going to be moving around to different markets if you’re going to climb the ladder.
Ladder, you’re probably going to be in a war zone, perhaps at some point or another.
And if you have any personal views, you pretty much have to stuff them on the air.
And if you have a family, they’re going to take back seat.

[7:06] And you know, it was honestly because of that reading in the summer honors program that by the time I ended college, I thought, I’m going to finish my degree, but I don’t know that this is what I’m going to end up doing as my career.
And part of that, yeah, it was a really interesting transition.
So part of the backstory there was during my senior year in high school, I was walking through our church and my pastor caught me and he said, Steve, have you ever thought about being a pastor?
And I said, no, haven’t you heard? I’m going to be the next Tom Brokaw.
And so I was quite clear about what my goals were, but oddly enough, as fate or faith would have it, I began to get kind of serious about my, more serious about my faith in my college years.

[7:50] And by the time I had finished my four years in school, I’d kind of made this divine exchange for what my dreams were that I had coming into college, and what I felt like God was giving me some new dreams for.
And still, I wasn’t sure, was I going to end up in religious broadcasting?
I had the ideas that I might actually go back to Japan as a missionary.
I mean, I was all over the place.

[8:14] And so I came down to my dad’s here in Idaho for part of the summer, and I’d actually had a scholarship and I had two more years of tuition waiver because I’d had a four-year tuition waiver and a two-year tuition waiver on top of it.
And he said, my goodness, you got free tuition? Go back to school, take some more classes.
You’re never gonna get this opportunity again.
And I thought, that’s good advice. So I went back for another semester, Yeah, free education.
You should always take advantage of that. And how many parameters would have thought, you know, I’d really kind of like to get you off the payroll.
So. Well, I was not his payroll in any case. Well, OK. I’m sorry to interrupt.
You can go ahead with the story. But that’s just fine.
So I went back and spent some time thinking and brain about that.
And so I took another semester. I thought I’m going to add started actually into a second major in English.
And so after my four years graduated, I took one more semester, and by the end of that semester with that, no, I’m not gonna do this anymore.
I’m done with school.
You know, and it was great, it was fine. It was some good reading and good writing and things like that.

[9:24] But simultaneous to that time, my pastor in college years, he said, hey, would you like to join me on staff? You’ve been doing some small groups up on campus.
You’re learning how to play the guitar, different things like this.
Why don’t you come and help me? And I said, yeah, okay, I’ll do that.
He said, I’ll pay you a hundred bucks a month. So this is 1992, which he was getting a good deal, but I didn’t know until much, much later, he had taken a hundred bucks out of his like $500 a month salary to give to me because he was also working part-time.
And the first staff meeting that we had, I remember asking him, I said, what are all the things that you hate doing in your job? He goes, oh, I hate doing the monthly balance sheet for the denomination. I hate doing the bank deposit.
I hate doing all the records and all these things. I go, I love doing those kind of things.
You take those things, I’ll take those things from you, and then you’ll have more time to do your stuff.
So it was, so that really, that was a, you know, I say all that to say that my pastor, Dan, he was a mentor to me.
That’s really where I began to grow up, where he began to challenge me, you know, and my immaturities began to challenge me in faith as well as in just relationships and all the things.
So I learned so much from that experience, both individually and as also being kind of part of an organization.
So I finished school, I’m coming on staff, and it’s like, ah, I don’t know what’s next.
And I thought, I’m just gonna hang out here until I figure it out.

[10:54] And that was fine, that was just a good first move, and I got some great experience.
But really, that’s kind of what launched me into the rest of my career, which was non-profit management was all those years serving kind of student ministry and then with my pastor and just began to get to know things like how to do books and how to keep records and, how to get communications out and those types of things.
Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches.
Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.
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[12:18] We’ll get back to our interview in just a moment, but right now I want to tell you a little bit about Physician Outlook. If you haven’t discovered this remarkable magazine, please do so very soon. It was created by physicians for physicians to showcase the intersection between clinical and non-clinical interests. Whether it’s writing, painting, cooking, politics, and dozens of other topics, Physician Outlook gives a physician perspective.
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And now, let’s get back to today’s interview. When you make it sound so simple, you know, you were serving a very important purpose for this church.
You were learning some things from your pastor, and you just a moment ago said words to the effect that you had it figured out and you knew what you wanted to do, and so I’m interested to know how you came to the decision and what it looked like for you at that point.
What did you think the rest of your life was going to look like?
You know, I really didn’t know, and I just thought, I’m going to hang out here for the time being. Maybe I’ll go to Japan. I had a friend who was a missionary in Japan.
I had other friends, of course, in the broadcasting arena that had gone and graduated and gone and done stuff, I thought, well, maybe I’ll end up doing those kind of things, but for the meantime, this is good.
And you know, that’s always been for me kind of how I’ve approached any job transition.

