Insights on Providing Healthcare in One of America’s Most Diverse Cities - Dr. David Lubarsky, Vice Chancellor of Human Health Sciences and CEO for UC Davis Health

Michael Carrese: Hi, everybody. I'm Michael Carrese, welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. 

We're going to do that today with Dr. David Lubarsky, the Vice Chancellor of Human Health Sciences and the CEO for UC Davis Health in Sacramento, California, where he oversees the UC Davis School of Medicine, the Betty Irene Moore School of Nursing, UC Davis Medical Center, a children's hospital, and a rehab hospital. 

Hallmarks of his five-year tenure include expanding care to underserved communities, creating unique partnerships with both the public and private sectors, and putting the health system on a sustainable economic footing. 

An accomplished physician and scholar, Dr. Lubarsky is also a professor of anesthesiology and nursing, a faculty member in the UC Davis Graduate School of Management, and a national expert on behavioral economics in health incentive systems, among other subject areas. We're really looking forward to getting a take on the current and future state of health care and medical education from the perspective of an academic medical system leader, because they play a very, very important role in our health care system. 

So we're very pleased to have you with us today, Dr. Lubarsky. 

Dr. David Lubarsky: Thank you for the invitation and for the kind introduction.

Michael: So, we always like to start with learning more about our guests and what first got them interested in medicine, and in your case, anesthesiology. 

Dr. Lubarsky: Right. Well, I sort of knew I wanted to be a doctor from the time I was eleven years old, and never deviated from that path. It all started with my family doctor, Dr. Leonard Shafton, who also happened to be the grandfather of one of my childhood friends. I was feeling sick with a stomach flu one day, and my parents called him up and he came over to our home, which was a few miles away. He made the old-fashioned doctor house call and came with this black bag and a bottle of flat Coke and spoon and sort of spoon fed me some, you know, flat sugar water, and oozed compassion and caring and made me feel better. I realized that I wanted to do that. 

Now you may say, well, heck, a home visit to a pediatric patient is a far cry from being an academic cardiothoracic anesthesiologist, and indeed, it is. But the same thing that drove me then, which was to be able to help people, drove me to try and be the very, very best doctor taking care of high-risk patients to get them safely through their surgery. And the same in terms of the leadership role I aspired to and now have, which is the ability to use that position to leverage all the good that an organization can do on behalf of each and every individual patient. Harkening back to that very first day when I was feeling so sick, and I just needed someone to hold my hand, basically. And in fifty years, that has not changed.
 

Michael: Yeah, that's very powerful. So, you knew from eleven you wanted to be a doctor. When did you decide that you wanted to be a leader? When did it get on your radar that you were interested in academic medicine and then leadership? 

Dr. Lubarsky: Right. Well, again, since I knew I wanted to be a doctor, I applied myself and got into a variety of combined pre-medical and medical school programs. I was actually the first graduate of Washington University in St. Louis's Scholars Program in Medicine. Got an amazing education -- undergraduate in history and then medical school there -- and I just wanted to be a pediatrician. I was on that route. I got three years through medical school, and I had all these electives lined up through pediatric orthopedics, pediatric cardiology, regular pediatrics and at the end of it, I felt the world was unfair and it made me very sad every night to be unable to help sick children, to not really be able to cure them all the time. And so I found myself adrift and sometimes you don't realize that there's a reason for that.

It turned out academic anesthesia was a great calling, but that wasn't what I was doing. I was a little disillusioned because of the limits of medicine. I'm like, I'm just going to go. I'm going to be a practicing doc. I'm going to give back to the community by, say, volunteering my services for anesthesia, and then I didn't realize that in academic medicine, my whole life would be volunteering, right?

Michael: (laughs) 

Dr. Lubarsky: So, in my last year of residency and my fellowship, I started to do some research into the basic physiology of cellular metabolism under low flow states and I was doing really well as a student and a trainee and they said that I would drive private practitioners crazy because I was constantly asking questions and wanting to know things for which there was no answer and they insisted that I pursue a career in academics, which I did.

I was recruited down to do some basic research more than a quarter of a century ago to work on near-infrared spectroscopy when it was first being invented. So, it was kind of accidental. It wasn't my plan. My plan was to be a practicing pediatric either doc or specialist and yet I ended up, like I said, in cardiothoracic anesthesia, taking care of ninety-year-olds and doing lung transplants and heart transplants and CABG valves and all that stuff. 

