Chapters Transcript Video Why Great Urology Programs Don’t Happen by Accident We're gonna work with the community to elevate those hospitals. So, I, I will tell you right now, the non-academic private practice docs at those hospitals do things better. I, I know this because we have a clinically integrated network with another group that we're working with, and we've started chatting about how we could work together and help each other. They do things better than us. They have some efficiencies that we have to learn from. We do some things better than them. And I think that if we leverage the greatness of the two, and people do what they're really great at, that the community, I mean, individual patients in the overall community will, will see an elevation in their healthcare that's unbelievable. Hi, I'm Lindsay Carrillo, director of Business Development at UCI Health. And hi, I'm Doctor Sunil Verma, Associate Chief Medical Officer for ambulatory and a laryngologist here at UCI Health. Welcome to Physician Huddle by UCI Health. Today we are joined by Doctor Jamie Landman, the chair of the Department of Urology, who is also a professor of urology and radiology, and the assistant dean of Development initiatives. Welcome, Doctor Landman. Thanks so much for having me. I hope we got all your titles. I know you have a lot. It sounds incredibly fancy, I assure you I am not. How did we get such a fancy man to come to UCI Health? How long have you been here, Jamie? So it's about 15 years now, and uh it was actually an interesting story because uh back in 2002, Ralph Klayman, who was the original chair uh after Tom Ollering, and then became the dean, invited me to come out with me, uh, with him. So he was uh coming out here as the, the new chair of the newly founded department. Uh, he invited me to come out. The Department of Urology was based in a trailer, and quite frankly, I was at WashU and we had beautiful facilities. We had a gorgeous lab, and, and just a very mature program over there. And I came and I said, Ralph, don't do it. And he said, no, I see so much potential here. So, in 2002, I, I actually stayed and got his job at WashU. He came here. Uh, 2010 comes around, he gets promoted to be the dean, and he says, hey, why don't you come out and take a look at it? I'm like, oh God. But I didn't actually say that. I said, sure, let me come out. So, I came out and the transformation he had created was remarkable. And, and Ralph realized a vision. He saw the potential here. And I, Laura and I, we thought we were going to be in New York forever. We're like, man, let's check it out. We came on over. It was beautiful. And 15 years ago, uh, it was not the same place it is now, and it's grown just almost exponentially and continues to improve and become even more wonderful. But, you know, I didn't have Ralph's vision initially, but then I, I bought in some 15 years ago, and since then it, it's also been transformed over and over. So, that's how I got here and I feel very blessed to be here. Well, I think we're lucky to have you. Uh, I've heard you claim many times. That you have the best urology department in the country. So, first of all, prove it. All right. So, first of all, you know, I'm full of crap. So, there, there was no official best urology department, uh, contest. Uh, but, you know, if I look at our department, uh, very objectively, which is a little hard, uh, because I'm very passionate about it, but if you look at it objectively, and I always have a roster of our faculty next to my heart here, as you can. No, I just brought that so I wouldn't forget anybody, um, but. Uh, objectively, and it takes a, a, a long time for people to catch up to where your reputation is and where you are. But faculty for faculty, pound for pound, every division we have among the best urologists in the world. And the nice thing is we have very senior, excellent people, middle level and junior people. Um, how do you, you know, question about all these amazing individuals? What does it take to support this sort of a team? Is it, you know, what is it about UCI Health that has enabled this, uh, this. Group of individuals because in a lot of places when you get that much power and that many strong personalities, you, these alpha people, they want to separate themselves. How do you prevent that from happening or, or does it happen? You know, we're, we're a family and every family has squabbles. I'm I'm not, not gonna pretend that, you know, we, we live in some, uh, perfect environment. But the truth is, um, Tom and Ralph, uh, so Holling and Klayman established this great culture. Um, and my job is just not to screw it up. Um, we actually help each other. This pronoia concept is pervasive. When you create this culture, I tell everyone who we hire, you're coming in and you're the boss. And your job, if you're successful, is to demote yourself down through service. So, leadership is service. You come in, everyone's working for you, and your job is to work for everybody. So, when we, like, for example, Yafi gets here 10 years ago, he's a new kid at a fellowship, great guy, we know he has potential. Tom. starts working with him, giving him his fellow support, giving him research support. And now, Yafi is doing that for others. Gina just got here 4 years ago. All of a sudden she has resources, she's helping others. So, you come in as the boss and you demote yourself down to the lowest guy on the totem pole, which is the chair. I'm trying to dig a hole to go deeper. Yeah, well, tell me about your