Interview with Stephen Klasko, M.D.
President and CEO of Jefferson Health and Thomas Jefferson University
I think that the main reason people died from Covid in the United States was their zip code.
What drove you to pursue a career in healthcare?
I was a broadcasting major and a Chemistry minor. I started out as a DJ and I got fired from my first DJ job. But I did so well in my Chemistry minor that I became a doctor. The hilarious thing is that I got rejected in my first interview because I have a big mouth and I criticized the neurosurgeon, which you never do. But the second interview was in Philadelphia where I was a DJ, and the doctor interviewing me had worked the night shift and recognized my DJ name. He thought it would be really cool for me to work there.
This is not the most inspirational story but what inspired me is that in medical school I loved surgery but I was in my OBGYN rotation. This was back in 1978-1980 and to know what the outcome would be in nine months’ time and to be with people in the best of times and the worst of times of their lives was very special. Many people make their decisions based on the people they work with on their rotations. I met this doctor in a poor hospital who treated all these mums and babies just like they were gold. I just thought, how could there be a better specialty? I didn’t think about money or lifestyle as neither are great in OBGYN. I went on to deliver 2500 babies in the first part of my career and I still get Christmas and Hanukkah cards from the babies I delivered.
What are the top three challenges healthcare is facing these days?
I think the first challenge is health equity. I think it is a global challenge, sadly it is a little worse in the United States than it is in other countries partly because the folks who have money have everything and so the gap is wider. I think that the main reason people died from Covid in the United States was their zip code, not your genetics, not whether you wore a mask, not social distancing. Your zip code. In Philadelphia, there are five zip codes where less than 50% of people have broadband. If you think about it, these people are in virtual jail. In May 2020, CNN was telling people not to go to the hospital because they’ll get that horrible disease. If you did not have broadband and you could not access telehealth and if you had chest pain, you may have thought that you should not go to the hospital but should just go to sleep, so people died.
We don’t get up in the morning and say we are going to telebank but we do talk about telehealth like it is a weird thing.
And here’s the second problem with our healthcare system. There was this guy from Google X who I was on a panel with and he had this great quote, “The problem with American healthcare is not that we aim too high and fail but we aim too low and hit the mark!”. The way I look at it is that the ability for me to use technology to affect a single patient has changed dramatically in 30 years. But the way we deliver healthcare hasn’t changed much at all. Healthcare needs to become a consumer sport. Every other sector has done a much better job. We don’t get up in the morning and say we are going to telebank but we do talk about telehealth like it is a weird thing. At Jefferson, I championed something called “Healthcare at any Address”; that we should not be defined by the hospitals that we go to but by the care that we are getting at any address.
The third crisis is that we are creating medical students of the past. We still accept students based on grades and not on them being creative or empathetic. Being able to memorize something is not what I want for my OBGYN student or my family doc. We need to start selecting medical students based on empathy, communication skills, and cultural competence.
We need to have a very different curriculum that does not assume that everyone is going to become an academic scientist.
We have to recognize that soon I will have a Google brain next to me that will be able to take a picture of the baby I just delivered and say what is chromosomally wrong with it. I don’t have to memorize every genomic formula. When the mother asks what this chromosomal abnormality means, she is really asking about her image of the perfect baby and the robot will never get that. So we need to have a very different curriculum that does not assume that everyone is going to become an academic scientist. 16 weeks on microbiology and 16 weeks on microchemistry but not much on health equity, robotics, AI, and digital health. Students coming out of medical school say that they only learnt half of what they needed to work as doctors. I think we need an extreme makeover of medical education. I think Sheba should get their own medical school and I would be happy to come and make that speech!
Can you share a specific challenge you or your organization have been dealing with?
Running hospitals is a really lousy business in the United States because expenses have gone up 8-10% partly because of Covid, and revenue has gone down. I used to work with Apple and what made Steve Jobs so genius is that he recognized that computers and iPhones were going to become commodities. I learned from him that if you are not number one in the market and the future from a financial point doesn’t look good, then you need to think about what is going to be obvious ten years from now and do it today.
Sick care is really a bad business. The health assurance of people is really going to be the key to having a successful future.
I shamelessly stole that idea when I came to Jefferson, I thought about “the old Mac” and “the new Mac”. The old Mac being in-patient revenue, out-patient revenue, NIH funding and in-person tuition. Whereas the new Mac is a digital lifestyle, strategic partnerships with venture capitalists, and philanthropy. When first speaking about it, I got the same reaction as Steve Jobs got in 2000 when they said he was crazy. But we went all in and invested about $35 million in telehealth, and we also invested in the companies that were making telehealth, and all of a sudden we became the place that Silicon Valley came to when they wanted to partner with a hospital. “The new Mac”, these strategic partnerships that we made became a big part of our revenue which is why we were able to keep an “A” credit rating. Sick care is really a bad business. The health assurance of people and having Jefferson be defined not by its hospitals but by the care and caring it gives wherever it is, is really going to be the key to having a successful future.
We created a whole leadership program around it so our leaders got the change. We recognized that 15% of our doctors would fight everything, so we ignored them. We have really become a leader in the new way of thinking of healthcare at any address.
What’s unique about the FOH community?
What’s fantastic about the FOH community is first that it is global. There are very few things in this world that are global as far as health. Understanding what is different and similar between countries so close to each other such as Canada and the United States where things couldn’t be more different.
Another thing is that FOH is being run by Sheba which is not only number 10th in the world but has also built their reputation on innovation. This is really exciting because it brings the best of both worlds, the traditional academic world and innovation. That’s reflected in the people who are part of the FOH; We have some of the top academic leaders and we also have folks from relatively new institutions who are really interested in innovation. That makes it unique.