We'll go ahead and get started. Thank you for those of you who were brave enough to get here exactly at eight o'clock on a Saturday. They didn't do us any favors with the time frame, but it is what it is. So thank you guys for being here. So my name is Tobias Wasser. I am currently the president of the American Association for Psychiatric Administration and Leadership. I am delighted to be here today to bestow the Administrative Psychiatry Award to Dr. Wayne Creelman, who's gonna be giving us this talk this morning. So a little bit about Dr. Creelman. So he received his bachelor's degree, magna cum laude in biology, philosophy, and theology from Boston College. He completed his medical degree at Georgetown University and did an internship at Hartford Hospital in Connecticut, completed his residency at the Institute of Living. After medical education, Dr. Creelman went on to complete a master's of business administration at the Medow College in Buffalo, New York, and earned a master's of medical management degree from Tulane University School of Public Health. More recently, he's earned a master's in theological studies from Ava Marie University in Naples, Florida. Before joining the faculty at the University of Florida in 2006, Dr. Creelman held positions at the medical schools at the University of Connecticut, University of Vermont, University of Buffalo, SUNY, at Michigan State University, and several private health systems. During his distinguished career, he has held roles as director of research, division chief, department chair, corporate medical director, chief operating officer, executive vice president, and CEO slash president. Dr. Creelman is board certified in both general psychiatry and medical management. He is a distinguished life fellow of the APA. He's an accomplished author, popular teacher, strong administrator, and excellent clinician with a lifelong commitment to mental health advocacy and the interface between religion and mental health. He's an ordained deacon in the Catholic Church and a chaplain to the Knights and Dames of Malta. On a personal note, as I say, he's also been a wonderful leader within our organization, the American Association for Psychiatric Administration and Leadership, past president, and we're delighted to be awarding him this today. Here you go, Dr. Creelman. Thank you very much, Tobias. I appreciate that. John Wilkitis, could you come up here and take a picture for our, hold on a minute. I'll send this in to Francis, our executive director. You're probably good at this. You've done this a million times. All right, we've got a few people floating in here or there which is kind of par for the course. I've attended these award presentations for the Administrative Psychiatry Award for about 25 years, and sometimes there have been three people. This would be a moderate group. Sometimes it's standing room only if a famous name floats by, but I'm delighted that you could all be here. Thank you, Dr. Wasser, for this very, very special award. As you'll hear later in the talk this morning, I've been a member of this organization for 30 years, so sooner or later they have to give you an award if you're a member of something for that long a period of time. So I'm assuming, I'm gonna assume that essentially the folks that are here and the folks that will breeze in and out maybe are either in some kind of administrative position as a psychiatrist or at some point you may want to be in an administrative position. So that's the premise I'm going to use as I walk you through my career that has spanned a little over 45 years. Now, believe it or not, I never wanted to be a psychiatrist. Attending Georgetown University Medical School and rotating through essentially, I'm gonna pop that back because this has a mind of its own here it looks like. I'm gonna leave that there for the moment. Having attended Georgetown University Medical School and rotating through multiple clerkships, my third year of medical school, in those days you could actually set up your senior year of medical school with electives in one particular field. And if you know anything about Georgetown, Georgetown is noted then and now for its cardiology program. Proctor Harvey was the inventor of the triple header stethoscope. Charlie Huffnagle did the first transplant, renal transplant, cardiorenal transplant. So Georgetown had an incredible legacy for cardiology and I myself spent my fourth year largely working with David Pearl who was an advisor to the White House for cardiology issues and I anticipated applying to the MATCH program in the field of internal medicine with a subsequent two year fellowship in cardiology which presumably would have been at Georgetown. At the last moment, truly the 11th hour for a variety of reasons and maybe in the Q&A you can push me on those variety of reasons, I actually became disenchanted with the field of cardiology and decided instead to apply outside of the MATCH for a position at the Institute of Living in Hartford, Connecticut. This was a program then that included six months of internship at Hartford Hospital which was essentially a walk across Retreat Avenue and then three and a half years of psychiatric residency at the Institute of Living. So I never really had to use the MATCH program as in 1977 matching deals could be made with training programs outside of the MATCH in certain specialties, psychiatry being one of them. Now in those days, the Institute of Living, many of you may not have even heard of it, the Institute of Living was in Hartford, Connecticut and many felt that the Institute of Living was kind of the counterpart of Menninger's that