Michael: Yeah. I knew a cardiothoracic surgeon who'd done 10,000 procedures and he said dealing with somebody's heart is a very, very special thing. There's a spiritual sort of aspect to it and it's incredibly important for people to feel trust in the team in that circumstance. Very important stuff.

So, give us a sense of UC Davis Health system that I kind of outlined there at the beginning and what you think makes it stand out. 

Dr. Lubarsky: Well, so first of all, I have never been to a place that is so down to earth, honest good. I mean, it's not that like there aren't characters and, you know, some self-interested people -- there always are in any large system, especially an academic system -- but people here are actually genuinely nice. It is much less like San Francisco than it is Iowa, in many respects. 

You know, we're the only academic medical center for a very large swath of the country, meaning between the Pacific Ocean and Salt Lake City. We're the only one east to west and north to south between San Francisco and Portland. There is no other. We're smack dab with a catchment area of six to eight million people. Our Level 1 trauma service serves thirty-three of the fifty-eight counties in California, and we train an amazing number of excellent physicians while turning out of our medical school the truly most diverse class in the United States of America. 

We are committed to doing that...to have our people, our employees, our students, and our trainees reflect our communities. And it's not lip service here. It is heartfelt and our principles of community are practiced every day. Our cultural and linguistic sensitivity is on our sleeves. Our care for everybody from a two-day-old to a hundred-year-old is focused and specialized. And we don't skimp on caring. I mean, we're lucky. We've had some resources to deploy recently, but it's really the care. 

As a CEO, I've had a lot of different jobs as an executive in many health systems and I used to get, you know, ten letters of complaint for every one that would be effusive in praise. At UC Davis, it's the exact opposite. I've never seen a place where I get ten letters of effusive praise for the team or the caring of the nurses and the respiratory tech and the transporter and, of course, the physicians and the nurses, and so few complaints because that is written into the fabric of this organization. So, that is something you can't do as a leader. You can't change the culture of caring, or at least it takes ten or twenty years. That is built in. 

But what wasn't built in was an appreciation of how great we are. So, I would say the one thing that I've been able to help this organization with in terms of changing its trajectory is for it to believe in itself about how good it is and was. And as a result -- by just giving great people the opportunity to do great things by believing in them -- we've managed to become one of the top ten brands for local consumer loyalty when we were near the bottom seven years ago.

We have the largest growth trajectory of academic medical centers, maybe any medical center in the United States of America. We have been growing 1% per month for the last sixty-six months, which is almost unheard of, even through COVID, through all of it. We've taken all of that growth and we have channeled it into the largest capital building campaign in the United States of America. We have more than $7 billion under construction.

Michael: That's huge. 

Dr. Lubarsky: Yeah, it's really big. It's a generational change, and we have not had a new research building on this campus until now, for forty years; we have not had a new major clinical building for thirty years; and we are literally quintupling our ICU capacity and doubling our OR capacity, building the largest hospital outpatient ambulatory surgery center in the United States. We are just hitting on all cylinders -- not because we're trying to take over, because our motto is to complete and not compete with other healthcare systems -- but to meet the needs for that giant area that I talked about and the specialized services that you can only find at UC Davis, and frankly, to stop thinking of our larger city companions in LA and San Francisco as being better than or different than what we can and are currently.

They are amazing institutions, but so are we. 

Michael: Yeah. This also resonates. I was born in the Albany, New York area, another state capital in the shadow of a huge, famous city with everybody expecting the best out of New York and maybe not so much the best out of Albany, but our health system was fantastic there. You have to sort of overcome that mentality, that inferiority complex, if you will. 

Dr. Lubarsky: Yeah. And I think just the growth trajectory, and again, our burgeoning subspecialty programs. We just finished our eleventh liver transplant, starting up our liver transplant program. You may say, well, why is that important? There's a liver transplant program, ninety miles down the road in San Francisco,. But all of Northern California actually has a higher mortality rate from chronic liver disease than any of the other urban areas in California. Why is that? Because there are no advanced programs easily convenient and when people are sick, they don't travel all the way to the big city. So, we're not trying to take any business away. Actually, what we're trying to do is increase the work on behalf of patients who would otherwise not receive those services.

So, we really believe that we're hitting our stride in a way that takes away nothing from anyone else but delivers in spades for all the local and regional hospitals with whom we have affiliations and partnerships.

