Executive Takes: James Burke, MD

James Burke, M.D., is System Chief Medical Officer and an Emergency Medicine Physician at Adventist Health.

Time on the job: One year

Previous roles: Navy Physician, Regional Medical Director, System Medical Director ‍

Ten Takes from Dr. Burke

Why he still works E.R. night shifts over the weekend: To make sure that I don’t lose my skills. You lose some of your sharpness if you’re not doing it on a regular basis. You need to have a day-to-day understanding of medications, but also it’s the pattern recognition that’s so critical.  

On how working in the E.R. informs his day job: I get to see how the work is getting done, and how things are working. And it allows me to see how our messaging is landing, and whether our efforts are getting down to the front line, and how effective is that? Otherwise I’m so far removed. Also, people have the tendency to come by the emergency room at 10p.m. and go, “Hey, what’s going on? Could you help me with this?” It gives folks unofficial office hours.

Why attention to detail is everything: If the otoscope is broken, or a piece of the eye machine is wobbling around, I get a sense that nobody’s going through and checking the equipment. That’s attention to detail, which is extremely important to how well departments are running. In healthcare, when things go south, you just have to react—and if you have broken equipment, you can’t react quickly.  

Whether all physician leaders should continue clinical practice: It’s personal preference. My specialty allows me to do it—I don’t have a patient load, and I’m a shift worker. If you’re a cardiologist in a meeting, and all of a sudden they need a doctor to put in a pacemaker, it doesn’t go as well.  

Contrarian opinion: We’ve done ourselves a disservice by becoming so specialized that we can’t provide basic medical care. We all go relatively quickly into our specialty to become nth-level eyelid specialists. I find that there are more and more people coming to me saying, “I want to work for the medical group, but I don’t want to do X, Y and Z, and I can’t do E.R. shifts.” I think we, as physicians, should be physicians first, and able to move into areas and locales that may need providers. We’ve dug a hole in that we don’t have the ability to transition.

His plan for how career transitions could improve healthcare: Take emergency room medicine: it gets really difficult for some of us to work overnights in our fifties and sixties. We should be able to create an off-ramp to do family practice, or enter some other high-need area, as opposed to just flooding it with APPs or NPs who do a good job, but also could use a workforce that might be more mature in life. We have all these individuals who are smart people, who could potentially contribute later in life, and we’re not using their skills. If folks want to transition out, they need to be able to access an education that’s not a full residency.

Currently dominating his brain space: We’re moving to an electronic health record. It’s a $500 million project. I’m told the day we go live, we will have the most advanced electronic health records out there. So the change management is the big brain cell pull, as well as all the emerging, unexpected problems.  

On benchmarking: There’s a lot of variability in how physicians treat patients. So we took high-volume disease states—hypertension, diabetes, sepsis, etc.—and said, “Hey, Market X, we want you to come up with what you think is the best practice for this disease state. You have six weeks: test it, iterate.” And we came up with best practices for each, and shared them with the medical group. It’s probably some of the best work we’ve ever done. With sepsis, we bent the mortality curve.  

What he’s adopted from his time in the military: Most organizations don’t do a good job in providing education for leadership at every level. In the Navy, we had to go through leadership training at different levels—often very basic stuff, like what to do in a situation, and “Do you want to be like this excellent leader, or this yelling guy?” Every leader needs to have a basic understanding of the expectations at their leadership level, plus books and articles to give a framework for how to do the job.  

How to improve American healthcare: As a country, we have to decide what we want to incentivize. Do we want to incentivize more procedures? Because that’s what ends up happening: a guy can do this one procedure so well—and he has to produce more and more. Really focusing on primary care and keeping people healthy needs to be incentivized from a government perspective.  

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