Dr. Ohaegbulam: It’s been a bit of a circuitous journey. Overall, I grew up and went to medical school in Nigeria. I came to Boston about twenty-five years ago for my residency in neurosurgery specializing in spine surgery, and at the end of my training, I was looking for an opportunity to practice in a setting that had a robust multi-surgeon spine surgery program and was fortunate to find one right next to where I trained at the Brigham women’s hospital and children’s hospital in Boston, but ended up coming a few hundred yards away to the New England Baptist Hospital which is a specialty hospital concentrating largely on joint replacements and spine surgery as well as sports medicine.
I’ve enjoyed practicing at a place that delivers very high-quality special care to a large number of patients and had always been interested in the logistics of how programs like this work but, admittedly, had largely been on the sidelines for four years. About a year ago, the opportunity came up when the previous Chief of the section moved on to a new opportunity outside the hospital, and I thought it was time to see if I could apply some of my vision to maximizing our potential as a group. The strengths, the personnel, and the resources we already had in place were excellent.
Surgimate: In terms of being in that new position, what do you feel are some of the greatest challenges that you confront, both in terms of what happens within the hospital environment and also in terms of healthcare in general in the United States today?
Dr. Ohaegbulam: Certainly, on the function in private practice myself, as do most of the surgeons at this hospital, but many of the challenges apply to employed surgeons as well as to the entire health care system, the paperwork and the administrative burden of the care we have to provide is enormous, and it simply takes away time from actual patient care. There’s only a finite number of hours in the day, and if x amount of time is spent on the paperwork, that just leaves less time to deal with people
Surgimate: Our industry technologists and we on the software side are trying to provide the best value products and services. What is it that we can do to help you as a clinician and a surgeon provide the best level of care?
Dr. Ohaegbulam: I think it always helps to have ways of decreasing the friction that is inherent in the systems we deal with. We deal with several different insurance companies, several different healthcare systems, and a multitude of patients.
And there really is a nightmare of paperwork and technological systems to navigate in coordinating all of this for patient care — reducing the paperwork and simplifying all of that is invaluable and starts to give us time back with patient care as well as just improving the quality and streamlining the work we do so it really falls very much, not on the technology side, but also on the on the administration side.
And the support staff, which you have surgical scheduling as a key component of that, being able to connect all the different stakeholders that are involved in scheduling a case together and making sure that it’s a seamless journey for the patient.
Surgimate: So, what do you feel would be the core ingredient that you’re looking for? Do you feel that it is critical to ensure that part of the process, the coordination of the surgery, is handled completely seamlessly?
Dr. Ohaegbulam: Being organized is paramount for a surgical scheduler and, along with that, having the initiative to deal with a complex schedule. I’m in spine surgery, for example, and the variety of cases that I deal with is pretty wide. There are smaller, less complex cases, and there are longer, more complex cases.
Fitting all this into a schedule can be tricky sometimes, and having the ability to struggle with varying requirements from different insurance companies at different times to get approval as well as helping patients navigate their own schedules and commitments to combine all of this in a schedule that works is a challenge, and it’s an always moving process that requires a scheduler to be very organized and and and have initiative, and along with all of this you need to be compassionate.
It’s not pleasant or fun for patients to be in a position of needing surgery, and having someone who can guide them through this entire process and soothe their frazzled nerves as they do so juggling all the other things I mentioned is very important and it’s quite telling when I’m meeting patients, for example, again on the day of surgery and they’re expressing gratitude to my surgical scheduler the main person they remember from the whole process, and you get them through a very difficult process.
Surgimate: You use the term juggling — a young surgical scheduler who actually worked in a circus and she said that my experience scheduling and working with a circus is perfect for what I do as a scheduler because scheduling surgery isn’t a linear process where this follows this follows this. It’s much more like a juggling act, and if any one of those balls drops or any one of those knives drops at any point in time, the surgery can get canceled unnecessarily, which can create a huge amount of frustration for the patients for the physicians and for the whole system. What would you say in terms of frustrations that drive you the craziest, right from the administration side of booking the surgery to when things get canceled or when the equipment rep doesn’t show? What are the things that are, as a surgeon, like, ‘Ah, if I could solve that problem, I’d love to be able to do that’?
Dr. Ohaegbulam: I think keeping track of the pre-authorization process is a big challenge for us. Making sure that we meet the requirements that different insurers have and how to make that fit into the schedule for the patients and for us — that is a big challenge.
