Welcome back to MedCast, the podcast from MedChi, the Maryland State Medical Society. In episode 11, Dr. Stephen Rockower speaks with Dr. Howard Haft, a Senior Medical Advisor with the Maryland Primary Care Program. They discuss Dr. Haft's background, primary care in Maryland, and Dr. Haft's key role in Maryland's Covid-19 response, along with some fun side notes for everyone. Enjoy the show.
Dr. Rockower (00:15):
Welcome to Med Cast, the podcast from Med Chi, the Maryland State Medical Society. Each episode will be doing a deep dive into medicine and taking an insider's view on issues facing Maryland physicians and patients and healthcare more broadly. I'm your host, Dr. Stephen Rockower. Today my guest is Dr. Howard Haft. Dr. Haft was formerly the Deputy Secretary for Public Health Services in the Maryland Department of Health, and is now a senior medical advisor to the department. Welcome Dr. Haft.
Dr. Haft (00:51):
Thank you, Dr. Rockower. It's a pleasure to be here, and I'm looking forward to the conversation we're about to have.
Dr. Rockower (00:56):
Well, I'm looking forward to it too. Ispent a lot of time listening to you over the last couple of years. I never really had a chance to ask too many questions, but here we are. So let's start with just a few biographical things. Tell me where you grew up where you went to medical school some of your, you know, professional things, and how you got to Maryland.
Dr. Haft (01:22):
Well, Dr. Rockower, it's kind of a long winding journey, but I was born and raised in Newark, New Jersey. I went to undergraduate school in Rhode Island and medical school at Penn State, and then back to Brown for my residency training in internal medicine. Then leftand spent a short period of time in the in the health service and in a Navy clinic in St. John in the US Virgin Islands. And then after that tour of duty went to the University of California Davis in in Cal to do both clinical work and also neurochemistry research. I did that for a number of years, supported by a number of NIH and program project grants, and found as I began to raise my family in, in California that the earthquakes, fires, and mudslides were a bit much. We moved back east to Maryland, and that is how I wound up in Maryland.
(02:26)
I switched my academic affiliation to Georgetown spent a considerable amount of time thereafter, billing primary care in developing a solo practice and in growing that to a larger practice and then multi-specialty practice. And and then after many years of a wonderful career and primary care, both in the direct provision of care and providing charity care in a free clinic in a number of other, really what I think were interesting and exciting opportunities that I took advantage of. I wound up in a place where I was ready to retire, but had the opportunity to join the Hogan administration as the Deputy Secretary for Public Health or the state health officer as that position is also known-and enjoyed that tremendously. I used the duration of the Hogan administration from beginning to end to do work in public health.
(03:28)
And then as the executive director of the Health Benefit Exchange for the state. And then probably what I've spent most of my passion with has been with the development the negotiations for, and then the start-up and implementation of the Maryland Primary Care Programwhich now is the nation's largest primary care program that's supported by the federal government by far in any state on a per capita basis. So we're reallyI'm privileged to still serve as a senior medical advisor for that program with my colleague Chad Pearlman, who now serves as the executive director. It's just a matter of great pride to be able to help my colleagues and friends in primary care in Maryland go through what has been a very difficult time and look forward to a bright future. So that's the short, that's the short and tortuous journey.
Dr. Rockower (04:30):
Okay. Well, that's, that's fine. I wanted to spend some time talking about the primary care program. As you know, I'm an orthopedic surgeon, so I don't have much contact with the primary care financial aspects, andhow things worked, especially in Maryland, which as we both know is different than the rest of the country. Perhaps you could explain somewhat about the waiver and how our primary care program fits into that.
Dr. Haft (05:04):
Thank you for that question. I would be delighted to talk about that as a matter of fact. So, so it's really, you know, interesting how Maryland has always led the nation in terms of innovations in healthcare payment and delivery. And in many ways, although I would say where we are now, it's not just leading, we're running with a lot of other states who are leading right alongside of us. But the, the waiver itself, as you probably know, really had its origins back in the seventies with the beginning of the all payer model for Maryland, which was really very exclusively hospital focused. And in that model allowed all of our Maryland hospitals to be paid the same by every payer that provided care or payments for patients within that hospital. Every hospital got a different payment.
