As a resident physician at Grand Strand Medical Center in Myrtle Beach, S.C., Adlai Pappy II has been working on the frontlines against COVID-19 and has seen firsthand both the strengths and inadequacies of the U.S. healthcare system.
But this anesthesiologist in training has found consolation in his ability to make a difference in the lives of his patients.
“Despite a difficult intern year, I have been touched by the support for healthcare workers from those in the community,” says Pappy. “I continue to learn how blessed I am to have the opportunity to do meaningful work treating patients.”
A 2019 graduate of Emory University’s School of Medicine and a Consortium alum of Emory’s Goizueta School of Business, Pappy has both an MD and an MBA. His hope is that the combination of the two degrees will ultimately allow him to play a larger role in “shaping what future healthcare looks like.”
In between treating patients and planning for an upcoming move to Boston, where he’ll train in anesthesiology at Harvard’s Brigham and Women’s Hospital, Pappy spoke with The Consortium about his dual focus, his experience treating COVID-19 patients and the impact the pandemic might have on the healthcare industry long term.
Where did your interest in healthcare and business begin? What motivated you to combine the two?
I went to Princeton for undergrad, and it was there that I kind of began to develop that interest. I always liked science, but that’s when I began to develop an interest in healthcare as a whole — as a systems-based approach — and I began to realize that having a business background could be really useful in terms of trying to improve the healthcare system as a whole.
After I left Princeton, I did two years of research at the University of Michigan to get a little more experience, to make sure this was the right path for me. I realized it was, applied and was accepted to Emory and, over the course of five years, completed my MD-MBA.
Did the fact that your dad is also a doctor help spark your interest in medicine?
I think, if anything, he really encouraged me to understand the business side of things. He’s seen how healthcare has changed over the last 30 years, and I think some physicians who have been around for a while aren’t as happy with how practice has changed over the last couple decades. My dad feels that we need to have a stronger influence and a stronger voice in shaping things moving forward.
As physicians, we must be focused on our patients. Yet, historically, this focus was only at a micro level. Physicians would rent out time at hospitals to do their surgeries or see patients and would go home. We generally didn’t take an active role in being leaders at the hospital to influence how patient care is delivered. This allowed other groups — without clinical experience — to be leaders and to dictate policy. In an effort to change this, we’re starting to see an increase in the merger of MDs and MBAs — a lot more people who have that healthcare background who also want to participate and be a leader to influence how we provide care as a whole.
How were you able to balance the demands of both the MD and MBA program?
Thankfully, the way that Emory has integrated getting a master’s degree with an MD works out pretty well. They accelerate the first two years of medical school into about 18 months. When I was finishing up my third year, it was February. I was able to take the second part of medical boards and have a nice transition into starting the MBA in May, taking a leave of absence from the medical school. The way the two programs work together allows you to be able to focus on one at a time.
You also have a concentration in entrepreneurship through your MBA. What do you ultimately hope to do with both degrees, and do you have any desire to one day go out on your own?
Coming into business school, I knew I wanted to get a concentration in healthcare. During my time there, I added the entrepreneurship concentration because of the fantastic professors within the department. I learned a lot that has many applications to my daily work in medicine.
That said, with entrepreneurship, you need a self-starter attitude, you need to be able to handle a lot of different things at once, be able to understand a lot of different facets of business as a whole. I think there are a lot of similarities to medicine with regard to that, in terms of not just being a practicing physician but one who is also working to improve your hospital system or to improve policy in your state or even nationally — trying to make sure that you’re balancing in an effective way taking care of your patients at a micro-level but also influencing things at a macro-level.
What has your experience been like as a member of The Consortium?
The Consortium has been great. I have really enjoyed the network I’ve developed. I was able to get an internship with Centene, one of the supporting companies, that I really enjoyed. It gave me a great 12-weeks of better understanding Medicaid. It gave me a better understanding of the healthcare system as a whole, and I made a lot of friends along the way.
Additionally, I was recruited by Wade Rakes, who spoke at the Orientation Program and has been instrumental in leading Centene’s diversity and inclusion efforts. I would highly recommend Centene to Consortium members starting the internship recruiting process.
When it comes to COVID-19, what has the situation been like at your hospital?
Our hospital was one of the luckier ones initially, but the number of cases has risen significantly in June. Overall, what I think initially helped was the layout of South Carolina — it doesn’t have a lot of mass transit, and it isn’t one of the most densely populated states. The state did a pretty good job of shutting things down early, but the early opening is likely why cases rose dramatically in June. Still, I have spoken with some of my colleagues in other places, such as Florida, who said that at least a fourth or half of their hospital beds had COVID patients.
We’ve really been able to manage it and have enough protective gear. Initially we had some sad patient outcomes, but clinically it seems like we’re turning the corner in terms of how we attack COVID, improving outcomes.
As a hospital, did you have a plan for how to deal with this crisis, or was your approach more reactionary due to how quickly the situation escalated?
Well, as a whole, we had a couple advantages. One, our hospital is part of a larger system, Healthcare Corporation of America, which is the largest company of hospitals in the country. A lot of things developed at the headquarters in Nashville and were top-down in terms of ensuring the safety of both patients and providers. Also, things came out in phases.
