Raise the Line

Sacramento, California has long been one of America’s most racially diverse cities, so it stands to reason that reducing disparities in healthcare delivery is a focus of Dr. David Lubarsky, the CEO for UC Davis Health in Sacramento. “We've realized that health equity can really only be achieved if you actually have the time and resources to get what's needed to make yourself well or keep yourself well,” he tells host Michael Carrese.  With that tight correlation between economics and equity in mind, UC Davis Health leaned into its role as an employer and launched an effort to hire more people from the communities it serves. “We've managed in two years' time to go from having 6% to 20% of our unlicensed workforce from the ten most underserved zip codes in the city.” Lubarsky is also focused on the diversity of learners in the UC Davis School of Medicine, which he also oversees, because it’s been well established that patients from historically marginalized groups have better outcomes when their providers look like them. Tune in to learn about the strategies he’s pursuing to that end, where he sees AI fitting into healthcare delivery and what’s included in the system’s historic $7 billion capital building campaign.

Mentioned in this episode: UC Davis Health

Having a waiting list of 20,000 people to take your training is a pretty good sign you’re onto something important. That’s the mixed blessing Dr. Richard Schwartz faces as interest in Internal Family Systems -- an innovative therapeutic approach to trauma and other mental disorders he developed -- continues to grow. The “family” in this case are the multiple parts of a person’s psyche that, in Schwartz’s view, need to listen to each other in order for people to overcome traumas and function well. “This is an alternative paradigm for understanding all kinds of what are seen as mental illnesses. Part of my goal is to bring this different perspective to all of these things that have been so medicalized,” he explains to host Shiv Gaglani.  A welcome discovery of IFS is that among the parts, there is a core Self that can't be damaged and knows how to heal. As Schwartz explains it, IFS therapy works by opening enough space for the Self to pop out and start relating to, and leading, the other parts that may be critical, protective or play other roles. Don’t miss this fascinating look at an evidence-based therapeutic approach that challenges conventional thinking and offers hope to patients with a long history of struggle. "There are many heavily diagnosed people who feel hugely relieved to know they're not sick."

Mentioned in this episode: https://ifs-institute.com/

Lessons From A Healthcare Entrepreneur’s Journey - Ari Blum, CEO and Founder of Clover Learning

Today’s guest, Ari Blum, enjoyed working as a hospital-based radiologic technologist and became a successful edtech entrepreneur, but he’s not one to sugarcoat either experience. That’s why this in-depth conversation with host Shiv Gaglani is a great learning opportunity for those interested in a healthcare career, or entrepreneurship, or both as Ari describes his remarkable journey creating and running Clover Learning, which helps medical imaging students prepare for certification exams and empowers working professionals to efficiently earn their continuing education credits. A longstanding entrepreneurial mindset spurred Ari to convert what was a side hustle creating short continuing education videos into an ed-tech platform that has been used by more than 50,000 learners. And while he loves what he does and the impact he has, he cautions that entrepreneurship is not for the faint of heart. “If you take the time -- and in many cases, people's money -- and you're convincing people to leave a job and come work for you and spend their money on your product or service, there's a stewardship with that and there's a weight and there's a sacrifice.” But for those motivated to manage those challenges, Ari says this is a better time than ever to get projects off the ground. Tune in to find out why he thinks that’s the case, where he thinks AI is going in healthcare and what plans he has for expanding the reach of Clover Learning into other medical fields and beyond. 

Mentioned in this episode:

Clover Learning

"This" - Song by Darius Rucker

Group dental practices are common now, but that was not the case thirty years ago when solo practitioners dominated the space. On this special episode of Raise the Line produced in collaboration with Areo Dental, we’re going to hear from two leading figures in changing that paradigm, Dr. Rick Workman, the founder and executive chairman of Heartland Dental and Pat Bauer, the company’s CEO. As you’ll learn in this fascinating conversation led by Areo Dental’s co-CEOs -- Dr. Anushka Gaglani and Dr. Abhishek Nagaraj -- Workman and Bauer grew Heartland from a handful of practices into the largest dental support organization in the US with more than 1,700 locations. Workman attributes that success to thinking of their members as customers, and making sure to create value for them and respect for dentistry. “We have to understand they have to have clinical autonomy and our job is to do everything we can to make their lives better and easier and to always honor the patient.” Heartland does that by providing everything from operational support to benchmarking for quality assurance to vetting technology, among many other services. From a business perspective, Bauer thinks an additional factor in Heartland’s growth has been being in synch with the needs and goals of the practices. “It's about alignment with our doctors, alignment with the owners, alignment with all the teams, and that led us to be able to continue to grow because more and more people become successful.” Don’t miss this unique opportunity to learn about the evolution of dental practices in the US, what it means for patients, and what lies ahead for the field. 