(05:59)
But within each hospital itself, it got the same payment from all payers, including, which was unique in MarylandMedicare and Medicaid, the federal payers. And that's the beginning of this story about how we got to the Maryland primary care program. So that worked fabulously well for providing equitable care and taking care of issues of uncompensated care for those hospitals for four decades or more. But this issue arose along the way where Medicare continued to be a fair payer paying the same as the commercial payers, Medicaid, the fair payer paying the hospitals the same as commercial payers, so everybody paying the same. But as you know, in other states, what has happened over those four decades is that Medicare, Medicaid paid pretty much a flat amount or small increases year over year.
(06:58)
And commercial payers really picked up the rest of the costs for care in hospitals. So in all other states, commercial payers paid a lot more than Medicare and Medicaid for the care overall care provided in hospitals. And that difference grew pretty sharply over particularly the last decade or 15 years or so. And Medicare said, you know, Maryland now is a place where we are paying more on a per capital basis for hospital care than any place else in the nation, and that's not sustainable. So the next chapter was hospitals, as you know, going to global budget and pledging and in fact, being able, to produce savings back to Medicare in a very substantial way on the hospital part, a side of payments. But that was just step one. Step two, which was an inevitable step, said, now we're doing that for hospitals, but we know that there, as the hospital costs and payments go down, you know, it's quite likely that those payments will be picked up in the Part B or the non-hospital side of the Medicare's responsibility.
(08:17)
In effect, some of that was probably happening as a normal consequence of good care anyway. But Medicare and the state agreed that we really need to have something that's more comprehensive, that includes part A and part B of the Medicare payments. And that was the next phase of the model. And where we began with MDPCP, the Maryland Primary Care Program, where Medicare in the state all agreed that in order to sustain a model like this, we need to have a really strong primary care infrastructure in the state. We need to be well invested. We need to have practices across the state that are able to provide preventative care and care for chronic illnesses so as to avoid unnecessary hospitalizations, which would only drive up the costs of care ultimately, and really impact the ability to stay within that global budget that hospitals had all agreed to be in.
(09:17)
So we spent several years listening to stakeholders in many, many groups and many, many hours and meetings and, you know, and every place across the state to get input on what our primary care stakeholders and others felt would be a good model for delivering and paying for primary care in the state. Included in that were a lot of hospital participants and payers, et cetera. And we wound up with, I think, a very unique program built on what I would call the chassis of a previous CMMI failed program, the comprehensive Primary Care plus program, which since then has been sunsetted. But we looked at the pieces of that program as it was faltering to see what needed to be done if they were able to make it a sustainable program.
(10:15)
Included in that was making sure the payments were sufficient, making sure the payments really targeted the patients or the beneficiaries who needed to have extra care. People with behavioral health disorders, people with dementia, people with substance use disorders, and others who we knew needed to have greater investment within this program because they required more intensive preventative and chronic disease management care. So we, we targeted the funding levels there, and then we looked at the ways that we could help transform in a meaningful way, in a sustainable way, primary healthcare across the state. And we said, that's hard work. Why don't I stop there and, and take a breath, and then I'll
Dr. Rockower (11:05):
Dr. Haft (11:13):
That's a great question, and the answer is the transformation is agnostic to payer. It occurs for everybody that's taken care of by that primary care practice. When you, when you transform the way you deliver care, everybody is enveloped in that transformation on the patient side. The payments in year one were just Medicare, but we looked for aligned payers from commercial and other places. And by year two, CareFirst, the largest commercial payer joined as an aligned payer. And, what alignment means, we can talk about later, but they joined the program essentially. And now in this year, we're looking forward to adding Medicaid as an aligned payer, probably to come on in 2024. And then we're wide open for additional payers to come in alignment. But so back to the, you know what needed to be done to you know, I'm happy to talk about the payments a little later, but for the, the really important stuff is transforming how you deliver care.
