Serving the Underserved - Dr. Chuck Cairns, Dean & Senior Vice President of Medical Affairs, Drexel University College of Medicine

DR. RISHI DESAI: I'm Rishi Desai. Today, on Raise the Line, I'm happy to be joined by Dr. Chuck Cairns, Dean and Senior Vice President of Medical Affairs at Drexel University College of Medicine. Dr. Cairns is a leader in emergency medicine and critical care research and brings significant experience in leadership roles at several other medical schools to his position. He was also the Principal Investigator for the National Collaborative for BioPreparedness funded by the U.S. Department of Homeland Safety. Thank you so much for being with us today.

DR. CHUCK CAIRNS: It's a pleasure to be here. Thank you for having me.

DR. RISHI DESAI: Absolutely. We have six core values at Osmosis. One of them is “Start with the Heart.” I just want to start out by asking how are you doing during these very tumultuous times?

DR. CHUCK CAIRNS: Well, Rishi, thank you so much for asking. Clearly, these are tumultuous times, and they're stressful times, so one of the things I've been trying to do is just keep it all in perspective, in context. I've been through a lot of different challenges and a lot of different experiences and different positions, and one thing that is clearly important is to just remain calm myself and keep the context because there are enough external factors that can really challenge us, so if we can at least control the internal ones, I think we're better positioned to move forward.

DR. RISHI DESAI: Any advice on how you control those internal factors, either the professional ones or personal ones? Any advice that you can share, the things that have worked for you?

DR. CHUCK CAIRNS: Yes. I think one of the biggest ones is just to keep it in the context, not just professionally, but also personally, whether we call that work-life balance or whether we do not, just think about taking the big picture and realize that many people are feeling the same thing. Many people are looking for sources of support and help and inspiration.  And I think the last component would be looking for sources of inspiration. 

Keep a positive, optimistic approach, because we will get through this, and we'll do that by leaning on others and also by bringing others along, so many people will be looking to you on how you approach these things and your attitude towards it.  So be optimistic, put it in context and bring others along while you have to lean on some at the same time.

DR. RISHI DESAI:  That might be a good segue for me to ask how you first got started in medicine and particularly emergency medicine in critical care, and who are those folks that you might have leaned on early on in your career?

DR. CHUCK CAIRNS: It's a great question. I really wanted to be a physicist, and I wanted to be an astronomer, and then I spent a summer on a Road Crew in North Carolina, and I was with medical students. It was one of those jobs where you got to work four 10-hour days a week, which was a good summer job in those days. It was a pretty hot summer job, but the good news was I got to sit down and talk to medical students, and there were some law students on the same program, and really talk about their philosophy of life and what drove them to their professions. 

After that summer, I really started taking medicine seriously as a career. I majored in chemistry. I love physical chemistry, and then I was involved a lot in research that I realized I could combine my interests in chemistry, combine those interests with research, but then see how it could really impact people. That's how I got into medicine. I got into emergency medicine and critical care following a similar pathway, although in this case, I was doing research one summer with a colleague the same age as me who had served as an EMT. 

This was in the early days of EMT as emergency medical services. We started talking about the need for evidence-based emergency care and what we could do to save people's lives at that very early stage after injury or illness. We started talking about how we could do things differently, so we started thinking about how to do research innovation. Now it all came complete to me -- science and research and clinical care, and then impact on real people. That drove me to emergency medicine and the further extension of that into the hospital is critical care. It really is all a continuum, and I've really enjoyed integrating those issues across my career.

DR. RISHI DESAI: And then at one point in your career, you got into leadership roles. How did that transition occur? I think that's a piece that a lot of people are curious about. How did you go from doing clinical medicine to an administrative role or a management role?

DR. CHUCK CAIRNS: Well, I really enjoyed my work in the emergency department. I got to meet people from a lot of different backgrounds, sometimes at the worst time of their life. While we made a lot of important interventions and frankly saved some lives, I realized there were still some limitations, not only to my individual care and the evidence basis and the research I was doing but also in terms of the systems of care and the systems of research and how we best integrate education, training, research, and clinical care. That drove me to pursue leadership roles. 

I started off with leadership roles in research, and then those led to leadership roles in clinical areas, and then as you combine those two leadership roles in medicine, I became a division chief and then a department chair and then a dean and then a senior vice president. What happened during all those different transitions? This absolute approach and the philosophy and the interest were all there, just the scope and scale, of course, increased dramatically. 

I think it's actually one way to not only integrate across missions, if you will, of education training, research, and clinical care, but also across the scope and scale of organizations, so you're not only taking on the needs of your hospital or your department or even your medical school, but then the whole needs of a population and in some cases states and even countries.

DR. RISHI DESAI: Your titles shifted quickly, it sounds like, and so you had a pretty amazing chance to see the different types of roles and responsibilities that occur at the different levels of an organization, which is pretty awesome. Now in your role here at Drexel University, and you've got an amazing background behind you, what are the things that you're most proud of that Drexel is doing at the moment?

