♪ opening music ♪ ♪ ♪ Welcome to This Week in South Carolina.

I'm Gavin Jackson.

This week, we're discussing health care in South Carolina and I'm joined by two heavyweights.

Dr. David Cole, president of the Medical University of South Carolina, and Dr. Patrick Cawley, CEO of MUSC Health.

Thank you all for both being here.

Dr. Cawley> Great to be.

Here.

Gavin> Dr. Cole, I want to talk with you first about just how South Carolina is doing.

We just got through the respiratory virus season.

It's still lingering a little bit, too.

But tell us about how we're doing with both that and the recovery from COVID, but also how we're doing as a state when it comes to health outcomes.

Dr. Cole> Sure.

Just looking back at COVID and three years and maybe I've sort of clicked delete in my mind.

Gavin> Definitely.

Dr. Cole> But, I would say generically, as a state, I think that we did above average, which is not a minor statement.

I think we did better than a lot of communities.

I know MUSC was engaged across every dimension of the state in terms of testing and vaccines, but I just think that we came together well.

I've actually been very proud of MUSC, but also proud of us as a state in terms of what we've done.

COVID is now really more of an endemic.

Think... ...the flu season.

It doesn't mean you should ignore it.

You know, yes, people can get ill, but if we do have the tools and the knowledge and maybe the track record behind us as a...society to better deal with that.

So this year, there's a lot I was telling somebody earlier, there's a lot floating around.

You know, there's just a lot or, you know, the latest respiratory viruses and so forth.

But those are, I would say, norms for the season.

Um...Pat, you might comment on this, I don't think that there's something that causes us to start throwing up alarms.

In fact, we several years ago said we just need to move forward.

You know, we need to be smart.

We need to have the capability to deal with things.

Always be prepared.

But...I think it's where we've been... Dr. Cawley> It's been a it's been a little bit of a tough season.

You know, these things come and go.

So you just got to be prepared when they come.

And we did see a big peak and there is that trifecta of flu, COVID and RSV now.

This year it was flu.

I mean, you heard people have RSV and people had COVID, but it was really flu that came in, came in hard, filled up the hospitals, filled up the urgent cares, the emergency rooms, all the hospitals across the state were experiencing that.

The good thing is, the latest numbers I've seen just in the last week, it's significantly better just in the in the last week.

It's just remarkable how you could peak.

And within 2 to 3 weeks, >> You're seeing a fourth of what you saw just a few weeks ago.

Gavin> It will be coughing up and through the spring, basically, but, Dr. Cawley, when you look at that, how I mean, are your folks better prepared?

I mean, obviously, ever since COVID, we've learned so much, we saw a lot of things exposed.

But are folks more prepared to handle these rough seasons?

Dr. Cawley> You know, the flu season, I think we've always been prepared for.

In fact, at MUSC, it's been almost 15 years now that we've actually required the influenza vaccine for all of our people.

And we do that to protect ourselves so people don't miss work and can be there, but also to protect the patient.

So for influenza season, I think we're prepared.

What COVID did, you know, it came in at different points of the year?

We were all used to influenza season being, you know, end of December or going through maybe March, but then COVID came in at different points of the year, and then it just got to have that heightened awareness all the time.

And I think we're I think we're definitely better prepared.

What's not clear yet is if COVID is going to stick to the typical respiratory season, that December to March timeframe, is it going to start popping up at other points of the year?

As Dr. Cole mentioned it is endemic now.

We're going to see it.

It's not going away, and we'll just have to see how it patterns out.

Gavin> Yeah, and the COVID pandemic, I mean, it really did affect so many industries.

But, you know, medical providers were right there on the front lines, too.

I mean, you guys were up close a lot of times and have enough equipment.

Didn't have enough folks.

People were getting burnt out.

Nurses were- nurses were leaving.

Doctors were leaving.

What have you guys, what have you all learned from that?

Have you recovered from the worst of all that.

Dr. Cawley> We've come out of it and I think as Dr. Cole mentioned earlier, I think we've come out of it strong.

You know, not every health system, not every hospital across the United States, I think is in the same place.

I think we were... We were in a good spot before going in.

We dealt with a lot.

I mean, as you pointed out, we dealt with testing issues, vaccine issues, supply issues, people issues.

Most of that were over.

The one that continues to linger are the people issues.

And that's not entirely new to health care.

We've been talking about burnout issues in health care for a long time.

I keep a standard list of things I worry about, and that's on my standard list.

And it has been on my list for ten years.