Mentioned in this episode:

https://www.areodental.com/

https://heartland.com/

It's safe to say the majority of people reading this post have used Uber as a ride service, and many have also tapped Uber Eats for food delivery. What you might be less familiar with is the Uber Health platform that enables healthcare organizations to arrange rides and services on behalf of patients including deliveries of prescriptions, groceries, and over-the-counter items to their homes. Patients don’t need to have an Uber account, credit card or even a smartphone because everything is handled for them by a care coordinator. According to our guest Dr. Mike Cantor, the company’s chief medical officer, the aim is to make the healthcare system more efficient and effective by improving access to the services people need to stay healthy. “In the value-based care system where you can save money by being preventive and keeping people away from hospitals, Uber is potentially a really good set of solutions for the healthcare system and ultimately for the patients as well,” he says. Cantor is well-placed to help guide Uber’s potential impact on healthcare because of his rich background as a clinician and executive working on quality improvement and care management programs for healthcare providers and health plans. Don’t miss this fascinating discussion with host Derek Apanovitch about how healthcare delivery is being impacted by one of today’s most disruptive and innovative companies, and learn what partnerships Uber is forming to grow its healthcare role including support for caregivers.  

Mentioned in this episode: https://www.uberhealth.com/

Today's guest fits into one of Raise the Line’s favorite categories of people: physician entrepreneur. We've talked before on the podcast about the overlapping qualities of drive, curiosity, and desire for impact that both share, and that last trait is the core interest of Dr. Navin Goyal. A great example is OFFOR Health, a mobile healthcare company he co-founded that expedites care for children in the US who face long waits for procedures. “If you’re a four-year-old with dental disease and you're on Medicaid, you have an average nine-to-twelve month wait to get into an operating room.  We can enable that procedure within one month,” says Goyal. His experience with OFFOR led to the formation of LOUD Capital, which allows Goyal and his partners to seek out other business opportunities that have a social impact. Since launching in 2015, LOUD has partnered with over seventy portfolio companies in healthcare and beyond. But despite his success, Goyal has embraced the concept of being an underdog, hence the title of the book about his journey, Physician Underdog, and his weekly newsletter Underdog for Good. Check out this episode with host Shiv Gaglani to find out why he likes the term, what qualities a potential investment needs to have to get him excited and what he sees as a key upside to having physicians working in a variety of industries. 

Mentioned in this episode:

https://www.loud.vc/
Underdog for Good Newsletter
Physician Underdog Book
Beyond Physician

One silver lining of the COVID-19 pandemic is a jump in enrollments in public health degree programs and that’s welcome news to Dr. Jan Carney, director of the Master of Public Health program at the University of Vermont's Larner College of Medicine, who believes the field needs a massive injection of personnel. “We need probably an 80% increase in people working in state and local health departments to have the essentials of public health.” As Vermont’s former Commissioner of Health, Carney knows the challenges public health officials face and brings those insights to Larner’s online-only MPH program, which covers the broad domains of the field from epidemiology to biostatistics to environmental health and also exposes students to the particular health challenges in rural communities. The program also prepares students for perhaps the biggest challenge facing the field: communication of health information in an era of misinformation.  To that end, Carney is urging more ascertainment of how different groups of people prefer to receive information and is suggesting a major change in approach. “Maybe we can start to think of public health communication more as a conversation than a one-way information flow.” Join host Michael Carrese for insights from a national force in public health into how education is evolving to prepare public health practitioners for their vital work in challenging times for the profession.

Mentioned in this episode: https://www.uvm.edu/publichealth/

Raise the Line’s in-depth look at the potential use of psychedelic compounds in mental health treatment continues today with a focus on the role they may play in helping people overcome substance use disorders. Our guest is Dr. Jeeshan Chowdhury, whose own mental health journey led him to found Journey Colab, a company combating addiction through psychedelic care while employing a unique stakeholder model that includes indigenous communities in ownership. “We have put 10% of the founding equity of the company into an irrevocable purpose trust so that the land, the traditions and the people that our medicines and our work are inspired from can benefit from it,” explains Chowdhury. He tells host Shiv Gaglani that indigenous traditions also inform how the company approaches psychedelic therapy itself. “When we look at their use, it is always done in the context of an expert healer, often called a shaman, and it's done as part of a very well-honed protocol and in the context of a larger community.” Check out this thoughtful discussion to find out why Chowdhury thinks of the therapeutic use of psychedelics as akin to surgery, and how Journey Colab is working with rehab center partners to integrate psychedelic care through clinical trials with the goal of creating an integrated treatment program.