If that didn’t exist, for example, the process would involve less juggling and become much more linear. There are valid reasons for having a pre-authorization process because it is so complex and varies from one insurer to another, which makes it a very big challenge.
Surgimate: You’ve been a renowned neurosurgeon for many many years. Have things just gotten increasingly more complex in the last decade or two decades from your lens as a surgeon?
Dr. Ohaegbulam: Without a doubt, it becomes more difficult with each passing year. The number of things that have to be taken into account with scheduling the number of rules that have to be followed — it is without any doubt becoming more complex with each year.
Surgimate: I want to ask a question now as a neurosurgeon, like a team here at Surgimate, are completely obsessed with the Netflix show “The Good Doctor”, as my wife sits there and binge-watches it at night. But when you’re a surgeon, and you watch shows like that, what’s your reaction? Is this completely outside of the scope of what happens in reality? How do you react to the way in which surgeons are depicted today on television shows like that?
Dr. Ohaegbulam: I have to admit I wish I had more time for TV as well, and this is not just a function of work but a pretty busy family life. I don’t watch as much TV! I think a lot of the time, surgeons’ jobs are sometimes depicted as more glamorous than they actually are. That simply isn’t the case for the most part; it’s not among the people I know, and certainly not with mine.
I also, from time to time, see surgeons portrayed as mavericks, if you will, and that’s really the case in my experience. Surgeons have to function as parts of complex teams, and while they may lead those teams, the teams are completely dependent on the surgeons working as effective members of those teams. Nothing works well if the surgeons are individualists or non-conformists. The surgeon who is a maverick all the time is rarely seen in my experience
Surgimate: If there was anything you could do to help improve healthcare in the United States today what is it that you feel would be the number one or two things you would like to see happen?
Dr. Ohaegbulam: I think at a fundamental level there is a big disconnect between people’s understanding of how healthcare is funded and the reality of what takes place and that leads to a lot of the challenges that we deal with a lot of frustrations patients have and difficulties delivering care.
So, I wish it were possible to improve people’s understanding of where their premiums go, what the employer’s contribution to premiums actually is, and how those funds have to cover increasingly complex and expensive care.
I don’t know that a lot of people truly grasp that resources of finite people have very different expectations from health insurance on the one hand, from what they do to auto insurance or home insurance, so it leads to frustration and happiness with the entire system a lot of the time and I think understanding the entire picture of how healthcare is funded would facilitate discussions about whether society wants completely private health care, or a government-run single-payer system, or some hybrid model.
I don’t think society, by and large, has the information that it needs to make that decision, and so frustrations continue daily. Nobody is happy with the system as it exists so it’s a combination of both the very high cost and also the lack perhaps of the transparency of information about what goes into the fact that there is such a high cost for health care, and that creates a lot of frustration you can provide the highest quality of patient care on the clinical side, but is that matched with the perhaps the value components on the financial piece that the patients get frustrated with. So, I think people don’t understand how the system works, and there’d be less frustration if they did.
Surgimate: Tell me a little bit about a patient who may have touched your heart and provided you with that sort of sense of satisfaction that you often go into when you decide to become a doctor to give that motivation also to those who want to go along that long journey of becoming a spine surgeon, that takes many years. Are there any experiences or stories of that one patient that you sort of have in the back of your mind that says I’m doing all of this hard work and all these long hours and that story really sits with you?
Dr. Ohaegbulam: There are a lot of patients like that. I, on the one hand, I’m not regularly dealing with trauma patients or patients with life-threatening issues, but the quality of life issues that come up day-to-day with what I treat are very important for many people.
I was talking with my wife recently about a wonderful woman I treated several years ago who was a nun in a convent. As part of her mission, she was a very accomplished organist and had gradually lost the ability to play the organ because of her spinal condition. She underwent surgery and had a somewhat challenging recovery but ultimately recovered her ability to play, the joy it gave her was incredible to see, and it was very very gratifying.
She was insistent for the longest time at pulling me and my family over to the convent so that she could perform for us and my kids. I had very young kids at the time who were tickled to see the attention given to all of us and the joy and gratitude that she and her entire community had over that restoration and ability that she had.
I’ll always remember her. There are multiple people like that who’ve just lost the ability to engage with family members or the community who get that back and that it fulfills them, and it’s very gratifying to see.