(12:19)
So the way that primary care had traditionally been delivered is one patient at a time. You come in, I'm your doctor, you tell me about your problems. I deal with your blood pressure and your diabetes or chronic lung disease. Give you your immunizations, take care of whatever it is right here and now, and then send in some prescriptions and send you on your way. The way that we are transforming healthcare is really a much more complete holistic, whole person longitudinal care that encompasses a team, not just a single provider, but a provider that's supported by a team who can add a lot of other features to the care that's delivered. So now we look at each of the providers or the practitioners, physicians, nurse practitioner, PA as the leader of those teams, and been, and along with them, they have medical assistants, they have pharmacists, psychologists, LCSWs, all working together in a team to provide care for the patient and each practice and each provider having a population that they serve, not just one patient, but a population, whether it's two, you know, depending on the size of the practice or the individual practitioner.
(13:41)
You know, a large practice with 10 providers could serve 20,000 people. A small practice with a single practitioner, perhaps 1500 to 2000 or 2,500 people, but that's who they serve. That's a sense, the flock that they are tending.
Dr. Rockower (13:58):
Would, does coordination take place through a computer system? Is is everything integrated that way?
Dr. Haft (14:07):
Yeah, absolutely. So as a necessary requirement to join the program, practices are required to have the most up-to-date version of an electronic medical record that's available. This is something that the Office of the National Coordinator for Health IT each year or several years, certifies electronic medical records at a certain level. So to be in this program, you have to have that highest level of certification, which helps to provide a lot of the, the technology infrastructure. But technology is really important, but it's not the whole deal by any stretch of the imagination, the whole deal, the really important thing is leveraging something that you can never get outta technology. And that's a trusted relationship between the practitioner and the patient and the practitioner, the patient, and the team that helps support them. That's really the business of primary care building those longitudinal trusted relationships.
(15:15)
So knowing those trusted relationships probably already existed, the work that we had to do was build these other structures and supports around it. One of the things that we noticed from the failed programs in the past is they really had insufficient supports and insufficient funding. So we amped up the funding still even with this amped up funding, still, primary care is still at the bottom of the totem pole in terms of the hierarchy of funding for all of the medical specialties. getting somewhere between somewhere around 5% of the total healthcare spend and providing care for 35% of the episodes of care. but still was higher, better, better significantly than what fee for service Medicare alone was. But that wasn't enough, just the funding. We created something that's not been done anyplace else in the country, in any of these other programs, organizations called Care Transformation Organizations.
(16:18)
And they were organizations that were also funded through this program. And what they did was they used economies of scale by kind of contracting on a voluntary basis for by the practices with these primary care practices across the state. Some of them contract with 50 or 60 practices, some two or three or four but they are able to use economies of scale to hire pharmacists and LCSWs and psychologists and care manager, nurses and others, and then share them with the practices based on the contracts that they have. So, a small practice, for instance, might only need you know, a pharmacist for four hours a week to do some med reconciliations or take care of some more complex medical pharmacy issues with their patients. While a large practice might need a full-time pharmacist. But the CTOs are able to do those hirings on a broad scale because they've got the the, the responsibility for many practices in many, many more patients, and then they allocate those across the board.
(17:27)
the other great thing that we were able to recognize is that health IT is a real stumbling block in all these programs. So again, we were fortunate to have CRISP our state health designated health information exchange here as a great partner, right, from even before the beginning. And we've worked with CRISP for to develop dashboards for every one of the practices that displays information about utilizations costs, equity related issues, you know, disparities and blood pressure, hypertension, COPD hospitalizations and includes tools that use machine learning to help providers predict who are, who among their patients is likely to go to the hospital unnecessarily or the ED unnecessarily in the next 30 days. And we give that to all the providers, and we give a team of coaches who go out and each coach has a group of practices that they're responsible for, and they develop a relationship with those practices and help them with the administrative details, how to implement these HIT tools.
