Tony Manuel, Anesthesiologist and Partner at United States Anesthesia Partners

How to Become a Change Agent in Your Health System with Tony Manuel, Anesthesiologist and Partner at United States Anesthesia Partners transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
Welcome back to the Outcomes Rocket. Saul Marquez is here, and today I have the privilege of hosting Dr. Tony Manuel. Dr. Tony Manuel is a practicing anesthesiologist in Austin, Texas. He’s a partner with the United States Anesthesia Partners, central Texas, and has been in practice since 2002. He’s an assistant professor in the Department of Surgery and Perioperative Care at the Dell Medical School. Dr. Manuel received his undergraduate degree from Vanderbilt, attended the University of Texas Health Science Center for Medical School, completed his residency in anesthesia at the University of North Carolina, where he was recognized as the outstanding resident fellow cardiovascular anesthesia at Duke University. In 2017, he received his Masters in Medical Management degree from Carnegie Mellon University. And today he’s playing multiple roles, as he has in his career. And today we’re going to be talking about physician innovation and in particular, how physicians can evolve their career to be greater contributors beyond the point of care. And so I want to thank you, Tony, for joining me today to have this very interesting discussion with you.

Dr. Tony Manuel:
Thanks so much. It’s great to be on your podcast. And I want to thank you for actually doing this podcast, because a lot of people like myself. It’s been a great conduit to learn about what other people are doing and what best practices are out there. And it’s an alternative to sort of the journal peer review articles that we have historically read. And I’ve actually looked up several companies that you’ve had on and engage with them. I just really appreciate what you’re doing.

Saul Marquez:
I love it, man. Now, that’s great. I’m glad to hear that you’ve done that. That’s the intention. And so I appreciate you for doing that. So, you know, we were having a discussion, folks. Tony and I connected and said, you know what, the role of the physician is changing. And so what I want to do today is just highlight how that’s changing through the life of Dr. Manuel here. And so, you know, I’d love for you, Tony, to just kind of walk us through some of the work that you’re doing and how it’s changed from just practicing to actually doing more. You know, as we engage this large, you know, three point five trillion dollar industry that we call health care.

Dr. Tony Manuel:
Yeah, it’s been an interesting journey for me. And, you know, I have to credit one of my anesthesia attendings when I was in residency. His name is Dave Meyers. Gave me great piece of advise. He goes, “Tony, you have to continually strive to maximize your career.” And I say, well, what does that mean? He goes, “Well, you definitely want to start trying to be the best clinician you can be. Once you achieve that, you should really look at becoming really strong in other areas.” And I always took that to heart. And so, you know, I think back to when I first started here in Austin, I became the division chief of cardiovascular anesthesia, right, as you say. I helped create the division of cardiovascular anesthesia because at that time we were basically everybody was doing it. And I felt coming out of the fellowship, this would be really better if we limited number of people that worked in that space. And, you know, put together some protocols and got the team together. And we saw some really good outcomes from that work. And I fast forward to what I’m doing today. And that work has changed so much, partly because I think every clinician you have to get educated and I use sort of rudimentary tools back then. But after getting that master’s degree from Carnegie Mellon, I really developed that toolkit that allows me to take on much more complex problems that we face in healthcare today.

Saul Marquez:
Yeah, that’s so interesting. And so you had that entrepreneurial bug from the beginning, right? So you kind of retooled the way that you guys approached cardiovascular anesthesia and I’m sure with much improvements and outcomes. But then you’ve taken other steps, too. You’ve been involved in startups and now you’re, you know, doing different roles. Can you talk to us a little bit more about that?

Dr. Tony Manuel:
Yeah. You know, I worked my way up of the medical staff leadership and also you became the president of medical staff. And while that was a great experience, after I graduate with my master’s degree, the entrepreneurial part really was intriguing to me. And more important is the interface between the clinicians and the technology. And so the startup is called Dynamic Lights, based here in Austin, and it’s actually technology out of the University of Texas. And they had a great idea concept. Basically, it’s how to noninvasively map blood flow during cerebral aneurysm surgery. And it uses what’s called speckle laser technology. And I was like, ‘Ah it’s great. It’s continuous, it’s non-invasive.’ But they never really thought about the interaction of how you get it into doctors hands. How do you test it? And that was sort of my sort of strength. And so I said, well, let’s work together and figure this out. And today, you know, we’ve incorporated. Were FDA approved and we’re conducting a clinical trial and we’re looking to partner with a couple of larger health tech firms. And that wouldn’t happen, I think, in 2005 when I first started, cause I would had no clue on how to begin to do that. But as I see sort of what the alignment is between technology and physicians is becoming clearer, a sort of pathway that we should pursue to get those kind of projects up and running because they can benefit so many people and we just got to ensure that we can make that happen.

