The Wound Specialist: Marcus Gitterle, MD, ABWM, FACCWS

 

[0:00] So it’s an odd situation to be in. I think we now have that critical mass of knowledge.
We know so much about so many categories of wounds.
We know best practices that shorten the duration, shorten the time to healing, reduce complication rates.
And yet, we still have this scattershot training. We’ve got people that, like you said, maybe they were pathologists, you know, and they sign up and, yeah, I want that job.
And the employer says, oh, don’t worry, it’s easy.

[0:31] Music.

[0:37] Paging Dr. Cook, Paging Dr. Cook, Dr. Cook, you’re wanted in the OR, Dr. Cook, you’re.

[0:44] Music.

[1:09] Welcome to the Prescription for Success podcast with your host, Dr. Randy Cook.
Hello everyone and welcome to Prescription for Success. I’m Dr. Randy Cook, 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.
And don’t forget, CME credit is available when you listen with us.
Just look for CMFI in the show notes to learn how.
My guest today is the co-founder and chief medical officer of WoundCentrics.
Where he leads a team of more than 65 wound care, hyperbaric, surgical, and vascular medicine specialists, providing care in more than 100 healthcare facilities in 12 states.
Dr. Marcus Gitterly joins us today to share his story of success.

[2:18] I’m really excited today to be talking to a person that I share some common ground with.
Dr. Marcus Gitterly has had a really successful experience in the care of chronic wounds, which is the way I finished my career.
So we’re gonna talk some shop today and we’re gonna have some fun.
So Mark, thank you so much for being here and welcome to Prescriptions for Success.
Well, thank you for having me.
Excited to have this conversation.
Yeah, me too. And Mark, as we always do, I like to begin at the beginning, as they say.
And let’s talk a little bit about your early life. I’m presuming that you grew up in Texas. Is that correct?
Actually, no. I was born. I’ll be darned. You got me already.

[3:09] Born in Chicago and spent a couple of years there before moving to Arizona. I vaguely remember the move, but then spent six years in Phoenix, at which time we moved back to Chicago.
So then I’m roughly eight years old, like third grade, and stayed in the Chicago area until I turned 18. So the last semester of high school, moved to Texas reluctantly with my parents.

[3:40] And been here ever since. I presume that was for professional reasons or employment reasons?
So, my stepfather was a script writer, did industrial films, voiceover work, things like that. So, he could really live anywhere. He just needed to be near a metropolitan kind of airport.
And so, they had been musing about moving to the Sun Belt for a few years.
And so, they made it a two, three-month road trip project, came back and announced to my, my stepsister and I, that we were moving to a town where I live now, still at Wimberley, that we couldn’t find in the Rand McNally atlas.
So we … place to be.
Exactly, well, but to you know to my 18 year old self it was in my life flashed before my eyes I thought oh gosh, we’re yeah civilization and moving to a place. I can’t find on a map, you know Oh my gosh, you have anticipated my question. I got.

[4:39] What state of mind you were in at that?
So some some trepidation was involved, but so we we loaded up everything and and we We literally had two vehicles, a U-Haul, and we drove to Texas.
And I still can remember, I’ve related this story many times.
But so where I live is just kind of south and west of Austin, Texas.
So maybe 35, 40 minutes from downtown Austin. But it’s night and day.
It’s literally, it’s beautiful Texas, hill country. So I didn’t know what to expect.
You picture Tumble, city kid from Chicago. You don’t know what Texas looks like.
And Texas is quite varied.
But anyway, so we turn on the last major road to get to where we’re gonna live.
And I had this palpable, just visceral, visceral, just this epiphany that I was home.
And I can still, I still get goose bumps. And I asked, are we getting close to where we’re gonna live?
And the answer was, yep, it’s just down the road, just a few miles up ahead.
And one of the most visceral things I’ve ever experienced, just that this knowing that I’m in the right place, it’s beautiful, I’m immediately in love with it.

[6:03] More details please. What was it about being in that profoundly rural or at least semi-rural setting in contrast to where you had just left? What was it?
Yeah, you know so so it’s it’s hard to explain it’s a beauty it’s beautiful, you know, it’s bucolic, Rolling hills, you know, it looks, you know, largely except for the you know built structures here and there, Which are sparse, you know, it looks probably like it did 200 years ago just rolling beautiful hills and green and you know creeks and And it is idyllic in many ways.
There’s a joke about where we live, Wimberley, that the third time you go to Wimberley, you’re pulling a U-Haul.

[6:53] So it is a special place, admittedly. Maybe I wouldn’t have had that same response moving anywhere in Texas.
But anyway, I’m grateful that they picked that spot. And it’s kind of a crazy story.
He was a theater person, my stepfather.
And so they actually intended to move to Austin. And the family they were staying with, on the day before they were gonna come back to Chicago and tell us we’re moving to Austin.
They said, hey, you know, this friend of ours, a UT professor of theater, called and they’re retiring and moving to like an assisted living and, and he’s a playwright, and they said you got to see their house.
So that’s how we ended up in Wimberley. So they looked at it that last minute. And that’s how we found Wimberley because they they wouldn’t have heard of it. You know, it’s a it’s this little, little, you know, tourist town.
And so it is kind of a cool story. You know so much of our lives Changed because of you know that little you know kind of happenstance. Yeah, Sarah serendipitous is a really great story, And I’m so glad that you shared that with us.