[14:28] Life was this sense of, I’ve got things figured out, I’m gonna climb the ladder, I’m gonna be Tom Brokaw, I’m gonna do this and this and this.
And for me, that was a very personal spiritual thing to say, no, I’m not gonna do that, I’m gonna make myself available, and however that turns out, we’ll see how it turns out.
And so I’ve been kind of resistant to setting big, long life goals, career goals, ambition goals like that because I feel like that was part of what I had to give up as a young man that was all about, I’m gonna do the thing and climb the ladder and be famous.
And I always had this kind of self-aggrandizement view of myself, I’m gonna keep journals so that someday when they’re writing biographies about me, they’ll have all the source material to come back to.
It’s like, oh my goodness, like how much hubris is packed into that statement right there.
Now I go through my journals, I need to throw this stuff out and shred it as much as I can, it’s embarrassing.
Well, let’s continue to move you along a little bit.
And I don’t quite know where to begin, how to ask you how you made this transition from part-time minister into full-time nonprofit management.

[15:40] And what was the first gig all about and how did those things go.
You fill in the blanks. Yeah, you bet. So that semester that I stayed after I graduated, my wife showed up to college.
And that’s the transition. Because once a young man meets a young woman, suddenly the need to actually make a living becomes a little bit more apparent.
And certainly, if my parents weren’t anxious, her parents certainly were.
That’ll change things. How are you going to pay your bills?
So I began to balance my time in terms of what I was doing.
But as she says, she was getting paid just for being her and got a monthly stipend from her parents.

[16:20] Which helped us out tremendously and allowed us to continue to live that kind of low-level income life for quite a while.
So we move into student housing and then we finally, she graduates a couple years later, we buy our own house, a new trailer park is going into town and suddenly it’s like, now it’s time to make money.
And then a year later she gets pregnant and that’s when the need to actually get serious about some income. There’s the pressure, right? And so I go through this moment, because I actually, she was working for the Pullman Chamber of Commerce.
I started working for them, doing books for them, working at the church, working at the student union, doing kind of cobbling together a life.
And then it became apparent, no, I actually need to go and get a real job.

[17:10] So my first job, actually, kind of real job that wasn’t like on the tailcoats of some relationship, were with a analytical laboratory nearby.
And that was just a bookkeeping job. And so I’d kind of gotten into the books, gotten into the books at the church and in the Chamber of Commerce, and then moved into keeping the books for them, did some programming, and all of these years that we were there.
So I was there from 92 when I graduated until we left Pullman in 1999.
After we got married, my wife and I always had a dream, you know, someday we’re gonna go out and plant a congregation in another city, probably here in the Northwest, most likely.
And of all the unlikely places that we felt led to, it was to Boise, Idaho, my hometown.
And it was near the family that we are least in relationship with and much farther away from the families that we were in relationship with. So it seemed absolutely nonsensical, right?
So we show up, I basically find a job, bookkeeping job, I move down here, it’s three-quarter time, it gives me part-time to work on the church, and I just kind of lean into that job.
And that was probably the first job I ever had where I felt like I was in slavery to a job that was so toxic.

[18:26] That after a year, I had to get out of there. Really?
Oh, very toxic. And part of that had to do with the personality and some of probably the mental health issues that the owner, very small company, had and the way that he treated his employees.
But to some degree, that’s going to carry forward when I get to the current job I’m in, in terms of, why I feel so strongly for physicians that they’re not in toxic work situations. So I’ll I’ll kind of come to that a little bit later on.
So after a year, I’m like, I gotta get out of this. This is killing me and this is so unhealthy.
So this is when I kind of began my nonprofit, if you will, career, still working very part-time for the church, kind of trying to, you know, cobble together a congregation. We had 20, 25 people at most.
And I started working for a social service agency. It’s called Family Advocates.
And they had two halves of their program. One was called Parents as Teachers, where these parent educators would go out into the home and help with ages and stages of development of children.
And this is primarily for probably low-income families or those who are skirting the edge of the Child Protective System, and they needed assistance.
And then the other half was part of the Child Protective System, the CASA program, the Cordis Pointed Special Advocate Guardian Ad Litem program, so I was the bookkeeper and operations manager for that company.

[19:51] And also kind of heir apparent, my executive directors thought, this guy is a leader, I’m going to start mentoring him.
So just a great time in that role, just learning to explore kind of the boundaries of what I could do and got involved in coalition building and always reporting to the board.
So just a ton of that kind of operational experience, you know, all the stuff from liability insurance to dashboards and reporting for the board of directors.

[20:20] And working with other community organizations, building websites, so all of the stuff, and really just letting all of my skills go along there.
Well, one of the things that pops into my mind when I hear that description is, were there moments when you felt like you were being crushed beneath the bureaucratic, detail-oriented things that you were being asked to do and not actually having any significant contact with the populations that you were trying to serve?
Did that, was that an issue at all? Yeah, that was an issue.
And I think, you know, ultimately within about five years we decided to merge our congregation with another church.
And I think that because, I think from kind of a calling standpoint, I was never in the office 40 hours a week kind of a pastor.
And the few times that I was in over 20 hours a week, it wasn’t good.
I was always more of a community-based servant, trying to live out my faith in a way.

[21:24] That was consistent with my values and with really the deepest held convictions that I had, without being preachy, but really just living that out.
And I actually found much more joy living out and doing the work that I was doing than all of the other things that went along with ministry, in essence, because it’s almost like the expression of my ministry and of my faith was more fluid and more seamless when it was put out into the community.
Does that make sense?
It makes a lot of sense and that.