then was in Topeka, Kansas. Menninger's has since essentially moved to Baylor in Texas and the Institute of Living has been actually incorporated into the Hartford Hospital system. But the Institute of Living has a very, very unique history. It was founded in 1822 by some of the very early pioneers of compassionate American mental health care such as Doctors Eli Todd, Charles Burlingame and quite frankly folks, after my first year of training, I never looked back. The Institute was a system that had some of the most famous and successful psychiatrists on their staff of whom I trained daily. They included Francis Braceland. Dr. Braceland was a two-star admiral in the United States Navy and a consultant to the White House. Doctors Bill Webb, Tom Conklin, Ted Mucca, Jack Hout, John Donnelly. John Donnelly pioneered the treatment of sociopaths way back 30 years ago. John Goethe and Rebecca Solomon was my supervisor for two years. Rebecca was then the president of the American Psychoanalytic Association at that time. I don't think any of you were around at that point. I'm 72 years old. During the time of my training at the Institute of Living in the 70s, psychoanalytic training as well as one's personal analysis was pretty much a residency requirement prior to graduation and heading out into the real world as a board certified psychiatrist. So essentially we would go through our own personal analysis during the training. Most of us would stay on the faculty at the Institute of Living for a year or two while we got our boards in psychiatry. And essentially then we would go out into private practice or stay on the staff for many more years. I myself chose the option of being there for four years of the residency internship and then another four years. And I'll speak to you as to why I left at that point. Our patients, believe it or not, the average length of stay was between three and six months. Unheard of today. I mean, you have a patient in the hospital in the inpatient setting. You got managed care on the line in 24 hours saying, come on, get them out, get them out, get them out. Can't pay for inpatient care. Get them out into the outpatient sector. Which is I think a struggle we're all gonna face and continue to face in the field of psychiatry. We rendered psychoanalytically oriented, psychodynamic oriented psychotherapy, every patient five days a week, whether they liked it or not. And most liked it. I mean, there's a certain sort of narcissistic component to seeing your psychiatrist every day essentially at the same time, Monday through Friday. And quite frankly, people got better. But the biological side, the use of medication for mental disorders really wasn't in its heyday yet. And during those years of my training, it occurred to me that a greater focus needed to be obtained by not only the residency training program, but the psychiatric attending staff with respect to medication management. And so with the help of two of the very early pioneers in psychopharmacology, Dr. Charles Boren and Drs. Tony Andralonis, Charlie Boren was actually the residency training director and Tony was in charge of the child and adolescent program. I actually spent my fourth year of my psychiatric training program at the Institute of Living, we call it the IOL, actually creating a psychopharmacology consultation service that over the years has grown into a major referral program to the Institute. So this was kind of my first taste in administration. Starting a brand new service in a hospital that was founded in 1822 was no small task. It was really the first opportunity to get my feet wet in the world of administrative psychiatry. And the key, quite frankly, to this program's success was the fact that I had excellent mentors who were willing to commit the time and the energy necessary to build a program, then offer a service to the hospital medical staff that became very, very successful and well-received. And as I look back, one of the keys to building a brand new service is not being afraid to say yes to an opportunity that one believes in. Psychopharmacology was coming into its own importance in the field of psychiatry and any institution that wanted to remain competitive for patient referrals really had to offer the state of the art in psychopharmacological treatments that the public demanded. Since then, just as a sidebar, I associated with a fellow by the name of Adam Serallo who was chairman of the Department of Psychiatry at Tufts in Boston. He had trained at the Institute of Living with me. And he and I and David Shader and Rick Greenblatt, we wrote a textbook called Drug Interactions in Psychiatry. You can Google it. You can purchase it. It's a little dated. There's been five editions. And if any of you speak Portuguese, it was translated, believe it or not, into Portuguese and it sold very, very well in Portugal and Brazil. But again, as I say, it's a little bit dated so I wouldn't try to pass your boards by memorizing the medications that it focused on when we wrote it seven or eight years ago. So I think here, it's got way ahead. We're gonna go back. So this little machine has a lifespan of its own. So you already heard about Boston College. I've had a very lifelong interest in the interface between medicine, psychiatry, philosophy, and theology, which has been a real blessing to me. All of my training, all of the places that I've been, I really work very hard to essentially give people a great opportunity to get better and alongside of many folks, really work very, very well with people that I admired. The mentoring issue is critical if you wanna move up in the field of psychiatry. Pick