The sixteenth episode of MedCast features Dr. Jim York, MedChi’s Board President. Dr. York has worked tirelessly with MedChi’s government relations team to get bills passed. He also established the first task force on child behavioral health. Listen in as Dr. Stephen Rockower speaks with Dr. York about a wide variety of topics.
Dr. Steven Rockower (00:00):
Welcome to MedCast, the podcast from MedChi, the Maryland State Medical Society. Each episode we'll be doing a deep dive into medicine and taking an insider's view on issues facing Maryland's physicians and patients and healthcare more broadly. I'm your host, Dr. Steven Rockower. Today my guest is Dr. Jim York, president of MedChi. Jim, why don't you introduce yourself. Tell us something about your education and welcome.
Dr. Jim York (00:30):
Well, thank you so much. This is a fantastic service that you have. They're very professional and very interesting. It's just great to get to know a little bit more deeply, all the various colleagues that we work with and interact with. It's fantastic, and you've done a fantastic job with this. I come from originally Schenectady, New York. When my great grandparents and grandparents came over from Ireland, they settled in the Schenectady, Troy, New York area and rolled up their sleeves and were blue collar workers. And Schenectady is a nice immigrant town. General Electric was their core industry, and so it was sort of like the Silicon Valley of its day, huge advances in electricity and electrical equipment and large steam generators. And so we had mostly Irish and Italian and Polish in the town ready to get to work and raise their families.
(01:33)
And my grandfather ended up, he was the youngest of that family. And back in the early 20th century, after graduating from high school, he went to medical school, he went to Albany Medical School and became a general practitioner, moved to Schenectady, and then raised a family. In fact, he served in the 1918 Flu Pandemic, and he passed away a year before I was born, and I was named after him. And this became very special to me during our war, our fight in the Covid epidemic. And I carried a picture of him in my wallet. He was in his early thirties and fortunately never got sick, although people that were a little older didn't, but he just worked like crazy. There's a lot of house calls in those days and just went out and took care of people whether they could pay or not. And then he got training as a pediatrician after a few years in general practition, and then became the first pediatrician in Schenectady.
(02:36)
And then so of my dad, he ended up also becoming a doctor and being a pediatrician. And so grew up with the medical background. My mother was a nurse. So my first jobs were shoveling snow. So when I was in grade school and high school, we got lots and lots and lots of snow in Schenectady. And I made a lot of money shoveling people's cars, out, shoveling people's walks and driveways. And then in high school, my last two years, I worked at Burger King during the summers and got to know a little bit about the food industry and lots of free food. So my interest in medicine came organically from my family, but really with me, it was science. Ever since I was a little kid, I was just fascinated by science, especially astronomy. You know my grandmother encouraged that; when I was six years old, she got me a telescope and I had an erector set.
(03:35)
I loved making things with erector sets and tinker toys and Legos, and so I built a little And that led you into orthopedics eventually? Yeah. I didn't think of it that way, but yes. And my mother's father was a tool and die maker in General Electric, the tool and die maker is the person that you have a product line. And so well, how do you set up the whole production line? How do you set up the tools to make the tools in the service line? And that's what he did. And he basically taught himself, he was a laborer down in Pennsylvania where that part of the family immigrated to. And his brother came up to Schenectady, and he came up to visit, and the family's lore is, he actually met Thomas Edison and went down to GE, was looking and said, what are you doing here?
(04:19)
I said, want to work? He goes, yeah. So he started and made his way up the chain and actually became a pretty high level designer. And so during World War II, he was getting older and he wanted to retire. They wouldn't let him retire. And interestingly, during the depression, in order to keep people on, they would alternate your one week on one week off. So they didn't fire people as much as they did one week on, one week off. So they could keep production going, but not reduce their overhead and so on like that. So that's how my mother's side of the family made it through the depression. And so anyway, he was always good with his hands. And ever since I can remember, I love to do things with tools. I never met a tool I didn't like. So we got into astronomy and reading books about that, being kind of a nerd with that and drawing maps of the moon.
(05:14)
And then later I became interested in chemistry. I remember reading my father's high school chemistry books and learning that stuff and just doing things that kids do, going out and playing sports and riding bikes and getting into mischief. So I ended up deciding to go to Georgetown and deciding to major in chemistry. I really just loved it. I still do. And then I figured I would go into pre-med because seemed like a natural thing to do. But I also thought of just continuing on in science. And Georgetown was great too because they really, it's a Jesuit institution and they really emphasize learning how to think. And so whatever course you're in, whether it's chemistry or theology or philosophy or whatever, it's really, they teach you to question, teach you to think, teach you to ask questions. And I like that kind of training.