[8:00] But You also arrived at that point just about the time it was You should have been about ready to go off to college, right?
Correct. I was fortunate to be able to move in the middle of that senior year in high school, but I was attending a special school in Skokie, north of Chicago. It was called the Alternative Learning Center. It was an alternative school and you could design classes and things. All I had to do as a senior project. That’s all I had remaining to do. It was a thesis on imagist poetry.
Wow. Yeah. And I thought I was going to be an English major in college.

[8:49] Curiouser and curiouser, said Alice. This is going to be a great story.
So I wrote my senior thesis in this idyllic setting, and it was really an adventure getting to know Texans and Texas, and so I didn’t have to go to a regular school.
So I had a lot of time to kind of roam and hike in the hills and in the creeks and things.
So it really was like a, it was an epiphany in many, many ways.
And then, yes, so I decided not to go straight to college.
I actually was in high school because of going to this alternative school, one of the things they wanted you to do was internships in various kinds of experiences with businesses. As a sophomore, I had called a recording studio out of the blue and I wanted to know how recording studios worked. I had many other experiences, some of which I’ve just forgotten about, but this one was very significant and I said I’ll sweep the floor so if you can, you know, if I can hang out and see how.
You know, music is recorded and commercials and stuff. And so, I ended up staying there, they hired me.

[10:09] And so, I was actually making pretty decent money and I produced commercials at night.
And they’d air the next day, you know, on the radio. And so, I had that in my sort of resume.
And so, when we got to Texas, I put out the feelers and I got hired by a recording company in Austin.
And so we got some really cool opportunities.
So I took a gap year and got to record, gosh, some really amazing, an amazing range of really famous artists.
And so that was a great experience. So anyway, everything from Amy Grant to Ted Nugent, which I was not a Ted Nugent fan.
But yeah, in the same summer, I ended up recording both Amy Grant and Ted Nugent.
So quite all of that going on in your life and you decided eventually to go to medical school, Yes There there is obviously more to tell here. So.

[11:06] Uh, what happened what changed when you got enrolled at texas state? Well, so so so actually in that gap here That’s when I decided to go to medical school. So I I had had an early interest in medicine when I was six years old, I became very interested in physiology and you know got an anatomy and physiology, my mom got me an anatomy and physiology textbook and a microscope and and so for my early, childhood years.
Like first grade, you know, to beginning of high school, I was just consumed with interest in science. I lived in the library, Absorbed everything I could I check out the maximum number of books and it was kind of, you know cross-disciplinary It could be astronomy. It could be biology anyway, but so I had up to that point the idea of becoming a physician, There were no physicians in my family But it was it was something that kind of fascinated me and then things shifted to the humanity So I really didn’t have that pull toward being a physician. It wasn’t a thing in my mind, as a senior in high school, That might have been the last thing that I could see doing not because it sounded distasteful to me It just didn’t it wasn’t on my radar, but I had a chance to.

[12:22] Spend three weeks Working closely with an internist on a film project So I was a the sound man for a documentary on droughts, And as part of the the crew this internist was along it was this actually in North Africa So we were documenting desertification in the sub-sahara And so we were in Kenya and we were in upper Volta ivory coast And so, you know how those projects go or you may know, you know There’s a lot of waiting between you know, shooting scenes.

[12:58] And there’s a you know, just a lot of waiting for government permits and this and that Yeah, so I had a lot of time to pick the brain of this internist from Minnesota, I don’t even remember his name now, but I you know Something struck me and I thought what a fascinating life and you know, ask him. What do you do?
You know, what’s your day like, you know, what how does this patient care work? You know, what how do you go to medical school?
You know at that point I because it wasn’t on my radar screen. I really didn’t even understand the process.

[13:28] So so I came home from that And announced to my parents that I was going to medical school. It was like one day to the next, I’m going to medical school and I though it was like a runaway freight train from that point nothing I’ll be darned, you know stopped. I mean, I just it was like it was that moment and somebody was handing me a diploma, you know, on the stage, you know, at UT Medical School. They, I could tell when I made that announcement that you could hear the eye rolling, you know, like okay, yeah, whatever. So, but, you know, notwithstanding, they realized that was serious before long. And, you know, Texas State was around the corner and I could live at home, so I saved a lot of money that way. And I enrolled, you know in the you know, next beginning semester and followed the, you know, the letter of the law in there.
You know, if you’re pre-med, here’s what you take. Yeah, the rest is history. Yeah.

[14:31] 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. I really hope you’re getting a lot of great information, but if you’re looking for an answer to a specific problem, management or administration challenge, or if you’re feeling just a bit burnt out like maybe you chose the wrong career, well then there’s a faster way to get the help you need. No, it’s not counseling, it’s coaching. Rx for Success is produced by MD Coaches, a team of physicians who have been where you are. I I know you’re used to going it alone, but you don’t have to.
Get the support you need today. Visit us at MyMDCoaches.com to schedule your complimentary consultation.
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Now let’s get back to today’s interview.

[16:38] Music.

[16:44] But the cool part of that story is that even though you were summa cum laude material, you never got a degree. I never got a degree.
I gotta hear this. You know, this is this crazy, I look back and I’m like, who is that guy?
I want to meet that guy.

