MGMA Insights: Academic Medicine in Practice with Jonathan Leer
Download MP3Hi. This is Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. The following is an interview that was recorded before the MGMA Leaders Conference in Orlando, but we believe this conversation about academic practices contains valuable insights for practice leaders. So in this interview, you'll hear from myself and our guest, Jonathan Leer. Jonathan is senior director of clinical business operations at the University of Maryland School of Medicine.
Daniel Williams:Let's go to that conversation now. So bring us up to speed. You were telling me offline. You made a move, back in January. So just bring us up to speed for anybody who hadn't listened to our previous episodes or hadn't heard you live before.
Daniel Williams:Who is Jonathan Leer? What are you doing these days?
Jonathan Leer:Oh gosh. Who is Jonathan Leer? What what a what a interesting question. I don't think we have the two hours. So I'll keep a 30,000 foot view.
Jonathan Leer:So, yeah, last time I was on the podcast and and last time I was in in front of individuals at a conference, I was at Johns Hopkins, working in a, you know, administrator capacity over there. Really just a fantastic organization. Very much appreciate all my time there, but was able to be provided with an opportunity to move over kind of across the street really. We're only about two miles away to the University of Maryland School of Medicine here in beautiful Downtown Baltimore and so from there, I'm a senior director in the Department of Medicine and right now, I'm overseeing about three different divisions. I oversee pulmonary critical care and sleep medicine working collaboratively with my clinical chief and my division chief and all the other kind of, you know, associate administrative individuals in the Department of Medicine, the largest department in the entire school of medicine.
Jonathan Leer:So big job, big shoes to fill, I've been enjoying it since January.
Daniel Williams:That is wonderful. So you, I was joking with you offline. You're going to be speaking a lot. People are going to see a lot of you in Orlando if they're anywhere near that academic track. But let's talk, let's take that wider lens view on academic medicine for just a minute.
Daniel Williams:So, what are some of the things going on there? I know you were telling me offline that you had been pitching this track at Leaders Conference for a while, 2025. We're going to have it But let's just talk about academic medical centers. What are some of those trends going on? What is what's happening there right now in that space?
Jonathan Leer:Yeah, it's a great question, Daniel, and I appreciate tee up there. You know, I I think, you know, I kind of fell backwards into academic medicine. You know III went off and got my MHA and thought I was going to be kind of you know acute care in the hospital or be on the physician side of the coin and really did not have a great understanding of what academic medicine was. Through a series of events after a consulting career, I started at University of Texas Southwestern Medical Center in Dallas, Texas where where my family used to live. And it really just kinda opened up my eyes, to what academic medicine was.
Jonathan Leer:It is, you know, and I say this a lot and people will probably get tired of hearing me say it at the at the conference too. You know, it it really is much more of a broad lens than just clinical operative, you know, needs and actions and things that we do on a very, you know, daily basis. It's it's a tripartite mission. You'll hear that a lot. You'll hear a lot of academic medicine people say that a lot.
Jonathan Leer:And what that tripartite mission is just to kind of boil it down. It's to educate, heal, and discover. That's really the the three things that we do every single day, right? We have individuals that are either going through medical school, residency, or fellowship or or some type of post doctoral program in the educate part heal. You know, that's that's your, you know, general come to the hospital.
Jonathan Leer:People, you know, get admitted, go to the Ed, you know, so on and so forth. That that we need to take care of on a on a daily basis and and really, you know, focus on the patients And then the discover part, which is the thing that really hits the headlines and makes academic medical centers, I think, shine is the research aspect, whether that's bench research or whether that's, you know, more academic research from a, you know, a data analytic perspective. It really is looking at cutting edge technologies, new therapeutics, you know, how we combat the diseases that that none of us want. Right? Like nobody, you know, wants to get sick every single day.
Jonathan Leer:And so, you know, we we're trying to figure out what's going on on a daily basis. In fact, I'll I'll share a a small story with you. Actually, the story just came out this morning. My division chief, Doctor. Jason Rose, has been working with the dean of the School of Medicine, who's also a pulmonary critical care doctor, Doctor.
Jonathan Leer:Dean Gladwin. And they might have found a protein and a therapeutic that will combat carbon monoxide poisoning, which affects over fifty thousand people every single day. And so, you know, that therapeutic that that protein that is, you know, well beyond my comprehension as a as a business, you know, professional, was developed here on-site at the University of Maryland School of Medicine. And and, you know, it's taking it from bench to bedside. Right.