COVID exacerbated that.

It also woke everybody up.

We're still dealing with that.

It just upended.

A lot of people left.

We had to replace the people that left.

In the meantime, South Carolina's growing and we're seeing more patients.

You know, so we needed more people anyway.

So we're still, we're still working through that.

But I think, you know, we've got a ways to go and feeling better about it.

But I do think we probably have another year or two before we're probably fully, Gavin> -fully settled, >> Yeah, fully settled on the people side.

Dr. Cole> We're through a broader lens.

You know, and the way I think about this, if you look at the economic impact on the health care sector in the United States of America, post COVID, you know, inflation, supply chain, workforce, you know, higher, you know, decreased.

It's hit across the United States significantly.

The state's done better.

MUSC's been fine.

But I will tell you that a startling fact in the United States of America, the majority of health systems were in the red this past year because of all the above.

So it's almost like an economic version of slow COVID, if you think about that, you know, working through what that looks like has been a challenge.

Again, I made an earlier comment that we've done, you know, we've hit above the mark and we're doing well.

We are.

And we understand and embrace the fact that we serve the state and citizens of the state of South Carolina.

You know, so we step forward in that moment.

One of the things we're asking for this year and the year prior is, hey, let's get some some infrastructure for better prediction of the next, so we can be able to better react, respond.

You know, one of the things, in my view, if we're, you know, talking about COVID as a nation, we were caught, you know, short cheated.

We weren't prepared as well as we could have been.

And it's easy to say in retrospect.

I'm not throwing stones, but we should learn from those things.

Right!?

And how do we as a state have the monitoring ability to say, hey, something's happened in the Far East, this is or is not relevant?

We know better what that may or may not do to impact South Carolina.

What do we need to do to better be prepared as a community and with all the other health systems, not just about MUSC.

We came together to see if we could do.

So...

So we're still working through it.

But I think our- again, I said I'm very proud of because people have been working so hard and doing great work at MUSC and we've actually grown remarkably.

You know, when COVID hit, we didn't just hunker down and look at our belly button.

You know, we stepped forward for the state.

We actually prepared for the future and have stepped into the future.

I don't think many, many organizations can say that.

Gavin> Yeah.

I was going to ask you, you're talking about having, you know, difficulties within the medical industry itself.

And you all have been doing better than others and you've also been expanding, too.

I mean, what's been driving that, those expansion efforts in South Carolina for MUSC?

Dr.

Cole>...I'll give initial thoughts and Pat can follow.

You know, I would emphasize strategic growth.

You know, if you look at and you asked earlier about health care in South Carolina and, you know, as a prelude to your question about COVID, you know, South Carolina has had and this is not a surprise, not new, chronic access, chronic health care issues in which we're often in the bottom quartile of the nation on any health statistic, You know, so those are challenges that we have to step into.

A lot of that is in rural and underserved areas we're a rural state in general, you know, so part of our growth is the understanding that for us to really make an impact, we have to have a presence with.

Not for but with and in partnership with those communities.

And right now, with our now three additional divisions that never existed five years ago.

We're in eight of the most rural and underserved counties in the state of South Carolina.

And you say, my gosh, we're running into a burning house.

We have assets and capabilities that can change that dynamic.

And it's something that we're very excited about as we lean into the future, making a really positive difference.

So we don't sit here five, ten years from now.

And I'm telling you, statistics that have been in place for 20 or 25 years.

So we see it as a significant opportunity.

If you look at I think it's important to define what MUSC is and what MUSC is not, because I think people get confused.

We are the state's only comprehensive academic health system.

What's that mean?

We have outstanding health care and provide 15 only care in several domains, the only high end heart, a solid organ transplant for pancreas and lung and so forth.

All those sort of things are only in Charleston.

Those patients that care, we believe firmly that South Carolina should take care of South Carolinians.

That's one.

The second thing, when we're in these communities, we feel that best care is local.

Nobody wants to travel elsewhere.

Nobody wants to travel to Charleston if they don't have to.

How do we win and how does, how does a community win?

if we have a presence and partner and we elevate best local care that community wins, that hospital's better.

The confidence in those communities is elevated.

And oh by the way, because of that relationship, we now have access downtown where our best is in terms of quality of complex care, and we can get those patients that need us and how, when, when they need our care.

So it's a virtuous cycle but it doesn't happen by hunkering down in Charleston, South Carolina.

You know, we have to have a presence to be able to both deliver on, I would say, our mission and and financially to be successful and healthy.