(18:37)
That's all state contribution. Again, one of the big differences here is the state has weighed in, in a major way and said, we're not just gonna put this program out there. We're gonna put a team together to help make sure that the practices are well supported, super supported, have some, you know, leadership have some ability to you know, go to somebody right in the state and say, I'm having a problem with this or that have an you have the ability when there are issues that need to be escalated to the federal government, a way to easily do that through these state channels. so I think it was putting together all of those pieces, the Care Transformation Organizations, the state team where we have we call it the Program Management Office, which has a team of coaches that, that help that help all the practices, and people that specialize in, in behavioral health integration models to help practices integrate these great behavioral health tools into their practices.
(19:44)
A team that works on equity, a team that works on how to, how practices can access and understand the social needs of their patients and, and be able to access resources from the community to address issues of food instability or transportation issues or housing issues. And we've even added special funding mechanisms for those patients who have those kinds of more serious social needs. So I think it's been an ongoing development wonderfully coordinated between the resources of funding resources, the federal government can provide our great colleagues on the hospital side and with the health services cost review commission, the Maryland Healthcare Commission, our colleagues at CRISP, the governor's office and, and the Department of Health through this Program Management Office being able to provide resources to make this I think probably not only the largest, but I would say the most successful primary care model that the federal government has ever established.
Dr. Rockower (20:56):
Is there anything similar in any other state?
Dr. Haft (21:00):
There is not. there are two other states that have state models now. One is Pennsylvania, but that's a fairly limited model for rural hospitals where they've taken rural hospitals to use, taken 'em to global budgets similar to what we do for all of our hospitals. And then the great state of Vermont which is a small state, you know it has about as many people as Baltimore has. Mm-hmm. but it's a great state. and they, they organized actually a bit, not as an all payer model but under the Green Mountain Group number probably 10 years ago and did a, a statewide, ACO model. and they've organized largely all of the providers under that model, and it's been very successful in that context of a small, mostly rural state. So those are the two other examples.
(21:56)
But as I said, this has really caught fire now. So I would say that places like Oregon where they really have organized, not on the Medicare side, but on the Medicaid side, and done a wonderful job organizing Medicaid care delivery across the state, Rhode Island, where they've organized largely on the commercial side, and other states that are now addressing the issues like Colorado and Connecticut, Massachusetts has done a great job. So this is really now a, a ground swell, I think of states taking on this mantle of we have to do more to build a strong primary care infrastructure, because states are understanding how critical that is to the improvement of health and the constraint of costs and for equity. There was a 2021, the National Academy of Science Engineering and Medicine put out a paper that was really very detailed on on the what is necessary to produce high quality primary care.
(23:07)
They described payment models that needed to change, moving away from fee for service to a hybrid model with, you know, as just as we, as we do in our program, provide some payments for infrastructure to support these teams, and then some payments for fee for service to provide care to make sure that there still is an incentive for our patients to sit down with their providers face-to-face and build those relationships and, and, and do what, you know, that special magic that happens between you know in the patient physician relationship. So, and they've also described the fact that we, we need to, in that report that we need to start measuring how we're doing nationally, state by state and nationally and improving the care for at the entry level to the healthcare system at the primary care level.
(24:01)
And the answer is, right now we're probably not doing very well in any states. We're, but we're all, we've now got a direction to go in, I think to make that delivery of care better. used to be that. So I'll harken back to, to my early days. you know when I was originally early training in the, you know, the early days of Medicare, late sixties, early seventies, it seemed like everybody had their doctor, you know, everybody could identify who their doctor was, and this is my doctor. I can identify, this is who I go to for my healthcare. over the decades that slipped, and now it's, it went probably 10 years ago, it was one in three people could identify. Now it's about one in five who can identify who their doctor is, who their regular source of care is. And some of that is that, you know we've seen this fragmentation and the winnowing way of the primary care infrastructure. So, we're just in the process of building it back again.