DR. CHUCK CAIRNS: What I'm really proud of is just being able to lead a group of people who are totally committed to our missions. We have students from a wide range of backgrounds, a really diverse range of backgrounds, who are committed to the care of people who, frankly, have been underserved by medicine. We also have scientists and researchers who are committed to making discoveries, taking new technologies, even new care models and applying them to those same populations that not only have been underserved by healthcare, but they've been underrepresented in these innovations and these amazing discoveries that we've had in medical science. Being able to translate those discoveries into these populations is so rewarding because the impact is great. 

Then finally, we've really had some challenges at Drexel as frankly, many medical schools have had, with rapid changes in the healthcare system. Being able to be agile and adaptive and embrace the community systems of care. At the same time, we're embracing this community focus of education and research, and it has really been rewarding. I'm very pleased with how successful we've been in terms of doing that at Drexel.

DR. RISHI DESAI: You talked about your team and how much you love working with your team, and COVID-19, I think, has made a lot of teams grow even tighter because there's been so much work that has had to happen. Do you mind just talking a little bit about some of the challenges that you've had to deal with at Drexel, as COVID has hit?

DR. CHUCK CAIRNS: Well, one of the big challenges we have at Drexel is that we have a really large geographical footprint, so we have regional campuses in the Philadelphia area and other parts of Pennsylvania and even New Jersey, but we also have a campus in California, in the Bay Area, with Kaiser Permanente, so it's been an opportunity for us to think about how we connect our geography across time and space. 

Well, with COVID, we couldn't do it physically, so we started doing it virtually, and I've been very proud of our team as our regional deans at these various campuses have connected with our leaders in research, our leaders in education, our leaders in clinical care, and really came together as a community because now we don't have to worry about the daily commutes in Philadelphia or the time that it would take to fly and stay on the West Coast. We can all gather together in this virtual world. 

Of course, we had to make many changes. We had to accommodate how you become socially engaged over the internet and talk about how we enhance that experience for our students that still makes it real, even if it's virtual. We had to think about what we do next in terms of finding solutions and really making them geographically impactful, how we take advantage of all these different perspectives and diversity of our faculty and students and trainees, and then how we take on the big challenges of our communities because one thing that COVID has highlighted is the health inequities that exist across these populations and our opportunity, therefore, to have an impact in our translation efforts. That really has been an important lesson and also an important strength for Drexel.

DR. RISHI DESAI: I didn't realize the connection with Kaiser in northern California, and I actually was a Kaiser patient at that hospital, so in many ways, thank you for helping to be part of the team that takes care of me. I appreciate that. 

DR. CHUCK CAIRNS: I must tell you, they're extraordinary people at the Kaiser Permanente system, and not only they are extraordinary, they have an extraordinary collective in terms of how they integrate physical medicine with other components of health, as well as, of course, the physicians in the hospital systems. It really is a remarkable system. I'm so pleased that our students and our faculty and our trainees all get exposed to it and be part of it.

DR. RISHI DESAI:  In terms of health inequities, obviously, there has been a lot of talk about this, especially this summer, with what happened with all of the racial injustice and violence and then the subsequent protests and outbursts around wanting equality and justice. What are some initiatives that Drexel has taken on in light of that and then wants to continue on in the months and years ahead?

DR. CHUCK CAIRNS: We had a real challenge at Drexel with the bankruptcy and subsequent closure of the Hahnemann University Hospital. It was a safety net hospital in the middle of Center City, Philadelphia, and it really served an underserved population. Drexel University has always been committed to the city as well as to these populations that really need support and impact. So we were able to partner with Tower Health, a healthcare system that's based in Reading -- which is a kind of a rural area of Pennsylvania -- and purchased St. Christopher's Hospital for children out of bankruptcy. 

That's a hospital that's in North Philadelphia, a place where there are a lot of people who have been underserved and, frankly, economically challenged. It's also a very diverse community, and so we've decided to focus on providing excellent care, providing community networking. We just recently partnered with the city of Philadelphia to provide COVID-19 testing. Our goal is also to provide vaccinations so we can be both proactive in terms of taking on the challenges and, frankly, the under-representation of that group in COVID testing, but also highlight opportunity for health and proactive approaches with vaccinations and hopefully take on the rest of those social determinants of health, which are clearly so important to the outcomes of people there. 

We're doing the same thing in Reading and in rural Pennsylvania, and we want to extend that model to all the facilities in our areas, both in the Northeast and on the West Coast. That's a key component, being into the communities, providing healthcare, but also recognizing these other opportunities impact the community.

DR. RISHI DESAI: Do you mind walking me and our audience through what happens when you identify a hospital that's maybe just barely making it, maybe about to kind of go under? What are the things that get put into place to help that hospital survive so that the patients that are relying on that don't suffer?

DR. CHUCK CAIRNS: That's a really good question and sometimes difficult. I've been able to serve in hospital systems that had a public mission. I started off at Harbor UCLA Medical Center in Los Angeles. This is an L.A. County hospital affiliated with UCLA but serves people in that South Bay that really have had challenges.  While I was there, I took over the ambulatory care clinic out of the emergency department. 

