Dr. David Seaberg has launched residencies and helmed ACEP, but his latest challenge, leading Summa Hospital in Akron, Ohio, might be his greatest work to date. If he can accomplish his goal of not only saving the department and the residency but making Summa a model for the future, it will be the capstone on his career. Interview by Logan Plaster.
EPM: Obviously there was a lot of press about the Summa/SEA break-up. I wrote a piece about it for our magazine back in February. I wanted to give you an opportunity to describe the current situation as it stands.
Dr. David Seaberg: I think most people in emergency medicine were aware of what happened in January. I don’t even know all the details. Unfortunately, it was a contract negotiation that frankly had a lose-lose situation to it. I’m coming in to move forward. In my opinion, it was amazing that US Acute Care Solutions was able to keep this emergency department open throughout all of this. We’ve made a lot of great strides even since I started August 1st. We’ve hired seven doctors. There are still is some recruitment needs, but now we’re looking at improving our patient care metrics. We’ve just implemented a physician-in-triage, which has markedly almost eliminated our left-without-treatments. We’re down to about a half-percent now. And our length-of-stay is going down. We’re working on ancillary services. We’re working on patient experience. And I think the last thing is for me to help restore and then enhance the reputation of Summa Emergency Medicine; we need to reengage the community.
EPM: How do you go about healing the rift in the community?
Dr. Seaberg: We’re going out to the community, meeting with various organizations, various physician groups. We’ve actually reestablished our training with the EMS community. So I’m going out with my new EMS Medical Director to meet with and help train the EMS community. We’re meeting with community resources. We have to establish or reestablish that link with the community. And I think we’re making some great progress.
EPM: You said you’ve had recruitment struggles. I know that when the contract initially went to USACS there was a general sentiment that local emergency physicians were refusing to work under the new contract. Has that changed? What’s been your recruitment strategy?
Dr. Seaberg: I’m open to reaching out to the previous group. I think what’s best for this community, what’s best for the training of emergency physicians. In the meantime we have hit a lot of recruitment events. We’re hiring some graduates. We’ve actually hired some of our previous graduates, some from the local area. Akron is a very nice area but not always the easiest to recruit to. But we put out a national search. We’re also looking forward to going to ACEP and touting our success and our new strategic plan going forward with the reestablishment of the residency. And we hope that we will have all of our positions filled or very close by July.
EPM: So you’d be open to reaching out to the previous docs, but that’s not really the strategy right now. Right now you’re recruiting from the outside.
Dr. Seaberg: Right now, we’re recruiting from the outside. I’ve set up some meetings with some of the physicians from the previous group. I don’t know what will necessarily come out of that. But certainly the hospital administration that existed during that transition has all left. Unfortunately, the physicians left. The residency left. It really was a lose-lose. And I don’t think that’s good for this community. And I think as we rebuild it, I’m certainly again willing to reach out to them.
EPM: Do you know if the sentiment has changed among the local docs?
Dr. Seaberg: You hope time heals all. But I think it’s still a pretty raw nerve for most of that group would be my guess.
EPM: Do you have any personal connection to the Akron area?
Dr. Seaberg: I trained at the University of Pittsburgh. I married a Pittsburgh girl, so all her family’s less than an hour-and-a-half drive. When I graduated, my first position was at Metro Health Medical Center in Cleveland, where I was a research director and helped them start their residency program. I’m very familiar with the area and the region.
EPM: What in your career do you feel prepared you for this particular challenge?
Dr. Seaberg: I’ve almost had a 30-year career in emergency medicine. I’ve been a research director at Metro Health Medical Center and the University of Pittsburgh. I was a residency director at the University of Florida, then also a medical director and chair at the University of Florida. In 2007 I went up to be the inaugural dean of the University of Tennessee, Chattanooga Campus. But I also started a new department of emergency medicine and was chair of that – a new residency program. And we also started two additional residency programs at the University of Tennessee.
So I’ve helped start five residency programs in this country. I certainly have a lot of experience. And so I think this was an exciting opportunity for me to come and reestablish this with a great company in US Acute Care Solutions. My ultimate goal is to make Summa a model for how an academic emergency department can work within a large contract management group.
EPM: Is there anything that you feel like the media got wrong about its characterization of US Acute Care Solutions during the contract dispute?
Dr. Seaberg: I wasn’t here for all that. I think the stories that have come out recently about my becoming a chair and what we’re planning to do here have been very fair to us. I mean, sometimes they do bring up what happened back in January, as sort of a starting point, particularly in the local area. But I think the stories have been very fair and have been mainly focused on what we intend to do and how we’re rebuilding emergency medicine in Akron.
In terms of what happened last January, I really wasn’t down in the trenches. I was just hearing what everybody else was hearing on a national level. In my opinion, it was really a contract issue. And contract issues can get ugly. And this one got about as ugly as it could get. I don’t think though in a contract issue you should ever lose a residency. That I think was the painful part of this. I think USACS has done a remarkable job even just holding the emergency department together. And now we’re at a place where we can really grow it.