a mentor, pick a mentor early in your career, work with that person, get to know how they achieve the position that they're in at the present time, and just be a sponge, take in all that they can possibly give you. And whenever you have an opportunity, even though you may be in private practice, try to get affiliated with an academic institution. Over the years, I've been affiliated with the University of Connecticut when I was a resident, University of Vermont when I was up in Maine, the State University of New York in Buffalo when I was in Buffalo, Michigan State University when I was in Grand Rapids, Michigan, and then currently the University of Florida in Gainesville because I think that having an academic orientation and being on an academic faculty will certainly open more doors for you in the world of administrative psychiatry. The next step on the administrative journey was a move to the state of Maine. Now, I'm just interested, just a show of hands, how many people have actually been in the state of Maine here? Oh, I'm impressed, okay. A lot of times when I talk to people, they say, is Maine in the United States? It really is up there. It interfaces Vermont and Canada, really up in that upper northeastern story of the country. And when I finished at the Institute of Living after being there as an attending for four years and a section chief, I had heard that there was one of our graduates, Dr. Alan Elkins, who was the chairman of the Department of Psychiatry at the Maine Medical Center in Portland, Maine. The Maine Medical Center is essentially, as we call it, the flagship. There are several, well, there are 16 counties in Maine, and several of those counties really have no major medical centers at all. But Portland is the biggest city, even though Augusta is the capital, and Portland had the Maine Medical Center, which was the premier place to do, essentially, work in psychiatry. And if you wanted to move up in your career, essentially, spend time there, again, under good mentorship. Alan Elkins mentored me very well. He had an approach, which he called, see one, do one, teach one. So you essentially would observe an event, next time it was your turn, the next time you were teaching it to someone else. So you had to listen very clearly in order to move up and get better at what you were doing. That included clinical events as well as administrative events. And as I look back over my career, during the eight years I spent under Dr. Elkins' tutelage, it was an enormously fulfilling time. I, during that period, became the director of the outpatient division. I ran the inpatient division on P6. I was the director of research with several phase three clinical psychopharmacology trials that I initiated, and then also started a private psychotherapy practice to enhance my psychodynamic therapy skills. And as I would advise all of you if you're going to do intensive psychodynamic work with patients, get some kind of intensive therapy yourself. You don't necessarily have to get an analysis. Again, you can't do better than getting an analysis, but certainly takes a lot of time. I worked with a psychoanalyst for three years during my residency. His name was Alan Broadhead, MD. And finishing my work with him after three years, it gave me the confidence to be able to conduct a practice of intensive, psychoanically oriented therapy on an outpatient basis. And that then kicked in the second administrative challenge in my career, and that was beginning truly a private practice of psychiatry with virtually no training regarding the keeping of financial books, for billing and coding purposes, maintaining a personal malpractice policy with tail coverage in the event of a lawsuit, and certainly promoting my particular expertise in psychopharmacology to the local community. Now, this also meant that I wanted to join the local medical societies, not just the psychiatric medical society. I mean, every state is a member of the APA with its district branches, and I think that's very important to join for networking purposes. But also, I think it's very important to join medical societies, because, you know, you're wearing essentially a white coat. You may not be wearing it in your office, but you're wearing it when you walk the wards and hallways of a hospital, and, you know, you're hobnobbing with other non-psychiatric physicians really for the rest of your life. So just from the point of view of, you know, collegiality, from the point of view of referrals, it really allows people to know who you are, what you might specialize in, and can really very much enhance your career. I was mentioning to Dr. Wasser before we started, I was down at Yale for several years as a member of the Connecticut Psychiatric Society that was involved in legislative initiatives. And I'll talk further about that down the road, because there's no better way to understand what's going on in psychiatry than to know what's happening in your state legislature as well as the federal story. I actually ran for the House of Representatives in Michigan on a platform of mental health parity, asking the public to be willing to pay for mental health care as they would pay for cardiology care or family practice or obstetrical care, which is still, although there has been a federal law passed in this regard, there's still some stigmatization from the point of view of, you know, mental health parity and being able to receive the same kind of reimbursement that you would receive if you went to a primary practitioner's office. But very important, again, to meet the general public and understand what's going on in the field. The next