Ep. 108 - Where Did All the Doctors Go? A Surgeon and Medical School Dean on What We’re Losing (ft. Dr. Chad Perlyn)

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I am Meredith Curry and this is Working Healthcare. I just interviewed Dr. Chad Perlin, and what a story. His career does not move in a straight line.

He goes from English literature to medical school, plastic surgery, Oxford University, Haiti, pediatric craniofacial surgery, an MBA, physician leadership, and now Dean of Nova Southeastern University's allopathic medical school. This conversation explores how one physician learned to lead by doing the next right thing, and what today's medical students need to understand about medicine, business, AI, hospitality, and the disappearing private practice model. You do not want to miss this.

Dr. Chad Perlin, welcome to Working Healthcare. Thank you so much, Meredith. It is great to be here.

You are a pediatric plastic surgeon and you have a slew of credentials. You're an Oxford-trained scientist, you're an MBA, you're a former health systems executive, and now you're the dean of an allopathic medical school. At what point did you realize your career was not going to fit inside a box? That's a great question and a big one to start.

No softball there. You know, I have been blessed to have the career that I have and still continue to have, of course. And I have very much enjoyed getting to see medicine through its three aspects. First of all, as a practicing surgeon, I still practice.

I love being a pediatric plastic surgeon, and I'm sure we'll talk about that. And I've been honored to take care of thousands upon thousands of babies in the operating room. As you said, I'm also a scientist, and so I see uh medicine through the scientific world, through discovery and research through my PhD and the work uh there. Even though I don't do any uh basic science research anymore myself, um having that background and appreciation of what goes into it has been critical for me.

And then as a healthcare executive and uh and now academic leader, uh, so it's been fun. I've gotten to see it all. It is not the career I thought it would be. I thought I would be a surgeon scientist.

And um 2010, the earthquake in Haiti happened. Uh, for those of your listeners who are in South Florida, they may remember it. It was this massive event in Haiti in this famous moment with my wife and our family. I was watching the chaos on the television.

I could see the devastation. And Brooke, who's an attorney, um, said to me, and I still don't know if it was a question or a statement, Meredith. She said, You're going, aren't you? And I did, and I wound up leading one of the very first teams of pediatric surgeons to Haiti in 2010, which just put my career on this totally different track.

I never opened the lab and wound up in healthcare leadership, and here we are today. And I want to talk about Haiti down the road in a little bit, but I really want to talk about you and who you were before medicine. Oh um, you know, I grew up in South Florida, South Florida native, born and raised. No physicians in in my family.

My uh dad, we joked, was a hot dog salesman. He worked for Nathan's hot dogs for many, many years. My mom was a dental hygienist, so I guess there was some medicine there, but no physicians in my family. Um I do have a pretty neat moment though that I can absolutely pinpoint um when I just knew that I wanted to be a physician.

I was young, I was four. And my brother had recently been born, he was six weeks old, and I remember like it was yesterday when the phone rang in the house. I saw my mother answer it, and I watched her start crying. And I put me in the car, I remember the pajamas I was wearing.

And essentially it was a trip to come to the children's hospital. Back then it was variety children's hospital now, and Miami Churchins now, Nicholas Church, but it was variety charges. And the call was to come say goodbye to my baby brother, who was almost certainly gonna die that night. And there was a young pediatric surgeon who came out and spoke to my parents and said uh he's almost certainly gonna perish.

This was before MRIs and CTs and things. Um his only chances if we do a laparotomy, exploratory surgery, he'll probably die on the table. But you want him to die in peace in the bed or fighting on the table? That was the choice presented to my parents, you can imagine.

And I watched this whole thing. And uh even at four years old, when the surgeon came into the waiting room a couple hours later, I knew what the smile on his face meant. And he was like a hero to me, these these superheroes dressed in their green scrubs. And they did save my brother, um, who's now almost 50.

And um from that moment on, I I just I knew what I wanted to do with my life, which was be a surgeon to help to help kids. And uh eventually, and we can talk about it if we have time, how I became a pediatric plastic surgeon. But that's what put me on the path early on. And I just grew up very fortunate, just having this dream and uh knowing what I wanted to do.

You studied English literature, though, in college at Northwestern. So I'm trying to figure out how that part of your education showed up in the way that you communicate with patients and parents and students and physicians, because somebody who wanted to be a doctor from the time, as my grandmother would say, knee high to a grasshopper, and then go study English literature doesn't make sense to me. Why did you choose that path and how does that show up for you? I knew I had my whole life to study medicine.

And there's a great expression once you start studying medicine, you never finish. And I I knew that. And obviously I was pre-med, so I took all of the pre-med classes, but I I wasn't interested in being a biology major or a or a biochemistry major. I loved writing, I loved reading, and I think most importantly, I loved learning to interpret something.

So you'd be given a poem as an English major and say, interpret this, right? Maybe there was a right, maybe there was a wrong, but most of the time, professors want to see how you thought, and then how you could communicate that thought and express that thought. And so whether it was poetry or the classics um uh or what it was, um, I just thought it was a beautiful major because it let me learn so much. It let me critically think uh historical aspects and the time periods of the pieces, and it was just a great, uh, great background.