[21:55] That’s a very good answer to the question, because in one way, medical practice is similar to what you’ve been talking about, and that is even though you want to be the person who is doing good things for sick people, treating high blood pressure and doing operations and the things that we do, but then on top of that, you’re trying to keep a business afloat.
You’re trying to keep the books balanced, and I think a lot of physicians have difficulty getting hold of that space, and we can probably talk about this more as we get into the interview, And that is how physicians ultimately swallowed the poison pill and let somebody else be in charge of balancing the books, and then dared them to go take care of the sick people.
But so let’s pick it up from there. You’re at a point where you really feel like you’re involving yourself in service to the community.

[23:08] I got to think that must have been more satisfying, yes, no?
Oh yeah, very satisfying.
And really for me especially, I grew up in a pretty conservative household, and so suddenly I’m being exposed to the needs of families who are in real tough spots, whether it’s because of poverty or whether it’s because of child abuse and neglect that’s happening in their household and their kids are pulled out of the home.
I mean, suddenly I became much more aware than I ever had been of just human suffering in general, and the crippling thing that happens to families when they’re not healthy parents.

[23:49] Because you can’t have healthy kids if you don’t have healthy parents. And so many of these tragic situations that, you know, I wasn’t even deeply involved. I was the operations manager.
So once in a while, I would see a fax come across and I’d read it and go, oh my gosh, this is happening in my city? This is terrible, you know? And so, yeah, really just being exposed for the first time, I feel like in my life, not necessarily that, but really up close to some.

[24:13] Pain and human suffering, and that I think began to sensitize me to the needs of the community in ways that I really hadn’t been exposed to before.
Dr. Darrell Bock Well, you know, I think it’s a reality of life in America that you can be insulated from those kinds of things, and I can see that it had a significant impact on your life.
Yeah, you know it really did. One of the opportunities I had was to take a training that was called Nurturing Fathers. It was basically a training that me and a friend of mine who took this training together and both of us, he wasn’t even a dad yet, he was one of the parent educators, but more on him later because he becomes a partner in crime on some things currently in my life. So it’s funny how all these things tie together. But in any case, Nurturing Fathers was a curriculum that taught dads how to really lean into that nurturing side of parenting and not just the strict disciplinarian role that in some times got them in trouble with getting their kids removed from their home because it was not just strict discipline, it was over-the-top abuse.

[25:22] And so we were working with men, with their children, and teaching them how to actually lean into those nurturing skill set.
Well, what was it about that experience that gave you the inclination to segue into what you’re doing right now.
Yeah, so you know what happened after this is, as I said, I was kind of heir apparent to this job and at the same time I had an organization approach me and say hey we’d like you to interview for this and this next organization was called Genesis World Mission.
And it was a Boise-based medical mission.
And they had two things going. They had an international side.

[26:03] So they went out with churches and they took medical equipment or they shipped medical equipment that was surplused or donated.
And they put it into big cargo containers and shipped it. Or they had a warehouse, different things like that.
And then they had a local side. They had a free clinic that was staffed by medical volunteers and personnel.
And they had dental and medical. and eventually, as I joined the organization, we added counseling in and community supports. And so, they offered me a job.

[26:32] I said, no, I’m working here, I’m heir apparent, and this is good.
And they said, we’ll make you the executive director job.
And I said, sold. So then, I’m thinking, whoa, this is cool.
So now I’m actually being able to stream ministry, because this was a Christian organization back in with nonprofit management.
And I’m thinking, this is beautiful. This is the marriage of both of these skill sets, and pieces of my life.
And then it was for me, again, another exposure to the level of human suffering of people, who were uninsured or underinsured and people that really needed that help.
And yet it also gave me a little bit more freedom in terms of the expression of my faith and how those two things married together.
So on the one hand, it sounds as though you felt like you had arrived at a place where you really understood what you were there for, you felt like you were accomplishing a purpose, and yet at some point you decided to make this move into one of the most difficult areas of the US economy, I think, and that is the delivery of healthcare.
How’d you get there?

[27:39] Yeah, so expensive and I saw it firsthand as the manager of the previous organization where every year we would manage the cost of health insurance by keeping the premium the same by lowering the benefit.
You know this story, right? It’s been happening for the past 25 years.
And so just seeing that this is never going to end, right?
It’s always going to be lowering the benefit and increasing the cost.
So yeah, how do we provide that?
And I can’t say that I was particularly interested in trying to help solve any of the, kind of the economic drivers behind that. That’s, you know, I can do business and finance at a small level, but I’m no macro economist.
And so I recognized my limitations there.
And yet we were trying to think about, well, how do we provide this care to these people?
How do we raise the money to provide this support? But ultimately, you can only do so much.
You can only help so many based on the resources you have.
And this is a much bigger solution. And it was about, what is that, about 2012 that Affordable Care Act passed.