[17:00] That guy was badass. And you know, so like I started out first semester, I took 14 hours.
And then, you know, everything went well.
And then I thought, well, you know, I probably can speed up this process.
So the second semester, I took 20 hours.
And you know, and here’s the thing. I had taken the bare minimum of science in high school because I didn’t think I was going to major in science. So I literally, I didn’t take any AP classes.
The highest math I took was geometry in high school. I didn’t take trig.
I took, I think, you know, like an intro to astronomy and I took biology, like one.
I took what they required, you know. So I was really starting fresh.
So I’d never had, you know, organic chemistry, you know, I hadn’t, of course, hadn’t had organic.
Hadn’t really studied physics. So this is all new stuff to me. So I don’t know who this guy was But so the second semester all A’s and at the same time that second semester. I took a nine hour per week It was 7 p.m. To 10 p.m.

[18:09] EMT special skills, you know sort of like a junior paramedic you could start I’ve rise and things, So and that was a semester long class So and I wanted to do that as a you know pre-med experience So I took that while I was taking the 20 hours at Texas State. I took that nine-hour, Evening course so like I said guy. I’ve yeah, I’d like to go back and meet that dude. So.

[18:34] And you know, I kept going and Kept up with that schedule. So second year I got to the third So I was into the third semester and I thought you know, why don’t I just take this MCAT?
They’re giving it in in April, you know in the spring, so I’ll just sign up for it and I’ll take it now I’ll just let’s just see what happens and I took the MCAT and I think I had the highest MCAT score that they had But they tried to dissuade me from taking it They didn’t want me to get discouraged the the pre-med committee, Actually convened a special meeting with me at the head of the table to implore me not to take the MCAT Really? Yes. And I just stuck to my guns and I said, I just feel like I should do this. I think, you know, we’ll see if I don’t score well I can take it again. And I had, you know, grad student friends that hadn’t taken it yet, they’re planning to go to medical school and, you know, like people that were in their sixth year, you know, of undergrad because they changed majors and they’re all like, what is with this guy? And then so I sent, you know, I sent my applications in and you know I did one more semester got accepted and and I did So I did finish out the spring of the next year, you know, just and then.

[19:46] Went right to medical school. But yeah, I did. I was about a year, 30 hours short of a degree, so.
Well, with that kind of enthusiasm for getting into medical school and doing it right now and not passing go and that sort of thing, once you got there, once you were in the.

[20:05] Medical school environment in San Antonio, did you always feel like you were in the right place?
Or were there ever any misgivings like a lot of us have during those basic science years? What What was on your head at that point?
Yeah, there were dark nights of the soul. No question about it.
It’s such a weird crucible. It’s really you’re on your own, even if you have vital friendships.
But I just had this knowingness that that is exactly what I was supposed to be doing.
And it kept me going. But there were definitely dark, dark times.
But, you know, all in all, I have very fond memories. I don’t want to say, I mean, dark in the sense that, you know, just like all of my friends, you know, there were those exam weeks where you just wondered if you were insane to pick it for a career, you know, and I would joke about it.
I called it the best exam. I would joke about it.
Medical school the world’s longest Maxwell house moment I remember once taking a whole pot of coffee instead of pouring it into a mug to drink before I think it was a I don’t know what exam it was. But anyway, so.

[21:17] But my Overarching feeling about it was it was actually more enjoyable than an undergrad I actually felt like I was with my peeps, you know, I was with like-minded people. I’ve made great friends friends. I loved the classes. I mean, so really, I have to say, I really enjoyed medical school.
Well, that’s a continuation of a really great story. You know, I hear from a lot of guests who, talk to me about struggles that they had in medical school for one reason or another, but sounds like you experienced some of those as well and you dealt with it very well.
And came time to think about postgraduate training and having heard the story that I have just heard I would have thought this guy is probably headed for Harvard or University of London or something and you took yourself over to the Medical Center of Central Georgia and I’m very interested to know how that I know, you know, so my faculty advisor trained there and.

[22:25] And I interviewed it, you know, it’s at some very interesting places the one in retrospect that I wonder You know, you wistfully think was Cook County Hospital and you know, I thought was hey, I know Chicago You know, this would be fun. Yeah back in Chicago and what a place I mean, it’s such it’s I don’t know if you’ve ever ever kind of been you know toured or the old Cook County Hospital but they it was one of those places where if you were going to interview there they made you spend the night and they made you experience because I think they had a, number of people that were shocked you know when they actually showed up for, their residencies because much of it hadn’t changed you know for decades I I mean, they still had open wards with like 20 beds in them.
And so what a fascinating place. But anyway, Medical Center of Central Georgia.
So my faculty advisor just kept imploring me, whatever you do, you’ve got to go interview at the Medical Center of Central Georgia.
And so I had tremendous respect for him.
And he just kept saying, trust me, it’s a special place, you’ll see what I mean.
So I did, and the guy was right. I don’t know if it’s still the same place, What a special.

[23:45] Place I I’m so glad that I that I made myself do that because it was Gosh, darn. First of all, just sheer experience from the first day. I put on you know, two pagers.