We initially started implementing protocols to quickly identify those with the virus. As soon as anyone was under investigation, they were placed in isolation and tested. Then the hospital counted all of our protective gear so that we knew what we had in order to identify items we needed to supplement. Things began to escalate from there, to where we had to limit the number of visitors. No visitors were allowed for a while, but we have now changed that to a limit of one visitor. We also made sure that we were checking everyone’s temperature at the door, limiting entry into the hospital, masking everyone who came in.
Now we’re at a point where we can test pretty much anyone with symptoms, and we’re testing anyone who is coming in even for elective surgeries. We’re trying to get back to a new normal.
I understand that, for a while, hospitals weren’t doing elective surgeries, and it was said that some people were avoiding hospitals to prevent exposure to the virus. This reportedly had some negative health and economic outcomes. Has this been a cause for concern at your hospital?
Thankfully, as a resident in training, I am essentially a government employee, and our salaries are guaranteed. I think, in part, that’s probably because we don’t really make a lot, so we’re pretty useful in terms of what we can do with our skill set for how much we make. That being said, though, it was definitely a worry across the hospital. We had to close different wings to consolidate costs when we were below capacity. I think at our lowest, we were at 30 or 40 percent capacity. Throughout the rest of the year, I can’t remember a time when we were much below 80 or 90 percent — and, a lot of times, we were over 100 percent.
Across South Carolina — and the country — volumes dropped a lot. It does worry us in terms of things you can prevent but that you shouldn’t really see a change in, like strokes, heart attacks, things like that. It makes us wonder if this is happening and unfortunately people are passing at home because they don’t want to seek care. Most places right now have really effective ways of treating people with strokes, heart attacks, things of that nature without having to risk exposure to COVID-19, and I would encourage people to seek medical attention if they feel like they’re experiencing something out of the ordinary.
How impactful has it been to see your COVID-19 patients, especially the more severe cases, recover and be released from the hospital?
It’s definitely a positive thing. I was working on ICU, and unfortunately, we had some people pass from COVID. But, being able to see the turnaround — especially when, the week before, we were unsure as to whether or not we thought a person would make it — see some of the interventions actually make a difference, see the smile on a person’s face and how happy they are with how things are progressing is why we got into this. It’s definitely what every physician wants, to see those really positive outcomes, especially with something as scary as this.
Has it been interesting to try different interventions and see what works?
Yes. A lot of times, we are basing our management on whether there’s any sort of published literature and clinical trial that supports the use of the intervention. Still, given the novelty of the disease, we collectively work together to determine if we feel the benefits outweigh the risks of a treatment.
What do you think this crisis has revealed about the healthcare industry as a whole? Do you think this has brought to light any areas for improvement?
I think it’s probably even too early to tell. One thing that I’ve noticed in talking to some of my Canadian colleagues, at least in primary care, is how, in America, we need to see patient volume in order to generate revenue and stay afloat, while in Canada and some other countries, it’s sort of the opposite. Physicians have the option to have a capped amount they receive each year, and a good day for them is not a busy day in the clinic, but one where their patients are healthy and living their lives well.
I think the pandemic will bring up some interesting questions in terms of disparity of care. We’re seeing COVID disproportionately affect minorities, African Americans like myself, and the research still needs to be done to figure out why that may be. Hopefully, we can move forward, learn from this and set certain things into place that could prevent this from disproportionately affecting minorities in the future.
Are there ways you think the healthcare industry might change as a result of this pandemic?
The big thing, actually, that I have seen and that a lot of my colleagues say is that telehealth has definitely taken a step forward in terms of reimbursement. A big issue previously was that there was very limited reimbursement for telehealth business, and so we weren’t really seeing it expand. But, given what’s happened, there have been some emergency changes put into place to allow telehealth visits to be reimbursed.
Currently, this works similar to going to your primary care physician, where you might have a copay, but physicians are getting reimbursed from Medicare or Medicaid for these visits. A lot of times you needed to be able to do a physical exam in order to seek reimbursement. Now, it’s a little more efficient, and it’s definitely safer for people to be at home. I think that’s been a big positive. I believe examples like this, where insurance works with hospitals to improve the efficiency of delivering care, will continue.
What is your main concern with regard to the pandemic and your hope for the future?
The hope is definitely for a vaccine. I think the big issue with vaccines is the question of “How do we give something safely to 300 million or 7 billion people across the world?” That kind of leads into my fear.
Ultimately, I worry about what might happen in the fall. We did a pretty good job in the spring of staying socially isolated, but even as things are opening up here in South Carolina, I’m definitely seeing some waning of people taking some of the precautions. There’s debate as to whether or not the heat helps. I think the heat prevents it from staying on surfaces as long, but if we get to the fall and it begins to linger longer, I worry that we’ll see a second outbreak. That’s what we’ve seen with pandemics in the past, but hopefully we can take the appropriate steps to be prepared if that were to happen.
Ultimately, COVID’s been difficult for the country, but I think there’s a lot of opportunity here to improve things. I’m happy to be able to have played a small part in trying to help people who have the disease.