[28:50] And our founder president was the American Academy Academy of Family Physicians Physician of the Year.
And so he actually was being exposed the whole model of the patient-centered medical home.
And along with another local kind of physician celebrity who was the president of the American Academy of Family Physicians and helping to consult President Obama on the ACA, you know, we brought the PCMH model back to the clinic and we began to experiment with that.
How do we coordinate care in a free clinic using volunteer medical personnel where medical, dental, behavioral health, spiritual, community resourcing, all of these things, we can do all these things actually easier than you can in the for-profit realm because nobody knows how to pay for coordination of care yet, right?
We’re still experimenting with this whole concept of how do you make it cheaper by actually serving the whole person rather than just bits and pieces of the person like the mind or the mouth or the body because they’re all the same part of the person, right?
So one thing that I’m really interested in is when you made this move into the world of health care delivery in America, which is an incredibly complex bit of machinery, I am inclined to think, because of what I’ve heard from you thus far.

[30:15] That part of what you felt you were going to be participating in was the improvement and the delivery of health care to the population that your physicians are serving.
And I’m wondering at what point, or even if at this point, you became aware of the brokenness that exists among physicians in 21st century America.
Yeah, no, I was not aware of that. I mean, I think the first time I bumped up against that was really with nurses in the clinic.
And so, I came in thinking in terms of my standard administrative, I work 40 hours, and yes, I’m salary, and so sometimes I work more than 40 hours.
But I began to bump up against some of the nurses who were on staff, say, no, we work till we get the job done.
And I’m like, that’s not healthy. You can’t do that. And I also remember talking to this.
Who asked you, buddy?

[31:13] Yeah, exactly. And I also remember talking to my boss, the founder, And I said, man, you’re gonna, I actually used the term, you’re gonna burn out.
You’re like going too many directions at once. You gotta scale it back.
And he said, and I remember this very clearly, he kind of wagged his finger at me and said, don’t tell me what my limitations are.
And I thought, okay, yeah, okay. You know, and so. That was a very MD thing to say.
It was a very MD thing to say. But I tell you what, part of it is is that, and I think that, you know, this is good for people to hear.
Everybody has to know what their own limits are.

[31:49] And the fact is different people do have different capacities. I mean, I look at, we have four children, and each of them has a different capacity regardless of their age. And I’ve got a couple that are just high performer, constantly going, you know, just they’re after it. They are totally after it. And I’ve got a couple of kids who are average students and frankly were like me back in in my early 20s, which is I’m going to make the minimal amount of effort possible to make the minimal amount of money possible to live on without starving, you know?
And so, I just, I think we have to recognize that different people have different ambitions and capacities and physicians are among those as well as anybody else.
And so, when he said that to me, I thought, well, I’m not going to touch that.
But it always stuck with me because eventually, you know, I did see him a little suffer from a little bit of burnout.
And so I think that part of that is a personal limitation, and part of that is all of these additional things.
That have been placed on physicians. And I do think that, you know, as much as people point to the Affordable Care Act and what it’s done positively, I think there are many things like HIPAA and high tech and ACA that have added on additional burdens to physicians that nobody knew.

[33:10] Was going to create, you know, a system that was so egregiously burdensome that landed on on physicians and not on administrators or people doing data entry.
It lands on physicians, and that’s a shame. That’s a refreshing amount of insight from a non-physician, and I really appreciate hearing that from you.
And so I guess my next question is going to be the impossible one.

[33:40] And that is, let’s talk a little bit about what to do.
Now, you’ve seen the inside of the machine, and I’m sure you’ve become aware of some concerns and some pressures and some aggravations that physicians and all healthcare providers face that maybe you weren’t aware of.
So let me ask you a really stupid question. If I made you king of the world, how do you think you would go about fixing health care in the richest nation on earth?
Well, I would not want to be king of the world, to be sure.

[34:24] Of course. And those that want to be, I’m always suspect of. So far we agree. Yes.
So, you know, I think it’s a challenge because I think it’s a human heart issue, and this This betrays, of course, my bias from where I come from, from all that I’ve said and that your audience has heard already.
My bias is the fact that people who run businesses for the sake of making money and not serving, their communities or their nation, this ends up making what we have in medicine right now, as well as many other industries.
And I look at the issues that we’re having in medicine right now in terms of workplace health.
And it reminds me of what happened at the turn of the 20th century, in the 1800s and early 1900s.

[35:18] And the worker rebellions against the mines, against the railroads, against the factories, against all these places of industry, where they said, it is not safe for us to work these hours, in these conditions, and for our children to work under these situations too, right?
And so we had the institution of what became our modern work weeks of five days, right?
And then a weekend, 40 hour work limit, all these protections, they came about because of people who stood up and said, no more.
And who were they standing up against too? They were standing up against the Carnegie’s and the Rockefellers and Sinclair Oil and all these different places.
They were standing up against industrialists who were basically there to make as much money and squeeze as much blood out of the turnip as they possibly could.

[36:10] And to me, that’s a hard issue. Now, we could have a whole conversation on capitalism versus socialism versus whatever, and we’re not going to, but the issue of employers who do not see that taking care of their employees’ needs is what’s going to actually bring the most profit, it’s short-sighted, and it’s cold-hearted.
And I don’t know how else to say it more nicely than that. And unfortunately, in large corporations, such as many healthcare hospitals have become now, there’s so much distance between the people who run the organization, and the people at the bottom of the chain that they simply can’t see the pain that it’s inflicting on people.
And so, you know, they’re divorced from reality and from the effect that it has on people.