(06:12)
And so then it was very difficult to get into medical school in those days. And I think only one out of 10 or one out of 20 got in or whatever. So I applied to lots of medical schools, including Georgetown and Albany and others. And I also applied to University of Maryland for a master's program in chemical engineering. So I thought that would be very interesting to do. In fact, I got that position way before medical school and was set up to do that. Also applied for some chemistry jobs, but didn't really pursue that. And then I didn't get into medical school until a month or so before school started, and I thought, well, which way do I want to go? And so I decided on medical school and thoroughly enjoyed all that. During college too, I had a lot of interesting jobs. I worked in the Marriott, the first hotel that the Marriotts had, the Marriott Twin Bridges down near the Pentagon.
(07:08)
So I was a belman and a bartender, and I loved it because I'm constantly meeting thousands of people from all over the world in all walks of life, just talking to 'em, asking 'em what they like and what they dislike about their life and their jobs. And so I just learned a lot, had some really interesting experiences. I remember one time, of course, I'm a child of the Cold War. The Cold War was a huge thing all while we were growing up and the threat of nuclear Armageddon and that kind of stuff. And then it was wonderful because I was in college that started to wind down and they had glasnost and they started having more contacts back and forth. And so a Russian wrestling team stayed there at the hotel. And so I took German in college. I took French in high school, and so I spoke to the whoever's, he's probably KGB, but I spoke to this guy and I wanted a ruble.
(08:02)
He couldn't ever get ruble. So had a little conversation in German. We both spoke some German. I didn't speak any Russian at the time, although I learned some later. And so I got a ruble and I gave him a dollar, and I think he made out on that deal.
(08:16)
He did.
(08:17)
But that was interesting. And so getting into medical school and Georgetown lost their DC state-like funding early on, so tuition just absolutely exploded. So I borrowed money from my first year. My father had already retired by that point, so I was basically on my own. And so then second year it just went way up and it was like, well, either I'm going to hit the streets or so most of our class of 205 signed on with one of the military health professional scholarship program or the public health. And so I applied to Army and Air Force, and I've always kind of liked the military ever since I was a kid.
(09:02)
I don't know. It's one of those things. And so I thought, well, Air Force bases tend to be out in the middle of nowhere, like missile bases and stuff like that. And Navy, you're way out on a ship. And I didn't want to be away from my wife. And so I took the Army. And so that was a really good experience and a way to pay through medical school. And there's a little add-on story about that, about getting interested in advocacy. So that's the medical school trip. And then Orthopedics, I was initially interested in medicine and maybe Oncology and Pharmacology. And then we did our third year clinical rotations, and I discovered orthopedics and I went into the OR and they had all these tools laid out on the table like, oh my God, that's incredible. This is better than the hardware store. So never turned off.
Dr. Steven Rockower (09:54):
Actually, they have better tools than us.
Dr. Jim York (09:56):
Oh my God, I love it. And so it is been great. So that's a little capitalization of where I came from and my journey through training.
Dr. Steven Rockower (10:09):
So when did you get to Maryland and get involved in Med Chi?
Dr. Jim York (10:16):
Well, I, of course, going to Georgetown. I was in DC for nine years because I took a year off between junior and senior year college, got married and worked full-time at the Marriott attending bar and being a bellman and thinking about what I wanted to do and just enjoying being married. So then I applied for medical schools and then I'm sorry, for residency. And at that time you had to apply to both military and they also gave you the opportunity to apply for civilian. And so I really liked University of Maryland program because they had shock trauma and they were one of the top shock trauma facilities in the entire country. And so
(11:00)
They started it.
(11:01)
Yeah, I mean, R Adams Cowley center is incredible. And so I thought that would be phenomenal to do that. And so I convinced the Army, I said, look, the Army needs trauma surgeons.