Dr. Rockower (25:09):
Does the primary care program encourage physician-led teams, or are other professionals in charge?
Dr. Haft (25:21):
Yeah, it, it's encourages physician-led teams, as, you know, the, I think that's more now pluralistic than it was previously. And we see, we see some practices that are nurse practitioner practices. We're not exclusive to physicians alone. So nurse practitioner practices and, and those teams then are led by nurse practitioners. PAs, physician assistants are often in the mix. I don't think we have any models now because of both regulatory and other kinds of reasons that are PA led teams. They're largely either physician or nurse practitioner with a vast majority of them being physician led teams now.
Dr. Rockower (26:05):
I do wanna put in a a compliment to CRISP during my career and even now as I'm doing charity care the CRISP website has been most, most helpful in getting me information for patients that are not necessarily in my practice, and figuring out where they've been, what they've been doing, what drugs they've been getting, et cetera, et cetera, et cetera. It has really been a terrific boon and advantage to me in my practice you know, I'm not primary care, as I said, or orthopedics, but having that information available to me has really made a difference.
Dr. Haft (26:51):
Yeah, I totally agree with you. I can't say enough good things about, about crisp, but I think they've, you know, they've really changed in so many ways the ability to practice medicine in, in Maryland. And I think they're recognized as probably the best case Health Information Exchange in the nation. And as you know, they now not only serve Maryland, they serve West Virginia and DC and as well as providing resources to other states because they're such an incredible answer to so many of the questions and so many of the needs that we've identified in terms of sharing information in the last several years. I've had the great opportunity for about five years which is the maximum duration of tenure to serve on the CRISP board of directors.
(27:56)
I was witness to the great deal of integrity and consideration for the public and for privacy and security in the very rigorous way in which they do all of the work that they do. But while it's rigorous and while it's sensitive to privacy, security and has this high degree of integrity, they also are able to consistently and at a very rapid rate, respond to the needs of Marylanders. and I give, you know, credit to them and witness to that statement, but everything that they did during Covid, it was remarkable bordering on miraculous that they were able to provide the kind of timely realtime information that was necessary for program directors, for policy makers, for our leadership, right up to the governor to be able to respond appropriately with the sufficient resources in the right places for covid as we did in a large deal of that, credit goes to CRISP's ability to manage and display the data that they were given and in other tools they provided.
(29:13)
I'll give you one for instance, is that at our request, or multiple people's requests, but particularly for the primary care program, they were able to establish a system so that the practices in their usual dashboards could look at which of their patients had covid vaccines, which vaccine they had, and who was missing a vaccine, so that they could specifically reach out to those patients and either invite them into their office and vaccinate them, or tell 'em, go to your local pharmacy or to the state facility, but you need to get a vaccination. Better than that, they were able to parse it based on the patient's risk levels. So people who were older, people who had more medical conditions, they could parse that, that data and the patient and the providers could not only could, did use those tools to provide very high levels of vaccinations for their patients. And Maryland, as you know, wound up nearly at the top in terms of percent of their citizens who were fully vaccinated early, early on in the in the pandemic. And that was all, a lot of that had to do with CRISP's ability to display that, gather and display that information.
Dr. Rockower (30:31):
Let's take a quick break right now. I wanna get back to Covid in a few minutes. We're speaking with Dr. Howard Haft, the Deputy Secretary for Health Public Health Services in Maryland.
(30:45)
Welcome back to Med Cast, the podcast from MedChi, the Maryland State Medical Society. We're continuing our discussion with Dr. Howard Haft as he discusses the advent of, oops, I'll try that again. Mm-hmm.
(31:15)
We're continuing our discussion with Dr. Howard Haft as he discusses the Care Transformation organizations and MDPCP, and Howard works with Covid. So I wanted to get back to Covid because most of us got to listen to you on a daily or weekly basis during the COVID pandemic and got very loving of your voice and it helped us through some very trying times. Could you talk about you know, how the state and the health department geared up for that and where things went?