leadership track. Are you the same guy you were here, you were when you started as chair, and I'm guessing maybe not, and maybe you've learned a few things along the way about leadership and setting the tone. So, Sunil, how long you've been at UCI? Say about a little longer than you. So Sunil's gonna nod yes to everything I'm about to say. I came in as an idiot. I had, um, you know, I, I guess leadership is a, is a series of skills, some of which is a little charisma, and then, uh, you have to have a high EQ, a little bit of IQ. So, I, I did not know how to lead. And, uh, Ralph Klayman, being an amazing mentor, got me a, uh, executive coach. Initially, I, I thought that was a punishment, and uh I just went for it because I didn't want Ralph, who at the time was the dean, to be mad at me. And then I realized very quickly that Lisa Barron, who was my executive coach, she taught organizational management at the time in our business school, was brilliant. And she taught me a completely new leadership skill set. And it was supposed to be a 6 month engagement. I think we turned it into 18 months because I just needed her, and I recognized I needed her. But not only did she make me a better leader at work, she made me a better husband and a better father. Just a little bit of, uh, listening and, um, understanding what people really want, not what they're saying. So sometimes people, um, ask for certain things, but it's not about what they're asking for. It's about maybe they need a little more respect or attention. Um, it was just transformative. So, uh, Sunilil will, will, no, I'm gonna, I'm actually nodding also because, um, I had the opportunity to be educated by Professor Barron, uh, when I went in the business school. And I, you said it very well. I mean, the lessons I learned helped at work when I was undergoing it uh in business school. It was through the COVID transition, so I found myself frankly utilizing a lot of those skills to listen better to my wife and what she, uh, what you just said really resonates true with me that what she wanted, not always what she said and especially with the kids as well. And um there's definitely a difference once you start to understand that um it's funny that you know the the natural concept for many physicians is I don't need this this is for other people and and but in reality I think it's it's we all need it and in fact refreshers are even super helpful as well absolutely I couldn't agree more. So not only have you distinguished yourself as a leader in that way, understanding that maybe you need a little bit of coaching, but I have noticed that you bring a lot of really unique ideas to your department. You're always willing to try new things. I think you're well known around here for your skills in donor relations, how to build up advancement support. Also some really fun marketing ideas you have brought to bear. So, you know, other physicians who are listening to this, they're. Thinking about how do I build up my program, how do I build up my practice, so I'm hearing, set the culture, set the tone, understand your own limitations, maybe where you could use some support or some training, but, you know, I think you're really well known for how to train people to talk to patients about supporting programs. So what do you tell your younger faculty who are maybe you don't have those skills? Right? So there's actually two things that I think are critical. One is, um, just. Your work should be fun. And if you're going into academics, the, the whole reason I think most of us went into academics was so we could do some really creative work, and that could be in, in any different format. Um, it could be creative research, creative writing, creative building of programs. So, what you need is a, that creativity, and, and when you look at me, you see a sixty-ish year old dude. But at night, I unzip this and there's like a 6 year old boy in there who just says, oh, that would be fun. And let's, we could do that. So, Ralph Klayman just lets you. When you're his fellow and in his training, you just are supposed to go with your creativity. And so, um, we call it neoteny, which is, it's probably not a compliment. It's being full, not fully developed. But Ralph and I are neotenous individuals in that we, we, we were like kids, we wanna try interesting fun things. Um, creativity in a barren environment is, is not helpful, right? It, it, it, it can't be realized. Uh, so what you need is you need that kind of neoteny. That creativity and that zeal and energy to create new fun programs. And then you need resources. And we've been very blessed. What we, what we've been able to do is, is actually a testament to the Discover Teach Heal mission. Our faculty that I just summarized in 2 minutes, is so extraordinary that they deliver world-class healthcare with incredible dignity and respect and operational efficiency. And we try and do that better and better every day, uh, and we will do better, but we're doing it at a very high level. So, people are coming from all over. County, all over California, nationally, internationally for these amazing doctors and their amazing services. And they are grateful. And they'll very often will say, hey, what can we do for you? And most doctors, uh, do something that I find disrespectful actually, and so it was nothing. And the reason I say that is when my son was saved by the NICU here, um, you know, I was fresh as chair, and my, my wife gave birth, my son aspirated, he was in the NICU. They're thinking about