(11:11)
I'd love to go there. Can I do it? And so surprisingly enough, I convinced 'em. I would've got paid better in the Army, but it worked out quite well. And then that was my journey to Maryland and living in Baltimore. So that was when the big renaissance in Baltimore was going on. And so that was exciting to be a part of that. And then after residency, then I had to pay back my Army time. And so then I called all around and tried to see who was going to have a position open that I might like. And we looked at Fort Campbell down in Tennessee. It's the 101st Air Assault. And then we looked at down in Louisville where Fort Knox is, because a lot of my wife's family is in Louisville, Kentucky. And of course with her family from there, I had to learn how to say Louisville instead of Louisville. So that worked out really well. Wonderful part of the family then. So yeah, I ended up being at Fort Meade, so join the Army, see the world, but Fort Meade. So I was there. Interesting place because most of the people that are there would rather you not know they even exist, because it's very focused on military intelligence and counter intelligence and NSA and all these little organizations that do interesting things around the world.
Dr. Steven Rockower (12:50):
And you couldn't ask them what they did.
Dr. Jim York (12:52):
No. And when I did, they sometimes told me, I can't tell you that. And so I remember one guy who looked like a hippie full beard and active duty army. I did a knee arthroscopy. I said, well, what do you have to do? I said, why? I can't really tell you that. I said, well, you sometimes have to jump out of airplanes. He goes, yeah, okay. Well, we can't do that for about six weeks and just keep going with your rehab and work hard at it. Thank you very much. See you later.
Dr. Steven Rockower (13:17):
And the next week he jumped out an
Dr. Jim York (13:19):
Airplane, I'm sure.
Dr. Steven Rockower (13:23):
So when did you start getting involved with MedChi and doing advocacy work?
Dr. Jim York (13:29):
Well, interestingly, advocacy work started in high school. So in high school I went to a Catholic high school. And so funding became more and more challenging. And so there was a bill which would've provided some state aid for private and parochial high schools. And so a whole lot of schools around the greater Albany area in New York got involved in lobbying. And I was on the debate team in high school and public speaking team. So I learned something about that. And I was also in plays, and we spent a lot of time at Albany lobbying for this bill, which we got as usual at the legislature. We didn't get exactly what we wanted, but we got more than if we had done nothing. And then in medical school, I got the Army scholarship, like most of the people in our class got one of the military or public health scholarships.
(14:24)
And so the deal was you got your tuition, your books, and $400 a month in 1970s dollars, which is pretty good. But then the IRS ruled within a few months after we all got that scholarship program that really, it was not a scholarship that it was a quid pro quo. It was payments for services that would be rendered in the future. And that by virtue of that, instead of getting 400 a month, we would owe 600 a month when none of us had any money at all. And I was like, well, this is what it's, this is the deal, and what do we do now? So about 20 of us from Georgetown and George Washington got together in sophomore year medical school, and we spent over six weeks and my wife was in law school at the time, and she had been taking this course called The Dance of Legislation, which is a fascinating and practical course.
(15:18)
And we started getting a bunch of us together and talking about it. And then we learned that in the Senate, you can do corrective amendments and do amendments on unrelated bills that would do what you want. So we spent time working with then Senator Dole's office, and his health legislative assistant was a nurse that Maureen got to know, my wife, and it worked. We would go in and start talking to the legislative aids, why should we help you guys? You guys are going to be doctors. It's going to make a lot of money. I say, you're absolutely right. We really need to get doctors in underserved areas in the Indian Health Service in rural areas. We need doctors in the military to support our troops. Absolutely. Well, in view of what the IRS did, it's subverting the will of Congress. You really need to support this amendment.
(16:05)
Oh yeah, you're right. That's great. So I think it's the most successful legislation I've ever been involved with because we got exactly what we wanted and we're in the gallery when the bill came up and the amendments came up and it all passed. And so we basically saved the HPSP program. Never thought of it that way at that time, but I was telling a friend of mine recently that who had a Navy HPSP scholarship and a career in the Navy, and I guess that's what we did. And so it was like, wow, we, a bunch of guys can get together, guys and girls and make a difference. And I got involved in the American Medical Students Association during medical school and then following military, I was joined a practice here in Anne Arundel County in private practice. And then there were a lot of issues.