Why pediatrics? Well, obviously the story of my brother um and and seeing this group of surgeons save my brother's life. I just I I wanted to help kids and children. And I had um until I got to college, thought I would be a pediatric general surgeon.

So work on the you know, the intestines and and and vowel and general surgery type things. And then when I was in college, and this was before the internet, um, which is important when I talk to our young students about effort, people always ask about how do you get mentors, and it takes effort. Um I read a newspaper article in the Chicago Tribune about a surgeon named Bruce Bauer. And Bruce was making ears for kids born without ears.

Make an incision in the chest, take out a piece of cartilage, hand-carve it into the shape of an ear, put it under the skin, and create these amazing ears. And I thought it was the neatest thing. And I remember this is pre-computers, pre-email. I took out my typewriter and I typed him a letter and stuck the post-it stamp on it and put it in the mail.

And to my incredible surprise, a couple weeks later, in my dorm slot, which never got any mail, uh, I had a letter waiting from Bruce thanking me for the note and more importantly, inviting me to come watch him make an ear. And he really became my one of my first real mentors uh in life. And when I saw the power of that, that in a finite period of time, with your own two hands, you could change someone's life, make an ear, fix a cleft lip, these types of problems that these babies were born with, I was I was hooked.

When people think about plastic surgery, they think of aesthetics, right? That's the number one thing that comes to people's minds. But your work does specialize, obviously, with children, you're in pediatrics, but you focus on congenital or acquired anomalies and craniofacial conditions, vascular anomalies, and pigmented lesions. What do people misunderstand about that specialty?

So it's a great point, especially in a place like South Florida, where aesthetic surgery is all over the place. And aesthetic surgery is great and it's a huge part of plastic surgery, but it's not my world of plastic surgery. I did train general surgery and then plastic surgery and could do all of that, but then went on to do a do a fellowship in pediatric and craniofacial surgery. So my world, as you said, is really helping uh infants or children with either facial differences, so cleft lip, cleft palate, severe skull deformities, where one orbit is down in the low cheek and the other orbit's up in the forehead, and we're literally peeling the face down and sawing the bones apart and moving the bones to limb deformities, uh congenital breast issues in teenage girls who may have an issue, uh feet problems, abdomen.

It's the last of the general surgeries, we like to say, because we are fixing every part of the body which nature or misfortune has taken away. When a child is born with a facial difference, what are families really carrying with them when they walk into your office? Um so that is uh that's a great um a great question, a great point. And uh it's in part why I went back to be a scientist.

So I went back and did my PhD um late. I was a plastic surgery resident. You know, most MD PhDs do it early. Because I was frustrated that we didn't understand why.

I could fix these kids. I was becoming a pretty good carpenter. But you would have a mom crying in the office. Why?

Why did this happen to my baby? Why did this happen to my family? Was it the piece of sushi I ate or the glass of wine I drank? Of course, none of which is true, but but not knowing why frustrated me and I didn't want to spend my career.

So I I did that. Another note of this, it's interesting you asked that because I was just speaking to a student about this today, and we were having a conversation about learning to care for patients. And one of the favorite things that I say to the students, the secret to caring for the patient is caring for the patient, caring about the patient and their family in this type of case. And he said an example, and I said, you know, when a family comes to me and there's a child with a terrible facial difference, um, and I like that word difference over deformity, the terrible facial difference and a cleft lip, and and it's a big cleft, and I'm meeting the family for the first time, and obviously they're so nervous and anxious and terrified what I'm gonna say, and I go through this moment, and I'm looking at the baby, I'm studying the cleft, but I look up and I always start with a compliment about the baby, something true, right?

A true compliment. But you know, the family is so ready for the first thing to come out of my mouth to be this scary or frightening bit, and I will say, look at those eyes, right? What amazing eyes. Who in the family does the baby's eyes come from?

Or what a head of hair, whatever it is. I always start with that. Because to your point, Mareth, these families are so distraught in this moment and so afraid and so torn that anything that I can do to help humanize the moment, this is not about fixing the cleft. This is about fixing their child.

Uh, and that's one of the things that that I love and frankly that I miss um now that I'm not doing so much complex surgery anymore or being being deemed. You studied why children were born with these certain facial birth differences, as you put it. What did that research teach you that you couldn't learn inside an exam room? Well, the first thing um is science is hard and it's frustrating, and it's very different than being a surgeon.

I will tell you, I struggled in the beginning, and my lab mates used to tease me because as a surgeon, it's about getting like fixing it. There's a problem and we fix it. That's what we do, that's why we go into surgery. In research and in discovery, there's no fixing it.

You're asking a question, maybe you get an answer, maybe you don't. It just leads to another question. And so my first few months in the lab and in a place like Oxford, an incredibly academic place, was challenging because I couldn't just fix it. I couldn't just get the answer.