[36:59] That’s a very interesting point of view and it sounds to me as if, and I’m prepared for you to correct me where I’m wrong on this, but it sounds to me as if what you’re saying is the powerful people in healthcare, and that is those that have the money, those are the insurance companies and the pharmaceutical industries and things of that sort, have been able to bring about their wish, and that is they’ve made the physicians employees.
And having done that, it sounds to me that, as if you’re saying, they should be prepared for those abused workers to fight back just like the hourly wage people did in the 1920s and 30s and 40s.

[37:44] Do you think so? I think so. I don’t know that that will happen.
You know, I have often, when I’ve talked about physician burnout and well-being, and again, this betrays where I come from in terms of the stories I draw from, but it reminds me of Pharaoh.
And you know, for those who know the biblical story of Pharaoh, he basically, when Moses came and said, let my people go, he said, no, no, these are my people.
I own them, right? And they’re working for me, and they’re building things for me, and not only that, but we’re not gonna give you straw anymore, but you’re gonna have to make the same number of bricks.
So don’t give them straw anymore, keep the same quota, which sounds remarkably like this phrase I’ve heard in healthcare over and over.
Well, I guess we’re gonna have to learn how to do more with less.
And it’s a very interesting statement to me because as I transitioned from Genesis after eight years.

[38:34] And I remember getting a job offer and I was let go by the board, we were seeing things differently, and so I didn’t have another job lined up and so some people, you know, approached me and this one person from an FQHC, Federal Qualified Health Center, approached me and said, hey, Steve, you got the skills, you could come in here and be operations guy or whatever.
And I said, let me ask you this question. I said, do you guys say this phrase around your place a lot?

[39:02] I guess we’re gonna have to do more with less. And he goes, oh, yeah, we say that all the time.
I mean, that’s healthcare, there’s healthcare for you, that’s the quote.
And I said, I’m never doing that again.
And I felt very convicted that when I left the job that I did this phrase, don’t work for Pharaoh ever again.
Because what I believe is Pharaoh is a mentality of slavery.

[39:24] It’s a way of keeping people working for somebody for their own benefit, not for the benefit of the workers.
And so you ask this question, will people eventually throw off their overlords?
Yeah, I believe that they will when they have the strength and the moral courage and the ability to band together to do that.
Now, let me pause and say, in no way do I equate our historical history with in terms of American slavery with what physicians work in. Let me be clear, these are not the same things. However, whenever you have a workforce that feels like, I don’t have any choice.
I have no choices. I have to stay here because I can’t exit out into any other place. There’s really no freedom for me. I think that that’s like slavery.
Well, that makes a lot of sense. I wonder what your thoughts are on the rapidly growing presence of what began as direct primary care and which has now segued into direct specialty care. We have not only internists and family practitioners practicing completely independently of insurance, but we actually have some specialists doing it as well. Do you think that will eventually.

[40:46] Put enough pressure on the system that it will consider making a change?
No, I don’t. And the reason I say that is- Do you see very much of that in Idaho, by the way? I’m just curious.
We see, no, we don’t. We see a fraction of that. And the reason I say no is I say no for the same reason that there was a few years ago, one of our, I’ll just not name call, but one of our legislators in Idaho said, you know what needs to happen to make healthcare work for people with no insurance? Doctors need to volunteer more of their time to take care of people who are indigent. And those of us sitting in the Idaho Medical Association building where where my office is, scratched our heads and said, okay, so wait a second.
So you’re gonna legislate that this particular industry, that these people have to cut further into their margins in order to serve these people who don’t have the resources.
Now, if I came to you as a business owner or a rancher or whatever and said, hey, we’re gonna take 20% of your cows or whatever, and you need to give that to people, You think that’s gonna fly?
No, I don’t think that’s gonna fly.
And I think to some degree, thinking that direct primary care is gonna do the same thing, that a cash basis, that a fraction of the number of physicians that would do that, that that’s gonna solve it.

[42:16] I just don’t see that happening. A.

[42:19] Medicare. This is the biggest, this is the biggest payer until Medicare fixes the things that it could fix, it’s, it’s not going to change. And so there’s, there’s just, there’s too many parts and pieces to how healthcare is paid for in too many convolutions within that, that when you’ve got so much distance between the, the buyer and the seller, or the, you know, the person producing the good, in this case, the the physicians, there’s too many middlemen there.
Now, the idea is that, well, direct primary care, you’re taking the middleman out, right?
Well, that’s great for those who have the cash to do it, but we have a hybrid capitalist government-provided service or regulated service.
It’s not a free market, and so it doesn’t work either on a total regulated industry basis or on a free market regulated industry basis. It’s a mess.
So unless you go in either direction entirely, I don’t think that a fraction of the number of providers doing direct primary care is going to solve it. And I’m not a macroeconomist, so that’s my two cents.