step essentially was I joined an organization, and again, do all of you know the American Association of Physician Leadership, called APPLE, many people have heard about it? And this is a very, it's a big organization, it's gotten bigger and bigger since I joined about 20 years ago. It was called ACPE until 10 years ago, the American College of Physician Executives, and they changed the name essentially to better reflect the focus of the organization. This allowed to connect one-on-one with a physician mentor, wasn't necessarily a psychiatrist, but this would allow you to take a really deep dive into your professional development and your personal growth, which really occurred for me. Knowing that professionals often attribute their success to those who help them along the way, APPLE has introduced a way for early career physicians and experienced physician leaders to connect in real time about how to be leaders in healthcare, and this involved for me, and I'm going to be very specific with you because I think some are going to be interested in the specifics, I received personally a certificate in medical management from this organization, and then I became a certified physician executive, CPE, and then I received a triple M, a master's in medical management from the Tulane School of Public Health. So obtaining leadership guidance in medical management and then obtaining that triple M degree, I was actually the 13th graduate at Tulane School of Public Health 27 years ago. That program has since closed with APPLE, but the five university partners currently include Carnegie Mellon University in Pittsburgh, Pennsylvania, and this is an 18-month triple M degree, Arizona State University, which offers a master of science in healthcare delivery, University of Massachusetts in Amherst offers the MBA program, Thomas Jefferson University offers the master of science in healthcare quality and management, and lastly, the University of Indiana, Kelly School of Business offers a 21-month MBA program. So both the CPE, certified physician executive designation, and the master's in medical management, if I really think about it, it involved about 125 core hour of classes, 30 elective hours that you could choose from, 60 options, and then there was one final CPE capstone event that would give you the designation of the CPE, and along the way there were multiple career development seminars. I actually received that first master's in medical management from Tulane doing a lot of one-week classes that were held all throughout the country at various lovely hotels, Ritz Carltons, Biltmores, that kind of thing, all over the country where you'd meet other colleagues with you, and then you went down to New Orleans for the capstone course that allowed you to then graduate at the major graduation with everyone else. These involved a lot of leadership sessions for development in management and administrative skills, a lot of work-life balance tutorials. If you wanted to go the entrepreneur route, a lot of entrepreneurial discussions, and then they also would give mentoring for specific projects that you might want to do in your specialty and much, much more. Working in the healthcare industry really brings unforeseen challenges along the way, and recognizing that seasoned physician leaders have valuable experience, knowledge, and insights, Apple, AAPL, provides direct access with senior physician experts to help younger physicians navigate the ever-changing world of healthcare and then successfully inspire positive changes working together with seasoned physicians, seasoned physician executives as mentors. Now an organization dear to my heart, the American Association for Psychiatric Administration and Leadership, of which I've been a 30-year member. So the American Association for Psychiatric Administration and Leadership, AAPAL, was established in 1961, and it was formerly known as the American Association of Psychiatric Administrators, AAPA. It is the premier educational, networking, and support resource for psychiatrists, specific to psychiatrists. You can't be a member unless you're a psychiatrist or a psychiatric resident or medical student. Those that are interested in leadership and psychiatric administration, the organization AAPAL is an affiliate organization of the APA. It promotes medical and psychiatric leadership and medical excellence in behavioral healthcare systems, including services for mental illness, substance abuse disorders, and developmental disabilities. With the ultimate aim of enhancing the effectiveness, the efficiency, and the humanity in service delivery, AAPAL seeks to promote the professional development as psychiatrists, as leaders. And members of the AAPAL, they are connected and supported through a nationwide network of new and experienced psychiatric administrators, receive training through AAPAL-sponsored lectures, workshops, and courses explicitly designed for psychiatric administrators. And there is a course coming up, Tobias, on Sunday 1 to 5, or Monday, Monday 1 to 5, you have the address? He's going to give you the address because Tobias and four of our senior people are going to be talking about key elements of psychiatric administration during this course. So at the Marriott Marquis in the Olmstead room on Monday, 1 to 5 o'clock, there will be, I think there's five of you that are giving that presentation, and these are going to, these men are going to focus, four men and one woman, these people are going to focus on obtaining psychiatric skills in leadership, and you're all more than welcome to attend. And we actually are having a reception right afterwards, a half