So learning to think like a scientist and to understand that was really key and fascinating. Ultimately, we did do some amazing work scientifically and had some very significant discoveries around why some of these babies are born this way. We helped develop a drug which later became the formula for other things around this path. So it was an incredibly productive time.

Uh and most of all, it gave me a deep understanding of embryology, genetics, anatomy, and the ability to explain to families what we knew and also what we didn't know, but to reinforce that this was no fault of any um any mother who often feel this tremendous sense of guilt or weight on their shoulders, um, even more so than the father's, because of course they carry the baby. So uh so being able to utilize that to help those moms in that moment has been very powerful. In pediatric craniofacial work, the patient may be the child, but you're dealing with the entire care system.

You're dealing with the parents, the schools, the specialists, the surgeons, insurers, and years of follow-up. How do you define a good outcome? Oh, well, there's so many. Um there's there's so many.

And one of the things I often say to the families on that first meeting, I'll make the compliment about the baby, and then I'll often look up and I'll say, you know, we're gonna be friends for a long time. And that's sort of my way of saying, like, this is a big deal, and we're gonna be working on this for a long time, but we're gonna get through it together. Because you're right, um, it does take a lot. And a good outcome is a happy, productive child who's absolutely thriving.

Sometimes um that's thriving in in a regular school in a regular um situation. Other times it's in a in a different. Um, I love telling the story. I I won't say the name, but if the family uh hears, they will know who they are of a child who was born with a cleft and was um deaf, no hearing in both ears, and a cleft, facial cleft, cleft palate, uh cleft lips.

So you can imagine this family thinking their child may never hear nor speak properly. What a terrible uh thought for any new parent. And he is now one of the most elegant speakers I think I have ever met publicly, in public service, an absolute rock star. And and and there you go.

Um so so that's obviously a case of you know, extreme, what is what does great look like? What does success look like for these kids? But ultimately, it's a happy child and a happy family, and I leave it to them to decide that. You went to Oxford to earn your PhD and you were actually almost done with medical school.

Why did you decide to go that route and take a deviation from the traditional let's do four years of med school? Yeah, so it so it was actually later, even I finished medical school. I was almost done with my residency. Okay.

At a really unusual time. It would have been strange to your point to do it at the end of medical school. Most do it sort of combined MD PhDs. I was almost at the end of my residency, which meant three years, three more years of training and three more years of not getting a job and all such things.

But I really, I was very passionate um about about it. I knew I would be unsatisfied in my career as just a surgeon um without having a deeper understanding of these problems. And as I mentioned before, I thought I was gonna spend a part of my professional life looking to solve them as a surgeon scientist. Uh so the other thing is most MD PhDs, like in our medical school with our MD PhDs, they they do their PhD really at a time when they think they know what they're interested in clinically, but you're still in medical school.

Um and oftentimes you get out of medical school, start your residency, become interested in a particular problem, and it may be nothing that your PhD was in. So the the advantage for me was that um I got to focus my scientific effort exactly on the clinical problem I knew I would spend the rest of my life working on, the rest of my professional life. Uh the disadvantage was if you're an MD PhD, you often get medical school paid for. So that uh that did not happen, but still worth it.

I laugh because my husband was working toward an MD PhD, and he and I met during his PhD training, and he took off between third and fourth year, and he thought he knew what he wanted, going back to what you said. Most medical students have no idea, even though they think they know. And he went through a year and said, to heck with this, I'm going back to medical school. So he never finished that work.

It would have taken him five years. How long did it take you to finish your PhD work? It took me three years. Um it was an incredibly productive three years.

The surgeon in me and the work effort uh there. I actually did not think I was gonna do it. After the first year, though, it was so productive that I wound up staying for for longer and uh and and got it done. And defending my thesis at Oxford was one of the more challenging days of my academic career, I'll tell you that, in my black cloak.

You know, if for the listeners, Harry Potter is based on Oxford and the life at Oxford. And uh I ate in that dining hall, the one that's in the movie, in my tuxedo and black cloak, uh, many a night. And uh it was it was challenging but an extraordinary experience. You expected to become a scientist and you wanted to open up a lab, but you didn't.

You actually pivoted your path again. Yeah. Why did you choose to pivot? And do you feel like you lost out on something going that trajectory?

No, uh not at all. Um it's been an amazing path, a path that I never could have anticipated in my wildest um dreams. Um, but I'm so thrilled how it how it's wound up. So, you know, as we said before, I I finished and I was at Wash U and had this PhD, and and and Wash U, as many of the listeners will know, is one of the meccas of academic medicine.

And so I finished um having been trained in that model and um was hired by FIU when FIU was just opening the medical school in South Florida. And uh back then it was Miami Children's Hospital before it became Nicholas. And I had this this amazing job, by the way, back at the place that had saved my brother's life. So you can imagine the joy for me of kind of coming full circle, this place where the dream began.

