“The Time for Innovation is Upon Us” - Dr. Julie Pilitsis, Dean of the Charles E. Schmidt College of Medicine and Vice President of Medical Affairs at Florida Atlantic University

Shiv Gaglani: Hi, I'm Shiv Gaglani, and today on Raise the Line, I'm happy to welcome Dr. Julie Pilitsis, who's the dean of the Charles E. Smith College of Medicine and vice president of Medical Affairs at Florida Atlantic University. Being the first woman neurosurgeon to become a dean, Dr. Pilitsis oversees the college's innovative medical student and graduate medical education programs in partnership with a consortium of five regional hospitals. She's also a board-certified practicing neurosurgeon and a national expert in multidisciplinary pain and movement disorders, including Parkinson's disease. 

Prior to joining FAU, Dr. Pilitsis served as division chief of Functional Neurosurgery and chair and professor of the Basic Neuroscience Department at Albany Medical College in upstate New York. She is the 2023 president of the North American Neuromodulation Society -- the first woman ever to lead the organization -- and president-elect of the American Society for Stereotactic and Functional Neurosurgery. 

In addition to all of that, she's published over 200 journal articles, four books, and numerous chapters. So Dr. Pilitsis, thanks for taking the time to be with us today. 

Dr. Julie Pilitsis: Oh, thanks so much. The pleasure is mine. 

Shiv Gaglani: I would like to start first with learning more about you and what got you interested in medicine and then ultimately neurosurgery. 

Dr. Julie Pilitsis: You know, it seems so long ago, but I actually decided I wanted to be a doctor in high school and ended up joining a BS-MD program where you could get your bachelor's and your MD in six years instead of eight. Then when I got to medical school, I just fell in love with the brain. It was my favorite class in my first year and actually went into a lab. I thought I had wanted to be a neurologist, but the lab was in the neurosurgery department. I met the residents and they took me under their wing and, you know, as soon as I got into the OR, the rest was history. 

Shiv Gaglani: Yeah, it's fascinating. I feel very drawn to your background because neurosurgery is why I got interested in medicine too. My background, as you may know, is I did two years of med school at Hopkins, took time off to start Osmosis, Elsevier brought us a year and a half ago, and now I'm actually back in Baltimore finishing my next two years of med school. I'm thirty-four, so neurosurgery feels like a long way to go. But do you know Daniele Rigamonti, the neurosurgeon? 

Dr. Julie Pilitsis: I do. 

Shiv Gaglani: He's my mentor and a big Osmosis supporter from the beginning and he has been on this podcast, too. 

Dr. Julie Pilitsis: Oh, that's wonderful. I think it's sometimes it seems like such a long time. I actually did a PhD during my residency and then a fellowship. So, I trained for nine years after med school and when I was going for that ninth year I thought, “Oh, my goodness, what am I doing?” But, that was actually the crucial moment because that allowed me to specialize in functional neurosurgery, which defines everything I do today. So, my advice for you is, if this is something that draws you -- regardless of whether it makes sense or not -- if it's something that you're going to enjoy every day, go for it.

Shiv Gaglani: That's great advice, and we'll definitely get into advice at the end of this. But the career zigzag is certainly a theme that comes across with the Raise the Line podcast and the guests we've had. Can you talk to us a bit about functional neurosurgery? I think it's a very exciting area and many people may not know that term. People are more and more excited about it because of things like Neuralinkand brain computer interfaces finally showing so much progress. It feels like every week or month there's a new breakthrough.

Dr. Julie Pilitsis: Yeah, I'm totally biased. I think functional neurosurgery is the coolest kind of neurosurgery. I became interested when I was a junior resident. You know, sometimes in neurosurgery, you see patients that have brain tumors or aneurysm ruptures and just devastating complications. Deep brain stimulation had just come about at the time I was training and I saw, gosh, what a difference this can make in people's quality of life. So really, I became interested in functional neurosurgery because of deep brain stimulation and treating Parkinson's. I had mentioned that I had gotten my PhD during my residency. That was in neurophysiology, so not only was I able with this career choice to really help people, but I was able to use that scientific creative part of my brain to really think about these topics. 

Right now, a lot of the things we do in functional are electrical devices and electrical stimulation and I think this technology is getting cooler and cooler with some of the brain computer interface things. But, I think electricity is just one thing that we can deliver, right? Now there's been recent excitement about thermal ablations or how do you deliver ultrasound, and then, of course, there's been stops and starts of stem cell therapy and gene therapy, but we're using the same type of techniques. So, it's just always an exciting time to be in functional neurosurgery and I'm fortunate that I have some of the best colleagues in the world in it as well.