(16:57)
HMO started to become popular and significant reductions in our pay. And then during one of the huge upticks in malpractice premiums, MedChi became very active in working hard for reform. And I started getting involved. And Dr. Hilary Oherlihy a cardiologist at Baltimore Washington Medical Center where I was, it was then called North Arundel Hospital. And interestingly, he was an Irish immigrant, came from County Cork, Ireland, had a wonderful Irish accent. And so he remember him, he was chair of the legislative committee a couple of times as President MedChi, and he said, yeah, you really need to get involved with these people. They're great. And so he really mentored me and encouraged me. And so I did. And that was the beginning of it, and so became part of the solution. I thought to myself at the time, we all grumble and whine, sometimes you're changing into scrubs in the OR lounge and grousing about this and grousing about that. Well, it's like, well, we could do that. And that doesn't make much...It's not very effective. Or go down to the legislature and at least talk to some people that might make a difference. And even though you might not get exactly what you want, it feels good to do that. And it feels good to work with your colleagues at doing that, and it does work. And so I got hooked and I like being part of something much bigger than ourselves, being with like-minded people and people, just colleagues working together for a common cause.
Dr. Steven Rockower (18:31):
Great. So you've been on the board of MedChi now that you're president, which is having been there myself, I know it's a very busy year. What kind of things are you doing and have you been doing, and what are your plans?
Dr. Jim York (18:46):
So I did start a committee, a task force on child behavioral health. And so at the beginning of your term, it's traditional for the president to identify a problem of concern in the community and society and to try to do something about it. And so just reading around and keeping track of things, it became scary to read about the significant increase in anxiety and depression and suicides in kids and having two grandchildren now. And I'm thinking, what's the world going to be like for them? And the devastating effect of social media on kids, and then CoVid on top of that. So I decided to do that. And so being an orthopedic surgeon, that's kind of a bit out of my lane. So somebody once said, the thing to do if you want to make a difference is to surround yourself with people who are smarter than yourself.
(19:43)
So I did that. We have some great child psychiatrists and former MedChi presidents and other colleagues on this committee, and it's been fantastic. And so we've spent a lot of time looking at the problem, identifying the areas of concern and interest, identifying bills in the legislature and lobbying for them and quite successfully this year and looking at more focus areas where we might make a difference. We were initially thinking of working on setting up screening programs for depression modeled on a program in Pennsylvania, although Maryland does not have the infrastructure to do that very well. So now what we've moved on to is the idea of promoting the Adolescent Depression Awareness Program, which is a program started by Dr. Karen Schwartz at Johns Hopkins. She's a professor of psychiatry there. And so our goal would be to do a pilot of that and some of the high schools. We have our first meeting actually in a couple of weeks with the superintendent of schools for Anne Arundel County, and we'll hopefully be able to kick that off and then spread it. And it's been going on. She's done this for 20 years around the country, and I think there's been at least 130,000 kids or so that have gone through and have done level one studies demonstrating its effectiveness. So I'm very hopeful that this will make a difference.
Dr. Steven Rockower (21:12):
Are there going to be bills in Annapolis that will help with that?
Dr. Jim York (21:17):
Not specifically with that. It's not really relevant for legislation at this time. It's more for a program to just be initiated in several pilots and
Dr. Steven Rockower (21:30):
At least getting the funding
Dr. Jim York (21:31):
And get it working. And then the next step may be through the State Department of Education. And we have a fantastic government relations team, and especially Pam Metz, who has largely responsible for public health issues, who knows the entire landscape of this. And there's been a huge help in our abilities and our work on that committee. So the work is ongoing and there's more to come, but it's a pleasure to be able at least try to make a difference.
Dr. Steven Rockower (22:06):
Yeah, that's absolutely a valid and wonderful thing to do. What other kind of medical programs have you been involved with that directly affects physicians and their patients?
Dr. Jim York (22:22):
Well, in orthopedics, I was a member of the American Academy of Orthopedics Board of Counselors. And so what the board of counselors is, there'll be two or three orthopedists from each state that forms this board, and it's the policymaking arm is the grassroots policymaking arm of the academy. And so we would meet several times a year, and I remember during the whole healthcare reform process, we actually had a meeting with healthcare leaders from around the country. And so we learned about the English and the German and the French healthcare system and others, and what are the advantages? What are the disadvantages? What's going on with our healthcare system? How can we be involved and what can we push forward with? And then every year we would meet in Washington and then we would meet with, each state group would meet with their senators and congressmen or their representatives in reference to healthcare related legislation.