Somehow I wound up there and and would eventually become one of the leaders there. But um So the earthquake happens, and I I go to Haiti and I volunteer to lead one of the first trips with some other great leaders and folks. And then I help kind of run the Haiti effort for the next um uh couple of months as it's all in full force. And to make the the long story short, I knew very little about leadership.

Um, but I did know as as you and I have talked before, how to just do the next right thing. And in this overwhelming situation of chaos, so much going on, I was this young green surgeon who no concept of leadership, no concept of what it meant to drive an organization, be responsible, but I did understand how to do the next right thing. And because of that, um shortly after that whole experience had wrapped up, the director of surgical services, it's essentially our surgeon-in-chief, that's what we call it, the director of surgical services, was leaving.

He was a very senior surgeon to take a very prestigious job up in New York. And I got tapped for that job. Uh, and I wasn't even out of my first year out of my residency. And I had some amazing mentorship, folks like John uh Rag of a neurosurgeon, and many of the senior surgeons with hair far grayer than mine.

Now I'm the guy with the gray hair, but at the time, um, there were many senior colleagues who I was concerned would would say absolutely like absolutely not. Um, but they were incredibly supportive of me, which put my career into this leadership tract, this major leadership role very early on. And from there, one thing just led to the next. And years and years later, I was the president of Nicholas Children's Pediatric Specialists, uh, which is the subsidiary of the health system that runs the clinical enterprise with the physicians.

Um, so uh it's been a need journey. And then obviously from there I made the leap to academics. I want to go back to 2010 with the Haiti earthquake, because it did obviously have a major impact on you and pivoted your career again. What did you see and what did it ask of you?

Not necessarily just, okay, I'm going into leadership. Give me some details, Chad. Like, why in that those few months when you were in Haiti, were you like, I I have a greater calling? Yeah.

Um I knew that I had a skill. It was it was a not a developed skill at that point because I had been trained as a surgeon, but I was not an experienced surgeon by any means. It was you know a young, very young attending. Um I knew I could help.

And um back to to saying I didn't know what leadership was or looked like. Um, and this story is so real. We had a got in a plane together and um got on the plane donated. It's a pretty big plane, and we had a lot of people and a lot of gear on the plane, and it was a couple of days after the earthquake.

And uh we get on the plane, and I'm one of the last people to get on the plane, um, which means I happened to be sitting in seat 1A, right? If you think about a regular plane. And the airfield, the airport had been destroyed, it was very unsecure. The Air Force was just taking control of it.

It was still a lot of pandemonium on the ground. And the pilot came out and and said, Um, we're gonna have a problem, there's gonna be some issues when we land the plane. Who's in charge? And we really hadn't gotten to that point at it.

But I happened to be sitting literally in that first seat. And he said, Well, I'm just gonna talk to you. And and that was that was how it all started. And two minutes later, I found myself on the speaker, like the flight attendants, um, starting to make plans and organize and figure out how to do the next right thing, how to get people off the airplane safely, how to unload it, what we were gonna do next.

And it just became one step after the next. And it was an extraordinary experience. And I'll share with the listeners one other story from there, which was maybe one of the most profound moments of my career, if not of my life, in terms of just raw drama. So um, we had gotten in in the early days, the government was allowing critically injured patients to come in on aircrafts through some of the smaller airports, and the customs folks were there to process everything.

Um, eventually that shifted when they sent the mercy ship and the comfort, the big uh naval ships. But in those beginning days, that's what what we were able to do. And so we had got an aircraft from a from a donor, someone who owned a private plane, and the pilots brought the plane, and and there were two critically injured kids, both sick as sick can be. And so the plan was to get the kids to the airplane and the airplane to South Florida and bring them to the children's hospital.

And this had all been arranged. The problem was that the pilots weren't comfortable with the plan. And the pilots were unclear as to what was happening with the government and the and the regulatory issues about coming in um with with people into the states from Haiti, right, from another country. So I'm at the uh hospital, and I get someone running up to me and says, there's a big problem going on.

You've got to get to the the the the runway right away. And what was happening was the US military was controlling at this point very short windows of ground time. There were so many planes coming in and so few working runways. You landed the plane, unloaded it, or picked up your passengers, and you took off, and they were not messing around.

Well, these pilots refused to take off. And the kids were on the plane, and they refused to take off, and they were going crazy. So this comes to me, and I wound up the one and only time I've ever agreed to be on the back of a motorcycle, because I don't like motorcycles, but a marine gave me a ride on a on a dirt bike uh down to the airfield, and I get there, and the two pilots are going crazy. They uh using every expletive in the bad word dictionary about getting these kids off their airplane.

And I I see what's going on, I see the aircraft um uh person from the Air Force um getting into it, and I just look at the situation and I walk onto the airplane rather than yelling at the pilots or getting involved in a shouting match, I say to them, gentlemen, I need to apologize for what I'm about to do to you. And I said, What I'm about to do to you and what I am about to say to you, it's not fair. And the burden that I am about to put on you that you will carry for the rest of your lives is not fair.