hour later, that you're all welcome to attend. It's right around the block, essentially on 11th Avenue, Boca da Boca, yeah, so you're all welcome to attend that reception afterwards. The AAPAL promotes achievement in psychiatric administration and awareness through a variety of AAPAL-sponsored awards. It supports continuing education and reward excellence in psychiatric administration by co-sponsoring lectures and awards with the APA Committee on Psychiatric Administration and Management. You have an ability to develop skills through the AAPAL-sponsored workshops and programs annually at our meeting, as well as at the Institute of Psychiatric Services. We just mentioned the one that's going to be occurring on Monday. It allows you to be an advocate for improved mental health care delivery by addressing problematic leadership and management issues. And you benefit from the knowledge and experience of expert members and guest speakers at AAPAL events. Prior to COVID, we actually used to have a luncheon at the annual APA meeting where this award would be given and this lecture would be delivered during that particular meeting. COVID came along and we kind of changed the format, so now this is a standalone award and lecture that's given in the context of the APA annual meeting. I think I have the privilege of being the only one who's ever started the APA meeting at 8 o'clock in the morning on Saturday, so there presumably would be more people at this lecture if it was later on in the day, since many are still flying into the actual meeting. But it's a great organization, creates a real forum to discuss issues and convey matters of interest to the community regarding mental health system delivery, and it addresses issues relevant to the education of psychiatry residents and medical students in the theory and practice of administration. Plus you find lots of psychiatrists throughout the country that are associated with residency training programs. You get to meet them, you get letters of reference in terms of applying to those programs for psychiatric training, which is a great deal. So gaining progressive administration experience and a variety of responsibilities at a major medical center like Portland, Maine system certainly will give you the competence to make any kind of move, which I did in Portland, essentially moving from the Maine Medical Center to a similar facility. Now Maine Medical Center was a not-for-profit. The Jacksonbrook Institute was a for-profit medical center in South Portland where I became the associate medical director and spent two years under the tutelage of an excellent mentor. His name was Stanley Block, MD. He was a very seasoned psychoanalyst slash administrator who had acquired extraordinary business acumen over his career, and he oversaw the 110-bed psychiatric facility for adults and children while mentoring me over two years to replace him as he was nearing retirement. Now, again, sidebars throughout this session, just so you can hear what it was like in the olden days. On the weekends, the psychiatrist on call had to make rounds, and there was never an empty bed at Jacksonbrook Institute. The 110 beds were always filled with patients. As one patient was being discharged, the next patient would be arriving either in a taxi cab or in a rescue vehicle. So when I was on call for a weekend, which was Friday at 5 o'clock until Monday at 8 o'clock, I had to make rounds on 110 people Saturday and Sunday. And let me tell you, we have a Navy guy right here. Talk about precision. You know, I'd come on to the units. The nursing staff would have the entire ward of either adults or children ready to go. I don't want to say lined up because that would sound militaristic, but they were pretty regular and ready to be seen. I'd see every one of them. They'd be the ones I'd have to see first that were going out on some kind of pass for part of the day or for the weekend. And by and large, with rare exception, at the end of that two-year block of time, I had seen 110 patients on Saturday and 110 patients on Sunday for about 15 weekends. So if you ever want to complain in your residencies about having too much work, remember my story, and you'll be grateful for the two patients you admitted that day. This was a unique opportunity and turned out to be a very favorable opportunity to really develop and understand contract and labor law as I had the opportunity to both hire and unfortunately fire physicians. That's not fun, but it did require, in those days, you know, physicians, psychiatrists were not as rare as hen's teeth, so to speak. And there were some folks that just, you know, they just didn't do a good job and after several chances of making it work, they did need to be fired. So this also enabled me to grow my toolbox in administrative psychiatry with respect to contracts and labor law involving the hiring and firing of physicians. You know, the world of healthcare involves the law that encompasses a wide body of regulations that provide healthcare services and govern the relationship between healthcare providers and their patient recipients. And essentially, as a healthcare administrator, you need to understand the law in areas such as medical error liability, managed care contracting, patient rights, equal opportunity in the workplace, and a variety of other areas. But a further sidebar, and again, I'm giving you my life story, you won't probably mimic this, but when we did move, my wife and I, from Connecticut to Maine, if anyone here has kind of a feel for New England, New England can be a little bit snooty, a little bit cliquish, and Connecticut, Tobias lives