Saul Marquez:
Yeah, you know, and I think it’s great that you took on that role. You guys have FDA approval now. You’re doing some clinical trials. You’re engaging some of the bigger players to get the distribution behind it. I mean, it’s said some critical steps you guys are taking there. It’ll be exciting to see where that goes. And, you know, the evolution of today’s physician is quickly, quickly changing. And so what are your thoughts about, you know, the stats? You know, because they say one out of every I guess this year, one out of every thousand physicians will commit suicide and satisfaction, you know? And so is what you’re doing making a difference for you? Can you give me some of your thoughts around that?

Dr. Tony Manuel:
Yeah. Yeah. I think, you know, those stats are unfortunate. I actually had a really good friend who passed away a couple of years ago and by suicide and I’m sorry. It unfortunately happens all too frequently. What I feel is if you’re really engaged in the work and you can create a space, it makes you happy, then everybody wins. Your colleagues, your patients yourself, your family.

Dr. Tony Manuel:
And for me, I think if I was just doing anesthesia every day, it would be fine. But I don’t think I would be as enthused as I am every day to come to work and work on the projects that I’m doing. So, you know, we know what makes us happy. What makes us sad and what we would love to fix and having a way to do that is been really inspiring to me. And so I want to see that happen for other physicians, because a lot of guys you’ll hear say, I don’t know how I can change this. And, you know, I think there’s a pathway you can do it. And one I think involves getting more educated about whatever it is that you’re passionate about and how you can change it within a hospital system and into giving yourself the tools to go forward and do that where, you know, before good or bad excel spreadsheets, I’ve had to become really good at figuring that out. And, you know, but it is the way the world right. You have to learn the business of health care. And if you can do that, then you can communicate much clearer with your administration, you know, with healthcare companies. It really gives you some great opportunities.

Saul Marquez:
And I think that’s great. You know, and there’s going to be some things that you’re going to have to learn that you maybe you don’t want to Right. and maybe you learn it. And then once you know it, you figure out how to delegate it because you know how it works. Right. You get the right person to help in that specific area. As you reflect on how your career has evolved then and other physicians are listening to this, you know, what would you say is one of those key setbacks that you ran into and how that’s helped make you an even better contributor and more fulfilled contributor?

Dr. Tony Manuel:
Yeah, I would say one of the… It started out successful and then it became a failure. But way back in the day when I was at C.V Division Chief, I noticed that we had a really hard time getting our cases started on time. First case on time starts. It was abysmal, like 15, 16 percent. So, you know, I said, okay, I’ll fix this problem and did what the equivalent of would now be process mapping. But I did it in a very rudimentary fashion on it, you know, a notepad. And then basically physically visit every site that our patient would go in on their way down to the operating room and how we got them into the ORs and worked through all the kinks. You know, like how do we get the case card set up? How do we get the room ready? What do we need to do to fix this, to get the patients out? And in a matter three months, we increase the first case on time, start to 88 percent.

Saul Marquez:
Nice.

Dr. Tony Manuel:
It was great. Surgeons were all involved in stuff. So basically, I turned it back over to the hospital to run. Basically, they had given me full control for those ORs for that time period. And we regressed right back to where we were before.

Dr. Tony Manuel:
And the failure by me was that I made it entirely a single person operation. It’s completely dependent on what if I was there or not. And so while I was able accomplish that, that one goal, we weren’t able to for the long haul. And so that lesson made me really sit back and see how when I take on a new project, how do I get all the people engaged in it? How do I get every identify every stakeholder? Because I didn’t even look at the other stakeholders, to be honest with you, when I did that first project and now I’m like, OK, I’m gonna spent a lot of time upfront thinking about all the different scenarios here before we even begin that work. And, you know, we’ve had an incredibly successful project here with OR scheduling. And you and I talked about it before we started our call. Our hospitals a level one trauma center has a high acuity surgery base and it also has a lot of add on surgeries defined as put on a schedule three days or less prior. So I always thought, why do we have blocks and we need to operate. Yeah, we just got to get more people on the schedule, and so I paired up with the McCombs School of Business and pitched the project to our then CEO, Craig Cordella, and he was new at the time.