[43:26] Well, have you been able to identify anything, or are you doing things to help the physicians in Boise, Idaho feel better about getting up and going to work every day?
Well, this is probably the thing that I’m most excited about talking about, actually.
You know, when I transitioned in this job in 2014, it was the next year that Tate Shanafelt and Colin West and Lottie Derby’s, some of their research began to come out on physician distress and burnout and how quickly that was progressing.
And it was then that our board identified this as a strategic priority, which being in my first year was great because I needed a strategic priority.
I came in and basically I told people I was the cruise director for the Ada County Physicians.
It was basically about setting up events and having a good time and making sure they networked with each other and doing some medical education, all these things.
And really, that’s what I thought my role was gonna be, an event planner.
And I came in and there was a lot more hours in the week to use than was being used prior to my arrival.

[44:34] And I thought, okay, there’s stuff for me to do. And also this question, how am I gonna blend, this missional sense of who I am into, forgive the phrase, serving the rich.
Because I had this perspective of, oh, they got everything together, you know, they don’t have problems like I have, and so like this, oh, what a bunch of phony baloney that was, right?
These are human beings, and if there’s any message I can say, it’s just like, hey, let’s accept the fact that we’re all human beings, we all got problems, and we all need help solving them, right?
And so I came to this, and the board had a strategic retreat said.
I think that physician well-being is an area we need to lean into, Steve, why don’t you identify what you think can work on? And I’d actually brought this as a question to them. And what we had heard about back in 2015 was a program running out of Eugene, Oregon. The Lane County Medical Society had started just a few years prior a program they called the Physician Wellness Program. And basically what they were trying to solve is that they had had a series of physician suicide in a very short period of time in their community. And they had doctors coming to this executive director of the medical society saying, please, please do something, do something. And so.

[45:47] She was able to set up a counseling program that functioned like an EAP program, except it didn’t go through the employer. And as you I’m sure are well aware, a lot of physicians are very reluctant to seek out any counseling services or even use the EAP program through their hospital or through their insurance for fear that it’s going to go on the insurance record and then somebody’s going to find out and then it’s going to come against their license or professional respect, all those things, right? Yep, exactly. And so she had set up an EAP program that ran through the county. They actually.

[46:19] Employed a counselor directly in their office. They had a separate entrance and everything and it was completely confidential. Only the executive director took the calls, made the appointments and all that. So a couple of us county societies were looking at this and going, you got to tell us how you did that because we need to start one of these right now, yesterday. It needs to happen.” So that fall, that summer, we had our American Association of Medical Society Executives happen to be in Portland, Oregon that summer. So she came up up from Eugene, basically she spread out her entire program, said, here’s how I run it.
And here’s what I do, here’s things that we did wrong, here’s the messaging, here’s what you got to think about.
And from that point on, several medical societies in that year alone, probably three or four, started their own program, which was very exciting because suddenly we were able to provide counseling services as a member benefit, no cost.
We vetted the counselors, we interviewed them, instead of hiring one, we actually went out and found several in the community that were reputed to have served physicians before.
So we had physicians and mental health professionals help set up a program and vet these counselors and say, what do you know about physician burnout? What do you know about modalities in terms of treating physicians? And you know, we asked all the questions.
We set this up and got this started at the end of 2016. A couple of years later, several county medical societies got together and we wrote a toolkit called the LifeBridge Physician Wellness Program Toolkit.

[47:43] And that’s free and you can download that. It’s at physicianwellnessprogram.org.
And we basically wrote how to do this.
And since then, we’ve had another 30 to 35 medical society startup programs across the nation as a result of being able to consult with them and give them the goods.
Here’s the contract, here’s the policies, here’s your communication strategy, here’s your vetting tool, here’s what you need to do about insurance, da da da da da da. We basically laid out the program, gave it away for free.
So that’s become somewhat prolific across the nation at the county society level, which has been very, very satisfying to have happen. Now, here’s the surprise, Randy.
This is really the surprise that came out of this.
The year after we started that, we said, okay, our committee that started this, we’re gonna get together each quarter and we’re gonna monitor how the program’s going. So we did that.
And the first quarter, oh, we had this many appointments. This is great, great start.
And we’d gotten out to all the hospitals and all the small practices and given them brochures and business cards and told them about the program. We had great reception and it started getting used.

[48:47] Well, after the first quarter, everything’s going well. And suddenly, my committee is like, yeah, yeah, yeah, we don’t care about the statistics. Okay, fine, share the statistics.
But we want to talk about other things. I’m like, well, what do you guys want to talk about? Well, we want to talk about what’s happening in our institutions and in our practices and in our hospitals. We want to share with each other what’s going on. And so suddenly, competitors or people who normally you’d think as competitors, two big hospital systems that only a few years previous had been in an antitrust lawsuit with each other are talking to each other about physician well-being and suddenly they’re beginning to say, hey, we heard about this peer-to-peer program. Let’s bring in Dr. Joe Shapiro from Brigham Women’s who’s done this peer-to-peer program. So they brought her in together, they did training, they both stood up a peer-to-peer program, for each hospital staff by sharing the resource. Hey, let’s get together and do some training together. Let’s, you know, and all of a sudden there was all this collaborative synergistic energy that came out of these relationships that were community-wide, not in any one place.

[49:47] And it was such a delight to sit at that table and just watch them share so many things with each other.
That is stunning, to say the least.