Mentioned in this episode: https://www.journeycolab.com

Today’s episode touches on some regular themes we explore on Raise the Line such as equal access to quality healthcare, provider burnout and the impact of AI on medicine, but on this episode, we have the welcome opportunity to take a look at these key issues from the perspective of a doctor-turned-entrepreneur in Brazil. Today, Dr. Bruno Lagoeiro is an executive at Afya, one of the largest medical education groups in Brazil, but he started out as a med student who was interested in solving problems he and his classmates were encountering. After years of experimentation, and guidance from a business mentor, the solution they developed was Whitebook, a mobile app for clinical decision-support that’s used in tens of millions of patient encounters every year in Brazil. Join host Shiv Gaglani as he draws out the details of Dr. Lagoeiro’s amazing journey to improve healthcare in a huge and diverse country that faces delivery challenges in poor and remote communities and a provider workforce being drained by bureaucracy. Despite these hurdles, Dr. Lagoeiro has an optimistic message to share about the power of providers to change healthcare and the promise of AI to allow them to focus more on the human aspects of medicine. 

Mentioned in this episode: Afya

Among the key qualities everyone wants in their healthcare providers is a love of learning and desire to serve others. That’s why we at Osmosis are confident Dr. Lewis Nasr will be a great physician and why we chose him to be the first guest in a new series of interviews on Raise the Line we’re calling “Next Gen Journeys.” The series will highlight fresh perspectives on medical education and the future of healthcare offered by students and recent graduates from around the globe. Starting with Dr. Nasr is a natural choice because of the many contributions he's made to Osmosis over the last several years including service in the Osmosis Medical Education Fellowship program and being a key contributor to our Year of the Zebra initiative. In this engaging conversation with host Hillary Acer, Lewis brings the perspective of medical students trying to learn in very challenging circumstances in which their personal safety and access to basic needs can be at risk. “It's another layer of obstacles that you have to get through. This gives international students a resilience and adaptability that they can bring to clinical practice.” Lewis also discusses his interest in hematology-oncology and reflects on entering the field at a time of remarkable clinical and technical advancements. “It's exciting to see cancer go from what is perceived as a death sentence to something manageable. I really hope to be part of the scientific wave of making cancer history.” We have no doubt that he will be, and neither will you after hearing from this thoughtful, compassionate young physician. 

Mentioned in this episode: 

https://www.osmosis.org/world

https://www.osmosis.org/zebra

https://www.mdanderson.org/

Today’s Raise the Line guest, Dr. Megan Meyer, has a pretty simple message for proponents of  psychedelic-assisted therapy (PAT) who are concerned that demand for therapists will outstrip supply in the coming years: don’t overlook the largest group of mental health providers in the nation. “Social workers provide more mental health services than psychologists, psychiatrists and psychiatric nurses combined and we’re embedded everywhere. I don't think the psychedelic renaissance can actually achieve its aims without us,” says Meyer, who is an associate professor at the University of Maryland School of Social Work. Meyers adds that social workers also happened to be well-equipped for PAT because they’re trained to act as guides in helping clients find their own voice and not impose their own perspectives or biases.  Getting large numbers trained will require collaboration across disciplines, universities and training institutes such as the project she’s working on with colleagues at the university’s Schools of Pharmacy and Nursing to survey social workers and nurses regarding their current knowledge and training needs related to psychedelics. Join host Michael Carrese for an expansive conversation about the role social workers can play in minimizing the risks and realizing the potential of psychedelics including issues of bias and diversity, community-based models of post-therapy integration and learning from the practices of indigenous societies.

Mentioned in this episode: https://www.ssw.umaryland.edu/

There's a relatively small number of people who have had the opportunity to create a medical school from the ground up, which is why today’s Raise the Line guest, Dr. Robert Hasty, is particularly interesting to talk to because he’s had that chance three times. Currently, he is involved in launching one of the nation's newest medical schools, the Orlando College of Osteopathic Medicine, in one of its fastest growing areas, Central Florida. “I think one of the things I've learned is that everything is incredibly connected at a medical school -- the facility, the curriculum, the culture, the clinical rotation partners...it all has to work together, so that's one of the things that we've done.” Hasty and his team have also designed a modern curriculum that’s taking a “lecture-less,” team-based, case-based, systems-based approach that interweaves clinical skills and knowledge of basic science throughout the four years. And on top of all that, given the school’s proximity to Disney World, you can see fireworks every night from campus! Join host Shiv Gaglani for this hopeful look at the cutting-edge of medical education.  

