Passionate Physician Leader: Q&A with Dr. John McCabe, CEO of Upstate University Hospital

John McCabe, MD, has been a part of one facility in the Syracuse, N.Y., healthcare market for more than 25 years. As a former emergency medicine physician, he expresses concern for the patients he serves as CEO of Upstate University Hospital and what future they will face if the hospital loses funding. He cares about his employees and keeping them up-to-date in creative ways. And he is not afraid to express disappointment when a plan, that he believes will help the hospital, falls through.

McCabe 1Here, Dr. McCabe discusses his leadership, what changes he has overseen recently at Upstate University Hospital and how those actions will help the hospital transition into the future of healthcare.

Question: You've been with Upstate University Hospital for 26 years, and you went to medical school there as well — why did you choose to stay at one facility for so long?

Dr. John McCabe: I went to medical school here [at State University of New York Upstate Medical University] and then left for a job in Ohio. I came back to the hospital in 1987 for an emergency medicine position, where I worked to build academic and residency programs at the hospital. It was an institution I knew well and the position needed my emergency medicine training, and I haven't left since.

Q: Last year, Upstate University Hospital acquired Community General Hospital in Syracuse. What brought this deal about and why was it important for the future of the hospital?

JM: It was important for the hospital on a couple of levels. In the Syracuse market, there had been four acute-care hospitals for forever. For over 30 years, consultants would come in and say the market is too small for four hospitals, that it is better suited for three. Then last year, the hospital was full and continued to be at capacity. At the same time, Community General Hospital was the smallest hospital in the market, and it was failing. The acquisition was a smart move for both institutions — we preserved care for that hospital's traditional patient population, and it gave us the capacity we need.

Also, in today's market, academic medical centers cannot survive as high cost tertiary care hospitals — we have to move towards becoming more of a healthcare system, and this was a step in that direction. We have to be able to offer the full range of services, from primary to specialty, from simple to complex care. The acquisition was an opportunity to add that to what we are.

Q: As the CEO of an academic medical center, what issues have you personally seen with GME funding and how do you think those problems will affect academic hospitals in the future?

JM: We have seen some decrease in GME funding in the past few years, and we are very concerned with the funding being reduced further in the future. We're also concerned about the caps put on funding. (Editor's note: there have been multiple proposals to cut GME funding as Congress attempts to reduce federal spending. A cap on Medicare GME funding has been in place since 1997).

What I'm seeing is more new medical schools opening up, which means that more students will be graduating from medical school, but they may not have a place to do their residency training.

My main concern is to ensure a continued source of funding for GME training. In Syracuse, 50 percent of physicians in the area trained here as residents. It is important for the community; GME funding feeds the work force here.

Academic medical centers serve safety net functions in most communities; we take care of patients that others can't or won't. For example, things like HIV, trauma and burns, no one else does that. And when we lose GME funding on top of losing other payments from the government, we worry that we won't be able to perform those functions any more. That's the concern.

Q: Recently, Upstate University Hospital launched an electronic medical records system. Why choose to do that now, and how important do you think EMR systems are moving forward?

JM: I think electronic medical records are critical as we are moving into a new age of accountability and coordinated healthcare. We have had physician order entry and patient tracking systems in place for a long time at the hospital, so the new system is in addition to those electronic systems.

This system is designed to get our affiliated doctors offices and the hospital to share information between buildings. It was an institutional goal, and the push from the federal government helped move us in this direction.

Q: You write your own blog on the hospital's website, called "McCabe's Rounds," and update it weekly. What inspired you to start and continue to write the blog?

JM: It started as a desire to communicate with my employees — I have over 4,000 employees, and it's impossible to stop and talk with all of them — so it started as an avenue to congratulate employees, call them out for great work, things like that. Then, when we began the steps to acquire Community General Hospital, I used it as a communication vehicle to get the word out to the community about that.

Now, it is a weekly spot for me to communicate things of interest to employees and the community. We use employee forums and do employee surveys to keep in touch with employees as well, like many other hospitals do, but this is another way for me to keep in touch with them. It's great when I pass people in the hall or the cafeteria they tell me they read it and that it was interesting.

Q: How has your background in emergency medicine helped you as a CEO?

JM: My background in emergency medicine has helped me in a few different ways as CEO.

First, emergency medicine physicians historically see anyone who comes to them, regardless of time of day or ability to pay. I take that perspective with me as CEO and I think that helps.

Second, emergency medicine physicians interact with every other specialty on a daily basis. I know how they think and what they go though.

Third, I got used to juggling 20 to 30 patients at the same time in emergency medicine. I'm a good juggler, and that has been helpful as a CEO.

Fourth, you get used to making decisions on less information than you would like to have when you practice emergency medicine. I have a comfort level of making decisions based on what little I know and my gut reaction. That helps me as a CEO.

Finally, I have been a physician, faculty member and department chair here. I understand the importance of both the medical school and the teaching hospital, so we do not have a fight between the medical school and the hospital. I understand the importance of both sides.

Q: How might people describe you as a boss?

JM: I would hope they would say I am a caring person, who is quiet but can be forceful when need be. I can be supportive and set goals and help people, but I also know when to stay out of the way and let them work. I would hope they would say I'm a good leader and that I know how to stay out of other people's business as long as they are getting their work done.

Q: What is the biggest challenge you've faced as a CEO?

JM: I think the hardest lesson I had to learn is that that you can't always get done what you want to get done. For example, the hospital had been looking at acquiring a nursing home in the area for a long time. My team did a great job with researching it and everything, and then we took it to the state of New York and the SUNY board and it died there. It is frustrating, and it was not the outcome I would have liked.

So I've learned that there are walls that you hit and you can't get past, even when logic would suggest that you could get past it.

More Articles on Hospital and Health System CEOs:

Mastering the Matrix of Healthcare: Q&A With Syd Bersante, President of St. Joseph Medical Center in Washington
How a Banker Turns Around a Struggling System: Q&A With Carlos Migoya, CEO of Jackson Health System
Facing Challenges With Meaningful Affiliations: Q&A With The Mount Sinai Medical Center CEO Dr. Kenneth Davis

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