[49:55] It was amazing to watch, and what happened out of that is we, in 2018, the County Society, we hosted three different national speakers.
We brought in Dyke Drummond, the happy MD. We brought in Colin West, who is a researcher at Mayo Clinic with Tate Shanafelt, and we brought in Dr. Paul Deschamps, who has done a bunch of stuff with consulting, and he used to run Sutter Health Foundation in California.
So we brought those in over the course of a few months, and we just kept this conversation going in the community.
What does it look like for physicians to take care of themselves individually?
What does it look like for institutions to take care of their physicians at a corporate level?
What does it look like for us at a community level to begin to think about how do we raise the water level for every single physician in the community, whether they’re a member, of Ada County Medical Society or not, how are we gonna work on community level solutions?
And at that time, what happened is in 2018, Colin West, who again, like I say, he was at Mayo, he was part of helping write the CHARM National Charter on Physician Wellbeing, which was published in JAMA in 2018.
And basically, they outlined three different levels that people need to be working on physician wellbeing.
First was interpersonal and individual commitments.

[51:18] And then they had different statements. For example, anticipate and respond to the inherent emotional challenges of physician work. Prioritize mental health care.
Practice and promote self-care.
So those would be individual commitments because this is, it’s not, we always say, oh, resilience building, we’re so past resilience building.
Well, resilience building, mindfulness, all those things, those are, work-life balance, those are all important, but we can’t hang our hat on those to solve this issue.
Moving up from there, organizational commitments. Build supportive systems.
Develop engaged leadership.
Optimize highly functioning interprofessional teams. Okay, so this is what individual practices, in the hospitals can do.
And then above that, societal commitments. Elevate a trustworthy and supportive culture in medicine and advocate for policies that enhance physician well-being.
And he gave us a framework for thinking about how do we approach this problem wherever we can approach it, knowing that it’s not just serving individuals with our EAP program, and it’s not only healthcare institutions solving it, and it’s not only advocating for policies, it’s all of it at the same time.
But we know that not everyone can solve that at the same time.
And I used to give this metaphor called the burnout river, because I talked about how we started with the safety net of a counseling program, and we’re trying to keep physicians from going over the waterfalls.
And we need safety nets.

[52:41] But looking upstream, we also needed to teach physicians survival skills, resilience, and mindfulness, and those were things. If you get thrown out of the boat in the rapids, you need a life jacket. You need to know how to swim to shore, right? And upstream from there, you actually need some warning signs for physicians that something’s wrong, and there’s rapids coming, and there’s a waterfall coming, and what are the signs, you know, of suicidality, and distress, and things like that. What are the warning signs? And we can train for people to people to look for the, but up from that, let’s look at the boat that people are in.
Is this a safe institution for people to be going down this river in?
And by the way, who’s the CEO on the back driving this thing so hard?
Is he qualified to guide people down this river?
And by the way, why is this river so difficult to navigate anymore?
And if you’ve ever been river rafting, you know that usually there’s sets between rapids, and you go down the rapid and you’re paddling hard and you go forward, you know, you’re doing this stuff.
And then the water calms out for a while.
And then you have another rapid off, you know, you’re doing the thing, but you have sets.
And now we’re looking at this river that physicians are going down through their career.
And it’s one set of rapids right after another. There’s no time to catch a breath in between.

[53:56] And we have to look at what is the culture of this industry that has made running this river as a career so dangerous for physicians.
And if we don’t change that, It doesn’t matter how resilient physicians are.
It doesn’t matter what kind of life jackets they have on. It doesn’t matter what raft they have on, or even the CEOs who are responding to the culture and the industry around them.
If we don’t change the riverbanks and the shape of the river, and the amount of volume that’s running through it, it’s always gonna be dangerous for whoever’s on that river.

[54:29] Well, it’s good to know that we’re actually talking about it out loud right now, and I want to thank you for your contribution to that, and I have really enjoyed this conversation with you today.
We have come to the point where I’m going to give you an opportunity to let me step out of the way, and you can speak to our audience on your own.
I’m really looking forward to this.
But this is the point, audience, where I’m going to close my mic, and Stephen Reams, Executive Director of the Ada County Medical Society in Boise, Idaho, is going to give us his personal prescriptions for success.
Stephen Reams Well, I would say the first one was actually advice that was given to me, and so I’m happy to pass it along.
And it was given to me by that pastor, that mentor of mine in my college years, and when we left Boise, he said, Steve, I’ve taught you most of what I think I can teach you, if there’s one thing you need to learn, it’s this, be efficient with tasks, be effective with people.
And you see, I’m such a person that runs really hard and fast that it’s really hard for me to slow down and be present with people.
And I remember one of the guys in the church, an older guy in his 80s said, Steve, you have a real hard time chewing the cud, don’t you?

[55:46] And I think what he meant by that was, you know, to just sit and enjoy conversing with people without having an agenda, you know? And you can’t always do that all the time, of course.
We have time constraints.

