October 16, 2019
Meet Dr. Scott Joy, MD
Chief Medical Officer at HCA Healthcare Physician Services Group
Scott V. Joy, MD, MBA, FACP, is board-certified in internal medicine. He graduated from the University of Pittsburgh School of Medicine in 1992 and completed his residency at Allegheny General Hospital. Dr. Joy has previously served as the Medical Director for Uptown Primary Care at Presbyterian/St. Luke’s Medical Center and Colorado Care Partners. He currently serves as the Chief Medical Officer of the Continental Division of HCA Physician Service Group's (PSG) Continental Division. He joined Englewood Family Physicians in 2018.
As an internist (a doctor for adults), Dr. Joy has been providing patient-centered and evidence-based care for more than two-and-a-half decades. He has an interest in keeping people well through regular preventive visits and is a specialist in the management of chronic medical conditions such as diabetes, high blood pressure, asthma and heart disease. He also regularly treats patients who need acute care for evaluation of cold/flu symptoms and muscular sprains and strains.
Dr. Joy holds a Masters of Business Administration (MBA) degree from East Carolina University, is a member of the Society of General Internal Medicine, and is a fellow of the American College of Physicians.
Where are your family roots?
My family property was West Virginia and my dad went to WVU so we had some roots and the cost of living is a lot less.
Where do you concentrate your time as a physician and what do you enjoy doing the most?
I spend 50% of my time in clinical care seeing patients and 50% in an administrative role with HealthONE as the CMO of our employed physicians groups. We have about 500 employed providers including physicians and APPs, which are Nurse Practitioners and PAs in both Denver and Wichita, KS.
I really enjoy splitting my time. I trained to be a physician and not knowing what’s going to come through the door every day is always interesting and challenging, the complex conditions we face keeps us on our toes, while at the same time, going into the administrative role is nice and gives me the opportunity to advise our senior leaders about what the needs are from a clinical standpoint.
As a physician leader being a practicing physician also gives me a lot more credibility with the other providers because I tell them I would not ask you to do anything that I’m not going to do myself because anything I sign off on I’m going to be doing it on the computer, in the workflow, so I think being a clinician administrator has been a nice fit for me.
What is the culture you infuse in your practice?
We’re definitely moving into a culture of team-based care where all of our team members have equal input into how we operate our practice, how we engage with our patients, we have weekly staff meetings that are all-inclusive focused on how we all work together to improve the patient experience and deliver a better quality of care.
How do you define a better quality of care?
Quality of care means a couple things where with a lot of the government programs and the value-based contracts, where we certain quality measures we have to meet, how well do we control someone’s blood pressure or someone’s diabetes, for example, those are some real objective measures we can focus on. Then you look at improving the patient experience. How can we be more effective in communicating back to our patients? I think one of the most interesting changes is how we in clinical practice are leveraging the electronic resources we have. One of those is a patient portal that all our patients can sign up for. As soon as I see a lab result, for instance, I can send a note to their smart phone instantly so they can see what the lab results are, what the interpretation is- so I think the opportunities with electronic resources and how to best use them are exciting.
In your role as a CMO, what do you do to move the needle when it comes to changing the culture for not only the physician, but everyone down the line from the PA to the NP and even the front desk personnel?
I begin by telling new, young, physicians that they have to work well with others in order to survive. The physician is at the top leading the clinical discussion, but I emphasize they need to use the input from the entire team, don't look to administration to solve your problems, work locally, tell us if there are big administrative barriers that we can help remove for you, but in the end, culture change is really local. The more we can encourage our physicians, providers and staff to be engaging with one another, focusing on what does exceptional, clinical quality really mean.
What’s a particular challenge that comes with leading culture change?
One doesn’t have enough time to address all the issues that need attention. The dialogue itself takes time, at the beginning there is so much pent up challenges to speak, that it can be frustrating to work through it all. We’ve gotten more efficient with our meetings, but at the beginning we budgeted 45 minutes and they always went long. It takes time to manage that, too, because if you don't manage it well, you’ll just throw up your hands and say it’s too big and you’re going to get overwhelmed. The key is to make atomic changes in behavior, and that’s one of my roles as CMO is to coach as we identify physicians leaders in other PSG practices.
Is there a physician that influenced you early on that helped give you a vision of the type of doctor you wanted to be?
I had an undergrad professor at St. Vincent College in Latrobe, PA, where the Steelers have training camp, Arnold Palmer has his golf golf and of course the home of Rolling Rock Beer, where Tom Antos took a young sophomore into his clinic and just me kind of shadowing him and seeing how he interacted- I haven’t thought about him in a while, I’ll have to look him up.
