Dr. Dan Landry

Dr. Dan Landry:

Deserve to shine.

Dr. Lisa Belisle:

Dr. Dan Landry trained and worked within the Harvard System in Boston as a pediatric anesthesiologist prior to joining Spectrum healthcare partners in 1994. Over the next two decades, he managed the largest division within Spectrum and served as president and chairman of the board. This past January, he gave up his administrative positions within Spectrum to focus on his clinical practice and advocate for health care reform within Maine and throughout the United States. Thanks for coming in.

Dr. Dan Landry:

My pleasure. Thanks for having me.

Dr. Lisa Belisle:

And you and I happen to be neighbors.

Dr. Dan Landry:

We are, yes.

Dr. Lisa Belisle:

Yes. We get to see each other out. You're walking your dog with your wife Deborah on a regular basis in our

Dr. Dan Landry:

little corner of heaven, huh?

Dr. Lisa Belisle:

Yeah, it's a pretty amazing place. Little John Island. You grew up in Maine. You grew up in Sanford?

Dr. Dan Landry:

I grew up in Sanford, spent the first 18 years there, went to high school in the public high school and we, after almost 20 years in Boston, decided to come back.

Dr. Lisa Belisle:

So what caused you to leave Maine in the first place? I'm assuming it was educational.

Dr. Dan Landry:

It was educational. I had a. I received a degree in mechanical engineering from University of Maine and then took a couple of years and was a ski bum in Vail and then went to med school in Boston and then trained in Boston. My wife was in school in Boston as well. But then after training and working for a few years, we came back.

Dr. Lisa Belisle:

Did you meet Deborah also in Boston?

Dr. Dan Landry:

No, we were acquaintances in college. Only acquaintances. And then I met her on the T of all places while we were in Boston, said, I know you, and then history from there.

Dr. Lisa Belisle:

So is she also from Maine?

Dr. Dan Landry:

No. Well, she grew up in Pennsylvania, but spent the last couple years of high school in York and then went to university in Maine as well.

Dr. Lisa Belisle:

So for you, there's something very personal about healthcare reform within our state.

Dr. Dan Landry:

Yes. Having participated in healthcare for more than 30 years, are you referring to my injury or.

Dr. Lisa Belisle:

Well, no, I was referring to just being from Maine, but now that you've said injury, I'm gonna have to ask you about that.

Dr. Dan Landry:

Oh. Oh, yeah. This is a word of caution for everybody that owns a ladder. Two and a half years ago, I fell off a ladder and broke both my legs and was a participant on the other side of health care. So saw how it worked. I was lucky in that I received excellent health care, but my injury, this didn't propel me to, to go into healthcare economics, but illustrates the problem. I was injured in the beginning of December. My health plan, probably, like everybody listening, has a large deductible and I incurred roughly $15,000 of out of pocket expenses because it was on the end of one year and into the next. I am extraordinarily fortunate that I could pay for that. Very few people in the state in this country can pay for that. Less than half of the people in the US have $1,000 more in the bank at any one time. Health care is the leading cause of bankruptcy in the United States. And of those 62% file for bankruptcy based on health care. 75% of those have health insurance. So I'm passionate about health policy because I believe that if we don't reform the health care system in this country, it threatens everything we know. It threatens our infrastructure, our educational system, our social programs, and no matter which side of the aisle you find yourself on, it will threaten programs dear to you. So we have to, we have to fix this healthcare issue.

Dr. Lisa Belisle:

Are there a lot of people in your field, which is very sub specialized, pediatric anesthesiology, Are there a lot of people in your field who are interested in health policy?