intubating him. Worst day of your life, right? Your, your kid may die, you don't know. And they saved him. And I was so grateful. Laura and I wanted to donate, and we went to the NICU team and the PES group, and we said, hey, we really want to do something for you. It was nothing. Like, holy crap, my, the life of my son is nothing. So, a lot of doctors just say it's nothing, and, and you're just trying to be reasonable and humble, and that's, and they are. They're wonderful doctors, and that's what they say. But the truth is people do want to help. And there's a lot of people who wanna give back. And if, if they uh don't have tremendous means, they give back with their time and, and they can help support and be volunteers. But there are also A lot of uh what we call special constituents. There are a lot of really wealthy patients who are going to give. And you just did them a huge solid. You, you cured their cancer, their infection, their physiologic challenges. And guess what? They want to help you. So, what we do is, is, as a team, is just work to engage those folks to see what their interests are and how we can partner to build fun stuff. And very often they rely on us, they lean on us, hey, what's your vision for going, taking it to the next level? Um. And then we work with the faculty, and there's different faculty phenotypes, right? So there's some that are, um, I can't do that, and they just bring the names to the development officer to myself, and we will address with the patient, um, hey, would you like to support, uh, you know, Doctor Sadegi or Doctor Oering or Yafi, and, and very often the answer is yes. And then there's some people who are a little more, um. Uh, accepting, and they're, and I'll work with them. And then there's some people who are really robust and interested in saying, hey, yeah, uh, Bob, it was great taking care of you. I'm glad you had a good experience. I have some great research opportunities. Let's have some dinner. Let's go together. Let's have some lunch or a drink, and we'll, we'll chat about the, uh, the amazing research. And, um, we have brought in some very robust resources to the department and to the school of medicine. That have allowed us to be creative. So, uh, you know, I started seeing my minimally invasive role as, oh gosh, I'm a reactive sick care doctor. Why am I only taking care of people when they're sick? If I'm really minimally invasive, let me help them avoid disease. So we built a men's health center, and this was a great collaboration with the institution. The, the C-suite was utterly supportive, but it was brought in by development dollars largely. And we built a kitchen into a urology office and floating light bulbs and all, and a beautiful lounge. And all of that are resources we're actively using to teach people how to eat better and live better. And, and, you know, we just recruited Gary Deng from Sloan Kettering in, in partnership with the Sam Wellley Center. We're starting a cooking show next week with uh Shyta Malik with him and myself, and we're gonna teach people how to make food that's easy to cook. It's inexpensive, it's super healthy and something you can provide your family. So, so without the support of donors, would this have been possible? There are other mechanisms, but I think it would have been really hard, you know, I, I, it, it's, it's, it's really hard to give somebody a vision that's out of the box, you know, the NIH, they want to do stuff that's almost certainly going to be successful. They're not going to go for that, let's hit a home run. They're gonna go, yeah, that's a single, we'll support that DOD, uh, you know, NIDDK. You know, you want to build a van, so another donor's passionate about prostate cancer, you build a van so that we can now go around Orange County and beyond, and screen men for with for PSA and maybe other things. Uh, you know, there's a man dying of prostate cancer in Orange County almost every day. Well, we can take that down to 0. So, you, you're like, oh, I mean, that's hyperbole. Uh, yeah, but why not try? And if we can take it from 350 down to 200. We saved some lives and if we can dig down even lower, that's great and yeah I'm gonna say we're gonna take it to 0 because I'm gonna try. One of the things I love about you, Doctor Landman, is when I bring to you operational challenges or I bring to you opportunities, someone who's frankly, uh, such a great leader as you, often people will say, yeah, you're you're whatever you're saying, Sunilla, it doesn't really count. And every time I brought something to you, say that's an opportunity for us to improve, and I've been really impressed by that and I just, I, I really wanna thank you because. There's so much hard work going on behind the scenes to support the amazing clinical teams and oftentimes it's hard to hear, you know, the, the challenges of individuals or the challenges that data show, but I think your desire to constantly improve and get better, not just yourself but your team, I think that goes a long way, and I can hear about it even today, the passion that you have really for the patients and, and the people that maybe even aren't your patients here in Orange County. So listen, if there's any doctors who are listening to this, we all know we live in a tough environment. Um, you know, as a medical administrator, you know, half the time myself, I hate myself half the time. It's just, it's, it, it's very hard to find that balance where we can financially make healthcare work and be excellent. Um, and