Gavin> Dr. Cawley, pick up on that too, talking about expanding to these rural areas that we're kind of left behind when we saw a lot of hospitals close, now that pendulum's swinging back around.

How are you guys able to get into those areas and to offer the care out there?

Dr. Cawley> I think there's two things that- people focus on the growth of the last five years at MUSC, but I think there's two things, two key things.

Number one is that culture of education and research and clinical care that we that we had, that was us.

Add telehealth to that.

Telehealth started significantly in the state around 11 years ago when the legislature asked MUSC to develop telehealth services, help develop them around the state.

As we started to do that and we started to see what was...possible, we then said, you know, we need to step into rural health care more.

And that was part of what has happened over the last few years.

What we find is there's a lot of telehealth we can deliver to those communities, but sometimes it can't all be telehealth.

There's things that have to be face to face or in person.

And we just we just felt that, you know, we could do it.

So our very, very first hospitals that we did acquire were in very rural areas.

And then we have learned and developed some things in order to make them thriving.

And...this is not all in the hospitals that MUSC owns.

We have great rural relationships with hospital affiliates.

Hampton Regional Medical Center is a, is a tight affiliate with MUSC.

We have a very unique connection there with telehealth, where we provide the backup from Charleston.

They provide the onsite advanced practice providers, and that's a system that works really well.

So, you know, we don't have all the answers, but I think we have discovered a lot of answers for rural health and we're confident of that.

We feel we just need to step in more.

And telehealth was the first.

Gavin> Yeah.

Dr. Cawley> The second thing we're stepping hard into is behavioral health.

You know, remember, behavioral health is mental health and addiction.

Those are both big problems in the United States.

And so we have felt based heavily on who we are as MUSC, we were doing a lot of telehealth psychiatric care for a long time, and then we took that and we're developing new behavioral health models.

Gavin> And with broadband and the state getting more connected, too, that's can be better and better, more expanded across the state, too.

But when you look at what all this is going to accomplish, I mean, how are you going to measure success?

Is it going to be a matter of seeing metrics dropping over the coming years because you've had a better presence in these rural areas, because you've had more telehealth connectivity, or how do you measure success from all this?

>> Well, we measure... we keep internal scorecards.

We keep an eye on matters.

And we can see these things improving.

We know where this community was, you know, before MUSC entered into partnership with them.

And we can see it now.

I mean, I just went over that a lot of details yesterday with a with a national company around just collecting data here.

We know it's better.

You know, the next hard part is going to be, can we do that for the entire state?

Gavin> Yeah.

Dr. Cawley> You know, can we get some things going?

This cannot be 100% on MUSC.

We're willing to go there with our resources to push as much as we can, But, you know, hopefully we're going to bring others along with us.

>> Just if I may, just to follow up, if you talk about rural hospitals specifically and the dynamic that happens, and I said, you know, MUSC is different because we're a comprehensive academic health system.

Say, well, what's that mean?

Well, if you look if you look at a rural hospital, the dynamic that happens is inability to recruit and retain physicians and or providers.

That leads to concerns about quality patients go elsewhere.

That hospital gets in a vicious cycle economically and closes it's door to added overhead in terms of an ability to sort of manage the costs of care that continually increase.

What we can bring uniquely is we train all of the above and we have the brand and ability to recruit so we can start to change that dynamic.

Pat already mentioned unique models that we are vetting and testing, which I would say are unique nationally in terms of how do we change the cost of delivering high quality care.

So, so and then we can actually one of our real prime purposes is to partner and partner productively.

It's not all about MUSC.

But we can bring in new programs that others couldn't to help manage, to stabilize and provide increased quality, increased confidence and better outcomes.

That's just the base when you talk about a rural area.

So now we can start doing that.

So one metric is that those hospitals are financially stable and they're not going down.

That's, that's going against the national dialogue.

Gavin>And then, Dr. Cole, when you talk about training those folks like you can do at MUSC that you all do so well and you have this outreach across the state.

How do you get folks, you know, first of all, interested in to maybe nursing, maybe to becoming a doctor or just any number of these roles in the medical field?

And then also, how do you get them to stick around?

And just in South Carolina in general or even these rural areas, what's how do you fix that?

What's the secret sauce?

What's the answer?

Dr. Cole> Great question.

So preface don't have all the answers, but I'll give you one man's perspective and maybe two men's perspectives.

So if you talk about physicians specifically, but there's a broader topic and I'm happy to talk on any of these.