Jonathan Leer:And, you know, how can we do that? And so that's a fascinating, you know, kind of announcement that they had that that we are now potentially going into into clinical trial phases on using this new therapeutic for people that are suffering from carbon monoxide poisoning, which, you know, is a silent killer, right? Carbon monoxide is odorless, tasteless. It, you know, it it really affects a lot of people in a lot of urban areas as well. So shout out to Doctor.
Jonathan Leer:Rose and someone that I get to work with on a daily basis, and I'm just proud to do so.
Daniel Williams:That is remarkable. Thank you for sharing that. And we had a carbon monoxide alert recently in our house. We had the detector there in our home and we thought something major had happened but actually it was just I think the battery had finally, run down. We'd had it for many, many, many years in our home and it freaked us out a little bit, but we everything was okay, but that is something not to take lightly.
Daniel Williams:So that is incredible that y'all are doing that work there.
Jonathan Leer:So It is, Daniel. It is. Yeah. PSA for whoever's listening to the podcast. Get a get a carbon monoxide detector in your house.
Jonathan Leer:A lot of them are paired with smoke detectors. Right. Yeah. So, PSA out there, be safe in your home and with your loved ones.
Daniel Williams:Okay. So, as we mentioned that we have added this academic track at Leaders this year, If someone is, an academic medicine leader, why should they make this event with this track in mind, a priority for themselves and their organization?
Jonathan Leer:Yeah. It's a great question, Daniel. And and again, I I I wanna I wanna stay 30,000 foot view and talk about these things. And and, you know, a lot of people hear academic medicine and they don't really, you know, think, well, maybe that's me, maybe that's not me. It's becoming more and more prevalent.
Jonathan Leer:And so I think this track honestly is for people that aren't just at university medical centers, that aren't just affiliated with academic medicine. I think it's honestly for people that are in metro areas that are in in close proximity to an academic medical center. Right. There's a lot of private practices that we work with on a daily basis, you know, that that really feed the beast, so to speak. Right.
Jonathan Leer:Because we are known for quaternary care. And so just to define that a little bit, right. There's there's primary, secondary, tertiary and then quaternary care. And quaternary basically means we have the sub, sub, sub, sub specialist in in these, you know, things that are super rare or or, you know, there's like three people in the world that know how to cure these diseases. And so, you know, if I'm talking to someone or if anyone's listening right now and and you're like, well, I work at a primary care office in, you know, Lincoln, Nebraska, then fine.
Jonathan Leer:Great. That's awesome. But, you know, we also have the University of Nebraska and they have an academic medicine, you know, presence there. And I'm sure that there is a relationship. In addition.
Jonathan Leer:Right. If you've got someone who you're recruiting, if you've got someone who you want to bring into the practice, they're coming from an academic place. Right. And so understanding what that even means, I will be fair. You know, when I was coming up, I didn't even know how long it took to become a doctor.
Jonathan Leer:Right. And then, you know, I kind of fell into this and I was like, holy moly, look at all the training that they have to go through and all the all the, you know, components that you have to meet in order to even, you know, put an MD after your name and get your and get your license and so I really think it's for everybody and and I would encourage everyone to, you know, drop into a session but but to be a little bit more concrete about, you know, why should they make it a priority? I think that academic medicine is is under attack, Daniel. I think from not only a and this is an a apolitical statement, only from a funding perspective, which is not only at the federal government level, but at many other different levels. Right.
Jonathan Leer:Funding is is tight. I think that we have to do a lot with a little because as part of a university system, you know, we are trying to spread, you know, an amount of money against those three missions that we strive for every single day. So how do we do that? And in addition, we're trying to recruit the best of the best of the best, every single day. And so, you know, one of my sessions, which we may touch on is, you know, how do you get that leader in academic medicine?
Jonathan Leer:What are they looking for? Because funny enough, it's not just about pay all the time. And so, you know, I I I think it really is a a good session. And then I'll I'll end with this, Daniel. Over the last fifteen years, and in fact, I was given some collateral to your marketing folks.
Jonathan Leer:Over the last fifteen years, there has been more and more expansion of academic affiliated. I'll put that in air quotes for anyone's anyone not watching us online. You know, practices that have grown outside the metro area and into what we like to call bedroom communities. And that's because way back in the day, if you had that sub, sub, sub, sub, sub specialist, you know, they were in Downtown Baltimore or Downtown Boston or, you know, wherever, and you had to fly to them or come to them. That's not the case anymore.