our metrics aren't great, even at, uh, I would argue we are providing some of the best care in the world. But when, for example, today you brought me some numbers and I'm like, man, we could do a lot better. And our numbers were pretty consistent with a bunch of other, uh, services here at UCI. And I was like, no, let's just pick a number that's better. Uh, so I'm not ever looking for like some national metric or what the mean is, or are we in the 25th percentile. I said, well, why don't we define that little point at the end of the bell curve? And we gotta work for it. And I know it's a pain in the ass, and I, I know I push really hard, and, and I, I, I try to kindly rub people, uh, in a way that we can push it that way. Um. But we gotta be really harsh on ourselves. We have to work harder. We're not perfect, and, and we should work towards perfection. Our patients deserve that. The community deserves that. And I know the doctors at UCI, not just in neurology throughout. They're amazing. And uh sometimes we get beat down because every day there's so many challenges, you know, and it's not just UCI, it's that the insurance companies and, you know, there's a lot of things that feel really tough, um. And quite frankly, I get frustrated too. And, and I think as a leader, my job is to yell into my pillow in the office and then open the door and say everything's fine. And that's not fake. We all get frustrated. And I, if there's one person who doesn't get frustrated, I wanna meet him or her, but Leadership is about, you know, saying we're, this, no matter how bad or good we are, we're gonna get better and it's gonna be all right. And you know what, it really is. Uh, if you travel around the world, healthcare is not what it is in the United States. And you can look at our national metrics, but, um, and, and this is bigger discussions about insurance and how everyone should or could be insured, but we provide amazing healthcare here. And then, The opportunity to do better is always there, is always there, and then we need to strive for it. So your vision, your energy is infectious. As an institution, UCI Health are on track to be up to 7 hospitals next year. How does that fit into your plan, your vision for urologic care for this region and beyond? Like, what, what's your 5 year goal here? Well, global domination, right? So I think, so I think urology should run the world. So, you know, uh, I, I just have always loved growth, a positive growth and a sustainable positive growth. So, when I found out that UCI was um engaging with these 4 hospitals and ultimately purchased them, I was super excited. We're gonna work with the community to elevate those hospitals. So, I, I will tell you right now, the non-academic private practice docs at those hospitals do things better. I, I know this cause we have a clinically integrated network with another group that we're working with, and we've started chatting about how we could work together and help each other. They do things better than us. They have some efficiencies that we have to learn from. We do some things better than them. And I think that if we leverage the greatness of the two, and people do what they're really great at, that the community, I mean, individual patients in the overall community will, will see an elevation in their healthcare that's unbelievable. So, am I excited about that? I'm over the moon and uh I want to work with our C-suite to try and kind of really figure out how we integrate this in a really efficient and good manner so that patients get better care all over community and here. It's a tremendous opportunity for us. I mean, the reality is getting to the city of Orange or finding a bed at our hospital, which is very busy, is a challenge. And even as we build the new hospital in Irvine, and perhaps when people listen to this, likely the Irvine Hospital may already be built. The fact is is that's not enough space and beds for people to travel to and so now we have this amazing opportunity to be in the backyards of so many individuals in Orange County, not throughout Orange County still, but this is a real tremendous opportunity and I love what you mentioned, Doctor Landman, which is, isn't it, it isn't always gonna be a faculty physician that's gonna be there. That's not realistic and so learning what other people are doing and partnering with them is really what's gonna make us successful and you know as the as the tide rises all boats will rise as well and I think that's what's really exciting about expansion and what's been different today than it was a few years ago. So, last question, you've been very generous with your time here. What are you most excited about in the field of urology, the innovations coming down the pipeline that really get you going? You know, um, it's, it's strange you should ask, because I, I find that like there's, um, um, micro errors that are probably about 5 years in length. When I go to meetings where things are kind of stagnating a little, and all of a sudden, we are seeing explosions in technologies and neurology, and we're just, I, I feel like we're like about to crest on another tsunami of innovation that's gonna be very helpful. So, The, the time is very exciting in all of urology, but I think at UCI urology, we're capitalizing on it. So, I think last year we had 4 world firsts. Like if an institution has a world first, much less one department, um, I'll, I'll give you some examples. Um, for 10 years, I worked with a company called Aris on developing the monarch