Most people don't understand that it's not merely amount of getting your M.D., you know, when you graduate from medical school, what do you have?

You have an M.D.

and a quarter million dollars worth of debt, but you can't practice because you need to finish your training.

That's called graduate medical training, Medical education, which is residency and fellowship.

So, so one of the things that we're actively engaged in is increasing the pipeline of educational opportunities so that physicians can actually finish their training in South Carolina and therefore practice an...statistic is that in South Carolina, the best predictor of where a physician will practice is 50-50, if they go to medical school here, greater than 75%, if they finish their training in South Carolina.

So we're building out programs in these rural areas in critical need domains in which we now have pipelines in which physicians can match, train, learn and stay.

You know, and, you know, we're very excited about that.

If you look at the those communities, it requires, again, the unique capability of a comprehensive academic health system that has experience and depth in that field to then partner with those local communities and local hospitals to bring those GME sort of programs.

So we've been very focused on that and we're making a lot of- we actually had in Florence this past fall, you know, it's hard to express the timeline.

We have in about a year and a half gone from zero to accredited.

And we'll have taken our first class of residents this coming year.

And when that's mature in Florence, that'll be 30 primary care physicians being trained ideally to stay in that community that didn't exist before.

And we're just getting started.

Gavin> Yeah, I mean, I worked in Florence for four years.

I know what they did to invest in that community when it comes to just the city itself, to build it up, to create that quality of life, because you are competing with the Charlestons, the Greenvilles, the Columbias of the state to get people to stay there.

So it's a matter of, you know, scaling up and having that medical industry out there because you do have McLeod I know, a competitor in some cases.

But Dr. Cawley, how do you see a matter of getting to those folks kind of piggybacking on what Dr. Cole said?

Dr. Cawley> Well, Dr. Cole mentioned that graduate medical education, you know, and just to play off that for a second, we'll be in Florence, Lancaster and Orangeburg with new graduate medical education programs in the next...few years.

I would say the other big thing is two things: nursing and what I call the tech levels, right!

So if you look at our workforce needs at MUSC and I look at open positions or if I looked at the number of travelers, half of it's nurses and half of it's these tech levels, right!

People are very familiar with the nurse side, but they're not as familiar with the tech level.

A tech is a position in hospitals and it's a generic position.

But they're more commonly known as a surgery tech or a radiology tech a nursing tech, an anesthesia tech I mean, there are dozens of these categories and that's a very good paying job, right!

That just frankly needs more people applying to it and getting that education.

I say that because most of the tech level positions are trained in our technical colleges, right!

We are trying to develop new relationships with the technical colleges in order to get more people trained.

You know, they have, they have tremendous depth when it comes to getting to middle schoolers, you know, introducing them to some of these positions.

And then we work with them and we're doing these in a way that it's been a long time since we've worked so tightly with the tech schools that, you know, we're offering people we're paying people to go to school.

In the last few years, tuition has been free in the tech schools.

Gavin>For a long time.

Cawley>...we've been paying people to go to schools We'll guarantee jobs when they come out.

So that relationship to the to the tech schools is probably something that's not been talked as much about.

And every community we're in, we're working with the tech school.

It's a little different maybe in Charleston versus Florence, but bottom line, it's a collaborative relationship with them.

Gavin> You're still competing in a very difficult job environment, with the red hot labor market, too.

So you're really trying to get folks to be interested in the medical field as well.

So.

Dr. Cawley> People are just not aware of these positions and they're good paying, stable positions and they're going to remain stable.

Gavin> Yeah.

A.I.s not coming for you all yet.

Cawley> No, but I don't think A.I.

is going to be an issue.

Gavin> Yeah.

I want to ask you a little bit about trust, Right.

Because that's been a big issue in a lot of industries and public institutions, including the media.

Gallup says 35% of folks have a very or somewhat positive view of health care.

Americans ethical ratings of nurses and doctors have dropped over the years from 2019 to 2023, but they still sit pretty high and they're much better than journalists.

So I can't really say anything negatively here.

But what's it like, Dr. Cawley, when you hear folks say they don't trust a doctor or, you know, I know there's always there's discussion like you do want to get second opinion on some things.

You do want to advocate for yourself.

But folks who come in and say, I don't believe what you have to say, or you saw a lot of that during COVID and they didn't believe in the treatments or the practices.

What's it like?

What's that?

What's it like on the frontlines right now?

Are people still that negative towards, I should say, hostile towards doctors?

Dr. Cawley> Well, you know, this is not new.