Jonathan Leer:Right? Patients are a lot more, picky when it comes to health care, which is great. Right? Choices is fantastic. But we have noticed that we've got to get out into the community rather than saying, you know, if we build it, they will come.
Jonathan Leer:That's not really a thing anymore. And so, you know, as an example, north of me in Pennsylvania, Penn Med or the University of Pennsylvania Medical Practice has bought additional community hospitals that are outside just the Philadelphia area because they're expanding their footprint and also their clinical practices. In addition, we have seen retiring private practice folks who, you know, want to, you know, go live on the beach or wherever they want to live and have said, well, I want to sell my practice, but I don't want to sell it to private equity. I don't want to sell it to, you know, whatever. And and maybe they don't have a junior partner that they've brought on.
Jonathan Leer:And so a lot of academic practices have been buying up. Additional private practices of UT Southwestern where I was prior to Johns Hopkins, they had a fantastic push And they are in the giant DFW Metroplex. You can find a UT Southwestern branded physician all over the metro area, not just at one place in in Downtown Dallas.
Daniel Williams:Okay. Thank you for giving us the 30 foot view. So, let's do a.
Jonathan Leer:I I may have dived it down a little We
Daniel Williams:kind of dipped in a little bit and that's okay. So, let's do this now. You are going to be part of four different sessions. Let's just do kits on these four sessions. Give a little taste of what someone could expect, little elevator pitches for them.
Daniel Williams:Let's start at the one that you did mention. This is on academic leader recruitment and retention. So wherever you want to go, I'll just I'll throw something out there for you and you can take it in the direction you want. But I'm looking at it from what's the core challenge that perhaps you'll be addressing in that session.
Jonathan Leer:Yeah. So I've got two fantastic co presenters with me. I've got Tom Rossi and Rebecca Napier. Rebecca is a senior vice president finance and administration at the University of New Mexico School of Medicine. And Tom works for Jackson Physician Search and has been part of executive recruitment for many, many years when he was at HCA.
Jonathan Leer:And then prior to that, he had other experiences. And what we're looking at there is, you know, with an aging workforce with with people that are in their sixties, seventies, and in fact, I even have an 80 year old on my faculty. You know, they're they're starting to retire. They're starting to to to take a step back. They're they're starting to say, you know, hey, I need to take it out of fourth gear and put it into second.
Jonathan Leer:And so how do you recruit that leader? And, you know, it's just as we've been saying the whole time, it's a certain phenotype of an academic leader. They have to do all three. They need to know all three, just like administrators need to know all They need to know the educate, heal, and discover. And so that's a very specific phenotype.
Jonathan Leer:And so how do you find those people? Where do you look for them? And when you are in the recruitment process, you know, it's not just about throwing a bucket of money their way. You know, what are their research passions? You know, do they need to set up an entire lab?
Jonathan Leer:And just a fun fact, Daniel, lab equipment, not cheap. And so, you know, what do we need to buy, you know, three negative 80 degree freezers? And for anyone listening out there, when I say negative 80, I do mean Celsius. It they're cold and they're very expensive and they come with little Bluetooth monitors in case they start to warm up if you have a power outage because you could lose your entire samples, if that happened. And so, you know, do they need a lab setup?
Jonathan Leer:Are they coming with, you know, personnel members that they've been working with for the past ten years? Right from and I'm gonna pick a random state. Right? If they're coming from in Nevada to Maryland, and, you know, they've had a lab manager that is followed them over the last three moves. We need to know that.
Jonathan Leer:Right? So it's not just about the the actual base pay. That's a component, of course. It's about a lot of different things. And so we're gonna talk about that and kinda how we address it.
Jonathan Leer:And then on the side of that, how do you retain them? What's in how do you, how do you retain good quality people?
Daniel Williams:Okay. Let's jump to our next one then. Just get a quick hit on this one. Academic Medical Center Roundtable. Just tell us what's the goal of this conversation?
Daniel Williams:What do you expect to get out of this?
Jonathan Leer:Yeah. I mean, I think the goal of this conversation, Daniel, is to is to trauma bond together with all of my academic medicine colleagues and cohorts. And just to say, hey, you know, we're all feeling it. And I think sometimes we can feel very siloed. We can feel very, like we're the only ones that are experiencing this challenge.