[24:00] One was for the neonatal ICU and they had they had one of the two Level three neonatal ICUs in the state and so I put in so many, central lines, you know umbilical artery catheters and and umbilical vein catheters, and I’ve done as many spinal taps as I’ve done in emergency medicine over the years.
I probably, for the first 10 years as an EP, didn’t exceed the number I had done on neonates, you know, like four-pound babies.
So anyway, long story short, great experience, lots of first call, you know, in the ED, resuscitation.
You know, the first time I went into an endoscopy suite, I did a full 60 centimeter endoscopy on a patient.
So, all the while, you know, feeling nurtured, feeling like they cared about me.
The residency program director was just a gem.
So, yeah, good experience. I’m glad I did it, really glad I did it.
I can’t say I’m surprised to hear that at all. I mean, it’s what you say is so true.
Macon, Georgia is not Chicago. On the other hand, the amount of pathology that you can see, and the living conditions of the patients that you see are frankly not altogether different.

[25:23] From what people are experiencing in Chicago. Is that your experience as well?
That was my experience. We had a, it was, yes, yes. And we were seeing, you know, like fully developed pathology that you hear this, you know, platitude expressed to you, like, and I think they do it to appease medical students and residents when you’re, just seeing these, you know, to use a term you hear all the time, you know, as a resident, Trainwreck, you know patients you see when you see really developed pathology that you’ve only read about, you know They say well, this is a privilege, you know, you’re getting to see stuff that other people only read about that is really true There is there’s nothing like seeing, you know, to tuberculosis, you know tumors in a patient, you know, and not just, So, yeah, absolutely and just extraordinary cases I remember you know, working up a 10 year old with abdominal masses.

[26:28] And this poor girl, I mean, it just, it broke everyone’s heart.
But she had PID and she had just massive abscesses, you know, and anyway, just things that you would, just the gamut, the full gamut, you know, in every specialty.
And you get to see them end to end longitudinally. They didn’t get lost to another service.
And you know, forget about it, you’d follow them.
And so, you know, I just.

[27:02] That was a privilege. Dr. Darrell Bock Yeah, and not to make the interview about me, but I did my surgical training at Medical College of Georgia in Augusta, and it was a similar, I mean, even though it was a major medical university, it was in the midst of an enormous rural wasteland of medical care, and the pathology that you see in those circumstances as profound, and it sounds as if it had the same profound effect on you that it did on, me.
And I’m sure it’s something that you reflect on frequently. Let’s move your story along a little bit.
So after finishing your residency in family medicine, it looks like you just decided that you were going to be an emergency physician all of a sudden.
Is that the way it worked?

[27:54] Well, yeah, and so there actually, you know, there’s a longer story there.
So I finished my first year of that residency program, and so at the time, and I didn’t kind of give this back story, but my grandmother, my father’s mother, my real father, he at the time was living in Alabama near Birmingham.
She had passed away when I was an infant of Huntington’s disease.
From the time I was about 15, I wasn’t told about Huntington’s.

[28:34] Till I was 15 or 16, and I didn’t think a lot about it. You know wasn’t I didn’t know much about the disease I knew you know Kind of you know, I understood it’s autosomal dominant, you know, if your parent has a 50-50 chance all that.

[28:49] In medical school, you know, obviously I learned a lot more about it and became pretty expert about because I was personally interested, And you know the early tests that were being developed and at the time, you know, you needed to have a family member to also be involved in the testing. But long story short, my father really started showing what I thought were clear signs of Huntington’s disease right around the time I was an intern. That sat really heavily with me.
I kind of had just this, I don’t know, in some ways regret the decision, but as you’ll see, you know, things played out wonderful way.
But I decided to interrupt my postgraduate training and move back to Texas and kind of a homebody, and so I just felt like I needed, I don’t know, whatever.
That was the decision I made. I got back and immediately I started getting, you know, people found out I was there.
I put out the feelers, you know, and I had all these job offers to staff ERs, And I had really enjoyed working in the ER, you know at.

[30:06] Medical Center of Central, Georgia and I felt like it was a natural in fact there I had thought to myself, you know I really had not thought about emergency medicine. They didn’t have an emergency medicine residency, That predated the ER residency. That’s right. Exactly. And so And I said, okay. So I started doing shifts in different EDs and pretty quickly I got hired at.

[30:33] At a downtown ED in San Antonio, and I thrived, I loved it, absolutely took to it.
And so, I was made the assistant medical director pretty quickly and spent six years in that department.
I just absolutely loved it. It was downtown, so we had some of the kind of gun and knife club sort of traffic.
Pretty good training program.
I put in a lot of chest tubes, I mean, yeah, I learned how to, you know, yeah, exactly.
I mean, I did so much there, you know, to drain pericardial effusions and, you know, the gamut.

[31:15] Yeah, so things worked out well. In retrospect, you know, it could have been different, probably more elegant to either do an emergency medicine residency or, you know, stay with that program, but circumstances were pretty kind to me in developing my career.
You know, residency programs were established back in the day precisely for the purpose of offering people an opportunity to get some more experience, particularly in specialized areas so that they could be competent practitioners.
And even though they didn’t call it an emergency medicine residency for you, it sounds to me like that’s exactly what you got.
Well I was surrounded by smart people and I’m kind of an autodidact and so I read voraciously.

[32:10] And I love to learn new things whether it’s a procedure or you know understand some kind of pathology so I just you know I maybe that’s why it just flourished and so yeah I agree with you. And to be in a place where you have rich experiences and you have people to sort of, you know, sounding boards to, you know, say, hey, could I have done this differently or is there another technique? I mean…
Dr. John Axelrod Well, that was actually going to be exactly my next question is, did you find that the other people who are around you, the surgeons, the pediatricians, the OBGs, those kind of people, were they really forthcoming with their help.
They were, absolutely. Again, I’m thankful that I started my career there because whether.

