ANSWERING THE CALL TO MEDICINE
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geographical region into a network structure called practice-based research networks( PBRNs). These PBRNs serve as laboratories to perform real world pragmatic studies in everyday clinical practice. It became clear how being a family medicine physician and doing research in such clinics would impact populations beyond the individuals I cared for in my clinic.
After residency, I stepped right into a leadership position back at my medical school as the department’ s research division chief. My role was to grow and develop research in the family medicine department. Over more than eight years as a faculty member at my medical school, I founded the North Texas Practice-Based Research Network( 300 + clinics today), the Primary Care Research Institute and secured a number of federal and non-federal research grants. Moreover, I had the opportunity to educate and train hundreds of medical, physician assistant and MPH students. My love for education was rooted in educating the future medical professionals and realizing how I am impacting future populations in a third way. I really believed that my impact couldn’ t have been more reaching at that point. Aside from normal daily nuances, I felt privileged to take care of my own patients, be allowed to teach our future doctors and PAs and do the research that I felt mattered. Then something else happened.
I was asked to step in as the chair of the department that had oversight of a large number of faculty and staff, five clinics, a high-volume hospital service, several education and residency programs, its research division and an undesirable financial situation. This experience quickly leveraged my work in process improvement, leading groups at a very young age and developing a strategic process that was ultimately developed and owned by the faculty and staff which redefined our culture. Long story made short, we were successful in many areas, especially in the clinical programs. This was at a time when health care was transforming at a rapid pace, and phrases like“ value-based care” and“ population health” started to infiltrate conversations. The U. S. started realizing how much it was spending in health care, yet we were not stacking up in terms of health outcomes compared to other industrialized nations. The picture was, and still is, unsustainable. Moreover, hospital and health systems were being held more accountable for their outcomes and controlling their costs, through a myriad of different federal programs. I realized that physician leaders have a key role in navigating their colleagues through these complex changes.
Serving as chair was my first experience in bringing my past small business experiences as a company owner into medicine. I started triangulating my process improvement research background, business knowledge and medical expertise into my administrative role as a department chair. As I started seeing how desired outcomes started to become reality, I quickly learned how
I can impact the health of populations in a fourth way – in medical administration. Navigating complex health care changes and leading a team of physicians, health care professionals and staff through sound financial models, regulatory requirements, while maintaining a culture rooted in trust and teamwork is some of the most difficult, yet rewarding, things a leader in medicine can do today.
The next 13 + years of my career as a physician leader included working for a for-profit organization, another large academic medical center( University of Kentucky / UK HealthCare) and two non-profit health care organizations, most recently being Baptist Health Louisville. During this past decade in Kentucky, I have served in a number of escalating physician leadership roles that includes being a division chief, department chair, associate chief medical officer( CMO) for population health and as an ambulatory CMO and hospital CMO for several organizations. I even decided to get a second master’ s degree in health administration at some point to augment my learnings from my MPH, especially as it relates to“ big” data and current drivers in health care. My passion is now focused on the vast impact I contribute to as the CMO of Baptist Health Louisville along with other senior leaders of the hospital. I have the privilege to oversee medical staff operations and ensure our physicians and advanced practice providers are positioned to succeed and care for our patients and for themselves. This includes ensuring our medical staff is aware and practicing within our regulatory requirements, our bylaws, and that they hold each other accountable through strong medical staff governance. Moreover, both quality and case management departments report to my role and through improvement / implementation science frameworks and methodologies, our teams are able to design and pressure-test new models to achieve our desired outcomes. A direct result of this work is ensuring high quality and safe care is provided to all of our patients.
So, while I never ended up having my own medical center and developing a multidisciplinary group, I am still blessed to lead and serve a large group of physicians and health care professionals who care for a large geographic area. I am also very fortunate to work alongside other health systems and leaders in Louisville for a common goal of a healthier Greater Louisville. I am very content knowing that I had a small part of educating hundreds of medical students and residents throughout my career and the populations they now impact. Most importantly, it is a privilege of caring for thousands of patients throughout my career as a family medicine physician. It is never lost on me that they entrusted me with their deepest secrets and were vulnerable during some of their darkest times. For all that I do today, it is still about, and for, the patient.
Dr. Cardarelli is the Chief Medical Officer for Baptist Health Louisville.
8 LOUISVILLE MEDICINE