Michael: Yeah, that's a really important niche that you're occupying there. Let's shift to education for a minute because it's been an unbelievably tumultuous time and doesn't seem to stop. AI has worked its way into everybody's consciousness and is starting to have an impact on clinical care, but also on education. So, talk a little bit about, you know, what's happening there from a curricular standpoint and how you're trying to roll with all these punches.

Dr. Lubarsky: Well, first of all, holding back the hands of time or the tides of water has never succeeded. If you just start from that supposition, it's like saying, “I don't like those dang iPhones. It's going to be too easy to look up answers one day.” Well, yeah, but the iPhone has not replaced the need for human cognizance, has not replaced the need for human sentience. It has augmented our ability to have information at our fingertips. This is just the next phase where the stuff that appears on ChatGPT, et cetera, is actually a little more robust, a little more complete and takes a heck of a lot less time to search through to get the answers you need.

It doesn't replace the need for holding someone's hand, being their partner in their healthcare choices, caring about them as a human being and helping them navigate either their limitations or their recovery from limitations. No computer and no AI is going to fix that. 

So, number one is understanding what is the place, not of artificial intelligence, but of augmenting the intelligence of our caregivers. So that's number one. At the same time, we have an obligation as the gatekeepers of such information and such searches to make sure that we can direct both our patients and our caregivers and others to the right information. To guarantee that so-called AI hallucinations that give you false information or AI has no actual thought, right? It just combs the available information from the past, synthesizes or looks for patterns you might not otherwise recognize, but can draw false conclusions, even if the data is sort of right, but inflected with bias. And so there's a lot of work to do to make sure that augmented intelligence doesn't augment our bias at the same time by accident. But to avoid it or not to work with it and not pretend it's going to be great...that's silly. It's about how do you harness it on behalf of our patients?

Michael: You mentioned community a couple times earlier on and having a very diverse student body so I want to kind of explore that area because it’s one of the hallmarks I mentioned at the beginning. Talk about the partnerships you've developed and how you're trying to serve the community, and also help people understand what the community is that you're trying to serve. I know you have a huge catchment area, but in this regard, what are the needs you're trying to meet?

Dr. Lubarsky: Right. Well, I think that's a great question and I'm going to start with some examples of our local communities, relatively local communities. We've realized that health equity can really only be achieved if there's a combination of the healthcare being provided, the education that's necessary to take advantage of the information and the prescriptions, if you will, for how to take care of yourself, and if you actually have the time, the energy, the focus and the resources to get what's needed to make yourself well or keep yourself well.

So, economics, education and healthcare equity occur in that order and so we're trying to do our part in our anchor institution mission we call AIM for Community Health. We said okay, we have all these empty jobs like everybody did a couple years ago...tons of empty jobs and yet all around us there were these ten very underserved zip codes in Sacramento by virtue of education, unemployment, and median income. We said they have a lot of unemployment and we have a lot of jobs so what's going on because only six percent of our workforce came from those zip codes. 

What we found out was that it takes, like, a four-year college degree to actually navigate our website and maybe more -- because I have trouble sometimes and I got a lot of degrees -- and so we actually did all these community job fairs where we walked people through the application process. We also became friends with our community benefit association and got them to be our allies in recruiting people who needed jobs to the jobs that we had. We've managed in two years' time to go from 6% to 20% of our unlicensed workforce from those ten most underserved zip codes. So, when people talk about health equity, you have to actually make sure that there's enough resources in the community to support healthy options. 
 

Then in terms of education we’ve been reaching out, especially to people in the high school level or early college level. We have several programs that specifically reach out to the inner city or to the Latino population that are around to inspire them to enter into healthcare fields. 
 

Our medical school has a holistic admissions process that tries to create or develop physicians who better reflect the makeup of our community. We've been incredibly successful in doing that. U.S. News and World ranks us as the number three most diverse medical school in the U.S., but that's wrong because Historically Black Colleges and Universities have more underrepresented minorities, but they're mostly African American.

Number two is Florida International University, which is almost all Hispanic. But we actually have Asian Islanders, and we have the largest number of Native Americans in the United States, and we graduate the most Hispanic medical students in the United States. Two-thirds of our medical students come from the lowest half of the economic strata as opposed to every other medical school, which is 80% from like the top quintile or something crazy like that. 