[33:04] Cardiology, neurosurgery, pediatrics, the ICU docs, so many of them, the radiologists, they were generous with their teaching. So yeah, great experience.
Wow, what an education. Yeah, and from there, I lived for a little while in the downtown San Antonio area, and I really missed being able to, at least on the weekends, get out in the country.
So a house came up for rent in Wimberley, so I could go on the weekends.
And what I found myself doing is, even if it was a Monday or Tuesday, I’d finish a shift and I’d drive back to Wimberley.
So I had a pretty long commute, that’s San Antonio to the Austin area is a good hour and a half.
So there was an ER in between, I moonlighted there, it’s New Braunfels, Texas, and another cool town.
It was about halfway between Austin and San Antonio, a very well-developed kind of metropolitan area, very charming German town.
And so I started doing some shifts there. And what I noticed about it was it’s an old German town and it had kind of that character to the medicine.
It was kind of just so. They were very particular about who was on the medical staff and how they practiced medicine.

[34:30] Like their medical staff meetings had to be held in the cafeteria. They were monthly.

[34:36] You had to go to 10 out of the 12 every year to maintain your privileges.
They would fill up the cafeteria. Remember that?
And now it’s like once a year and it’s like a Christmas meeting and it’s optional.
And they would really dialogue with administration. They’d hold their feet to the fire.
You know, they were opinionated and you know, you can imagine.
And so I fell in love with the place and I thought, you know, this would be a next nice I can be in Wimberley. It’s, you know, half the commute. I literally found that I could commute this way where I took only two lane roads, you know, sort of beautiful country roads. And one of them is called purgatory road. I laugh still. And so that’s, you know, sort of the was the next phase in my career that was bought by Christos Santa Rosa, which is one of the regions of Christos Health.
I became the chairman of the ED, and we went from just a small crew doing too many shifts to 12 full-time EPs.
I was recruiting basically all residency-trained people. I felt a little bit unconfident at first.
I thought, gosh darn, these guys are going to a real residency somewhere, and they better teach me some stuff and but I realized that you know just the experience.

[36:04] Absolutely, and so so now is that where you were when you got the.

[36:10] When you when you found the interest in wound care It was so we were actually kind of, bludgeoned into Starting a hyperbaric program with wound care, you know attached to it None of us knew, you know, we…
Bludgeoned by whom?
By the administrators of the hospital before Christos bought it.
And they said, you know, we’re going to do a hyperbaric program and we want you guys to run it.
And we owned the contract for the ED and so, you know, it was like they were holding that out as, hey, we’ll get somebody else if you don’t do this.
So we all went off and got training in HBO, came back, started up this program. program.
Most you know the other three docs the four of us that did this kind of just wanted to read a book while the dives Were going on but I got fascinated. I really started to enjoy it. And so I kept, Collaborating they all dropped out of the program and then later Christus wanted to do, Eventually that closed and then Christus bought the hospital and they wanted to do a full-time wound care and HBO program So they tapped me on the shoulder and said hey, you know, remember you used to do the you know, HBO and WoundCare and we’d like to do that again.
So 2010, they started up a full-time program.
They gave me basically the choice. We want this to be full-time.
And I’m gonna ask you to pardon the interruption. I wanna make sure that the audience understands that HBO is hyperbaric oxygen.

[37:38] So. Yes, correct, thank you. Carry on. Yes, and so it was a tough choice for me.
I could continue to moonlight in the ED, which I did to maintain my skills, but they wanted a full-time medical director for wound care and hyperbarics.
And so my joke about this is my wife said yes, first and then I did later, but because no nights, no weekends.
And so that was the appeal because I was still doing a fair number of surgeries.
And you do reach an age where that becomes important, don’t you?
You really do. Emergency medicine is not kind to those of us who get past about 50.
So it was a great choice. And where the epiphany happened, where, I realized that it was the best choice I could have made, besides just enjoying it, was that about two months into doing that full-time.
I had at the time a seven-year-old and a two-year-old.
And I got home one day, and in emergency medicine, they never knew when I’d be home.
I could be home late at night, early in the morning, I might be cranky.
Mom would say, don’t bother Dad, he’s gotta sleep.

[39:01] But now, for two months, I’ve been coming home at about the same time.
And so I opened the door, and it’s like 5.45.
And from across the house, these two little guys start sprinting at me and practically tackled me and said, daddy’s home.
And it really hit me that I had been like a ghost for years.
And yeah, now I was, wow. The time couldn’t have been better both for you and your children, it sounds like.
Absolutely. It was a great, great choice. Rather than just being a guy that punches the clock, you actually took this wound care hyperbaric medicine project to quite a…
More elevated level. So let’s hear the story behind one centrix Well, so yeah, you know when you when you get into a new specialty, you know which which I would say that one of my other epiphanies about this is is, what a privilege it has been to be able to make a.

[40:08] Lateral move in mid-career you do you know, that’s that’s a tough thing to do in medicine It doesn’t happen very often doesn’t happen very often And so it was a privilege, but when but at first you lack perspective, you just don’t know, you know The lay of the land you don’t know Even the most mundane things, you know, you kind of know you’re gonna see a lot of diabetic, you know foot ulcers, you know.