Shiv Gaglani: Yes, amazing. I'm always really impressed when we have people like yourself on the podcast who wear so many hats. We were talking before the recording about Dr. Charles Lockwood, who was on the podcast earlier...a very successful OBGYN, great researcher and also administrator. What percent of your time do you spend in each of these -- academic, research clinical and administrative?

Dr. Julie Pilitsis: Charlie's a great guy. I think the world of him and he is a role model in so many ways. I think I've always been able to balance things. Having said that, there's times when you're going to be busier clinically than you are research wise and administrative wise. It's important to realize that it doesn't happen instantly. First and foremost, you have to get good at your job. My primary job was to be a good surgeon. I think if you start with that basis, then some of the other things happen. I made sure that I had some protected time to do research, but oftentimes these things happen in series. 

I'm a big believer that our competitive advantage as neurosurgeons in the research space is that we're interfacing with the brain, we're interfacing with the patients. We know what some of these real issues are that need to be solved and can think about some of the technologies in order to do so. For me, that was a way to have a successful research program building off my clinical experience. 

There are other researchers that managed to completely separate things where they have a research program a little bit in one direction and a clinical program in another direction, and they're much more talented than I am. I like it that my two worlds kind of intersect. And then I think from the administrative standpoint, I've been dean here at Florida Atlantic for fourteen months, so when you're in a new job, you're always going to dedicate more time to getting the skills to succeed in that job. 

But at the same point, it was really important to me -- especially coming in new from a completely different system and completely different geography -- to understand what challenges faced my faculty. In order to do that, I needed to practice and I needed to perform research so that I could be the best leader possible for them and I could inspire students and learners to go in any of those disciplines. 

Shiv Gaglani: Yeah, absolutely. I think it's a very powerful place to be because when you talk to students or other faculty, or mentees, you can talk about all these things with ease, it seems. So, tell us a bit about your decision to go into leadership, into academic medicine, and then the decision to go to Florida. I mean, the New York to Florida transition is pretty common. I say this as a Floridian, somebody who grew up in Florida myself in Cape Canaveral. But I would love to hear more about your academic track or your administrative leadership track. 

Dr. Julie Pilitsis: So, I'm a big fan of getting more training along the way. You can probably see that from my credentials. My first experience with getting more training was in a junior faculty development program when I was four years into my career, and in that experience, I had a really terrific mentor -- Dr. Luanne Thorndykewho is still at University of Massachusetts -- and she was talking to me about what I wanted to do. The idea of being dean hadn't congealed in my mind yet, but as soon as I explained to her what my passions were, she said, “Julie, next time somebody asks you, you're going to say, I want to be the dean.” 

It was interesting because I reflected on that often and thought about, “Do I really want to do that? And sure enough, I did. Then I was lucky enough to move back to Albany at that time. I had gone to medical school there, and twelve years later, I came back. I was chief of functional neurosurgery, and I had done a good job, so my chairman advocated for me to the dean. 

The dean was Dr. Vincent Verdile, who's still a mentor to me. He was one of the longest standing deans ever. He met with me and said, “What do you want to do? Do you want to be a chair?” I kind of looked at him, and then he pointed to his seat and he said, “You want my chair?” And I said, “Not yours, but, you know, I think that's the way I want to go.” So he was just amazing and mentored me for this position. 

I subsequently became chair and was able to learn from his experience. When I walked into this position, he had me so well prepared, because we kind of went through where my expertise was and where it was lacking. He created kind of a whole personal mentorship program for me, where I got more experience with finances and with philanthropy and other things. 

So, the next part of the question: how do you end up in Florida? Well, in Palm Beach County, most people are from New York, so it does feel comfortable. Having said that, a lot depends -- like anything in life -- on timing and when it became time for me to start looking for a job as a dean, there were several jobs available. This one resonated with me because they were looking for a clinician scientist who was an expert in neuroscience. I thought they'd made the position statement for me. 

Shiv Gaglani: That's awesome. So, tell us a bit about FAU. I obviously know quite a bit about it, having grown up in Florida and having friends who've gone through the both the undergraduate as well as the medical programs. But in your view, what are the things that attracted you to FAU? And where do you see it differentiating over the next five, ten years under your leadership, hopefully?

Dr. Julie Pilitsis: Yeah, so it's much more fun to answer that question post-March Madness than it was beforehand. Florida Atlantic made the Final Four and I think there's a lot of things with that story that tell our story in general. I think we actually are pretty large. We have six campuses, all the way from Davie to Vero Beach -- so, a wide span over four counties that are about four million people -- and we have about 30,000 students on campus. So, it's hard to say we're the little engine that could, but in many ways we were. 

I think that Dusty, who was the coach that led us to the Final Four, really is a gentleman that cares about the kids and really enforces the concept of team. As opposed to some of the other teams, we had nine people that could play, and so we weren't relying on our starting five. I think that that team spirit is something that's so integral and reflective of FAU. 