Dr. Haft (32:01):
Yeah, Dr. Rockower, I'm happy to tell you about that, that sor that story and that saga. So, you know, this was one of those situations that none of us ever wanted to experience. when I, this situation that I'm speaking about is the Covid Pandemic. We, in, in public health always knew that there was going to be a pandemic a respiratory illness that spreads from person to person that has a high degree of lethality and perhaps can be transmitted while it's still, while people are still asymptomatic, that that concurrence of things was inevitable, that it was gonna happen sometime or another, whether it happened because of a transfer from an animal to human being someplace in Wuhan, whether it was from a lab. I don't know that we'll ever have the answer to that, but we'll be speculating about that for about as long as we've been speculating about who killed John Kennedy
(33:04)
But, but doesn't really matter. What really matters is that it was inevitable, but like a lot of inevitable things when it finally happened, you go, oh my God, I never thought this was gonna happen. And we didn't really think it was gonna happen, at least not on our watch, but it did. And I recall being in the Department of Health when we first heard of this outbreak in Wuhan. And I was there serving in my role as the executive director of the Maryland Primary Care Program with Fran Phillips, who was at that time, the Deputy Secretary for Public Health Services, and we looked at each other and recognized that this is it. This is what we've been fearing for a long time, but it is inevitable now. So even at that time, and this was, you know, early in 2020 when that, you know, that news came out, we began gearing up for what was inevitably gonna be a rocky time.
(34:08)
You know, we thought a rocky time for maybe a year, some said rocky time, maybe it'll last longer than a year. Nobody at that point really had the anticipation that we'd, three years later, we'd still be, you know, still be experiencing significant Covid. But but we knew it was gonna be rough. And one of the things we did early on was start thinking about what resources we have to deploy. and we knew that public health by itself was really underfunded and under-resourced and by itself as it was configured, you know, with you know, getting somewhere around 5 cents of the total healthcare spend in, of, you know, five less, less than a percent of the total healthcare spend in the nation in Maryland being one of those at that time, a very underfunded public health infrastructure that we'd need more than just what we have available.
(35:03)
So we immediately looked to this, what we had already built in the primary care workforce, and said, let's start thinking about ways in which we can engage the primary care workforce. And the first thing we needed to do was to educate people. And we needed to understand what, what the reality was, learn as much of the science as we could, and be able to bring that information in a regular cadence to everyone who needed or wanted to get that information. I recall thanks to MedChi in the early in March when, you know, we really started seeing cases in the us and, and the public health emergency was declared, I believe it was a Saturday, could be wrong about the day of the week, but MedChi hosted the initial webinar, which was one where people were able to ask questions live on the phone.
(36:00)
There was a moderator that teed up patients to providers to ask their questions. I think it started, that call started around six o'clock at night, and I think finished around 10:30 or so. We moved away from the, the telephone calling ones, I think, because they were a little unwieldy to the more of the webinar and chat questions version. But as you recall, we, we were, the information changed so quickly and people needed to get information so rapidly that we made. The initially was every night and I can't recall how long, but it was for months, it was every night. And then eventually, you know, wound down to few times a week, and then weekly as, as things waxed and waned in the pandemic.
(36:56)
but it was, I, you know, we felt it was a duty. and this was a good conduit already established through MedChi and one that we already had a large number of primary care providers, but open it up widely to everyone to say, we can provide whatever the state of the art best credible information is, andw answer questions. So that there was a single point of, of trusted information. And that became really important because, you know, as, as a pandemic war on, one of the things that really became evident was there was a lot of diverse information, misinformation, disinformation that started popping up all over. And it was a little hard to a little hard to suss out, which was true and which wasn't. So we tried to, and I think did stick to our knitting and also included what we thought was also other important information.