[40:31] Pretty quickly But the politics of it, you know the nuances, you know, what has shaped the specialty, you know, right?
And so it was like peeling an onion. So within a couple of years I realized how much opportunity there was was to, you know, just kind of rationalize and optimize the, you know, delivery of wound care.
So, I became a regional for Christus. So, they had four clinics at the time. And I noticed how different, you know, care was in different clinics. You know, they’ve all got their own personality. Every clinic and every specialty is different. But just the way things got worked up.

[41:11] And managed and, you know, the options offered and so forth. And the other thing I noticed was the disparities in vascular testing. You know, there were, that is a whole, you know, that you could, we could talk for hours just on that. But so, so I started getting fascinated by this question of how can you have a group with multiple providers, you know, in multiple places and assure that patients get a good experience and get the right options and get the right care.
And for whatever reason, that just deepened. The other thing I noticed was it was a very siloed specialty.
And so people that were strictly outpatient kind of didn’t know what happened when a patient went in the hospital, except that what wound care providers often noticed was if that patient went in the hospital, you stop seeing them, and next thing you know, next time you see them, they’ve got a below-the-knee amputation, you know.
Exactly.

[42:12] About talking to you before they do that.
Yep, exactly. And so I would, you know, one of the first principles that I started to sort of, inculcate into, you know, my, my folks was, you know, you have to keep those patients in a tight orbit, you know, don’t let them get in too far in orbit from you, because they’ll get, you know, things like amputations will happen. So, so we, you know, started developing methods to, you know, just make sure that the patients came back every week or that they knew that if they, were going to go to an ER, they needed to let us know so that we could be involved in coordinating care.
But what the real epiphany was, was we needed to be in every domain.
We didn’t just need to be in the outpatient clinics.
We needed a team that covered the whole territory.

[43:02] So by about 2015, I think we had 17 providers in the San Antonio area.
We had folks in most of the LTACs, the long-term acute care hospitals, in the skilled nursing facilities, in the inpatient rehab facilities, in four STACs, or general hospitals, and in the outpatient clinics.
And what that did was it really helped us to, by being in those domains, we could continue to follow patients as inpatients. And that epiphany led to the realization that we needed a bigger vision.
And so that’s where the idea for WoundCentrics germinated and to grow beyond the region.
And so in 2012, we formed WoundCentrics, myself and a partner who has just been a just a gracious partner, Rodney Franklin.
And he had the vision to do that original contract with Christos.
But he thought we could have a bigger vision. And we did. We’re in 12 states.

[44:08] Maybe 300 employees now altogether, most of whom are non-clinical. And then training programs, we have WoundCareUniversity.com. We do undersea and hyperbaric medical society approved hyperbaric training every month. We do what we call WoundCare University, which is kind of a training program to help people sit for the American Board of Wound Management exams, the CWS and CWSP, the WCC exams, the Wound Care Certified. So we’re training, you know, nurses, physicians, advanced practice providers of various kinds and it’s now grown to vascular. We have ambulatory surgery centers doing vascular procedures, office-based vascular labs.
So it’s really come a long way. What are your thoughts, if any, on if we will live to see chronic wound care or a woundologist or whatever you care to call it as a specialty recognized by the ABMS?
Is that going to happen? I think it’s inevitable, and I think mainly for the reason that unless we consolidate the knowledge base and have expectations for assimilation of that knowledge, we’re not going to contain costs.

[45:36] I think people are doing a really good job, for the most part, even though the training Training is all over the map.
It’s on-the-job training, and you’ve seen it, I’ve seen it. Everyone I’ve hired has had to do some degree of OJT, which is true in every specialty.
We’re always learning that half of what we learned in training was wrong anyway.
It’s in a specialty like wound care where things are time sensitive and you’ve got.

[46:14] Very complex problems like diabetic foot ulcer, which are you know, widely oversimplified even though, We really know, you know, what what makes those wounds special?
And so yeah, I think without unless we kind of come up with a model so that we can, Present, you know that corpus of you know, evidence-based practices and and test people against it, we’re going to have a terrible amputation problem. You bet. You know the The interesting thing to me is when I try to take the $40,000.

[46:51] View of how we do specialties, most of the ones, if not all of the ones that we have right now, sort of sprang forth because the science around whatever specialty you happen to be talking about was already fairly well developed.
And from that genesis, it seemed like it was a relatively logical step to let’s have some some formal training and let’s have a set of guidelines and let’s have some rules that we can live by, whereas, and I’m happy if you’re going to disagree with what I am about to say, but my experience in wound care was that this technology came along, namely hyperbaric medicine or hyperbaric oxygen, which was found to be very effective at managing chronic wounds among other things, and a substantial cluster of entrepreneurs suddenly figured out that there was some revenue to be gained from that.
And they began to open these wound care centers, hypobaric oxygen centers, with people who, were willing to come from any place.

[48:13] I used to be part of a faculty on a wound care education course.
We actually had radiologists and pathologists show up.
Dr. Darrell Bock Yeah, clinical people, right. Dr. Robert Parker Yeah, and so with that background, for me it seems like it’s created an unfortunate stumbling block to the usual organic blossoming into let’s do residency programs, let’s train these people right, and I’m interested to to hear what your feelings are on that.

