Compassion, Passion, and Commitment - Dr. Mark Schuster, Founding Dean and CEO, Kaiser Permanente Bernard J. Tyson School of Medicine

SHIV GAGLANI: Hi. I'm Shiv Gaglani. Today, on Raise the Line, I'm really privileged to be joined by Dr. Mark Schuster. Dr. Schuster is the founding Dean and CEO of the Kaiser Permanente Bernard J. Tyson School of Medicine, which opened earlier this year. Before assuming that role, he had a long career in the Harvard system and at UCLA during which he held various leadership positions. He's recognized as an international leader in research on child, adolescent and family health and he is a member of the prestigious National Academy of Medicine. Dr. Schuster, thanks so much for taking the time to be with us today.

DR. MARK SCHUSTER: Thank you for having me.

SHIV GAGLANI: Can you start by telling us a bit about yourself and how you got into medicine and then specifically pediatrics?

DR. MARK SCHUSTER: Yes. In college, I got involved with converting the campus to become more accessible for someone who would use a wheelchair. That got me very interested in health policy issues. Then I worked in Congress for a Congresswoman, one summer, on health issues. That got me thinking that I'd like to work in health advocacy. I also, around that time, met a pediatric surgeon and asked him if I could shadow, and I came away from that experience thinking that I might want to be working with patients as well, but I didn't have an instant decision. I was a History Major in college, and I thought and thought and thought and eventually decided that I would like to both work with patients and work in policy research. 

That's how I wound up going into med school, and then in terms of pediatrics, I didn't really know what field I wanted to go into. I just started doing my third-year rotations in med school, where each month you do a different specialty, and I loved pediatrics. It was easy to like the children, but I also liked the parents, which wasn't always true for my classmates. I enjoyed the parents and understood their fears and frustrations, and I really liked the doctors and nurses and social workers. Everyone in pediatrics just felt so committed to the patients and so nurturing. I found my home. I was happiest during my pediatric month and then did more pediatric rotations and confirmed that it was a good place for me.

SHIV GAGLANI: That's fascinating. I actually didn't realize that about your college experience helping make the campus more wheelchair accessible. Do you mind telling us a bit more about that? The reason I want to double click on that is that we actually work with a bunch of Michigan medical students, including a gentleman named Chris, who I believe now is a fourth-year, if not in his first year of residency, who has quadriplegia. We actually did a clinician's corner with him talking about his experience as a medical student, and all of the great concessions that Michigan and his team made for his education. We'd love to hear a bit more about that.

DR. MARK SCHUSTER: Yes, sure. I haven't talked about this in a very long time. I worked for our college newspaper and I was assigned to cover the situation where a student was admitted, and then in the summer before he joined, he was in an accident and became quadriplegic and he still wanted to come. This predates the ADA. This is a very different era. The campus needed to be changed and I was covering it officially as a journalist, but I was the only student involved. So the team that was going around the campus kept turning to me and then I started jumping in. I was a terrible journalist. I was not able to just be an observer. I became a participant. 

An administrator would say, “Yes, this building's too hard. There's no reason for a student to have to go to this building,” I would jump in and say, “Well, actually it's the center of campus life. It's the major library where everyone gathers and meets, and the assigned readings are on reserve and everything else. He has to get in here.” I don't think they were very happy with me, but I do think it was important to have a student voice on where students needed to be, what buildings and rooms needed to be accessible so that was really how I got involved. They put in curb cuts -- again, there was just nothing and it made a real difference. I would say what was done back then in 1979 would be pale by comparison to what we would feel is appropriate now. But it got me really interested.

SHIV GAGLANI: Totally. I can see that. You've been advocating for students since maybe then, or even before then, and now in your role as Dean of Kaiser Permanente School of Medicine, I'm sure there's some parallels there. Transitioning over to your role in administration and leadership, can you talk a bit more about the innovative medical school? We'll get into COVID in a little bit, but we'd love to hear your own transition from being a pediatrician to being a leader in academic medicine, and then assuming the role as Dean of Kaiser Permanente Medical School.

DR. MARK SCHUSTER: I guess I've been president of the residents section of the American Academy of Pediatrics, so that gave me some experience with leadership responsibilities. I would also say that I got a Master's at Kennedy School of Government when I was in med school. That also gave me some experiences or some training in how to think about leading and managing, but when I was very early in my career as a pediatrician in academic medicine, I applied for a grant to start a center. It was the UCLA/RAND Center for Adolescent Health Promotion. 