(23:19)
So we're very involved in the healthcare reform under the Obama administration, although it was quite frustrating because often we would come up with ideas that were from the trenches and the grassroots, and they would say, well, no, that's not right. So there was a definite discouraging partisan aspect to it. But nevertheless, I think it did help, and it was very beneficial, very grateful to be a part of that process, and also I have been involved in leadership in hospitals at Baltimore Medical Center. I was in the presidential line and went all the way through med exec and was president of the medical staff there. And so it was a privilege to be a part of that and to understand hospitals and how they work and to be the bridge between the medical staff and hospitals and how to improve communications and help everybody along in our ability to do what we do in taking care of patients.
Dr. Steven Rockower (24:22):
That's certainly a thankless job on the hospital level. I've been there myself. So tell me more about the things that are going on in Annapolis. We did something about step therapy.
Dr. Jim York (24:38):
Yes, the insurance companies. A few years ago, we had legislation and successfully passed that would restrict the ability of insurance companies to force physicians to use a series of drugs, for instance, in anti-inflammatories. Let's say you wanted to use one of the newer more up-to-date anti-inflammatories because they had bad reactions to or were not tolerating some of the others. And that we wanted to go right to let's say Celebrex or something like that. And we couldn't do it. We'd have to do the mother may I and maybe force patients to use something that was not very effective or potentially harmful. And so we thought we solved that problem. Then they figured out ways of getting around it. And so they have step therapy, and this really affects oncology and rheumatology, and there's a lot of biologics that are used. And then patients will sometimes develop allergies to them.
(25:35)
And so that the first line treatment against rheumatoid arthritis may have been helpful for a couple of years, then they become allergic to it, then they have to go to second line, third line, and so on, and they would run into roadblocks. And so maybe a patient would have basically no medication for a month or two and then be unable to work. And so it's really all about dollars, and we're trying to take care of our patients as effectively as possible based on everything that we have learned. And so this year we had a huge effort to pass a bill that would limit that, and it got a lot of traction. Obviously, the insurance companies lobbied hard against our ability to have these reforms, and we did get a bill that restricts step therapy, but that's only a piece of the problem. And there was a promise for them on their part to meet with us and to continue the dialogue on that.
(26:36)
So we're going to be holding them to task on that. We're always keeping our ears open for what the plaintiff's bar is doing in terms of medical liability. And so there was one bill which could have negatively affected that, and we were able to get that quashed. And so the legislature is really like the NCAA tournament. I've given a talk frequently about what advocacy is about, and I talk about the legislative process. Somebody comes up with an idea for a bill, A bill is written, it goes and it's heard, it goes to committee. I said, no, no, no, no, no. It's not that at all. It's like the NCAA tournament. You got a team, you want to put together a basketball team or a soccer team, you want them to do well, you bring in some good quality talent coaches, you look for talent to bring on the team, and then you just want to do well.
(27:34)
You want get into the tournament, and then you want to do well enough. You get into the second round and you want to get to the final four, you want to win. But that takes many, many years. And each year the whole process has restarted. And so it's about building relationships. It's about us going out and meeting with our legislators and meeting with our state senator and our state delegates and supporting them in their campaign runs because it's hard to run for office. So they need funds to do that. And so we just have dialogues that become friends and so that when issues come up regarding healthcare, they give us a phone call and say, what do you think about this bill? Is this good, bad, or what should I? And so at that relationship blossoms. And so sometimes you get involved with somebody and become friends, and that person rises perhaps in the hierarchy of the legislature. And so you can have an increasing impact.
Dr. Steven Rockower (28:26):
Let's take a quick break. Now we're speaking with Dr. Jim York, who is president of MedChi.
Dr. Steven Rockower (28:34):
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Dr. Steven Rockower (29:02):
Welcome back to MedCast, the podcast from MedChi, the Maryland State Medical Society. We're continuing our discussion with Dr. Jim York as he discusses advocacy and the NCAA tournament. So you were talking,
Dr. Jim York (29:21):
It's a great analogy. We have a great team. We have our legislative council, 150 or more people that volunteer their time from January all the way through April. And we have it divided into subcommittees of boards and commissions, public health and then health insurance. And then we have people on each of those subcommittees. And then we have Sunday morning phone calls where we've reviewed bills and go over discussion and set up preliminary talking points and positions. And then Monday evening, it'll go before the entire commission or board us our legislative committee. And we'll have further discussion and then form policy and we'll go through maybe 2000, 2,500 bills and so that we know what the bills are, what the issues are, how we want to approach it. Do we want to support, support with amendment? Do we want to defeat it? And then our legislative team, our government relations team will go to Annapolis and will testify along with us.