[48:48] Yeah, I know, I agree, I agree. It’s a critical need, but unlike perhaps the natural history of some of the other specialties, like as you said, where there was like a body of knowledge and technique and it naturally coalesced into a kind of a training program, vascular surgery let’s say, or general surgery, you know, it this is kind of happened in reverse. And, and now and so in this era where, you know, monetization of a procedure, you know, can happen so quickly, you know, there’s opportunity, you know, by payers are paying for something and next thing you know, you know, all these people are showing up to try to monetize it.
I think we’re on that knife edge now where the third-party payers can’t support that.
And there’s almost too much pushback, you know, because so it’s an odd situation to be in.

[49:52] I think we now have that critical mass of knowledge. We know so much about so many categories of wounds.
We know best practices that shorten the, you know, duration, shorten the time to healing, reduce complication rates.
And yet, we still have this scattershot training.
We’ve got people that, like you said, maybe they were pathologists, you know, and they sign up and, yeah, I want that job. and the employer says, oh, don’t worry, it’s easy.

[50:20] Anybody can do this. Oh my goodness. And it’s not easy. And so I, you know, when we hire, I try to make it a point to ferret out, you know, the people that think this is going to be easy, and tell them it’s not easy. Diabetic foot ulcer patients are some of the most challenging patients you will ever see in your career. But you can heal them, and you can keep them from getting amputations, but it’s going to take everything you’ve got, all your communication skills, your clinical diagnosis skills, your procedural skills, and just the skill of not giving up. I just kind of keep feeling like CMS, for instance, will start saying, Yeah, I don’t know. Maybe, you know, we really maybe they’ll start weighing in and say and then, you know Help influence the approval of a fellowship by the American, you know, the American Board of Medical Specialties Yeah, but I don’t know. We can only hope we can only hope and it’s so factionalized That’s another interesting thing about it. You know, there are people, you know, this group says we should you know, know, call it this and somebody else wants to call it that.

[51:36] So I don’t know. Do you think there’s any hope? Hope, yes. Will I see it in my lifetime?
I’m pretty skeptical about that for exactly the reasons that you have just mentioned and particularly, you know, the turf battles and things that go on.
But the good news is that because people like you are doing it well and emphasizing the fact that there is good science behind this, I think it certainly has a chance.
It’s just a matter of when the stars and the economic forces start to line up in the right way. Yeah, yep.

[52:19] Well, I can’t tell you how much I have enjoyed this conversation, Mark.
It’s been, I forget how long, but between four and five years, I guess, since I retired.
And it looks to me like because of you and people like you, a lot of good things are actually happening in the world of chronic wound care.
I certainly hope so because you and I know that it’s just a gigantic problem and we’ve got a lot of people out there that deserve better care than they have gotten up to this.

[52:55] Point and thanks to people like you that is the case.
There is no question that if you had the time I could carry this conversation on literally for hours because it’s an area that I have obviously a lot of personal interest.
But this show is about you, so what we’re going to do at this point is I’m going to close my mic and get out of your way, and audience, Dr. Mark Getterly is going to share his personal prescriptions for success.
All right, well thank you. So first and foremost, I would say that I try to lead a relentlessly examined life, and so I’m often asking myself, why am I doing things this way?
Why is my practice the way it is, my marriage, my business?
Why do I have the current set of frustrations that I have? Can it be different?
I try to eschew assumptions that the most common pathway is the best one.
So hence my decision to take the MCAT as a sophomore.

[54:04] I try to see myself as an element in an ecosystem at work, at home, at large.
What am I giving out? What am I receiving?

[54:15] And I know it can’t all be good or optimal. So I try to be open to the idea that my patterns and tendencies don’t always meet my needs or others’ needs and just ferret out the opportunities to create change.
One of my observations is that as physicians, we can be incredibly obtuse and even arrogant in our attitudes toward those we work with and those we ostensibly work for, including our patients, without realizing it.

[54:46] So for those of us who have been in medical leadership, we see this writ large.
As a hospital chief of staff, I just could not believe the degree to which as physicians we can fail to sometimes see our foibles.
As chief of staff, I dealt with colleagues with anger management problems, documentation problems, productivity problems, knowledge gaps, life balance issues, substance abuse challenges.
And I would go home, and I’d look in the mirror, and often, I’d see some of the same things.
It’s a chronic malaise in medicine.
And of course, career burnout, for partly these reasons, is epidemic.
So the challenge, I think, is to bravely see our maladaptive behavior patterns, and do not assume that we’re immune to them.
We all have them.

[55:47] And own them, and then relentlessly chart pathways to replacing them with better ones.
Just continuously be looking for these opportunities. I think we’re all in some kind of rut at any given time, and so the first trick is to notice the rut and then look for an exit, and really chart a new course and stay with it. So one of the ways I’ve tried to do that is is I’m a big believer in journaling.
It has helped me to be objective. When I see my words on a page, it’s one thing to have an opinion about something or an intuition about something, but something happens when you see your words written on a page.
Things become clear, epiphanies happen.
I think it stimulates our frontal lobes to go to work on finding solutions and you start to notice solutions.
And besides journaling about the present and the past I found immense value in writing out goals, Envisioning for the future and I have just I’ve written numerous pages and I don’t necessarily do this on a regular basis, but I do it on a periodic basis and.