I mean, as the Internet has developed and as there's more medical information out there, it's not uncommon for a patient to come in and question a lot of different aspects of what you may be recommending or you think there's a certain diagnosis.

I mean, that's just that's picked up over time.

You know, what's different is during COVID, you know, our politics were already divisive.

It entered into health care as well.

And then we sort of became just involved in that.

You know, that's that has significantly decreased, you know, as things have settled back.

You know, we've always had to work with patients and and help give them advice.

You know, we can't mandate these kind of things.

But, you know, it's just part of what you what you do each and every day.

And, you know, it's a partnership to help take care of patients.

Dr. Cole> My additional comment and, you know, I'm a surgeon.

I still take care of patients still operate weekly.

You know, and I've been in this for 30 years, as Pat has, you know.

So I've see and understand what you're saying.

But I would still say at the end of the day trust is earned, you know, and the relationship you can form with patients, that is still, to me, an incredible thing that people give you that trust.

Now, I think a positive thing that is happening, which I think is I mentioned earlier that I think we need to transform health care in the United States of America.

And certainly we have an opportunity to do better in South Carolina.

You know, we haven't delivered on a lot of things in health care.

We have delivered on high costs.

We've delivered on hyper competition, duplication and honestly, a lot of things that we know can happen in health care, a difference in patients' lives we haven't been able to implement, but we can't do it alone, you know.

So that's why we turn to partnership as a concept and a reality.

It's like we need to partner with you, either an individual patient or, you know, entities within communities.

It's like, so that trust has to be built together.

Gavin> And a lot of personal responsibility, too.

I mean, I might not like your diagnosis, but I'm going to have to follow it anyway or, you know, try and better myself and be healthier because, you know, you can't just eat and drink whatever you want and expect things to work out in the end.

Dr. Cole> It's hard.

You know, we talk about delivering health care, but what we really need to to transform into is delivering health.

It's as simple as that, and it's really complicated.

You know, health means you need patients and people involved and have ownership of them, right?

It's like, it's not dad telling you what to do.

It's like, hey, we'll work with you.

We'll get to where that is.

So that requires partnership.

Gavin>We only have a couple of minutes left.

I want to ask you a tricky question about abortion, because that is something that has been delegated by the state at this point when it comes to health care access.

And we've spent about five months since the state Supreme Court upheld the six week abortion ban law in South Carolina.

There are exceptions for sexual assault, for fetal anomaly, and for the health and the life of the mother.

I want ask you, Dr. Cawley, what have y'all been seeing now five months out since that ruling?

Has that negatively affected anyone at MUSC to your knowledge?

>> You know, the hardest part has been, you know, when are obstetricians, gynecologists are faced with a situation that's on the borderline, either because of time or because of the diagnosis just dealing with that.

And, you know, some people are better at dealing with that than others.

Some people become immediately fearful.

So, you know, I take calls regularly from our front line physicians who are dealing with some of these things and try to advise them through that.

But that's how we feel it.

We have had occasional patients who we've had to help through.

And, you know, they they really wanted to get to another state and then, you know, we don't abandon them.

We try to help them in that.

So it's tricky.

It's you know, it's mainly at the individual physician level that we're seeing.

It's, but of course, there's patients being affected as well.

Gavin> So you do have doctors kind of saying, hey, should I or shouldn't I?

Do I need to talk to a lawyer or what do I need to do at this point?

Dr. Cawley> Absolutely.

Absolutely.

And that's why I'm getting involved as the CEO of the health system.

I'm trying to help through that.

Our attorneys help through it as well.

It's -you know, these are not easy cases or easy situations.

So sometimes you have to talk it through and find an easier path.

Dr. Cole> You know, the lens that we look through, the principles, you know, it's patients, you know, and we're responsible for our patients lives, specifically the mothers.

And so it's not just sort of a random sort of thing.

Hey, we're, you know, thinking about this.

Usually, we're... in this tight space where there's very real concerns and we want to follow the law.

You know, we're law abiding citizens and the organization that follows the law.

Gavin> Yeah.

>> You know, so we are doing that, but trying to make sure that we're, you know, able to support and take care of those who we're responsible for.

Gavin> Gotcha.

>> That's where there's sort of that balance between those two.

Gavin> A lot going on there for sure.

Dr. David Cole, Dr. Patrick Cawley.

Thank you for joining me this week.

Dr. Cawley> Thanks.

Dr. Cole> Thank you so much.

Gavin> For South Carolina ETV.

I'm Gavin Jackson.

Be well, South Carolina.

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