(30:28)
It's extremely important for us to be down there and testify from our point of view and discuss what it's like. Sometimes we'll even bring patients who have had experiences and who can testify. And they listened to us. We're really respected down there. It was very interesting for me to know and learn when I started getting involved there. They think a lot of us. And so it does make a difference. You're walking around in a white coat, they can identify who you are and they will listen to what you have to say. They understand all of the training and experience we have and all the hours that we put into taking care of patients. Of course nowadays after Covid, how difficult things are.
Dr. Steven Rockower (31:09):
And as you mentioned before, getting to know the legislators even between sessions is most important because that way they get to know who you are with any kind of idea or policy. And then when it comes around to being in Annapolis, they know you and know that you're a straight shooter. I think at this point I need to also put in a plug for the Maryland Medical PAC as we talk about advocacy. Everybody listening should always help contribute to the legislators by way of our Maryland Medical PAC. Back to advocacy, we talked about prior authorization and things that are going on with that. Can you talk about that some?
Dr. Jim York (32:06):
Well, I think that we covered it pretty well. We will continue the dialogue on that and continue our legislative efforts next year. The other thing that we do is we interact with the executive department. So we have spent a lot of time with the health services cost review commission. They have a subcommittee on physician alignment. And so Maryland is an odd state, and it's the only state where there's a Medicare waiver, which means that Medicare basically sends this huge pot of money over to the hospitals and then they use it according to how the health services cost review commission decides they should be paid and so on. And so it's a global budget paradigm, which is very unusual, but of course, we get paid through insurance or Medicare or Medicaid and private or if we're employed in whatever deal we make with the hospital through contracting.
(33:09)
But ultimately, the hospital payment system is extremely important for how healthcare is rendered and paid for. And there are now programs that are being established in which if physicians come together, whether they're primary care under the Maryland primary care program or now with specialists in a program called equip, which has about quality improvement program. So for example, Orthopedist, if we do a really good job and we do total joints and other similar surgeries and come under budget and have savings based on what prior historical costs have been, we'll actually get to keep a portion of that. And this has worked particularly well in the private sector. In the hospital employed sector there's still work to be done and how that money flows to the employed physicians, but it is the opportunity now for specialists in addition to primary cares, to partner with hospitals, to partner with healthcare organizations so that we can come up with our ideas in the trenches of, it's only we that really know how to properly take care of a patient and save money so that we're not also putting a patient at risk or in some way harming the patient.
(34:39)
And there's a lot of people with master's in public health or executive level people that will come up with ideas and they might be okay and they might not. And it's in working closely with us as physicians, it's truly the only way that we can move the needle on making things more efficient, decreasing cost, and having something that may be a model for what could be done in other states.
Dr. Steven Rockower (35:11):
And physicians do need to be the leaders of the healthcare team.
Dr. Jim York (35:17):
Absolutely. It's funny, I made an analogy once back in the Clinton years, there was the whole thing with attempted healthcare reform, but they had these huge commissions to do it and they had hardly any physicians on it at all. And I thought, well, geez, that would be having a reform committee on air traffic control. But they didn't have any aircraft controllers or maybe only a pilot or two, but they had doctors there. And I would think, well, let's see, having two miles between planes, that seems about enough separation. It might be okay, but it might be a disaster. No idea.
Dr. Steven Rockower (35:55):
Well, on the same note, I think the new CEO of the American College of Cardiology is a nurse.
Dr. Jim York (36:06):
That's interesting.
Dr. Steven Rockower (36:07):
Yeah, so I noted that. So what other things are you involved in and what are your future plans with MedChi? Other advocacy things, either locally or in the AOS or now that you're a delegate to the AMA
Dr. Jim York (36:30):
Well, just to continue to be involved, we started this set task force on child behavioral health. And so we're going to continue to work on that and continue our works with our colleagues and partners over in Health Services Cost Review Commission and the hospital systems to continue working together on making things better in Maryland. I have fun things I like to do. We are Ravens fans in our family. And so we have seasons tickets to the Ravens. And interestingly in the Covid period, you'd go home and you're like, oh, geez, I need a disconnect. And so I ended up listening to a whole series of podcasts and stuff and about ham radio. I ended up getting my FCC amateur radio license. So I don't use it a lot, but it is an interesting thing to do. And I'm part of an organization called the Amateur Physician Radio Council or something like that. So it's interesting because we'll get together and have these communications around the world about things that are problems and issues that are happening around the world. And
Dr. Steven Rockower (37:36):
When the nuclear pulse happens, you'll be the only one able to communicate.