EPM: What is physician morale like right now?
Dr. Seaberg: I think in the last couple months it’s been great. People are really seeing that we’re moving forward. They see now since I’ve been brought up here that we are going to reestablish the residency program. The loss of the residents on July 1st was a bit of a hit obviously. We’ve had to change our model a little bit for now. But I think it’s working very well. And again, if you look at our metrics, we’re making remarkable improvement in length-of-stay and left-without-treatments. And now we’re starting to work on our patient experience scores.
EPM: Part of your role is to come in and be a cheerleader for this program and to really charge it forward. But honestly, how is the perception in the community right now? It really took a major hit.
Dr. Seaberg: I’ve done a lot of stories in the last week for the newspapers and radio. It’s all been very positive, focusing on restoration. When you get right down to it, Summa is Akron’s only local hospital now. With the Cleveland Clinic and University Hospital’s moving in, Summa is really the last Akron hospital. And I think people want it to succeed. And I think we’re now focusing on the positives. We’re trying to move forward, and I think we’re making great progress in terms of the care that we’re providing.
EPM: Can you walk me through sort of the short-term and long-term trajectory for reinstating the residency? Is there a roadmap in place?
Dr. Seaberg: Yes. So, we had an institutional survey. When the residency was closed down, the institution also went on probation. So the ACGME, Summa’s institutional ACGME accreditation was put on probation. There was a site survey in June. By mid-October we will get the report from the ACGME. I fully expect that we will come off probation, and that will be the first step for me to really move forward with the residency program. If we come off probation and there’s no restrictions on emergency medicine, we will hire the rest of the core faculty. And we’ll get our program information form hopefully in by this next summer, so that we can be in the match to start our residency July 2019. That’s the plan.
EPM: Since you’re in this healing process, how big of a role does it play to heal the wounds with the physicians who are in the area and who worked for SEA? How important is that to you?
Dr. Seaberg: You always want to have good working relationships. The other group, SEA, runs some other emergency departments and certainly we were part of that referral pattern. That changed slightly when they left Summa. I think it’s important to reach out to them. I would think that they would want Summa to still succeed. I would not think that they wanted their residency to close down. So we will need to reach out to those doctors.
EPM: Will that involve actually reaching out to the former leadership of SEA and extending an olive branch?
Dr. Seaberg: I already have. I will be meeting with several of the physicians. I’ve known several of those physicians for decades. So, we have talked and we will talk more. Am I absolutely depending on them coming back in? No. I don’t think we can. It was a very acrimonious split. But certainly if they want to help rebuild the program, we are certainly willing to talk.
EPM: Where does this role fit into your overall career trajectory and narrative?
Dr. Seaberg: When you get to be my age, you start looking at your legacy. I want to rebuild Summa emergency medicine, restart the residency. I think there’s opportunity to make Summa a model for how an academic residency program, academic emergency department can work within a large contract management group. Because the reality is consolidation and mergers are happening at an impressive scale right now and they have been really for the last five years. There’s thoughts that there’ll be 170 health centers eventually or health systems in this country. If all the balance is on the hospital side, I’m not sure that’s great necessarily for patient care. I think physicians have to have a say in patient care. So I think having either a large multi-specialty group or a large group of single specialists, which US Acute Care Solutions is, is going to be the future model. They can do things efficiently. They can help represent their doctors with the hospital.
I’m not saying hospitals are all bad or all good, physicians are all bad or good. What am I saying though is that there needs to be a balance. And so I think there’s a real opportunity here. I don’t think the large groups have really been in the academic emergency medicine business to a great extent. And I’m not convinced that they fully understand the business and the special needs that are required in a residency program; not only funding but faculty development and faculty incentive. So I bring a lot of experience in that and hopefully we’ll build that within the US Acute Care Solutions.
If I can help make Summa a great program again from where it was last January and make it a model across this country or at least for some of the other academic emergency departments, I think that would be a great, great part of my legacy and my career.
EPM: What message would you send to a reader of our magazine who works for a small, independent local group that fears that they’re going to lose their contract to a larger contract management group?
Dr. Seaberg: Well, I certainly understand the independent practice of emergency medicine. And there’s whole organizations developed for that. But the problem is it’s just not the reality of medicine now. I think those groups are going to have a hard time. There will be small groups. But with the consolidation in the healthcare industry and the consolidation of health systems and the employment of physicians by hospitals, I just think we need to have a better balance in terms of the business, the patient care and creating a good working environment for physicians.
I think it’s going to get harder and harder for the smaller groups to compete economically because the large groups can do things more efficiently. What I like about USACS is that the physicians are the owners of the company. And so physicians can come in, develop leadership opportunities, have a say in how medicine is practiced. I think it is a very viable model and frankly one that will definitely increase as hospital systems consolidate. It’s the reality of where medicine’s going. I’ve been in it for 30 years on both sides, and I just see where this is leading.