We literally had the challenge of all these walking people who frankly weren't insured. Many of them were undocumented. All of them were in need, and so working with the county in order to provide support, sometimes highlighting where the shortages were and then thinking about how we would take those academic advancements out of UCLA and start to apply them to that population. What was so amazing about that is that led to research endeavors that I took in, but also a real investment by various groups around Los Angeles in that hospital and in that mission. 

It made me think about other systems. I was in Denver, again, associated with both a state public hospital at the University of Colorado as well as a city hospital, Denver General, which became Denver Health Medical Center, and again working with local governments and state governments became key. Being an advocate for these populations that are underserved, highlighting where those gaps are, and then finding solutions frequently through innovation that would be applicable. Similarly, we had that challenge in North Carolina, the University of North Carolina, working with state governments, but it's been amazing working with these private hospitals and the challenges they face. 

I was at Duke University, and we really were working to take on the challenges of an underserved area of Durham, North Carolina. Duke really responded not only with investment and with innovation, but it had to be directed, needed to have champions, and we needed to make that case of how that would be impactful.  In Philadelphia, there aren't any public hospitals.  A major American city with a lot of challenges, but with no public hospitals, and I think the Hahnemann Hospital closure highlights the challenge of not having government support. 

This is a discussion we have among the deans of the medical schools in Philadelphia about how we are going to preserve that public service mission, how we are going to highlight the challenges that we see and how we are going to have an impact on those patients that are being served. That's an ongoing challenge. It's easy to spot where these problems are going to be. It's going to be in an area where people are poor. It's going to be in an area where people are underserved by medicine. It'll be an area where outcomes and health inequities are obvious -- decreased life expectancy, high levels of chronic disease, low levels of proactive health approaches like vaccinations. 

That really gives you an idea of where the challenges are, and then the need to step up to support those hospitals, I think could be served by these academic partnerships if we focus on innovation and we focus on really making a meaningful difference in the outcomes of people with the population served by those hospitals.  So there are lots of challenges out there in medicine. There are lots of challenges in terms of serving populations, but I do think there are opportunities for us to use innovation to effectively address those challenges.

DR. RISHI DESAI:  I almost imagine you like a bee or a butterfly kind of cross-pollinating flowers in different parts of the country with knowledge and of sharing things that work and things that didn't work. I think it's wonderful that you're doing that. I appreciate that you've done that in your career.

DR. CHUCK CAIRNS: Well, I think there's so much value to experience, but the experience needs to be applied in the future. I say research with impact is innovation. Well, I think experience with learning and application is innovation. That's one of the things that I have learned throughout my career, as I moved from my specialty to broader kinds of views of medicine, as I moved from research in the laboratory to research across populations, and I started with the education of individual medical students and thought about systems of education and training and how those would apply to communities. 

You begin to realize this can be done. They’re daunting, large challenges, but if you think about them based on what's worked, when you think about basing them on experience and opportunity, then I really think you can have an impact. I'm proud of my record, all those places, and being able to apply it. That doesn't mean we solved all the problems, and that doesn't mean that the problems aren't big and the gaps remain. They clearly, clearly, do, but I do think it's one of the things in my career that I've really tried to focus on and really tried to keep going as part of my own personal development.

DR. RISHI DESAI: With that in mind, I'd like to close with any sort of knowledge gap that you'd like to fill. Maybe you'd like to teach us something that you think people may not know, or maybe offer some general advice or maybe a combination of the two specifically aimed at folks that are just coming into their own in their healthcare career, whatever that might be.

DR. CHUCK CAIRNS: Well, first of all, follow your passion. I think that following your passion is wonderful because I've been able to integrate my passion for clinical care and emergency care and then couple that with science and research interests and then couple that with the ability to organize others to focus on those problems and education and training and research and then lead to broader organizations. It's all the same passion, just different manifestations. 

I think the other thing to do is to keep an open mind. I think that it's easy to say, but sometimes hard to do, especially in medicine. Always remain open to how you might follow another path, how you might be able to expand your opportunity, but most importantly, how you might be able to enhance your impact. 

When you start doing that, you'll start finding other collaborators outside of your field that can help. You'll start working with organizations that you thought wouldn’t partner with you, and you start being able to bring new resources, new energy, and new opportunities and then leverage them for impact. I would say most certainly to follow your passion and keep an open mind, and my last piece is, “Be optimistic.” It's amazing the advances that are occurring in medicine and science. It's extraordinary how many people share this vision for the future of a better life, longer life, higher quality life. 

It's extraordinary when you start talking to people, and finding where they value those intersections, how much of an impact you can have on an individual, much less a population. I think that's the advice I have, but obviously, I look forward to working with people who figure things out faster than I do and better than I do and will have more knowledge than I do. I think that's the best part of keeping a long-term vision.

DR. RISHI DESAI: That's a wonderful, positive, and upbeat note to end on. Thank you so much for being with us, Dr. Chuck Cairns. We really appreciate your time.

DR. CHUCK CAIRNS: Thank you so much. I really appreciate, Rishi, the opportunity to speak with you and appreciate what Osmosis is doing. Thank you so much.

DR. RISHI DESAI: I'm Rishi Desai. Thanks for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together. Thanks.