Mentioned in this episode: https://ocom.org/

If you get nothing else from listening to this memorable episode of Raise the Line, you’ll at least have the chance to do a breathing exercise in real time along with host Shiv Gaglani and his guest, Dr. Michelle Thompson, who is triple board certified in lifestyle, integrative, and osteopathic family medicine. Dr. Thompson has come to rely on a breathing practice for her own daily wellbeing and offers to do it along with all of her patients as well as countless medical students, residents and colleagues. In fact, as a strong advocate for provider wellness, she's created full-day programs for physicians and nurses to learn tools like breathwork for resilience and self-care. “Self-care is not selfish. If we are caring for ourselves, we are more available to others,” she explains. In addition to her role as medical director of the Lifestyle Medicine Institute at the University of Pittsburgh Medical Center, Thompson is a national force in establishing lifestyle medicine programs in health systems across the country, as nearly 100 organizations have done.  Taking it a step further, UPMC is building a new hospital in the city that Thompson says is going to have a “lifestyle village” on the first three floors to facilitate the efforts of community members to choose healthy habits. Join us as we explore the impact lifestyle and mind-body medicine is having on patient care, employee wellness and medical education in Pittsburgh and far beyond in this perspective-shifting conversation.

Mentioned in this episode: University of Pittsburgh Medical Center

Today’s Raise the Line guest has created two new degree programs at Brown University, is a vice president and board director at one of the oldest venture capital firms in the nation, and was CEO at a groundbreaking digital healthcare company. Oh, and he’s still in his twenties.  As an investor, Morgan Cheatham -- who is also a third-year medical student at Brown University -- is applying his impressive experience, intellect and energy to the use of computation in improving patient care, and he’s encouraged by what he sees. A prime example is Abridge, a company that uses an AI audio system to capture and summarize the information patients share during appointments, allowing the doctor to focus on the patient, not on typing notes.  “A guiding light in my career has been how we take this sacred one-to-one relationship and scale it one to many, and Abridge is the company that does just that,” Cheatham tells host Shiv Gaglani, who also happens to be a successful healthcare entrepreneur and third-year medical student.  And while Cheatham is excited by the potential application of AI in healthcare, he notes that the medical community needs to move quicky to establish quality standards for its use. “How do we build the right validation benchmarks and evaluation criteria to know whether or not it is performing well?” Don’t miss this fun and fascinating conversation that also covers the necessity of embracing ambiguity, remaining curious and seeking diverse perspectives to navigate the rapidly evolving landscape of healthcare and technology. 

Mentioned in this episode: Bessemer Venture Partners

As researchers continue to explore therapeutic applications of existing psychedelic drugs such as LSD and psilocybin, there's been a parallel effort to create new compounds that produce the same beneficial effects, but that come without the lengthy protocols and regulatory obstacles attached to those currently criminalized substances. "If you could develop new molecules that were more targeted and shorter acting, you may actually be able to create medicines as potent as the existing ones, but administratively and medically more efficient so we can reach more people," says Ronan Levy, a serial entrepreneur in the space. After a foray into creating a business model for ketamine-assisted therapy, Levy is now looking to support the community of millions of people who are already using psychedelics in various capacities through his Non-Ordinary Therapy Company instead of providing the therapeutic experience directly. “Wherever you're having your psychedelic experiences, that's wonderful. We're there to help you get the maximum impact from your sessions.” Join host Shiv Gaglani for this fascinating conversation about responsibly pushing regulatory boundaries, whether hallucinatory effects are essential to therapeutic benefit, and the rapid pace of change in a field that holds the potential to, as Levy puts it, “displace most forms of mental health care currently provided.” 

Mentioned in this episode: 

Non-Ordinary Therapy Company

The Ketamine Breakthrough (book)

Distance learning continues to grow in popularity with most college students in the U.S. now taking at least some classes online offered by hundreds of brick-and-mortar and exclusively online institutions. We’re going to learn about one of the highest ranked programs in the space today with Geordie Hyland, president and CEO of the American College of Education. One way ACE sets itself apart in a crowded field is that 85% of its students graduate with no debt, which Hyland says is reflective of the school’s mission. “ACE was founded with a key consideration about return on the students' time and financial investment so we have some of the lowest tuition in the nation, but we also provide a fully online, high-quality experience.” Check out this informative conversation with host Derek Apanovitch to learn about ACE’s programs that are tailored to address pressing staffing shortages in healthcare, its data-driven approach to student support, and the collaborative interactions it facilitates among its 10,000 students. "It's fascinating to see students from very different geographic regions be able to share ideas and collaborate," says Hyland.