[55:58] But I know that this always bites me in the rear when I ignore this advice.
And usually it’s when I’m sitting in a meeting or I’m having a meal with somebody and they’re a storyteller and I’ve got this agenda and I’m trying to press for it.
And internally, I’m not present because I’m thinking there’s a limited amount of time here, cut to the chase, we got stuff to get done, but that’s being efficient with people.
And to be efficient, to be effective with people, means not being efficient with them. And I think in medicine, especially, that’s really hard right now because industry and regulation has turned this the other way around. It forces physicians to be efficient with people in order to prioritize being effective with tasks, namely billing, coding, charting, prior auths, and all those things. And somehow we have to reverse that and say, look, if you really want good outcomes for people, then we can’t rush the process. So that’s something I always lean into is the first one. The second one is kind of somewhat related. It’s about time. It’s about learning how to Sabbath or stop, or if you prefer to build regular sabbaticals into your life. And by sabbatical, I don’t mean once every seven years. I mean, you know, really once every seven days or every seven hours if you can. I just as human beings, I don’t believe that we are well designed for the pace at which we live our lives in our modern society and especially in our work lives and then And of course it bleeds over into our personal lives.

[57:23] I think that there is this expectation in the 21st century that we can always be 100% productive.

[57:29] With 100% quality at 100% speed all the time.
And if that can’t happen with a machine, why do we think it can possibly happen with people?
And I think we’re destroying ourselves and some of the really things that are valuable to us as human beings by trying to always be, 100% everything all the time.
This is a rhythm that I’m really leaning into a lot more now in my middle years of career.
How do I rediscover those rhythms of rest and work that are sustainable?
But it’s definitely a battle and it’s definitely anti-cultural to turn your device off.
Obviously, if you’re on call, you can’t do that.
But to go back to an agrarian speed of living, at least part of your time, part of your day, part of your week, slowing yourself down.
And again, you can’t do that all the time, of course. We don’t live in an agrarian society.
We live in a very high-tech society.

[58:24] But for your own sustainability, for your own long-term energy and outlook, for mine, at least what I need, is I gotta turn stuff off.
I gotta say, I’m not gonna use my phone to read with. I’m not going to play games on it.
I’m gonna actually put it away, put it in another room.
It’s really hard. And to just, you know, to be present with people, you actually have to be not present from other things.
And so I encourage people just to stop. That’s actually what the word Sabbath means. It means stop.
And the third thing is this, and it’s just believing that most everybody is trying to do the best they can within the constraints they have.
You know, just very recently this summer, I had a leader from a former job, and I’d been let go of employment.
I talked about this, and she came to me and said, you know, I know we had our differences and we had to make a decision, but man, I wish as a board we could have done that whole thing better.
And the fact is, what I was recognizing is that she and the board were doing the best they knew how to salvage a situation that was difficult at the time, just like I was trying to do the best I knew how as a leader.
And she said this, and by now I have tears streaming down my face, and she follows it with some just really personal encouragement about what she had been developing and playing out in my life.
And what I realized is that, man, we have so much impact on people, the way that we treat them, we have really high standards for them, or really high standards for ourselves.

[59:53] And it can be almost demoralizing to people or shaming and judging and discouraging other people when our standards are so high that they’re impossible to meet.
And we say, well, I don’t expect that of other people, but the fact is it leaks out.
It leaks out in all sorts of statements. I have four kids, I know it leaks out, it does.
And so I would just encourage people, don’t give up your high standards, but carry yourself with a high amount of grace towards others who don’t meet those standards, as well as towards yourself.
And if you’re so darn awesome at something and somebody else isn’t, then reach in and help them grow into the abilities that you have.
And by doing so, you’re passing on to the next generation of people behind you, to help them develop their capacity.

[1:00:40] So, I could be, as with any prescription, individual results may vary, so you can take it with a grain of salt, but that’s what I have to offer the audience.
Well, I think you’ve done very well. I’ve got, be efficient with tasks and effective with people, I really love that.
I’ve got, know and respect your limits, and perhaps most important of all, respect everyone’s effort and adjust your own expectations.
You could create a lot of happiness with that list. So thank you so much for sharing that with us, Steve.
Before we go, I want to give you an opportunity to tell our audience where they can find you if they would like to.

[1:01:19] Sure. We’ve got a couple different resources. One for kind of a general resource for physician wellness is our website, physicianvitality.org.
And what we’ve done there is put the National Charter for Physician Wellbeing up with a a bunch of different ideas about how to implement those commitments and principles.
That’s one. And then also, just our regular Medical Society website is adamedicalsociety.org.
That’s A-D-A, medicalsociety.org. And if they want to email me, they can find my contact information there.
Steven Reams, Executive Director of the Ada County Medical Society.
It’s been a lot of fun, and I appreciate you being here with us.
Thanks a lot. Randy, thanks for having me. appreciate it. Thank you so much for listening with us today. If you enjoyed the show, you can help us reach more listeners by leaving a rating and a review, especially on Spotify or Apple Podcasts. And if your app doesn’t have that option, just leave us an email or a voicemail through speakpipe at, www.rx4successpodcast.com. You can also help by becoming a Patreon member. That, That link is in the show notes, and we hope you’ll also follow our companion podcast, Life Changing Moments with Dr. Dale Waxman.
Special thanks to our producer, Craig Clausen, our promotions manager, Mariana Rotabaugh.

[1:02:44] And to Ryan Jones, who created and performs our theme music.
And remember, be sure to fill your prescription for success with my next episode.

[1:02:54] Music.