The grant was from the CDC and it was a Center where you partnered with community groups to do work together. I got the grant and there was only one person at the Center and that was me. I had to quickly recruit other faculty and recruit staff to build this Center and then build our relationships with the community. That gave me, I guess, an early taste of what it meant to be a leader, to create something from scratch with a team in a very collaborative way. I really liked it. I liked the people I was working with. I liked our mission, but I also liked the idea that I had to think in a certain way and really feel a certain sense of responsibility for how this Center developed and succeeded, and then I wound up getting leadership roles. I was put in charge of a large program at RAND, which is a think tank in Santa Monica, and I became Division Chief, so I've had a series of leadership roles that I've liked. Those helped me learn a lot about myself and what I enjoy and also helped me develop skills that have been very helpful in my current position at Kaiser Permanente Bernard J Tyson School of Medicine.

SHIV GAGLANI: Can you tell us a bit more about the School of Medicine? Kaiser Permanente has a long track record of being an innovator in how they deliver care, how they insure patients. We have the connection of Rishi Desai, our Chief Medical Officer who, as he was transitioning from Khan Academy to Osmosis, was working with you all a bit on your ideations around the medical school. But what was the impetus for the school? What makes it special and different compared to the traditional way of learning medicine?

DR. MARK SCHUSTER: Yes. I really appreciate that Rishi was an early advocate for, and an advisor for the medical school. He actually predates me in terms of his involvement. I think what Kaiser Permanente recognized is that they've been involved with medical education for a very long time. They've had residency since 1955. They have been having students rotate through from other medical schools and they're getting site visited all the time from around the world by people who want to learn how integrated care and team-based care works and how all the innovations have been implemented. 

At a certain point, I think they just recognized that they have a lot to offer, and this would be a great place to start a medical school. I'll say I first learned about the medical school from one of the many health newsletters I got. I read that paragraph and I just thought it made perfect sense, and I wondered why they hadn't done it years before. Once you think about it, it feels so obvious that Kaiser Permanente should have a medical school. So I'm really glad they did and I'm really glad that I wound up getting to be in this position.

SHIV GAGLANI: We've been fortunate to get to know a number of the folks over at KP School of Medicine, including Matthew Silver in the Emergency Medicine Department and Abbas Hyderi, who we knew from UIC, where we work with as well. You have surrounded yourself with a really great group of people, the ones we've met. The students are obviously the reason for the medical school. How did you all select them? What were you looking for? As I understand it, you all have made a pretty impressive financial commitment to them in terms of making sure that none of them will graduate with any tuition debt.

DR. MARK SCHUSTER: Yes. We have a terrific admissions team. The team is led by Lindia J. Willies-Jacobo, our Associate Dean for admissions who is very experienced. She put together a committee and what we've done as a whole school is to create a very authentic holistic admissions process. We don't use computers. We don't use artificial intelligence for admissions. Although we use artificial intelligence in the clinical setting, in admissions, it's by human beings. We have almost 12,000 applications this year for 50 spots. We have a very high ratio of applications to spots and our fall reviewers review all of these applications. What they're looking at is of course the metrics that are there -- the MCATs and the GPA -- but they're looking at who these applicants are, what they care about, what drives them, what distance they have traveled.

We take into account if they have come from a community where it's unusual to go to college, and it's unusual if you go to college to finish, or to even get yourself into a position to be able to apply to med school. Our committee really thinks about what hurdles our applicants have to overcome. Of course, they look at their activities and their passions. They really try to look at the whole person and I think they did a phenomenal job. Our first 50 students are wonderful. They are compassionate and energetic. They are engaged with what's going on in the world. They are committed to health equity, and they want to be fantastic doctors and advocates for patients and communities. I can't say enough about how excited I am about our student body.

SHIV GAGLANI: Yes. And add to that, they must be resilient, right? Let's switch gears over to COVID because clearly, I think when most of them, when those 12,000 people and 50 successful applicants applied to medical school, this was probably last year before COVID was a major factor in the U.S. How has it been opening a medical school in the middle of the worst pandemic we've seen in the century?

DR. MARK SCHUSTER: We had some decisions to make when the pandemic hit. “Should we postpone the whole school for a year?” Should we go completely virtual?” I will say that we benefited greatly from the advice of deans from around the country, deans from other schools, everyone at other schools. They have been extremely generous in taking our calls and answering our questions and helping us learn from their own experiences. We were far enough along that deciding to postpone a year would have been very hard. We'd already been accepting people. They had accepted us. They were coming and we were eager to have them, so we quickly set aside the idea of postponing the school for a year, and then we really focused on whether we should be virtual or what we did become, which is hybrid, meaning that most of our classes, most of our learning isn't in person, but we do have some components of our curriculum that are virtual. 