(37:57)
So we brought on our colleagues from the Behavioral Health Administration people to talk about not only about, you know, how the pandemic affects people who have behavioral health disorders, but also to say, and I recall some of the best times when, or when they, the the co-consultants on the calls would be people who did relaxation exercises. And I find myself pretty much almost asleep by the time they were done with their portion. you know, but, but you know, and, you know, and, and others you know, other experts in other areas to share their expert information on Covid. But always to be able to answer until we were, until we exhausted all of the questions that people had to answer every question that people that, that anyone in the audience had.
Dr. Rockower (38:46):
and we're still dealing with misinformation and disinformation even now.
Dr. Haft (38:51):
Yeah. Yeah. We, we still are. We still are. Yeah. I think we, we did actually all told about 150 of those webinars and you know, we still do an occasional one now as a need arises. but it was it was very, it was fun to do and I really enjoyed doing them. One of the folks who would, who would listen regularly gave me one of the greatest compliments that hey, I think I ever got. And she said, you know, I, I enjoy the information that I get from your webinars, but my dog really loves it. And every time my dog hears your voice, he comes over and sits right next to me.
Dr. Rockower (39:37):
Well, that's
Dr. Haft (39:38):
Dr. Rockower (39:40):
Okay. Well that's, that's probably the best compliment you can get.
Dr. Haft (39:43):
I think so.
Dr. Rockower (39:44):
Okay. Let's, let's change gears a little bit. hat might you have been doing if you were hadn't become a physician?
Dr. Haft (39:52):
Hey, that's a good question. In college, my intention was to be a marine biologist. you know, I was a lifelong, from the time I was knee high to a grasshopper surfer and boat captain and those things, I really loved the ocean and still do. So I'd hoped that I'd be a marine biologist. they had limited slots in the marine biology program, so I wound up going to medical school instead. So I think if, you know, I'd be, I think if I wasn't a doctor and I can't imagine at this point in my life, having not not be a doctor I'd, you know, I think it was, it was always in, in the fates that that's where I'd wind up. And I can't imagine anything else. I, this is a, it is such an honor and a privilege to, to be able to serve patients and, you know, whether it's one at a time or serve as a, you know, as a health officer and serve many at a time. but if I didn't, probably would've been wandering the oceans in one way, shape, or form.
Dr. Rockower (40:54):
Dr. Haft (41:04):
Follow your heart. Be true to yourself is just on a personal level is the best advice that I've ever received. The best administrative or leadership advice I've ever received is if, if you really wanna get something done on a large scale, get the two or three important decision makers in a room with nobody else around, close the door and don't leave until you get, till you get the decision that you want.
Dr. Rockower (41:34):
Okay. That's, that's very good. You know, for anybody that's interested in running organizations, whether it's on a large scale or even a small private practice, you gotta be able to have people to get things done
Dr. Haft (41:49):
Right. And people bought in to whatever it is that needs to get done. Mm-hmm.
Dr. Rockower (41:53):
Dr. Haft (42:02):
My the best advice I would say that I give to young physicians, no matter what their specialty they're in is to love the work. Cuz if you love the work mm-hmm.
Dr. Rockower (42:32):
Good.
Dr. Haft (42:33):
So that's, I knew you would say that. So, you know, as a, as a lifelong primary care provider, I said, you know, we've had these discussions and he's said, you know, Dad, primary care is not for me. I love orthopedics. I always loved orthopedics. And I said, that's the right answer. That's you.
Dr. Rockower (42:49):
Know, and, and my son's an internist.
Dr. Haft (42:51):
Dr. Rockower (42:54):
Yeah.
Dr. Haft (42:57):
No, I wouldn't trade for all the money
Dr. Rockower (42:59):
In the world. I know. Okay. Well, I want to thank Dr. Howard Haft, who has been our guest on MedCast, the podcast of the Maryland State Medical Society. Tune in next time as we continue our conversations with the leaders in medicine in Maryland to discuss issues facing physicians and our patients. For all of us here at MedChi, I'm Dr. Stephen Rockower. Thank you. And goodbye.