Dr. Jim York (37:42):
Right. So that's been a fun thing to do. I've been involved in our community and coaching soccer for a long time. I'm not doing that anymore. Now. I'll be probably coaching grandkids, although my daughter will be a better coach since she played all the way up through college.
Dr. Steven Rockower (38:00):
Well, as we're taping this, we're in the middle of the Women's World Cup. When this finally airs we'll be well past it and we'll know how well the American women have done, but it doesn't look good as of now.
Dr. Jim York (38:20):
Yeah, there's a lot of concern. Hopefully they'll really pull it together. In fact, my younger daughter just flew over there. She's now in either Australia or New Zealand, and she went to the, she's an attorney down in Carolina and a big soccer fan. She supports the North Carolina Courage, and she still plays recreational soccer a little bit. So she went to the World Cup when it was in France and now she's gone to Australia.
Dr. Steven Rockower (38:49):
So what kinds of things got you through the Covid epidemic and how did that change your practice and the hospital that you work in?
Dr. Jim York (39:02):
We did a lot of interesting things. We were very good at quickly switching over to telemedicine. So at work, we are on the EPIC system and they had just started putting things in place to do telemedicine, video visits, and the infrastructure was there enough that we could quickly switch over to that. So we would have one day a week open or you went in person to see people that you really, really had to see in person. And then everything else was telemedicine. So we rotated through that. And so we still did emergency surgeries. All the elective surgeries of course were stopped. And part of it because anesthesia was pulled into the ICUs and Anne Arundel Medical Center because of our capture area of Anne Arundel County, and Prince George's County just had a lot of patients there with Covid. And so it was all hands on deck to take care of them in any way possible. In fact, we were retrained to be medical doctors, so I actually...
Dr. Steven Rockower (40:08):
Not easy for an orthopedist.
Dr. Jim York (40:10):
Oh my God. I said, oh, those poor people. No, that worked out well. Fortunately we didn't have to do that, but we were ready to do it. We rolled up our sleeves and did all the retraining and all these courses. And then another interesting thing is as soon as we shut down, one of the guys in our practice had some experience and knew some guys that were expertise on doing wide awake local anesthesia. So because we didn't have Anesthesiologists, there is a technique for using a lot of local anesthesia. It's done an hour before the case, and there's a specific way of doing it so that you can do some major surgeries on limbs with the patient wide awake and not intubated. And so we became expert at doing that. We had this podcast Zoom meeting actually between this guy in Thailand and this other guy in New York where he was teaching us how to do it. And then we started doing it. I remember doing a quadriceps rupture and it was one that was discovered late, so he was significantly retracted. So it was a huge surgery. He had to go halfway up the leg and do some reconstructive stuff to get it all together, totally wide awake, no pain, completely comfortable. And so we did a lot of that kind of work and have published papers on that. So we're very proud to do that.
Dr. Steven Rockower (41:27):
That's very interesting.
Dr. Jim York (41:29):
But in Covid, we had to kind of be our own secretary. So we're meeting ourselves coming and going and doing more work with a lot less infrastructure. It's just the way it was. And it's continued a lot. It's now been getting better. Our institution is doing a better and better job just like everybody else and trying to hire people and train people and keep people. It was difficult to keep people in healthcare during that time. My niece was a nurse in Texas, and so during the worst of the Covid, we had a lot almost weekly conversations about things that were going on, kind of encouraging each other. She was in an orthopedic floor on a big hospital down near the Dallas, Texas area.
(42:15)
So I think we all have our sleeves rolled up. There's more work to be done and maybe less infrastructure to do it with. And so we're being innovative, and I like being innovative, thinking of different ways of doing things. I've always been a little bit of an IT geek, so I like working with computers and coming up with nice IT solutions to problems that we have. I actually got facile with the Linux operating system during part of Covid and did a lot of changes in the way I set up Epic to practice to make it more efficient.
Dr. Steven Rockower (42:53):
Did you tinker with their system?