And I'm sorry, and I'm gonna apologize in advance. And I paused and I said, But you have to understand these children's lives are in your hands. That's it. This is the moment right now, it's black or white.

If you fly, they have a chance of living. If you don't, we will take them off the aircraft, but they will die. And there's no other way that I can say it. And I have to say it like that.

And I hope you are able to do the next right thing. But if you can't, we understand that'll be that. And I said, I'm gonna step off the plane and give you a minute, and I did. They closed the door, and a minute or so later, they opened the door and they said, Okay, we'll go.

And those two kids are alive today, and I wish I knew the name of those pilots. I hope they hear this one day and reach out to me so I can give them a hug for their courage and bravery. So it was examples like that, examples that in outside of that type of environment, I just never in my life would have gotten the exposure to. Um, and I grew tremendously as a human being during during that time.

You've said that you didn't have quote leadership skills when you went to Haiti. Obviously, you did, and you had not cultivated them to where you are right now, but you had these basic skills already. Even if you didn't call them leadership skills, what are those basic skills? And I ask Chad, because there are so many other younger I I don't even know how to put it into words myself, but I loved your story.

But just young professionals, young physicians who want to do the next right thing, and they don't know how to verbalize what leadership is to themselves. What are those skills that you had during that time that you've been able to build upon? Yeah, I um I've thought about this a lot lately. Unfortunately, it was because my father passed away last week.

Uh, he was an amazing, amazing person. And both he and my mom, how they raised me, but he in particular, at his funeral, I told a story about one of my very first memories of him. And um back when the gas station attendants used to pump your gas. And I remember it was an older guy, a Jamaican guy who was pumping the gas.

And I was so surprised by my father's warmth and engagement with him. That even as a little kid, I asked him, Dad, why did you care about that man? And he just looked at me with surprise and said, Why wouldn't I care about that man? And that's just how I was raised.

And so to answer your question specifics, I think, you know, empathy, curiosity, communication. Um I have a little sticky note often on my desk. I'm looking, I don't have it now, but I must have fallen off. But it reminds you of the three H's.

Um stay humble, stay honest, and stay helpful. And if you can do those things and how you make decisions and lead, you may not make the right decisions. You certainly won't always make ones that make everybody happy, but you know at least you have a true north in uh in your actions. I've heard you say a lot, your personal motto, do the next right thing.

Where did that come from? I don't know. It just it I just it just it just did, you know. Well I I maybe, well, maybe it um maybe the first time I heard it was actually from a cousin who I heard say DTRT, which is do the right thing.

Right? And and that's often, you know, trying to make a decision, should I should you go to the party, you don't want to go or whatever. And it's just like do the right thing, right? Do the right thing, DTRT.

I don't know if along the way I picked up, you know, do the next right thing, but certainly that's how I learned to manage chaos in difficult situations when you don't know what to do and it's overwhelming, just do the next right thing. You are highly credentialed, you have your MD, you have your PhD, and then you decide to go back and get your MBA from the University of Miami. Why did you make that decision? And do you think that it was necessary to grow in the leadership role that you're in right now?

So um, this is a great story, and I love sharing this with young physicians who are interested in leadership or maybe an MBA or um you know another opportunity to serve others. So I got called one day, one of my mentors, I talked about Bruce Bauer on the plastic surgery side, Matt Love, who's currently the CEO of Nicholas Jordan's. Matt was one of my mentors. And one day I got called to the CEO's office.

And and of course, you know, you get called to the CEO's office, the first thing you think is, oh, what did I do? Right. Matt sat me down and said, Um, hey, I want to ask you a question. Are you interested in doing an MBA?

And I kind of thought for a second, and I'll share with the listeners. I'm a little embarrassed to say I was surfing a lot at the time. I loved my time in the water, and I was like, uh, if I serve, if I go to do an MBA, I won't be able to surf. I was like, I'm interested, but I don't know, Matt.

Thanks. You know, let me think of it. And I was just super wishy-washy. And I walked out of the office, like, pretty much having said no.

Then the next day, and it's interesting how things happened in our lives. Next day I ran to the chairman of the board of the health system who was there for a meeting. He's coming down the hall, I'm going the other way, and he says to me, Hey, congratulations on that MBA. And I realized in that exact moment, I was not being asked if I wanted to do an MBA or not.

I was being asked, was I interested in being developed and mentored to become a leader of the health system? The MBA was just a way that the system was willing to invest in me, but it had nothing to do with the MBA. And I knew in that moment, and I think this is important for the people considering these things, I knew in that moment what would happen if I said no. I did not know what would happen if I said yes.

But I knew if I said no, the doors would close. I would not be asked again if I was interested in any leadership role, any position, and and the investment and opportunity and mentorship would go to someone else. So I knew that, and luckily I realized it, and I said um to the chair, oh, I'm so excited, delighted. And of course, my next phone call was to Matt saying I would be honored to do the MBA.

Um, it was the right decision. I later would be asked to become the president, as I mentioned, of NCPS of the group, and have a major healthcare executive job and help lead the physician organization, um, which was amazing, which is amazing. Uh so was it worth it? For me, in my role, a thousand percent.