robot, an endoscopy robot that lets The average surgeon do what the best surgeons in the world can't do. And we brought it to life, and I just met with them again in late next year, we're going to be the first people in the world to actually, we, we did the first trial, we did the first cases, there were 13 cases, they went brilliantly. Those patients are, are still following and they're, they're awesome. Uh, but we'll be the first people to have that. Uh, we're doing a drug coated balloon trial. So all of a sudden, in combining the mechanics of surgery with, you know, pharmacology and immunology, amazing. So, we're among the first people in the world to do upper tract balloon dilation with these drug coated balloons. Um, Doctor Yffie's got a couple of trials that were first in men's health. Um. The um female urology team is working with a new technology that's going to revolutionize your dynamics. Now, your dynamics is this 50 year old technology where you put tubes in the bladder, where the sun don't shine, it's very uncomfortable. Little deployable device. And that's available nationally, but we're, we're among the first to have it, and, and it's very exciting. So, we, we are, you know, the, the fine, bloody edge of that cutting edge blade. And excited to be there, especially right now because there's just so much going on. Um, robotics is just huge. Um, there's some great new robots that are gonna be, uh, challenging kind of this da Vinci dominance, which is great because competition just elevates everybody's game. It's not great for the intuitive, but it's great for everybody else. Um, I'm sure intuitive will do just fine. Yeah, there's a, they'll, they'll, they'll they'll do just fine. They're, they're not suffering. Can you comment a little bit about, um, I understand there's some new procedures to help patients with hypertension that your team is doing? Yeah, it's another, uh, we weren't global first. So there's 9 cases done in Korea. There's a company called Deep Cure, and they have a hypercure, which is a little robotic uh device that you deploy on the renal artery. And The early data, still very early. It's the first time this has been done without a giant open surgery. It was done in the 50s and 60s that defined the concept of denervating the, the renal arteries to get rid of the autonomic innervation and diminished blood pressure. But 40 millimeters of mercury dropped. We've only done one patient here. We're, we're actively Um, collecting, uh, the, the trial's ongoing. But, man, this is, and, and we did a study, probably over a decade ago, uh, anatomic study showing where the nerves are. So, I knew these other techniques, uh, that other companies weren't going to work if they go endovascularly. This is the right way to do it, a little more invasive, still done with the robot. But holy mackerel, imagine if an option for your hypertension, cause, you know, pills kind of suck. I forget to take them. I think the compliance with hypertension medicines is awful. People do not control their hypertension well. And maybe, I'm not saying yes, but maybe this innovative new strategy is gonna let people just have an outpatient procedure, and you don't have to take any medicine, your hypertension is controlled. Now, Still very experimental. I don't have data to prove it. We've done one patient, um, but we'll see. And if it does pan out, it's just gonna be utterly disruptive. I think that's the exciting part about receiving care at an academic health center, right? Like that's the You're literally experiencing the future here and sometimes it's gonna work and sometimes it's not, but it allows us an opportunity to dream and innovate and think big um because. When I was in med school, we never thought about going to the neurologist for hypertension. And who knows, maybe we will in the future. Maybe, maybe, in fact, that's one of the challenges is that, uh, you know, it's just a reality when you take, um, a specialty, meaning nephrology or cardiology, and take those challenging hypertension patients away, it scares them, just like it scares any of us when our business is going to be taken away. But my, my experience is that no matter what they take away from us, there's always new things that come out for every specialty and that we shouldn't be fearful. We should be just kind of. Uh, always forward thinking and, and patient always should come first. Absolutely great. So you're here to hear first, everyone, Doctor Landman rolling in a van cave near you very soon. Thank you so much for being with us, guys. Thank you so much for having me. It's a real privilege and um, um, really uh just. Gotta tell you, I am Honored and um uh excited to be at UCI, uh, and I don't just say that this is a really a special place, not just the department of urology. We work with partners throughout the campus, and, um, I, I know that in the next few years we're gonna see nothing but uh amazing progress. So thank you all for, for letting us share that and thanks to our C-suite, who I criticize often. I just, but thanks to our C-suite for actually letting a lot of this happen because they actually do a great job. Appreciate it. This has been Physician Huddle by UCIA Health. Thank you for joining us. This was an episode of the Physician Huddle podcast by UCI Health, produced by Brett Shaheehan, Angelica Yagubi, and Victor Ting. For more episodes, information on clinical trials at UCI Health, or to refer a patient, view the show notes or visit clinical connection. UCIhealth.org. Created by