We just did a complete review of the curriculum and decided what we could do in person and what really needed to be virtual. We have the benefit of a building designed for over 200 students, but we only have 50. We only have our first class so we were able to take all of our small groups of eight students or six students, depending on the class, eight students with two faculty, six students with one faculty member and move them into much larger rooms than we had originally planned. We had the space, so we were able to do it. Everyone is of course wearing masks. We are keeping our distance. We need to be screened every day to get into the building. We have a lot of cleaning, so we were able to make it work. 

We do have some classes that are virtual. For example, learning how to take a history from standardized patients or actors who are playing a patient. We're doing most of that virtually so that you can see each other without a mask. There are some other elements that are virtual, but the bulk is in-person and it's been going really well, and we're really happy with it. COVID-19 has also affected the curriculum, not just in terms of the logistics, but in terms of the content. We were, of course, already teaching about corona viruses but now the students really wake up when we teach about corona viruses. They're not just one more virus. 

They are something that really resonates with our students, and we are teaching how to prevent, diagnose, and treat people who have COVID-19. In addition, it's coming into the curriculum through health disparities. We already have a pretty robust training in health disparities, but now we have an example playing out in the news and people's lives and the lives of family members with COVID-19. So they’re learning about, they're observing, the racial, ethnic, and socioeconomic disparities, and who gets COVID-19, who is treated for COVID-19 access for healthcare, who dies. 

All of that is playing out in real time, so it has become an extra opportunity for us to teach our students about health disparities. It's also an opportunity to teach our students about disparities in who gets new treatments. In this case, who will get the vaccine? How does vaccine distribution work? How has new technology been disseminated in the past? Who's gotten it and who's gotten it a few years later or a decade later? So vaccines have also become an opportunity for students to learn. There are many ways in which COVID-19 enters into our curriculum.

SHIV GAGLANI: Yes, clearly. It'll be interesting to see how many of your inaugural class of 50 wind up choosing their career paths based on the seminal experience of their first year in med school. On that topic, imagine it’s 2025 now, and this first cohort has graduated. They're all in residency at this point. What would you see as success for your inaugural cohort and moving forward for the KP School of Medicine? Do you want most of these students staying in an integrated delivery network like KP, going into family medicine? How would you gauge success as the Dean of the school?

DR. MARK SCHUSTER: There is no requirement for the students to work in the KP system. You mentioned earlier the fact that we have waived tuition for our first five classes, but there are no strings attached to that. We want them to find what they love and go off and do it. They can go into working in a community health center, a Federally Qualified Health Center. They can go and work as a staffer in Congress or in the state legislature. They can open up a private practice. They can work at a place like Kaiser Permanente. They can go into academic medicine. They can go abroad and help build a clinic. They can do whatever works for them. We are not pushing them in any direction. 

In terms of success, our students have come in with enormous passion, enormous commitment. They are the kinds of students who want to save the world and save the world in that nebulous -- well, actually many of them aren't so vague and nebulous -- many of them are very focused, but still they fit into a category that is often talked about in medical schools of the students who want to save the world. Well, that's our student body. They're not just the subset of our student body. 

They are a student body, and they'll get more focused as they go through med school, but I would love to see them leave with the same compassion, same passion and commitment they entered with. We do not want to drum it out of them. We do not want to burn them out. We do not want to destroy that specialness that so excites our admissions committee and so excites us now, so that will be success. If we help them go into the careers that they really care about, that we help them go into the residencies they want and be prepared for the careers they want, that will be success. It is our job to serve them and to help them get where they want. 

I do think many of them will be going into primary care and wanting to work in underserved communities, just based on the interests that they brought to our school and that they are learning about… disparities and the wide variety of types of patients that they will potentially be exposed to throughout their careers. This is not the kind of school where, when someone says they want to go into primary care, they're told, “You're too smart for that.” They are celebrated. They are in an environment where it's understood that being in primary care means you have to understand everything. You have to understand every organ system. You're the one who often makes the diagnosis and then refers the patient to the subspecialist for treatment, but primary care is an important and wonderful field. 

That's because it's viewed that way in Kaiser Permanente in general, and it's viewed that way by our school. The fact that we are waiving tuition we hope will help students who come into medical school wanting to go into primary care or pediatrics or infectious diseases, fields that pay less generally than some other fields in medicine. I say that with a recognition that all physician fields are still in the higher end of the income spectrum in our country, but still within medicine often students come in wanting to go into certain fields and as they watch their debt rise, they switch. If one of our students who wants to go into primary care right now falls in love with orthopedics and decides that she wants to go into it. That's great. We want to support her in it, but we want her to do it because she falls in love with orthopedics not because she's looking at her debt and decides that she can't go into primary care or can't work as an orthopedist in an underserved community. We want them to hold on to their dreams that they came in with and help them follow wherever their heart takes them.