Dr. Dan Landry:

I don't believe there are many physicians that are interested in health policy per se, on a regional, state, or national level. That said, I think physicians are interested in health policy in the manner in which it affects their Patients. So you know a physician such as yourself who works on the front lines of medicine and deals with patients on an everyday basis. Every patient that is undergoing treatment, it has been shown that the finances of that care is forefront in their mind, much more so than whether or not they're getting better. There's a study done on breast cancer, women with breast cancer in that of whether it's treatment toxicity, treatment efficacy or treatment cost. The majority of women chose treatment cost as a determining factor of the type of treatment they would receive. Which I think as a physician, that's not acceptable. That's just not acceptable.

Dr. Lisa Belisle:

Yeah, it's actually rather scary because if you have somebody who's deciding that she can't actually go toward the type of treatment that she really needs, then it might not even be a cost effective way of dealing with it, even in the short term.

Dr. Dan Landry:

Exactly, exactly, exactly. So it's a pervasive, It's a pervasive problem.

Dr. Lisa Belisle:

When you were growing up, did you know that you wanted to be a doctor?

Dr. Dan Landry:

Well, interestingly enough, I have a big brother, David, who's seven years older than I am. Sorry, David. But he, he and his wife, who is also a physician, she's an internist. So David went into medicine. And I've kind of modeled myself after my older brother. I grew up without a father, so David was a father figure. So I modeled myself after him. He went into medical school, went in to be a physician, and I followed in his tracks. And I was thinking of becoming a orthopedic surgeon because of my background in engineering. And both he and his wife said no go into anesthesia.

Dr. Lisa Belisle:

Why anesthesia? What was his background?

Dr. Dan Landry:

He was a biologist in college. They just said it was interesting, allowed flexibility, which it does, more flexibility than other specialties. And it was interesting. So I'm glad I did it. They were right.

Dr. Lisa Belisle:

What you're talking about is something that has become an important consideration in medical school generally, which is lifestyle. And many of the people who are going through being doctor is hard enough. But as you're going through, if you've incurred a lot of debt and you also would like to have a family, at some point you do have to start looking around to decide, can I really even afford personally and financially to be a primary care doctor?

Dr. Dan Landry:

Right. It's very difficult for folks. And I think the people that are the younger folks that are coming out of medical school have. It certainly have a better balance than I did. I'm not going to speak for you, but I remember I was just at the end of the era when the term resident physician versus visit was coming out of vogue, meaning a resident physician being one in training, lived at the hospital and the visit, which is the staff person came and went and that was the norm, and that's just not healthy.

Dr. Lisa Belisle:

And I was a resident right before they changed the resident work hour rules, which meant that we were still, even though we weren't technically residents of the hospital, we were there a lot more than the current residents are.

Dr. Dan Landry:

120 hour a week was not uncommon. Do you remember that? I do. I lived it. Yes. Yeah. And now I think rightfully so. Folks coming out are saying, I'm not going to do that. And I think it's better for them. Better for. But that raises the cost of care because it requires more physicians to deliver the same care. So it's a conundrum.

Dr. Lisa Belisle:

When I was talking to a woman who finished residency just a little bit ahead of me as a surgeon, and I had trained in family medicine, she mentioned that one of the problems with the family resident work hour rules was that somebody still needs to be taking care of the patients. So the work gets shifted back on to younger, typically younger doctors, but also sometimes older doctors who have already done their own version of 100 hour work weeks. So the issue seems to be that we can move things around so that somebody else ends up dealing with whatever needs to get dealt with. But it's still there.

Dr. Dan Landry:

It's still there.

Dr. Lisa Belisle:

There are still patients, they still need care. It's still going to be expensive.

Dr. Dan Landry:

Right? The. The solution is which. Primarily hospitals, which are now the largest employers of physicians. The solution is to hire more, either physicians themselves or advanced practitioners, but the money's not there. Although physician cost of health care is only 11% of total expenditure, so it's not an overwhelming cost. But still hospitals operate on a very, very narrow profit margin. Most hospitals in Maine are losing money. So the expenditure for additional physicians is just not going to.

Dr. Lisa Belisle:

We've talked about some of the issues. What are some of the other issues that you've learned about during the time that you spend in administration and also in the study that you're doing at the London School of Economics, where you're getting a degree in health policy and economics?