Um a thousand percent, particularly on areas where I was weak, finance, um, uh those type pieces. And and that's been a tremendous asset for me. Do I think every physician, if if you're gonna run your own private practice or or or interested in startup, do I think it's necessary? No.

Um, but I certainly think for people who want to operate um at a corporate level, it is a necessary credential. Physicians don't often go and get their MBAs when they're given a leadership opportunity. When I worked through my MBA at the University of Florida, I was in an executive MBA program, and there were 50 students in my cohort, and four were doctors. And so they were working on that track too.

But a lot of times leadership is very informal. It's service training, becoming excellent on the clinical side, and then they suddenly manage teams and budgets and strategy. For those who don't seek the MBA track, what do you think is wrong with the informal model? Um You know, I think there's a couple of things.

And like you, I I was at the University of Miami where I did my MBA in healthcare uh through a program like that, which was which was terrific. But for those who who don't seek it, um how do I answer the question about the informal model? I think um there's certainly like anything else, there's a language, there's a vernacular, there's a skill set that you develop. And you did your MBA, so you so you you you you can appreciate this.

You know, could you do what you do without it? Sure. Um, do you do it in a more polished way, in a in a in a more efficient way, a more sophisticated way? You know, probably.

And and I think that the best part about it is human nature tends to let us do what we like to do. Um, so we tend to gravitate to our strengths. Doing the MBA um made me realize my weaknesses. And I think people who are leading, and they may be great leaders without the education, they may not appreciate their weaknesses as much as folks who like yourself who did an MBA and you really um you really get to see what you're good at, what you're good at and what you like.

And and I always say focus on what you don't like when you're in school, so you're strong at that later. It definitely helped. It makes me more comfortable speaking to my accountants. You're right.

It makes me more comfortable when I sit at the table because you have that vernacular that's really important. You, in your high-level leadership role now, and in leadership positions you've carried for several years, you still practice medicine. And you told me that you spend about 20% of your time still in the clinic. Why is that important to you?

Yeah, it's it's really important to me. So um, as we said before in the intro, my my primary job today is uh Nova Southeastern University. Nova is um major university in in Florida, largest educator of healthcare professionals in the country now. So we're very proud of that, and uh largest educator of physicians in the state of Florida with our two schools, the MD School and the DO school, as well as dental school and nursing, all other things.

So I serve as uh the executive vice president at the university and the chief medical officer for the whole university, and I oversee all healthcare and the health system, and then also dean of the school of medicine of the MD College, which is great. But I um Nicholas is uh always has a place in my heart. I was um so proud that I could work out when we when I came to NOVA, I was sad to leave Nicholas in my leadership roles, but thrilled that I was able to not leave the family and still be able to operate.

And um A, it's a part of my my soul, who uh who I am as a surgeon and helping kids and families. B, it keeps me legitimate and keeps me in the game. So I understand what goes on and the struggles of the EMR or whatever the challenge of the day is, I get it, and I'm uh right there. And C, it lets the students um see me leading by example, which I think is is really important.

How are today's medical students different, do you think, from when you were in medical school? Yeah. Uh I think our medical students are at a very interesting point in our times. Uh, and I'll get to AI in a second.

Before even adding AI, um, just there's two big pieces that I see, and I talked to them about this. Um, one is communication skills. So, you know, the Egyptians communicate with hieroglyphics, right? You and I could end this podcast, and I could text you a strong-arm doctor, smiley face, and hand praying or thank you thing, and you would know exactly what I meant, right?

Thanks for a great strong podcast, right? You can't learn to communicate with other human beings sending emojis. And sadly, that's what this generation of kids has grown up on. Right?

They text, they communicate, they, they, they uh TikTok, whatever it, whatever it is. And the skill set, right, to have a conversation, to really engage with someone, that's that's been lost. That's been lost in in this generation of kids, not all of them, but in general, I think it's very fair to say that communication, eye contact, one-on-one dialogue is something that that we shun from, right? It's it's a lot easier to go to the chat bot than pick up the phone and ask for help.

So number one is that. Number two is the medical students right now are facing an unprecedented period of loss of trust. Loss of trust in institutions, loss of trust in science, loss in trust in scientific method, loss in trust as to what defines an expert, um, who's an authority, and and sadly, loss in trust in medicine and in the medical system. So we spend a lot of time talking about um that, how to deal with that, how to navigate through that, um, and that piece.

And then you take all of that, and of course, now add AI to the mix. Um, it's a challenging time for for these young, you know, for these young students. The AI piece I'm not worried about. Uh people ask me all the time, do I think AI is going to end medicine?

And I say, no, I think it's going to liberate medicine. I hope it does all the things that the doctors are so burdened down by now that are just done digitally. We've already seen it, but just the beginning of the AI note taking services. It's going to be incredible in a few years.