Jonathan Leer:And and and and that's not true. And so I it's it's really what the goal of this would be is it's a moderated session, but it's gonna be a fairly opened forum with some prompts and round table discussions with people to say, you know, what are you experiencing? You know, yes, the NIH is is is a big topic of conversation right now and what's coming down the pipeline for, you know, what we call the F and A rate which we don't have time to delve into that but come to the session. We can talk about it. You know, and and what does that mean?
Jonathan Leer:And how do we shift and change? You know, what's going on with, you know, recruitment of individuals who are international? There's a lot of, you know, visa issues right now and with travel bans and things of that nature. I mean, these are things that that other people have to think about too. But but just trying to get in a room together and talk about it and just know that not everyone's alone.
Jonathan Leer:And my hope would be for me and my my co moderator, is that, you know, people walk out of there with an idea, with a spark, with a something and take it back to their organization and say, well, why don't we try this? Oh, well, I just went to the MGMA Leaders Conference and, you know, Jonathan at at University of Maryland said, right? Maybe we can, you know, talk about that and so, you know, I think that that's what's great about these conferences is that we can all get together and just, you know, say, I hear you. I understand you and you know, let's talk about it together. So, that that's kind of what we're trying to get out the round table.
Daniel Williams:Okay. This next topic, you have touched on a little bit already, but it's maximizing impact, resource management amid shrinking professional fees. The the title kinda says it all right there. You've already touched on this. Is there anything within context, maybe your co presenters, anything else you might wanna share about this particular session?
Jonathan Leer:Yeah. Amazing co presenters, my colleagues from when I was at Hopkins. We've got Christian Hartman, the brand new chief administrative officer for the Department of Medicine. We've got Jameson Kays and Anu Raman. All wonderful professionals that I had the honor and privilege of working next to shoulder to shoulder when I was at Hopkins.
Jonathan Leer:And, you know, what we wanted to talk about was and I did touch on it a little bit, but, you know, I think if you just kind of think about it from an overall perspective, you know, we we are working with people that are sub, sub, sub, sub, sub specialized and so often times when we encounter those individuals, you know, they they are the experts in their field. They are the go to when it comes to, you know, certain things. And oftentimes as the administrator, you know, we kind of get put in the middle of what they need and and and what we can provide. And, you know, those two things, unfortunately, are are somewhat, you know, on on a scale here. And so, you know, I would love Daniel every single day to every time a faculty member were to come to me and they need four negative freezers to be able to wave a magic wand and say, here you go.
Jonathan Leer:Unfortunately, that's not the case, right? We have to think about capital request because those are very expensive pieces of machinery. They have to be capitalized. So what does that mean? Right?
Jonathan Leer:We also have to think about labor, right? I would love to put a, an MA or an LPN or even gosh, a full RN paired with a physician one to one every single day. That's just not possible. You know, I would love to do a lot of different things and sometimes, unfortunately, I sit in the hot seat when it comes to, you know, well, what can we do and how can we do? And so, you know, we are having a threat of shrinking professional fees.
Jonathan Leer:We are having an issue when it comes to our FNA rate on NIH. We are having a lot of different challenges. And so how do we prioritize those resources? Can we think outside the box? Right.
Jonathan Leer:Fun little teaser story. Right? We've got a cardiology practice at Hopkins that wanted to expand their clinical footprint up to a northern location in North Baltimore County where GI was already sitting. We discovered and Christian really deserves a credit on this one. But we discovered that, you know, GI was seen most of their clinic patients in the morning because the GI physicians would then go to the Endoscopy Suite and do, you know, EGDs and colonoscopies and whatever.
Jonathan Leer:And cardiology could use that same space and we could co locate, right? Where the traditional model is you get a clinic. It's like Oprah, you get a clinic, you get a clinic, you get a clinic, right? Can we think outside the box? Can we Right.
Jonathan Leer:Can we look at different ways of doing things? And so that's what we'll talk about.
Daniel Williams:Okay. Your last session, this culminates with everything you've been talking about. So if you're shrinking resources, not you, but if that is the environment you're experiencing, then there is a battle for, well, if it's we had 10 of whatever denomination we wanna say, and now it's five or three, then you have the remaining lab folks and everyone else competing for those sub zero refrigerators or whatever it might be. So then it gets into this last session, grant management. What does it all mean there?