So, FAU’s College of Medicine -- I affectionately refer to as my startup college -- has been around since 2011. It was built by people that are as impassioned about healthcare as Dusty May is about basketball. People worked so hard to get us accredited, start our medical school, get our residency training programs up and running. Now, I have the really fun job of looking at other things. 

In terms of education, I put us up against anybody. We're best in class. Now, we're looking at the clinical enterprise and at the research enterprise and I'm having a really fun time doing that. We have outstanding leadership that has said their two main priorities were athletics and health, and we've seen how athletics went, so I’m sure health is soon to follow. 

Shiv Gaglani: That's awesome. I love the startup mentality. Obviously, I'm biased, having started the company out of med school myself, but this feels like a very innovative, exciting time, both because of all the net migration into Florida and the investments, and because it seems like a really great place to be, especially your area. 

We launched this podcast at the beginning of the COVID pandemic and called it Raise the Line, as in ways to strengthen our healthcare system, ranging from digital health and value-based medicine to how do you train more healthcare professionals and how do you keep them in practice longer, because a lot of them have obviously left the profession and burned out along the way. Can you talk to us a bit about some of the macro trends you're seeing in healthcare over the next couple of years, including maybe even artificial intelligence? Charles Lockwood and I spent a lot of time talking about that one, too. What gets you excited? What gets you worried? How are you training the clinicians of the future?

Dr. Julie Pilitsis: Wow, great question and a lot to unpack there that we could tackle in a variety of ways. So, first let me say just a little bit about my ecosystem here in Florida. Florida is great at very many things. Having said that, on US News & World Report, we rank twenty-fifth out of fifty in healthcare in the US. When you dig into those numbers a little bit deeper, we're forty-first in access, meaning that it's really problematic to get in and see a physician. An example that really resonated with me is if you are a woman that's gets diagnosed with a lump on her breast in Florida, on average it takes you thirty days to see a doctor while the national average is three to five days. 

Shiv Gaglani: Wow. 

Dr. Julie Pilitsis: We have to do better. And what's going into that? Well, it's an interesting market and I don't know if it's reflective of certain markets. In many of our communities the average age is sixty-five and we know that people that are over sixty-five use healthcare at five to eight times that of people under sixty-five. If you look at our doctors in this market, 40% of our physicians are over sixty. Sometimes as you get older, you may not want to work a full FTE and so we see some of those numbers change. And as everybody in New York and from elsewhere seems to move down to Florida -- but, in Palm Beach County it's New York and New Jersey -- I think these numbers are going to get even worse. 

So, a couple of things that we're doing...we've been a teeny, tiny med school. We had sixty-four students and over the next two years, we’re going to get up to 104 students. It may not seem like that big of a jump, but it's 62%, and if you look at how many extra patients those forty students can see over their career, it's a pretty big number. We're doing the same with our nursing school as well. So, we're trying to make more doctors and nurses.

Then we're trying to figure out ways to keep people happy. I think there's a lot of things that can demotivate people when you look at all the burnout issues. A lot of it comes from the time spent in the EHR and the time spent not actually doing what many people went into medicine for, which was to take care of patients. I would echo a little bit of where you may have gone with Dr. Lockwood -- we need to have better technologies in order to free up that time and maintain that physician-patient relationship. That holds true for all of healthcare. 

So, how can AI do that? If ChatGPT can write essays and take the USMLE, it certainly can help us with this issue. I think there's other technologies, too. One of the things that stuck with me is in this nursing shortage, we particularly have a shortage of nurses that want to be bedside nurses. It's a really tough job, it's sometimes a really thankless job, but for all of us that have been in the hospital, that bedside nurse and how they cared for you is really what you remember about being in the hospital. One of the things they've done in Japan is actually use robots to dispense medication. So, is there a way we can take some of those tasks that may be less glamorous -- and especially those that are prone to error -- and automate them? I'm sure there are. 

Shiv Gaglani: Yeah. It's a super exciting time and certainly something we like to cover here. We've had people like Eric Topol on this podcast, who you may know, talking about the future. As a dean, you have a great opportunity, but also responsibility, to train doctors and nurses to be able to practice in the future, right. For instance, value-based medicine. I know in South Florida there's a huge rise in value-based medicine form ChenMed and other organizations like that. 

Do you want to talk a bit about the healthcare model and how you think about that? Your field of neurosurgery has been fee-for-service for a long time. How are you thinking about health policy changes and what we need to be doing there to increase access? 