Dr. Tony Manuel:
So I think I got lucky. And he just said, Here you go. Go for it. And he effectively funded the project and it lasted about four months. And what our analysis showed is that we really needed to get rid of block time and we needed to move to open scheduling. So I took the data that team it put together and they ran forty years simulations for me. We did. We tested multiple algorithms. So I had to go to the surgery council and pitch a lead balloon and say, hey, hey, what you think about take away all your blocks. But they trusted me and I had I was armed with a lot of data and they let me run a one month pilot. And the pilot absolutely just was a success. We upped our primetime utilization, which is defined how many rooms we have running between the hours of seven and three. We were in a low 60 percent to 77 percent in one month and then going forward. We’ve been hovering around 70, 70, 80 percent. And we doubled our case volume with the same number of rooms. And so.

Saul Marquez:
Which is amazing. Right. I mean, it’s just like and it’s one of those things where that you just don’t think about changing because it’s the way that it’s been done forever.

Dr. Tony Manuel:
Right. If you want to, angios and surgeons, you can tell them you want to take away their block time. It generates a very visceral reaction from them. But, you know, there’s a willingness to challenge the norm. And now they are very happy because they can get on schedule whenever they want. They’ve been doing more and more cases. And it’s actually also made the economic argument for us to expand our ORs because we’re using them so efficiently. So now we do need to have more ORs. And it’s not because I well, so-and-so couldn’t get on on a Tuesday morning. It’s actual we’re really busy. We need more space.

Saul Marquez:
And there’s something to be said, Tony, about having a physician making some of these changes, you know, instead of a traditional like our manager, that is not necessarily always ever a physician.

Dr. Tony Manuel:
Yeah, I totally agree. I think, you know, the surgeons definitely bought into it because they’ve known me for a long time. But you also can bring in that physician perspective. And it’s almost like a language you have to speak for, then administrator sides as well. We want to do X and I’m like, well, I wouldn’t really pitch it that way. You know, I would be understanding the doctors want this outcome. And if you approach it from a different angle, I think they’ll be more receptive. And sort of being that liaison for both sides has been, I think, really helped me find my niche, you know, better because I’ve been able to speak to both sides about that and get her by your come to a common goal.

Saul Marquez:
You know, it’s fascinating. And, you know, you hear of physicians, you know, eventually running the hospital. And and there’s an opportunity to do that, of course. But there’s other things, too, right? I mean, there’s the opportunity of helping optimize operations. And maybe like, you know, as we talk about physician evolution and wellness and, you know, there’s also financial wellness where you say, hey, look, this is where I am at. Rather than just focus on driving our views, why can’t I get on this, like, metrics-based performance that if I help operations and outcomes here, there’s some extra stuff for me, you know, at the end of it.

Dr. Tony Manuel:
Yeah. I think and also I’ve actually applied that to the operating room staff. And I’m working with Ascencion now to a small task force about how we redesigned the work that we do in the ORs. And I think incentives are actually a powerful tool. And if you get everybody aligned towards a certain incentive that they feel is meaningful. Everybody works really well together to accomplish that goal as a team. And you’re right, it’s not just about cranking do the RVs. It’s actually how do we get these patients in, in and out safely? Do we get a great outcome? Do we do the work efficiently? And was everybody happy while they were there? And I think the more engaging yet the associates, the better outcome. Everybody. Yes. And for the physicians, you know, having a great day in the operating room was really, really fun. And I think part of that is we need to get back to that versus just you on that RVu treadmill is, hey, I had a great day working with the team. I really helped somebody. And, you know, we got this person to a better place.

Saul Marquez:
Yeah, well, Tony, you’re certainly you’re not on that treadmill. You’re on the stair cycle over there and you’re doing weights on the other side and you’re seeing it from the outside. But you’re also you know, you do get on and you’re able to cross-pollinate. And it sounds like you’re creating some awesome efficiencies. I’m glad you’re sharing these with us as an example, right. as an inspiration for other physicians listening to this. Or maybe you’re a physician leader and you want to inspire your team of physicians to do more and to think about how they could have fulfillment, because, look, you know, physicians are smart people. Physicians are critical aspect of what we need for health care to work for all of us. Let’s find ways to get creative to provide that satisfaction, because honestly, like I think about you, Tony, and it’s like you’re doing so many amazing things for the health systems and companies that you’re working for, you know, and working with. So it’s inspiring to hear your story.