Dr. Dan Landry:

It's a broad question. What have I learned? I've learned that I firmly believe, strongly believe that physicians should be in leadership positions in hospitals and healthcare. There is a growing trend that that is occurring, but physicians understand what it means to take care of patients and what is necessary. Like this conversation you and I just had about the need for more physicians. We inherently understand that and administrators look at it more as dollars and cents. I think non physician administrators certainly have their heart in the right place and are doing the right thing. This is not to malign them. I just think that physicians have a deeper understanding of what it means to take care of patients and so they should be in charge. And in Maine, there's only one CEO of a hospital who's a physician, and that's Mark Foray up at Waldo Penn Bay. And he's, you know, and that's a trend, that's a movement in the right direction. Let's see what else you'd asked me, what I'd learned. So I think physicians should be more involved in leadership. But it's hard for physicians because we don't have the training. It's taken me 15 years of on the job education of myself, primarily self education, to learn about health policy and finance. It is very, very complicated who gets paid for what and why they get paid. My studies at London School of Economics have given me an insight into how other countries are tackling these problems. Most other countries around the world are coalescing around a capitated payment model, meaning I get paid X number of dollars to take care of you, and that's all the money there is. And the US has not moved in that direction, but there is. Certainly every country in the world is dealing with high pharmacy prices and high increasing health care costs. But some countries are doing it much better than us. And so these studies have given me a more global view, which has been helpful.

Dr. Lisa Belisle:

How do we encourage more physicians to take positions of leadership within the healthcare system?

Dr. Dan Landry:

That's very difficult. I've been wrestling with that for a long time. It is. Well, first of all, most of the times when physicians work in leadership positions, as you're moving up in gaining experience, they're almost always unpaid positions. So they're just tacked on to the end of the day. So an emotionally drained physician who then has to sit through three hours of meetings every night is very difficult. So there could be. Companies need to invest in young leadership. There's no question about that. So it's really an investment that needs to be made. And we need to find leaders and invest in them, but also train them as well, send them to school, send them to programs to learn how to manage. And unfortunately, in my experience, I don't have experience managing other folks other than physicians. But physicians are a very difficult group to manage. Very, very difficult. And people that have managed other sorts of have told me that they're one of the more difficult, although I don't, as I said, I don't have experience with anybody else. But I will say they are very difficult. The job of the old management style, a physician expected of their manager. Don't allow change to occur. And that's still the mantra to some degree. And in this day and age, that's impossible. Change not only is occurring, it has to occur. And so physicians have got to be on board with what's coming. And that's hard.

Dr. Lisa Belisle:

I can't really deny anything that you've just said. I mean, I think I've seen this personally as a physician chafing a little bit under management, although I have a lot of respect for the people that are managing my practice and ultimately me. I think there's a different mindset that we have as a result of our training perhaps, and there's a different level of responsibility that's expected of us. And so it's a strange dynamic to be able to go back and to, on the one hand, be responsible in your case for putting children under anesthesia and keeping them alive long enough to get their surgeries and then bringing them back out again and making sure that they're in good shape. And in my case, trying to work with women who have new breast cancer diagnoses or manage people's heart disease. And these are people's lives that you have responsibility for. So you're at, you're tasked with being a leader and a protector. And it's hard to then have somebody come in and say, well, we need you to do this, this and this.

Dr. Dan Landry:

Exactly. It is very hard. And I think you and I are of a generation. I think it's going to have to be a generational change because our training was the captain of the ship model, right? You are the captain of the ship. You are in charge. That woman that comes to you with heart disease, it is up to you to keep her healthy. And the shift now is in team based approach. And you and I are not, we weren't trained that way. We're trained to be autonomous. And so it's very difficult for doctors trained in our generation to make this shift to a team based. And not that you're, you know, I don't mean to say that people aren't good team players, but team based approach is you got to follow a protocol. This is a pathway. You got to follow it even though you may not agree with it. And physicians are very bad at that. They don't want to be told how to Practice, right?