[56:58] Especially when I sense, you know that things are kind of in a rut and I really try to have you know sort of clarify what an idealized future would be like. And then once that clarity starts coming, then sort of the frontal lobes kick in and things start to, you know, start to notice things in terms of where I should move to meet those goals. So, I cannot overstate that.
Journaling.
And visioning, I think, are just absolutely key. Coaching, I also think, has helped me to jettison limitations.
And I was skeptical at first about the idea of having a personal coach.
But just for example, in terms of a mundane goal, if you will, it’s helped me to double my income in one year, but meet other goals that I never would have believed possible.
So I really recommend finding a good coach and give your best effort.
If professional athletes do it, why shouldn’t physicians do it?
One of my greatest personal realizations has been the incredibly different psychological profiles of the human beings that I have known and worked with.
And when I began to study Myers-Briggs personality profile system, I was really dumbstruck at how obtuse I had been for most of my life in that I was projecting my own motivations and tendencies on others and.

[58:25] Of course I knew quote-unquote that there were personality differences but I didn’t realize how fundamental they were or how impactful it could be to understand my own personality type and others better. So studying this has given me incredible gains in my marriage, my business, my career, patient care, life Life satisfaction, life balance for physicians gets a lot of press, a lot of platitudes are spoken and written about it.
For me, it’s a primary principle to be home in time for dinner 95% of the time and home, on weekends with very few exceptions.
For a conference or for an important evening meeting, I’ll make an exception, but 95% of the time I’m at home by six o’clock and I’m home on weekends. Now I know that’s impossible in some specialties to do predictably, but if that is a life balance goal for you and I you know it’s it’s worth pondering, it’s worth journaling, it’s worth brainstorming about how that might happen at least in some predictable way. I just feel like we give lip service to life balance and Again, a lot of platitudes are spoken about it.

[59:47] Making life balance happen has featured very heavily in my own journaling and visioning as my career evolved and.

[59:57] In addition to that just those sort of those time Parameters in terms of life balance. I’ve tried to meditate every day for about 30 minutes in the morning for the past 20 years I think that has been immensely. I mean just the benefits of that and of course, they’re written about you can find literature on this it has really made a difference for me.
Nutrition and fitness are extremely high priorities for me. I feel like I can’t give health advice if I’m not physically fit and vibrant.
So I can outperform my 25 year old self in many ways. I can deadlift more, I can bench press more, I can, I think I can do wind sprints better.
And I owe this to myself, my loved ones, And really, I owe this to my patients and my colleagues.
I feel like when you show up in great shape, you inspire everyone you make contact with to do better, especially your patients.
Finally, regardless of how burned out you feel, I would assert that there is a way you can evolve your career in any specialty while improving your life balance.

[1:01:09] But the specific pathways involved may not be immediately apparent.
So I recommend visioning a life for yourself and your family that embodies the balance you seek.
Visualize what your days look like. Visualize the things that occupy you.
Sort of re-imagine your specialty and doing your specialty.
And I think when you start doing that and journaling that, describing that, describing those values, you’re gonna be receptive and open when options and pathways conducive to that balance appear.
For me, as an example, that has meant transitioning over the past several years to less clinical time.
I still love taking care of patients. I still get to do some patient care every week, but it is more in the context of mentoring other folks in my specialty.
And I can do one-on-one mentoring now, I’ve carved out time for that.
I’m lecturing, you know, oh gosh, 25 hours a month and involved in administrative work.
So it’s much more balanced and it has allowed me to do those things.
And maybe that’s a pathway that would work for others.
You know, think of other ways your specialty, you can be involved in your specialty, that still are supportive of all of your life goals, your family, nurturing yourself, your needs, their needs.
And I think you’ll find them.
And that’s it.

[1:02:39] Well, that’s about as thorough a list as I have ever heard since I began doing this interview program.
I think you really covered the gamut and you’ve done it very, very well.
And I thank you for sharing with us today, Mark.
Before we go, I want to give you an opportunity to tell our audience, because I know some people are going to be interested, tell us where you can be found and how they can get in contact if you like.
Absolutely. So, my email address is marcus.gitterle at woundcentrics.com and that’s wound, W-O-U-N-D-C-E-N-T-R-I-C-S.com.
And I check that regularly.
And I love to collaborate. And if you’re interested in wound care, we have many openings on a regular basis.
And of course, our training opportunities, Wound Care University, hyperbaric medicine training.
And if you just want to collaborate, I’m a PI on a couple of research projects at any given time, it seems like. And I’m always interested in new things.
So I welcome the contact.

[1:04:04] And you guys have really sort of upped the game in off-site learning.
It’s not like if people are interested in learning more about hyperbaric medicine and wound care, they don’t necessarily have to travel.
They can actually attend your courses online.
Is that correct?
That is correct. And we even have asynchronous courses now. We have a 20-hour wound care exam prep course that can also just be taken as an introduction to wound care.
And you can do that on your own time anywhere. Of course, the hyperbaric course is a live course, but it is remote.
And so, gosh darn, I’ve had attendees, multiple ones from Canada, all over the US, Europe, Eastern Europe, Western Europe, Asia, South America, just it’s incredible.
The reach of that course.
Well, it’s a great opportunity and I appreciate you sharing that with us.
This has been a great conversation. I have, for many selfish reasons, enjoyed it very much because of our shared background.
But once again, Mark Gettledy, thank you so much for being here.
It’s been a pleasure.
It has been a pleasure as well. Thank you.

[1:05:25] Thank you so much for listening 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.
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That link is in the show notes, and we also hope you’ll follow our companion podcast, Life Changing Moments with Dr. Dale Waxman. Special thanks to our producer, Craig Clausen, our promotions manager, Mariana Rodabaugh, 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.

[1:06:17] Music.