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Today I have the honor of having Dr. Robert Spetzler with me. [Dr. Spetzler is the Director of Barrow Neurological Institute at St. Joseph’s and is one of the world’s most renowned neurosurgeons.] He has built a unique program here at the Barrow and I hope to get some idea on why he was able to do this.spetzler-robert-2011-color-photo

 

You came here in 1983 and became the director in 1986. At that time you were already a fairly well known neurosurgeon. Why did you pick the Barrow to build your career around?

It was serendipity. I was very young and interviewing at an academic medical center in New York to build a program and was negotiating with the dean when the director of the BNI, John Green, asked me to come here and take a look. When I told my wife I wanted to [do that], she said, “if you’re going there you’re going by yourself” because she remembered going through Phoenix in the middle of July in an un-air-conditioned car when she was ten. But John Green and the people that we met were absolutely delightful, and I saw an opportunity. The Barrow at that time was a very small institute but it had all the support from the Catholic Healthcare System, from the nuns and the medical staff and the neurosurgeons that were here, to really build something that I wanted to be a part of.

 

This is really a unique institute. It has the largest residency in neurosurgery now. I think 50 % of academic departments have one of your graduates on its staff. What do you think accounted for the rise of the institute? Was it timing, the technology developments, the people that you came with, or something else?

 

There’s no doubt in my mind that a program really depends on the people. My first goal when I came here was to put all my effort and all my energy into the residency program. I wanted to make it the residency program that every top-notch medical student that was interested in neurosurgery wanted to apply to. And I was fortunate enough to find Dr. [Volker] Sonntag, who was in private practice in Phoenix and whom I had heard about from one of my academic friends—Dr. Ben Stein, who had trained him, said he was a “diamond in the rough.” He shared that mission and was very instrumental in building up the residency program. So today, although we have the largest program, I am much more proud of the quality of the applicants. And they in turn—because they’re so much smarter than the attendings—make sure that we are at the cutting edge. So my goal has always been to hire neurosurgeons, or any one of the other neuroscience specialties, someone who was on the cutting edge and would develop his or her area of expertise. So whenever nationally there was a meeting and someone wanted to put a committee together of the leading individuals in that specific area, one of the BNI faculty would be one of them.

 

How do you cultivate talent? How do you bring these people forward?

 

The other thing I think is very important is that I wanted a culture in which people wanted to come to work. Especially the neurosurgeons and the residents [who] work extremely hard. I wanted them to be in an environment where there was no abuse. I am an avid disliker of people who bully, and so we have no bullying. I would be willing to say that the camaraderie that is present in our institution is the envy of most of our academic centers.

 

I remember back in the 90s, I was here as a fellow and you were offered the joint chair of UCSF and Stanford. I’m sure it must have been attractive to you given that you trained at UCSF. Everyone was extremely concerned that you would be leaving. What made you stay at that time?

 

It was tempting to go—it really wasn’t a joint chair but both institutions were trying to get me to come. It’s always nice to go back to the place you create [for yourself], but it would have meant leaving behind people I had recruited, part of the BNI family. It would have meant starting all over again. And we had a much larger neurosurgery program here than at UCSF despite the fact that it was such a magnet for neurosurgery.

 

There are a lot of hospital systems that are trying to build centers of excellence. Do you think what you’ve done here for neurosurgery—some pieces of that—are transportable to other efforts to try to build centers of excellence?

 

I can’t tell you how many groups of administrators and neurosurgeons and hospital leaders have come through here to look at what we’ve built and to take away whatever information they could gather in order to start their own neuroscience center. I think the neuroscience center is certainly a viable option for any health institution willing to make some very specific decisions and support those decisions. And it depends on whether you’re an academic center, where you can build it around a training program like [the one we have for] residents. Most centers don’t have that available. But you can still build it around a teaching program that consists of fellows for the various subspecialties—neurosurgery, neurology, neuroradiology, etc. But it requires leadership that can bring the diverse personalities in these departments together so they’re pulling in the same direction. That’s why I emphasize the need for training so much because that is the glue that brings everyone together. When you have conferences that bring in the various specialties, you’ve got to have that in order to pull in the same direction. That’s why in my opinion you’ve got to have that residency program or really work hard at having fellows.

 

I trained in Sweden for a year and saw that they had regional centers of excellence as opposed to [a hospital or provider] every five miles. Do you have any thoughts about the future of healthcare and how these centers of excellence should fit in that broader map?

 

It’s a tough thing. I too have spent quite a bit of time in Europe, and I’ve gotten to know the systems very well. There’s always a trade off. When you have free enterprise you have the disadvantage that any hospital or health system, as it looks at its books and finds a specialty that is a moneymaker, it makes sense for an administrator to put resources behind it. Neurosurgery happens to be a profitable line in virtually every healthcare facility, so you have [with free enterprise] that disadvantage of having very small pockets of neurosurgery spread throughout a city. Unfortunately the bottom line is concentrations of super specialists regionally are much better than [doctors] in every small hospital. So for a [large] health system that’s a positive because they can in fact help to direct patients to one of their facilities and bring in neurology patients, neurosurgery patients, and really get a staff that allows them to super-specialize to get the very best care to the patients.

 

I would love to see Dignity leverage its networks so that patients ended up here. I think it’s very difficult for patients at times to find that tertiary or quaternary care. Do you have any suggestions for patients who are looking for the best care?

 

It’s a toughie because there are all sorts of systems out there—great facilities and physicians—and in general those are pretty worthless. They tend to have a self-fulfilling prophecy so that the more you use them the more you pay them. I always think [a patient’s] local physician, or if they know a neurosurgeon or somebody and they can get into the network, that helps. What is very important is for patients to recognize is that they are the captain of the ship. They and their families need to take charge of their loved one that is in need of care—not let the caretakers direct them but they need to direct the caretakers.

 

After all these years you’re going to be retiring in June. It’s going to be a real loss. Every leader needs a transition plan. Do you have a vision for where you’d like to see the Barrow go in the next three to five years or maybe ten years?

 

We have a lot of irons in the fire, and I would like to see this process continue. Whoever comes will have a specific view of how to accomplish the goals that are part of that mission. I see my job as supporting that individual to the best of my abilities. Nothing would be more detrimental to me personally than to see the next person fail for lack of support from the current leadership.

 

Looking back over your long career here, do you have any disappointments or things that you would have liked to have gone better?

 

There are a lot of things I would have liked to have done better. But overall what we have been able to accomplish—and that’s a very big “we”; so many individuals like yourself—we have accomplished so much more that I had ever anticipated or hoped for. When I go to bed, I’m grateful every night.

 

Any final thoughts you’d like to share on centers of excellence?

 

I think it is people, people that are working together because they want to work together. It’s so much healthier an environment than [one where] people are forced to work together. That’s my final thought.

 

Thank you Dr. Spetzler.