Mentioned in this episode: https://ace.edu/

Chronic stress can be at the root of everything from mental health struggles to digestive problems to heart disease.  Today on Raise the Line, we’re going to learn about a wearable device made by Apollo Neuroscience that uses gentle vibrations to help the body adjust to stress. “Apollo is based on all the same principles that music is based on. It's wearable music for your body,” explains the company’s co-founder and chief medical officer Dr. David Rabin, a neuroscientist, psychiatrist, health tech entrepreneur and inventor who has been studying the impact of chronic stress in humans for over fifteen years.  A close reading of non-Western medical practices led him to realize that, generally speaking, the focus was on reducing the “fight or flight” response and increasing our parasympathetic rest and recovery system. With that in mind, the Apollo device acts on the vagal nervous system with a gentle vibration that delivers safety signals to your skin in the form of low frequency music that you can't really hear, but you can feel. In this revealing conversation with host Shiv Gaglani, you’ll learn more about how and why Apollo works and its connection to Rabin’s interests in psychedelic-assisted therapy, the importance of safety in the provider-patient relationship, and how to effectively blend Western, Eastern and tribal approaches to medicine and healing. 

Mentioned in this episode: https://apolloneuro.com/

You may have seen today’s guest, Dr. Raj Dasgupta, on Chasing the Cure, The Doctors, CNN or ABC News and if so, you’ll understand why he is an award-winning medical educator and a force in the field. His irrepressible enthusiasm for patient care and teaching pours out in every moment of this fun and illuminating conversation with host Shiv Gaglani. “I really have this desire to make my teaching engaging and educational at the same time. To be a good teacher, you have to change your style with the times and for who your audience is,” Dasgupta says. Beyond his work with students, residents and fellows at the Keck School of Medicine of USC and the many attendees at his USMLE exam prep classes around the world over the past twenty years, Dr. Raj has touched a multitude of others through a series of books published by Elsevier that include the popular Morning Report: Beyond the Pearls and Case Reports: Beyond the Pearls. It’s a wide-ranging discussion -- he is quadruple board certified in pulmonary, critical care, sleep, and internal medicine, after all -- that offers insight on everything from licensing exams to AI to mentorship to battling burnout to the power of a smile. Don’t miss this whirlwind wisdom drop from the kind of teacher you always wish you had. 

Mentioned in this episode: The Dr. Raj Podcast

Something as complicated as starting a medical school is bound to include unanticipated obstacles, but few schools can match the roller coaster ride of the American Canadian School of Medicine in the Commonwealth of Dominica which just welcomed its first class of students. Our Raise the Line guest, Dr. Ramin Ahmadi, along with colleagues from Yale and Penn State medical schools, had worked for years to design an innovative curriculum and train faculty for a new medical school in Kazan, Russia. Then came Russia’s invasion of Ukraine. “Because of the war, we had to pull out. That was the end of the project at that point and we were all very sad,” Ahmadi tells host Shiv Gaglani. Tune in to learn how the project was given new life and how Ahmadi and his team are meeting the needs and preferences of modern students with a flipped-classroom, case-based approach to education. You’ll also hear about ACSOM’s different approach to clinical training, new model for residency programs and other innovations. And be sure to stay tuned to hear about his remarkable experiences in global health and human rights, and gain from his insights on how physicians can protect themselves from burnout.

Mentioned in this episode: https://www.acsom.edu.dm

Of the many hopeful developments in psychedelic research in recent years, perhaps the most important is that FDA approval of MDMA-assisted therapy for treating post-traumatic stress disorder appears likely within the next year. That prospect is due in no small part to our Raise the Line guest, Dr. Michael Mithoefer, who has spearheaded clinical trials of MDMA-assisted therapy for more than twenty years and is a senior leader at the Multidisciplinary Association for Psychedelic Studies Public Benefit Corporation which has led this groundbreaking research. Although he notes that FDA approval isn’t guaranteed, Mithoefer is contemplating what the practicalities will be of implementing this multi-stage therapy regimen, and he has cause for concern. “I think now the question is going to be, if it's approved, how does it fit into this medical system we have, which I think is quite dysfunctional, especially with mental health. To me, the challenge is going to be not to try to distort the treatment to fit the system,” he tells host Shiv Gaglani. In this enlightening conversation, Shiv and Dr. Mithoefer discuss the need for specialized therapist training, the importance of making the therapy available regardless of ability to pay, and other potential therapeutic uses for MDMA. This is a great opportunity to hear from an important voice about the current and future state of psychedelics as a treatment modality. 

Mentioned in this episode: https://mapsbcorp.com/