Dr. Julie Pilitsis: I mean, there are so many different directions that you can go with this. I think that one of the expressions is, “If you've been at one medical school, you've been at one medical school.” Each model is a little bit different and the model I'm at is very different from where I came from in Albany. So, in Albany, it may be more of what you think of as a traditional model where the practice, the medical school and the medical center, were all one -- not quite one -- but you know, they had somebody that was generally overseeing them. 

Where I am at Florida Atlantic, we have traditionally been a community-based medical school, and so that means that my learners go to a series of hospitals. I have my medical students at ten different hospitals. I have my residents at five different hospitals. So, what does that model look like? I think for me in terms of medical education, it's no secret that the clinical enterprise funds medical education and so we have to think about how funds can flow differently to accommodate those needs...thinking more about the macro environment outside.

I think academic medicine and academic hospitals are essential. I mean, they have a tremendous economic impact on the landscape -- $22 billion in Florida alone. They bring in high paying jobs and bring in brain power and they are so good for the economy in so many ways. So, I think the community needs to understand that. I think everybody wants good healthcare, but I think sometimes they don't understand the economic impact that good healthcare brings to the area. Amazon certainly does. On their top five things they look for when they are going to establish a big facility is whether there's an academic medical center. So, I think people need to understand those dynamics. 

In terms of value-based care, I think there are a lot of different opportunities to do things smarter and to do things more efficiently, and I think that we're being forced to do that. In this market, COVID kind of turned everything on its head. Now, as we're looking at different medical practices and how we practice medicine, I think the time for innovation and really thinking differently is upon us.

Shiv Gaglani: One hundred percent. We talked about how crisis is a terrible opportunity to waste, and it feels like there have been a lot of changes in healthcare because of the COVID pandemic that hopefully we can take into the future -- like telehealth, digital health, remote patient monitoring, aging-in-place -- these kinds of themes. 

I know we're coming up on time, so I just had a couple other quick questions for you. The first is, as you know, Osmosis is a teaching company and so we like to ask our guests if they could snap their fingers and teach any audience, any subject matter -- whether it's a video or a course or whatever it may be -- what would it be for you? Like, who would you want to teach and what would you want to teach them and why?

Dr. Julie Pilitsis: It's a great question, and I think there are so many things you could talk about. But I would like to think about the thing that is most influential to the most number of people. I have had the opportunity to not only attend leadership training, but to do a good amount of leadership training for people. When you look at highly successful people in medicine and probably in any career, one of the things that really makes people capable of accomplishing great things is having a support system that tells them they can do it and helps them to persevere. I think of all the things, make sure that you're surrounding yourself with the right cheerleaders and the right people to get where you want to go in this life. If you're not, find those people. They're out there and they want to help you. So, I would spend time talking about the value of that support system -- mentors, sponsors, coaches -- and getting people to a place where they can best succeed.

Shiv Gaglani: That's wonderful. That's really, really insightful, and I agree from personal experience, as well. People like Dr. Daniele Rigamonti, who I mentioned at the beginning, comes to mind. 

What is your general advice to our audience about approaching their careers in healthcare and meeting the challenges of this moment and beyond?

Dr. Julie Pilitsis: I think we were talking a little bit at the start of this about different careers and what you want to do. I would say, follow your passion. If there is something you want to do and you love to do, go for it and go after it and figure it out. There will be a way, you know. I may sometimes be wrong, but I'm never in doubt, and I just move forward and follow that. The worst thing to do is to have regrets. Don't let life happen to you. Just go out and grab it by the horns.

Shiv Gaglani: I love that. It's a great mentality where you can't go wrong, right? You may need to switch trajectories or whatever, but the decisions you made in the past, mistakes or not, are what made you who you are today and you're just going to go forward. 

Last question, is there anything else you want to leave our audience with about you, FAU, neurosurgery, healthcare, or anything else that's top of mind for you?

Dr. Julie Pilitsis: I'm really excited to be at Florida Atlantic, and I think we're doing something really special here to change the way healthcare is delivered in South Florida. So, keep an eye on us, and make sure to bet on us. If you had bet on the basketball team, some people made a fortune. But, we're doing great things and it's really a fun time to be in South Florida with the people coming down here, the resources coming down here and the spirit for innovation and entrepreneurship. 

Shiv Gaglani: Well, that's exciting. We'll definitely keep an eye out and I know a bunch of our audience do train at FAU and other Florida programs. So, we're really excited to have you on the show, Dr. Pilitsis and I want to thank you not only for taking the time to be with us, but more importantly, for what you've been doing for your entire career to raise the line and strengthen our healthcare system. 

Dr. Julie Pilitsis: Oh, thanks so much, and thanks so much for having me. This was a pleasure. 

Shiv Gaglani: Of course. And with that, thank you to our audience for checking out today's show and remember to do your part to raise the line. We're all in this together. Take care.