Dr. Tony Manuel:
Appreciate it. You know, I’d love to give you one more example of a transition. I didn’t think about, but I was lucky enough this year to get invited to the Consumer Electronics Show.

Saul Marquez:
Oh, OK. They were just becoming more and more health care focused.

Dr. Tony Manuel:
Oh, very much so. And it was through some friends at the AMAs Physician Innovation Network that I was connected with a vice president of the CES, and she extended an invite to me. And I think there was about fifteen or seventeen physicians there. And they had a whole day on digital health. And then we had a curated tour of about, I think, almost 18 companies that were at CES. And it was great for me to see what’s out there and how advanced some technologies have become. And then also seeing how we could use some of those technologies in our operating rooms or in our hospitals right.. And so getting a chance to talk to the developers and just say, tell me, how did you come up with this idea? You know, I was involved in technology-wise and he was very, very cool.

Dr. Tony Manuel:
There are some amazing products there and I encourage all, you know. I don’t know. CES will happen again and the way it has happened given COVID. But it was an outstanding experience. And I think many doctors would never think about going to CES.

Saul Marquez:
Yeah. You know, that’s so interesting. And I’m glad you brought that up. I have been hearing, like for the last three years, really how that meeting, the consumer electronic meeting has changed and the focus like there’s an entire track on health care. So thanks for bringing that up. I actually was going to go this year, ended up not making it, but it’s usually in January, right, Tony?

Dr. Tony Manuel:
Very early January.

Saul Marquez:
Yeah. So as you think about, you know, post COVID and what you do and maybe your mind’s already shifted to 20, 21 like mine has, you know, is maybe CES. And that is a meeting that I think will inspire you as I hear it’s inspired you, Tony. But others that are seeking for insights in health care. And it’s getting out, you know, and getting off of that treadmill to really get that satisfaction and be part of this evolution, because there is an evolution happening. You know, you’re seeing more and more chief medical officers and chief technology officers and also CEOs that are physicians of industry, not just the provider organizations and the pay organizations. So. Tony, I thank you for your perspective and encourage all of the listeners to be inspired by your story and take action if that did inspire them. Leave us with the closing thought, Tony, and the best place where the listeners can reach out to you if they wanted to.

Dr. Tony Manuel:
Yeah, you can find me on LinkedIn. Its Tony Manuel M.D. or on Twitter. It’s Dr. Tony Manuel1. One closing thought is sort of what I referred to earlier. Become the best doctor you can be, but then keep evolving your career. There are so many opportunities, as you mentioned, not only within a hospital system, but companies are just in the community. You know, just the expertise that we gain as clinicians, I believe is invaluable. And really an injustice would be not to share that with other people. And so, you know, step outside of your comfort zone and go to a CES or do something like a TED MET or, you know, go to a meeting like a health. And go meet other people. You’ll meet a ton of people who were in the industry that you never knew about. And that opportunity to network and meet and really inspired change within your own community, I think is what I would encourage people to do.

Saul Marquez:
That’s such a great message, Tony. And you know, that’s true. Right. you’ll go to this meeting and you’ll probably like what in the world am I doing here? You’ll be uncomfortable, probably. But then as you start talking to people, it’ll be the aha moment, right?

Dr. Tony Manuel:
Oh, totally. And the meeting I went to Health at the end of last year. Twenty. Yes. I think of the entire population at the meeting, less than an eight were physicians. And to me that was a little disappointing. I mean it’s a relatively new meeting, but there should’ve been so many doctors there because you could see how passionate non-clinicians are about health care and changing it and making it better. And there were so many opportunities to pair up with people working on projects and just understanding the entire landscape, not just about being in an office or in a hospital.

Saul Marquez:
I love it, Tony. This has been great. You know, I certainly appreciate your contagious passion for health care outside of the walls of the hospital and I thank you for having this really fun discussion with us today.

Dr. Tony Manuel:
Its been great, Saul. You know, can’t thank you enough for doing outcomes, Rocket. Keep up the strong work.

Saul Marquez:
Thank you, my friend.

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