Dr. Jim York (42:56):
No, nothing in the guts. So I'd like to learn how to do that at some point. Just what's available for you to do in terms of templates and doing automation through the Dragon Dictate system. And there's something a little bit like VBA that they had for a while and then they changed the way that worked. But now as fun to tinker around with things, make it better
Dr. Jim York (43:21):
In my blood.
Dr. Steven Rockower (43:21):
As an aside, when I first started in medicine and we got our first computer back in the eighties, it was all written in basic, and all you had to do is hit the escape key and type list and you saw all the code. And so I would rewrite their code and I would write my side routines and all that, and they always hated it when I did that kind of stuff.
Dr. Jim York (43:47):
I actually did the same thing. I learned the Microsoft Access and learned the Microsoft Visual Basic for applications and did some applications that I used in my old practice. So they had a EMR system, but there's a lot of inefficiencies in it. And so I set up something that I could use on my laptop that would assemble things together in a certain way, and then I would port it over to the EMR system and save a bunch of time.
Dr. Steven Rockower (44:15):
Yeah, we should talk. I did the same thing. Yeah, that's a lot of fun. Okay, let's switch gears a little bit. What would you be doing if you were not a physician?
Dr. Jim York (44:26):
I'd probably be a chemical engineer. It's interesting. I love to go to the Renaissance Festival and you'd look at all things that were done back in the 14th century or whatever, and I thought, well, I probably would be, what do you call that when a forger with a making swords and a blacksmith. A blacksmith. So what I would do now, I love to work with my hands and tinkering with things. A couple of good friends who were, well, my brother is in, got into electrical engineering and got into a really interesting line of that. And I thought of chemical and had friends that had some interesting careers in chemical engineering. And working as a bellman, they came to me and said, if you stay with us, you could become a Marriott manager. So it's interesting, the different, everything you've ever done applies and you learn from it. And so I don't think I would've ever pursued that because I love to play with things too much.
Dr. Steven Rockower (45:39):
What are you currently reading or watching or listening to?
Dr. Jim York (45:46):
I like to listen to YouTube and podcasts. And so I just started a couple of podcasts on this social psychologist who has done a lot of very interesting work on social media and the effect of social media as it became more widespread and after the effect of putting these algorithms in it that would basically capture people's heads and how that helps to explain the polarization and divisiveness in our society and mostly English speaking society. It happened in the US, Canada, England, and Australia around the same time and a little bit differently in non-English speaking countries.
(46:34)
Interesting
(46:35)
Very interesting. And the same thing on college campuses. Why did college campuses, why do people feel like they need to be safe instead of exploring ideas? Colleges used to be a place where you can go and be open to ideas and now we have to shut down ideas.
(46:54)
And so it's like, how do we work our way through that? And so the whole idea is like we invented fire way back. And then now the invention of the internet. And now social media is sort of like a new invention of fire, which is extremely useful and practical and wonderful and opens up tremendous opportunities, but when used in the wrong way to be destructive. And so I think that we need to understand that better. And I think he's done some very interesting work in that area. And so as part of this committee, part of what we're doing too is looking at research papers and work that's been done on the effect of social media and kids. And so that it's driving a car. Maybe people need some training in, especially kids. And what are the effects of social media? How will this affect you? How does it affect your head? If a whole lot of people are talking badly about you, what does it mean? What's really going on? How do you deal with that, especially in middle school?
Dr. Steven Rockower (47:57):
Well, speaking of kids, what advice would you give to your younger self?
Dr. Jim York (48:04):
You're going to be okay. You're going to do well. It's keep going. Keep doing what you're doing, which is kind of what I did. A little bit of a rebel, a little push hard. Hey, I am going to do this. Come hell or high water. I was like in college and first two years of medical school, I had no car. So I basically rode my bicycle everywhere in DC through all neighborhoods across the 14th Street Bridge, Southeast, Southwest Freeway. I was in great shape. I rode over a hundred miles a week. Some people say you're crazy.
Dr. Steven Rockower (48:39):
Well, thank you to Dr. Jim York who has been our guest on MedCast, the podcast from MedChi, the Maryland State Medical Society. Tune in next time as we continue our conversations with the leaders of medicine in Maryland to discuss the issues facing physicians and our patients. For all of us here at MedChi, I'm Dr. Steven Rockower. Thank you and goodbye.