And if if so many of these tasks can be managed by the AI system. systems, allowing the physicians to spend time what they will need to do best, which is communicate one-on-one with other human beings, that I think will be magic for medicine because that that we've lost that. We've sadly lost that to some extent over the last few decades. Aaron Powell Since you are an English literature phenomena I'm going to ask you with a few adjectives, what kind of doctor are you trying to graduate?

You talked about the compassion, you talked about the communication skills. What adjectives would you use to describe the type of doctor that you want walking out of Nova Southeastern? So empathetic for sure. It's a key, it's a key word and I choose empathetic over sympathetic because whether or not we are ill or sick today we all will be we all will be.

And um I think that's really important. That recognition that we all will be sick. We all will have loved ones who will be sick. We all will have issues and challenges getting our docs and our students to appreciate that um is really important to me.

It's really important to me. Compassionate goes along that same line with empathetic being available to our patients and when I say available I don't mean office hours I mean being available sitting at the bedside in the room. We talk about this with our students when was the last time you had a doctor sit right come sit on your bed in in in the hospital room um of course technically able and competent obviously but that piece will come with with with education and AI and the knowledge will be democratized.

So I'm less worried about the knowledge as I am about having empathetic physicians who are hardworking who are dedicated who will make themselves available to their patients and available not just in time but available in emotional space and um and time and ultimately who can lead who can lead and we spend a lot of time we have a leadership bookup we try to teach leadership in this medical school different than others around what it means to lead and what are the challenges and how to navigate it so we can produce the next generation of of the finest physicians that's out there.

Where do you think AI belongs in medical education right now it's certainly a big part of it and it's coming more and and more and we're going to see it more and more obviously you know in the education piece it's going to be the the the end of memorization because the the it the information's there in in a in a nanosecond and as the as the AI agents for healthcare become more sophisticated it'll be there. You know we talk about and obviously people ask about education and think it's you know how are we going to use AI to teach the students?

But there's so many more interesting questions. So for example um research publications and and I know you know this and all of the listeners we only we collectively scientific society only historically has published the positive findings. So you do an experiment and it worked and hooray you publish the results right you could have done 999 like the what the light bulb was created in that famous expression right you could create 999 failed experiments and none of them were ever shared or published because there just was no way to archive it and mine it and understand why they failed.

Today with AI, that information becomes just as important as the positive why it didn't work because now you can populate it and crosslink it in a way that was never feasible before. So whether it's in in research or other things, it it's going to be game changing. We don't know it yet I don't pretend to predict the future what I do know is it will create a new set of skills which is not going to be how smart you are and not going to be how sav you are but it's going to be how you communicate how you take that information off your little device whether it looks like our iPhone in five years or something totally different whatever the device is how you interface with that device to interface back with that person in an empathetic, compassionate and available way.

And I think that will be the key. And at the white coat ceremony I love that you give every student the unreasonable hospitality book. Yeah why that book so so for the listeners um what is talking about at the white coat ceremony last year I decided to give a book and the book was called Unreasonable Hospitality as you and in my speech I said you know why is the dean giving the medical students this book about food and wine and how they took 11 Madison Park restaurant in New York to be the number one restaurant in the world and the answer is because it really has nothing to do with food and wine.

It has to do with how they built a culture and how they taught and educated their team to make people feel valued, to make people feel seen to make people feel heard that was in the staff, in the customers and the whole culture that they created. And it's it's just a magnificent way to share that example which is often missing in medicine today. And of course unreasonable hospitality what's the key word in hospitality? Hospital right and what's missing so much in hospitals in our healthcare system today, right?

Hospitality where we started that warm, engaging touch, right? That desire to care for another human being to reach out and really um take someone else as your charge their wellness as your charge that that sadly to some extent is uh is missing today and I I I hope we're able to regain to regain some of that. I think it's missing in all aspects and I had never thought of the fact that hospital was part of hospitality but I would say it's missing in so many sectors right now and I can't really pinpoint when that happened for me.

I feel like it was about during COVID time because everybody could cover themselves up with a mask they could be rude to others and not be seen or they can eliminate the ability to have physical contact and just hide behind a screen and still in 2026 do that. If we're looking at these young physicians coming into medical school are we expecting too much of them are they equipped for this well um let me break that down are we expecting too much of them I would say no. This is I would agree no but I'm a little nervous.

Yeah yeah I would say no because this is um in my opinion the most extraordinary profession um it's not easy it's not the best job right you work long hours you give up a lot of sacrifices um you you you don't create generational wealth physicians obviously do well but you're not creating generational wealth uh but as a profession it's the greatest profession there is because there is no honor like taking care for others. So do we expect um too much of them? No. Are they prepared for it?

Not always right not always because of some of the issues we talked about before which is why part of our job is the curriculum and the education and and the opportunities for them to get exposure and develop their skills um so they leave here prepared and ready for residency and then residency they grow again another layer and it it it it takes it takes uh it takes time um but uh but I'm I'm confident in in our students and who we send out in the world and obviously very proud of them.