Dr. Lisa Belisle:

Yeah. Well, I'm smiling because I think that's true. Although I do actually like being personally like being part of a team and many of the physicians I work with enjoy being part of a team. I think what I struggle with is at the end of the day, it's my medical license that ends up being at risk. The malpractice suits are largely filed against physicians. So even though we are part of a team, if something goes wrong on the team, we still are taking responsibility for that. So do you see that shifting so that it enables us to feel more comfortable with the team based approach?

Dr. Dan Landry:

No. So it gets into the realm of legislation and that's a legislative effect. I believe where healthcare is going is into a much more, we call it cookbook approach. It's much more predicated on best evidence. You see the Watson project for the IBM that Watson's now reading X ray studies, pathology studies recommending cancer treatments. And I think the cancer treatment is a good example of no matter how good a physician or a team of physicians is, they cannot keep up with the literature that occurs in cancer medicine. It's just physically impossible. So you need decision support and physicians are less and less developing, making and implementing the final decision as as opposed to using a lot of these decision support tools. And I think that's what I'm get what I mean with myself, for instance, uncomfortable with not having it in my head, but relying on other things to tell me what the best thing to do is. I mean, I'm just not comfortable with that. And I think we have to be. And I think the younger generation is a little more comfortable than I am in that regard.

Dr. Lisa Belisle:

Yes. What about the recent news of these organizations, the heads of these organizations coming together and deciding outside of medicine that they want to do something about medicine.

Dr. Dan Landry:

I can't tell you how glad you are you asked me that. So we've heard. I'll get to that. We've heard that we've relied on the government to help with health care. President Obama did the aca, which no matter how you feel about the politics, was a movement in the right direction in that he was putting a focus on health care. There is a problem, let's try and fix it. As what happens in politics, it became partisan and some people thought it was the worst thing and some people thought it was the best, but it started the conversation. But what did not occur in the ACA and certainly is not occurring in the debate today, is the cost of healthcare. So what they're talking about is who's actually going to pay for health care. They're not talking about the fundamental problem which is the cost, which we pay almost 18% of our GDP to healthcare. Whereas the next most expensive healthcare in a country is 10 or 11%. National international average is around 9. So for every individual in the US we're spending $10,000 a year on healthcare. So these companies you're referring to, Amazon, JP Morgan and Berkshire Hathaway have come together to develop innovative ways for the delivery of healthcare. So why are they doing that? It gets right back to why health insurance was developed in the first place, which was to keep the workforce healthy and ensure insure a workforce for companies and country. I mean that is why health care insurance came about. These folks that employ millions of people can no longer afford health care for their employees. It's just too expensive. It's become the single largest expenditure for the company, for their companies. So they are coming up with new solutions. And I believe that health care reform will not occur through the government or through legislation. It's going to occur through avenues such as that. Insurance companies really don't have an impetus to change health care. They're simply a conduit for the money. In Maine here we have a number of self insured. We have a large number of self insured companies initially. So self insured meaning like biw, they don't have insurance per se, they pay for it out of their pocket. And that's starting to trickle down to medium and small size companies that are taking on this risk so that they can control their costs even more. And so it's going to be innovations like self insurance, these big companies that innovate. That is going to be where the reform is going to come from. I am convinced of that. And what's it going to look like? I don't know. Although there is technology out there, you can get an EKG done from your smartphone at home with a cardiologist reading in 30 minutes. You can do most things online. There is an enormous amount that can be done. And hospitals and health systems are reliant upon the money coming into them because they have such high fixed overhead that this disruptive innovation will have profound consequences for the hospital systems and the hospitals. Particularly in a rural state like Maine, we we no longer can support 39 hospitals. So health care reform is going to come from people like Jeff Bezos and Warren Buffett and those folks that have the money to invest in it. That's where it's coming from.