We really have a process of our admissions that says how do we find people with talent and drive commitment and compassion and give them the support and the help that they need to become physicians and they don't have to have the best MCAT scores to start with. There's a bunch of new publications that show that on standardized tests, the rich do much better. It doesn't necessarily mean they're the more intelligent or more clever or more hard-working. It's just that they're trained on standardized tests. I speak about this because one of my daughters had a perfect score on the ACT. She's one of 1500 kids. How did she do that? I got her tutored every week when I was a professor. I thought that's really important but it didn't make her a smarter person just made her a better test taker. 

We need to reach down into our communities and find those incredible talents that maybe haven't been tutored in taking multiple choice tests. We're being very successful with that finally because it requires a pipeline. So, we have this great diverse class. We're graduating some great doctors and now we're beginning to bring them into our own graduate training programs and so they're becoming more diverse, and that will then help us get to the level of diversity in our faculty. That's the ultimate goal: that the entire organization reflects the community that we serve. 

I will just say that in terms of our brand loyalty, our growth trajectory, people go, “Well you're taking substandard people you're probably hurting medicine.” I hear this all the time and I'm like, “You don't know what you're talking about because we have a very diverse organization and you know we're lately number two or number three for mortality in the United States of America, so I don't think that what you're saying is right.” We have the best mortality rates in trauma in the United States, so I’m pretty sure that the people we're hiring are great and they're diverse, and those things are not at odds.

Michael: Yeah, there's also a fallacy that people learn at different rates. I saw some research that it's really not about that, but just that people start at a different place. If they have had exposure to tutors and have taken lots of tests, they're sort of starting at a different place than other folks who haven't had that in their life.

Dr. Lubarsky: Right and again...native intelligence and street smarts. I will just say as someone who ran the largest anesthesia training program in the United States for many years that some of the very best highest scoring test takers were by far not the best physicians in the organization because those are two different skill sets, right? Regurgitation of information is one thing that you get on standardized tests; synthesis and application and compassion are different skill sets.

Michael: Yeah, completely, and the more important ones, getting back to AI’s ability to take a lot of the memorization and that sort of rote learning off the plate -- all the decision support stuff that it can do -- that makes it even more important that people have the soft skills, the human skills, that ability to synthesize and connect that you're talking about. 

Dr. Lubarsky: I'll just say that plenty of studies out there show that if you have people that look like you -- either as your caregiver or around in that clinic -- the people who are from that ethnic or cultural background trust what you're telling them so therefore they follow the directions and their health outcomes improve. So, again, you can be the smartest person in the world and give the best prescription that's exactly correct but if you don't have the faith and the trust of the community that you're serving they won't follow your directions and so therefore you're not doing the job of healing and curing. So, it's something just to think about. It's not just being right, it's being effective.

Michael: Very well said. I’m sorry to say we're getting close to the end of our time, so I want to shift to one of our favorite questions, which is to get some advice from our guests. You are around students, obviously, all the time. What's your go-to advice for learners and early career health professionals? 

Dr. Lubarsky: Find your dharma. That’s from Jay Shetty’s book, Think Like a Monk. Someone insisted I read it a few years ago. I'm like, wow, that's such a great book. It has a lot of great information about leadership, but the part I really liked was find what you love, find what you're really passionate about, find what has meaning to you, find what you're really good at, and if you can join those all together, that's what you should be doing every day. Because then it's not like a job. It's your avocation, not your vocation. It's your purpose. 

If every day you go to work and you're fulfilling your purpose in life, your life is great. My life is great. I love coming to work. People go like, “You work so hard, so many hours.” I'm like, I love what I do. That's why I work this hard. Not because I think I'm making a difference. I could be deluding myself, but that's how everybody should be, which is that they shouldn't live to work, but you should actually love your work. 

Michael: Wonderful advice and a great note to end on. I want to thank you so much for taking the time to be with us today, Dr. Lubarsky, and also for all the work you're doing there at UC Davis to provide the community with the healthcare it needs and to train future healthcare professionals. It's really been fascinating.

Dr. Lubarsky: Well, thank you very much. It's a privilege to work with the team here at UC Davis Health and I just want to close by saying I have been inspired all along the way by one of the foremost African American educators, my boss, Chancellor Gary May, whose lifelong commitment to diversity and equal, not only opportunity, but equal outcomes for learners and students is inspirational. 

Michael: Well, thank you for sharing that with us. I'm Michael Carrese, and I want to thank our audience for checking out today's show and remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.