If I look at the American Medical Association statistics back in 2012 60 percent about 60 percent of doctors were in private practice and just in 2024 it's plummeted to 42 percent I have a private practice you've worked in a hospital setting is private practice something that you think is achievable for young physicians you know it I think that part of it depends on the specialty in today's world so there are certain specialties where where the financial models may allow you to to as the old expression goes hang your shingle and and have a single practitioner private practice.

It's hard and and many of the specialties today um for good or bad the the mechanisms of how the specialty works the reimbursement the time to reimbursement it it's just not not feasible. You know what's interesting today on the employment side is as you said the majority of physicians are employed. Many are employed by large hospital systems or universities like I am um others may be employed in a in a quote private practice um meaning not by a hospital system or a university um but it may actually behind the scenes be be owned or invested by private equity.

It may be part of a large multi-specialty group or other things. So there's a lot of different models that are out there today but I I do think the um the model of the individual doc um having their own shop and running it soup to nuts as they say without without any support um is becoming more and more challenging I want to end this with a couple of next right thing scenarios because I love that motto of yours. What is the next right thing for medical education aside from Nova Southeastern what would you like to see of your colleagues across the country as the next right thing for medical education so I I think there's um two big pieces one is around um interprofessional learning and teams and physicians um are obviously key parts of teams but often we don't work in the best team environments and that's going to become increasingly important to be um the integration of AI and figuring out what that looks like.

And I certainly am no AI expert and I don't have the answers. I love to use an example though of a friend of mine who flies uh I forgot what the biggest plane is today I think it's a 777 whatever the jumbo jump whatever the biggest plane is he flies it um as a commercial pilot and I once asked or I recently asked him what's it like to fly that huge plane and he laughed and he said Chad we don't fly the planes anymore he said we manage the systems and I think about that with what AI is going to do to medicine.

And to some extent that worries me but I'm also okay with it because we have to learn it and understand it. How will we use this new tool and learn to manage the systems? It's not going to replace us um but we will have to learn how to use it and and how to manage it which is going to be which is going to be critical. What do you think the next right thing for physicians is oh that's a great that's a great question.

You got me on that one. I would say it's probably going to be around the same space and around it's going to be very easy uh and very tempting to let technology um do things for us. And that's okay. And I made that point before that I'm actually excited for that.

That's a good thing um that uh we want to unburden ourselves from a lot of the mundane so we can go on the challenge and maybe here's your answer on doing the next right thing is not letting the machines um step in for us um to the full capacity that they will be able to and what I mean by that there's been studies already that have shown uh that if you take a radiologist's um reading accuracy for example and I'm I'm I'm gonna grossly paraphrase if not make up these numbers but it'll make the point for the reader and and you have them read a hundred x-rays they'll read it with a you know great accuracy rate right because they peer review it if you then let them read it with AI as a tool that will go up it will increase when you have the human and the AI doing it makes sense two sets of eyes right if you then take away the AI what do you think happens to the accuracy rate when they're reading independently again right it drops.

It falls below the baseline so so maybe I'd answer your question what's the next sort of thing? Making sure we never fall below the baseline because it will be very easy to do that. And and that's what we have to make sure we don't do that that we manage the system and not the other way around. You have spent your career reconstructing what is injured, malformed disrupted or not yet whole so I'm making a bit of a caveat to my traditional last question.

If you could reconstruct one part of our American healthcare system what would you fix first? And I think to answer that question we have to go back to the very beginnings of this profession and what this profession was built on and what it means. And that is compassion and trust and those two pieces we need to restore. And I know it's easy to say because there are so many problems I could have answered.

We could have talked about the electronic health record we could have talked about the payer mechanism we to could have talked about rates and finances and access there's a dozen things we could have talked about and there's two dozen more that challenge physicians every day and make this as I said before a challenging job and bleeds away from the beautiful profession that it is there's a difference between the profession and the job. And so if you ask me what I would do to fix first, as naive as it sounds and I know that it's naive I would want to start back with ensuring that physicians are able to practice in a way that lets them express their compassion and lets patients trust them again.

And um that is spending time with patients making eye contact with patients reaching out and touching the patient on the hand or on the shoulder when appropriate and engaging with people one-on-one again. There is no profession out there that lets us engage in such a vulnerable way with other human beings not law not finance not accounting not hospitality like medicine when you are there for a patient or a child or the family in often their most vulnerable moments and you can make a difference in that person's life and that family's life whether that difference is a positive outcome which obviously we strive for of course but even that difference as I just went through I I mentioned I lost my dad um the care and compassion even when when my father could not be saved in the end um that will resonate with me for my rest of my life how those people made me feel how they treated me um at the time of my dad's passing and whatever we can do to get that back as our number one priority in this profession that's what I would want to start to work on first.

Well said Dr. Chad Perlin thank you for joining me on working healthcare if this conversation hit home or made you think a little differently don't keep it to yourself share the episode tag a friend or post about it on social media. Connect with me on LinkedIn to keep the conversation going in between episodes. If you've got a question an episode idea or someone you think I should feature send me a note at Meredithhirst.

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