Dr. Lisa Belisle:

Well, you raise an interesting point because I enjoy taking care of the patients from Bath Iron Works, for example, because they will come in and I think also L.L. bean, there's a few other major employers within the state and the patients will come in and they will, will have been seen by their health coach. They'll have their numbers in front of them. I have a set of labs that have been done by these patients. And so I'm already starting with more information than I would otherwise. And that's really useful to me as a primary care doctor. However, the point that you're raising about it no longer being money that goes into the medical system is a good one. So if I am not ordering the labs and they're not being drawn by my hospital and not being run by my hospital, there's already a loss of profit. So it'll be interesting to see how this all works out because you can't really pull a string in one part of the world, they say, and not feel it tug at the other.

Dr. Dan Landry:

Right. And these companies are, you know, before they relied on the insurer, they thought the insurer was looking out for the best interest of finding the lowest cost. You know, they were, they weren't. It's immaterial at this point. But now lab's a great example. They can send lab specimens essentially all over the country. So you find the lowest cost. And now consumers are starting to do that as well because as I mentioned earlier when I got hurt, we now have, we are spending enormous amount of out of pocket expenses. So people are starting to look for lower cost, lower cost lab work, lower cost radiology services. And you go to the doctor and the doctor may prescribe three tests and four medicines. And people are saying, why? So there's much more consumerism in medicine, tends to be more outside of Maine because there's more choices outside of Maine than there is in Maine, but it's coming.

Dr. Lisa Belisle:

Well, I will be interested to see as my son finishes medical school in a few years. Yes. See where things go with him.

Dr. Dan Landry:

Yeah.

Dr. Lisa Belisle:

Good for you. I know my dad, he's 70 something years old. He's still practicing medicine. So the landscape of medicine has just completely changed since he was starting. But. And I know that you have two kids, Sam and Chris, who are 23 and 20, so to know what the things are going to look like for our kids would be fascinating. I believe it will be.

Dr. Dan Landry:

And I think that, you know, I wish the best for your son practicing medicine. We absolutely need more physicians. I'm more concerned about our kids in their ability to pay for health care. If we continue on this trajectory. They won't be able to afford health care. They just won't. And if they can afford health care, it's going to be to the detriment of every other program. That's my biggest concern. And if we don't change the trajectory, our kids and their families are going to really struggle with health in their future. Their own health.

Dr. Lisa Belisle:

Yes. And they're already starting with enormous educational debt, which is something that I thought I had. Large educational debt, which I will pay off until I'm probably about 70 is nothing compared to the next generation.

Dr. Dan Landry:

And their incomes, you know, doctors are always going to make more money than average and more money than most people. So really fortunate in that regard. But incomes for physicians are going to fall. They're going to fall. And so it's going to make the payment of that debt even more difficult. And therefore fewer people are going to go into medicine.

Dr. Lisa Belisle:

Yes. I mean, discouraging, but I think that's the case. I know it's very true and it is, it's hard. I mean, when I'm actually I'm as a doctor, me personally, making 20% less than I was when I started, when I was a brand new doctor, when I knew much less.

Dr. Dan Landry:

Right, right.

Dr. Lisa Belisle:

They're paying me less for these years of experience.

Dr. Dan Landry:

Despite the fact that healthcare costs go up on average 5 to 6% a year, physicians aren't seeing it right.

Dr. Lisa Belisle:

So anybody out there who's thinking that it's that we're lining our pockets as the costs go up, that's. No. At least not my pockets. I don't think so. Well, this has been a fascinating conversation. I'm glad that you are doing the work that you're doing in healthcare reform. I wish you all the best with this. I've been speaking with Dr. Dan Landry who is a pediatric anesthesiologist who is now working on his clinical practice and being an advocate for healthcare reform within Maine and throughout the United States. Thank you so much for coming in today.

Dr. Dan Landry:

Thank you for having me.

Dr. Lisa Belisle:

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