I also went to a Dr. Grossman, too. When I was in medical school in my first year I did an internship at a community hospital in western PA. He was a pathologist, a very thoughtful, evidence-based guy who always seemed to be in control, navigated the relationships with other providers really well, especially as the medical staff President. Those are the two I think about - an internist and pathologist.
What’s exciting to you now as a clinician and clinician administrator?
When you work for an organization like HealthONE you’re not just one hospital. There are eight hospitals in the region, two in Wichita, and then when you think about scaling up to what role you have in the nation with HCA having 185 hospitals, 250,000 employees, your part of a really big, solid, Fortune 100 company. It provides us with so many opportunities, so if it doesn't work out here, then there are other options. It’s also exciting that HCA as an organization is now bringing service lines together. We have a Primary Care meeting in October to talk about Behavior Health Integration as one of the big topics. So when you have HCA moving on that you can be a part of moving the whole needle nationally. It helps with recruiting new physicians who want to be a part of something both nationally and internationally, who if they want to work on some of these bigger initiatives, there’s always an opportunity.
What are some of the new technologies in medicine that have changed how you practice medicine?
I tell my patients and students that I use my smartphone more than I use my stethoscope. There’s so much information about cost of medicines, preventative screening tests, that I am pretty much with every patient encounter on my smartphone for information. This is an extremely powerful tool that’s only gained in importance. I can pull up a discount coupon on a medicine for a patient while I’m sitting there with them and the technology is real-time and nimble, where as some of these legacy systems we use in medicine simply are not.
What are some things you like doing outside of work?
I love being in Colorado, I’m a huge outdoors guy—I like to hike, bike, and backpack. I’ve never found a bad trail in Colorado. I love the Lost Creek Wilderness- I’ve done a lot with the Scouts, my son is an Eagle Scout here in Colorado. We went through the whole Scouting thing, I was an Assistant Scoutmaster. We did a lot of the high adventure stuff, went to Philmont in the monsoon season, I’ll never forget it- 9.2 inches of rain in 36 hours. We did the boundary waters trip and backpacked in Europe. I love the National Parks, too, and knock those out. We just got back from Crater Lake, absolutely beautiful.
What was your first job?
I worked in a grocery store as a bagger. That’s what my son did this year, too. He’s continuing the legacy I guess. Those jobs are important because they certainly teach you the importance of a good education.
What’s your why? Why do you love what you do?
I think back to a chemistry teacher I had in High School who saw some aptitude there, that I was good with people and suggested that I might like medicine. I think back on those special people who took an interest in me and I realize now how fortunate I am that they took the time to care and respectfully shared with me their wisdom. I think in the role I have as CMO that I can do the same with young people, particularly these students in med school who I can influence in a positive way. I can be like one of those people who modeled good behavior, were positive, and enjoyed what they did.
We talk about a spiral career path that I do advise young physicians on, to take advantage of opportunities that come up. When doctors get into practice, there’s not necessarily a clear path any more like there was when it was get good grades, get into med school, get a residency, etc. I tell them not to get frustrated with that but instead to be open to different opportunities that come up.
You speak often of the importance of integrative health and that there’s some Eastern and Western that comes together there. Could you please elaborate on that?
Being an internist we get our patients asking about this too, so we have to have some sort of educated answer to give them when it comes up. We get questions about nutrition and wellness, and what a lot of people don't know is that about 20% of our job as a primary care doctor is in Behavioral Health. It’s such a big focus and I’m glad to see it’s gaining traction and being taken seriously as a major factor in healthcare. If you’re going to be a good internist, you better be good at Behavioral Health, there’s no doubt about it.
Behavioral Health in medicine is significant too. Instead of the term “burnout” we prefer to call it “moral injury”. It’s a new term which is defined as "when we perpetrate, bear witness to, or fail to prevent an act that transgresses our deeply held moral beliefs. In the healthcare context, this is caused by the need to accomplish the impossible task of satisfying the patient, the hospital, the insurer, and ourselves, all at once.” So moral injury locates the source of the distress, external to the physician, within the business framework of healthcare itself. Burnout is talked about as a personal weakness, such as “you’re just not strong enough,” but moral injury is a result of when your core beliefs as to why you went into medicine is insulted because of all these external factors.
Our job is to help all of us in this industry navigate this environment of rapid change and competing interests and learn how to respond in a positive way while keeping our core beliefs intact. Easy to say, not easy to do, but it can and needs to be done.