SHIV GAGLANI: That's great. It's no wonder that you've had 12,000 applications for those spots with that mentality. We had another guest on Raise the Line, Dr. David Skorton, who I know you know well from the AAMC. One of the shocking facts that came out was that the median debt of graduating medical students is now over $200,000. So, it's quite a gift you all have provided them to not encumber them with that. 

Hopefully, one thing from our perspective that COVID will lead to is policy changes that reduce the debt burden on our future healthcare heroes, because I think there's been a societal shift in how we all view and look at everyone from grocery store workers, to nurses and staff to obviously primary care physicians. I have two last questions for you. One is, what advice have you given to your inaugural class of students and what advice would you give to other people considering careers in healthcare, especially given all of the turbulence of this past year with the COVID pandemic?

DR. MARK SCHUSTER: The advice I've given to our students is really something I've already talked about, which is to hold onto their passion, remember who they are, remember why they wanted to go to med school and what they cared about. I've actually asked them to write that all down in a letter to themselves that we will give them back at graduation. The other thing I advise medical students is to remember their patients, and that may seem obvious, but to really commit to their patients and do everything they can to help their patients, to serve their patients. 

We are eager for our students to be those who practice patient or person-centered care. To remember that they don't just tell the patient what we're going to do but to tell the patient what the options are and help them understand the pros and cons, and remember that it's the patient's decision what kind of treatment they might get, how they're going to manage their health and their healthcare, and that we are here to help be guides and to be interpreters and to do whatever we can to help the patient. And to also remember that what we do in the clinical setting is important, but there's so many other factors that influence our patient's health. 

What goes on in their home, in their schools, in their workplaces, in their neighborhoods, all have a huge effect on their health and their ability to get healthcare and follow through. Can they afford the copay when we write a prescription? Are they actually going to fill it? If we encourage them, if we tell them they need to exercise, do they have a plan? Do they know how?  Do they have a place where they can do it? Is it safe in their neighborhood? Can we help them come up with a strategy to get healthier food, learn how to prepare it and eat healthier? 

Or are we just saying things like, “You should eat healthier,” and not actually helping our patients figure out what that means? We are very much working to help train our students so that they will be really engaged with their patients and being able to view them as whole people in the context of their whole lives. We believe that will make them much more effective physicians and advocates for their patients. That's just part of what I advise our students and other students who reach out to me.

SHIV GAGLANI: I couldn't agree more. I've been working a lot to rewrite questions that had been written at Osmosis some years ago to describe someone as “a person with diabetes” as opposed to a diabetic patient. So even language changes in assessment items or video scripts can help create this narrative long-term that you've got to see the whole patient and understand concepts like shared decision-making. So, it's been great to partner with you all on some of that work. Is there anything else you'd like to share with our audience about you, your background, about the Kaiser Permanente School of Medicine that you think they should know?

DR. MARK SCHUSTER: I would just say that we are working really hard to create a terrific learning opportunity at our school. If you're thinking of applying to med school or coming to work in a medical school, please go to our website, read about us, learn about us and see if you think we might be a good fit. But even if we're not a good fit, I hope that if you're thinking of becoming a doctor, that you pursue it. It's a wonderful profession. This international tragedy of this pandemic has made it even more clear how important physicians, nurses, respiratory therapists, pharmacists and everyone else working in the healthcare system is. 

I also recognize that it has helped us understand how important many, many people are, particularly people who help keep food, the whole food chain in our country. You referenced people working in grocery stores earlier. So many people are making a difference in keeping people alive and keeping people safe but since I'm here, I'm speaking to you from a medical school, I do want to emphasize how much of a privilege it is to get to work in healthcare.  So for those of you who are thinking about working in healthcare keep thinking about it, look into it, talk to people who are in it. I hope that many of you will pursue it. It's a wonderful opportunity to get to work in healthcare and in particular in medical education and as a physician. Thank you for the opportunity to talk today.

SHIV GAGLANI: Totally. Dr. Schuster, thanks. Thanks for taking the time out of your busy schedule to do so and also more importantly for the work that you and your team at the KP School of Medicine are doing to raise the line and increase healthcare capacity.

DR. MARK SCHUSTER: Thank you for taking the time to talk to me and to learn about our school and to be engaged with our school. We have found your videos very helpful. Our students use a lot of your videos in their pre-work and their preparation for meeting in their small groups. I appreciate what you all are doing, and you are helping us all do a better job in medical education.

SHIV GAGLANI: Really, really appreciate that. It's a privilege again, to be able to work with you all. With that, I'd like to thank our audience for checking out today's show and remind them to do their part to flatten the curve and raise the line since we're all in this together. Thanks again. Take care.