Daniel Williams:So, I mean, that is gonna be even more important. What what's going on in grant management, balancing those resources, making people have, making sure they have what they need, but then also prioritizing because some unfortunately are not gonna get the funding they need there. Talk about that, Jonathan, and what's going on in that side of the business.
Jonathan Leer:Yeah. I mean, gosh, Daniel, I could I could do forty five minutes on that. Yeah. I won't. But, you know, I I think for people that don't deal with grants every single day, it can it's it can seem very daunting.
Jonathan Leer:And I'm not gonna say that it's not. Right? Like, there's a lot of terminology that, you know, unless you're in the in the know or in the biz, know, you don't really talk about every single day. And so, you know, let's say that you are a administrator and you're coming to the conference and you've just gotten the job at, I'll pick another state, the University of Indiana. And all of a sudden you show up and you're really good at clinical operations because they hired you from a private practice and a little bit about education.
Jonathan Leer:But research in grant management is completely foreign to you. Hopefully, this session will give you some of those tips and tricks and what we're talking about when we say grants. And the fun part is, Daniel, and you kind of teed me up super well here is that grants don't just have to be at academic medical centers. There are grants that are, you know, supported by Eli Lilly and and, you know, a veritable cornucopia of foundations, American Cancer Society, American, you know, Lung Association, and on and on American Heart Association that give grant money to people that apply for it. And so if you're even listening to me right now and you're like, I have nothing to do with academics.
Jonathan Leer:I don't even know why I got, you know, you know, into this, you know, podcast. I just want you to know that that you can if you work at a cardiology practice in, you know, Davis, California, I keep picking different states. You know, you can apply for a grant through the and you can get new heart monitors. You can get new, you know, you know, pulse oxes. You can apply for, I'm going to say free money.
Jonathan Leer:Obviously, there's a lot of strings attached to that. But that's not money coming out of your operating account and coming out of your physician's professional fees. And so what does it mean when I say grants? And then, you know, for people that maybe are in the biz and are doing this every single day, what are the challenges that we're facing right now? And how can we shift and change?
Jonathan Leer:Do we need to open it up beyond just federal grants? Right. NIH, DOD, HRSA, which is HRSA, which is a more of an education based federal organization to more foundational organizations, right? Like the American Heart Association, the American Cancer Society or what I have done, you know, and maybe spill a little bit of of the of the tea here. You know, I really have partnered very collaboratively with industry partners, right?
Jonathan Leer:Pharmaceutical companies. Sure. GSK, Eli Lilly. Gosh, II can't think of another one off the top of my head but like there's a cornucopia of them out there and so, you know, we in academic medicine for a long time have been very laser focused on federal because that's how you get, you know, certain ratings and that's how you get papers produced in the New England Journal of Medicine. But, you know, now that we're facing some turmoil, you know, maybe we need to take those horse blinders off and we need to look outside.
Jonathan Leer:And so we're gonna talk about that.
Daniel Williams:That is wonderful. Thank you for sharing so much information about this academic track at our show. If someone's, looking to pick your brain or just connect with you at the conference, any idea what's the best way to where do they find you in Orlando? Will you be at Disney or where will you be?
Jonathan Leer:What's No. I unfortunately, my daughters will not be coming with me much to their chagrin. They've got school. So, you know, you said it at the very top of the podcast. I mean, with four sessions, hopefully people don't get sick of me.
Jonathan Leer:So I will be around. But I am always happy to connect with anyone. You know, when you're on the app for for leaders conference, which MGMA does for most of its event, there is a directory L E E R. It's pretty easy. You can type that in.
Jonathan Leer:I should have all of my contact information there. But, you know, let's say that someone's listening right now and they're like, hey, I'm on the fence about whether I should come or not, which spoiler, you should come. But you can email me at jleer@som.umaryland, which is you maryland dot edu. So it's it's a bit of a long one, but people are welcome to email me. I'm on LinkedIn, l e e r.
Jonathan Leer:I'm the only one out there. I've got alphabet soup after my name. You should see this ugly mug. Happy to connect with anybody.
Daniel Williams:All right, Jonathan, you're so gracious with your time both here and you will be in Orlando. So thank you so much for that. Great catching up with you today.
Jonathan Leer:Wonderful catching up with you, Daniel. Thanks so much.
Daniel Williams:All right, everyone. I will drop in those, direct links to Jonathan's email, LinkedIn, and perhaps some other resources where we've connected with Jonathan previously. Thank you so much for being MGMA podcast listeners.