in Connecticut, I lived there growing up, they had their own sort of snootiness. Anyone would win the prize par excellence for snootiness. And so, after about a year in Maine, I decided, you know, because we really weren't connecting with the community, I figured, well, a great way to connect would be to get into municipal government. Government always had an interest for me, so there was an election that was coming up for the Cape Elizabeth Council. There were going to be four open seats, and seven people were running. I was the seventh. I went out and knocked on doors, essentially, in the community, and having been in Maine for one year, I won the fourth seat. I beat out a guy, Mr. Bostwick, who had been in the community for 100 years, and it was a great opportunity because I ended up actually serving on the city council for six years. I was mayor of Cape Elizabeth from 91 to 92, and have the distinction of the first psychiatrist that ever ran a municipality in the state of Maine and the history of Maine. But during that time, I also had a tremendous experience in learning about government and how government works. The Greater Portland Council of Governments, I was a member of the General Assembly, and then, because I was a mayor of a town, the National League of Cities in Washington, D.C. tapped me to become chairman of the Human Services Steering Committee, which I did for essentially three years, and it was really kind of humorous because I was the chairman of a national steering committee in mental health and legislative leadership, representing a community of 15,000 people. My two vice chairs were Greg Leschutka, who was the mayor of Columbus, Ohio, representing a million people, and Michael White, who was the mayor of Cleveland, Ohio, at the same time, representing also about a million people. So this little guy from Cape Elizabeth, Maine, representing 15,000 people. I had my two vice chairs, both of them, representing close to two million people in the United States. So it just goes to show where psychiatry can end up. We had a lot of fun. But the interface of medical practice and public service, I think, also opens many more doors administratively, because you get to meet a lot of people and get involved in advocacy, which the APA is fabulous for advocacy. When I ran for the House of Representatives in Michigan, the APA Political Action Committee was very generous with me. They sent me a lot of money to help run my campaign, and sadly, had I won, I probably would never be here today, but I did lose with 30,000 votes being cast. I lost by 860 votes to a fellow who was essentially the chief of staff for the lieutenant governor of the state. So I don't feel too bad, but again, had I won, probably I'd never be giving this lecture, since I would've never gone to Florida. I would've stayed in Maine, probably, and tried to become the governor. The other thing that you really wanna take advantage of, even if you don't have any training, media, media presentations, both on the TV and the radio. I had a lot of opportunities, essentially, to interface with media, and these would just, everyone around the holidays is looking for someone to talk about seasonal depression. Seasonal depression. Everyone wants to know why people, during the Christmas holidays, don't all experience the Walton Christmas, where everyone is happy, everyone is smiling, they're dancing around the Christmas tree, you get the perfect present, and we know that the realities in life are that most families have incredible dysfunction. In many ways, there's someone who's suffering from mental illness or substance abuse. So you have an opportunity to really teach the general public about psychiatric care, psychiatric psychotherapy, medication intervention, and there's no better time to do that than when you're asked around the holidays. So never say no. Always say, sure, I'll be happy to go on this radio show or this TV show, whatever it is, because it's gonna connect you with more people, and as soon as you go on once, the door opens for multiple new opportunities, essentially, to educate the public. You are all educators. You've been in education all of your life. You're gonna continue to be educators, and you want, in every way, to be able to pass that on to the general public. That's what being in medicine is all about. So, as healthcare administrators, just to think about the issues that you're gonna face down the road, laws, statutes, and regulations that govern healthcare, contracts in the world of medicine, both oral and written, the corporate practice of medicine, ownership and oversight, medical malpractice, litigation, the process, the rules involved, insurance policies, carriers, claims, tail coverage, the working for a profit corporation or a not-for-profit corporation, and dealing with boards of directors, human resources people and legal considerations, important statutes that every physician should know about, voting and billing requirements, marketing strategies and mistakes one can make that can be almost irreversible, patient privacy and dealing with breaches of HIPAA, medical records, ownership and access, power of attorney, living wills and guardianships, as well as risk management, telemedicine, and informed consent. Now, at some point in time, most psychiatrists will come to the attention of physician recruiting firms, which essentially pay their bills by moving psychiatrists from one position to another for a substantial block of dollars. Today, you're gonna get a call. If you're a resident, you're gonna get a call or an email as an attending from some physician recruiting organization that is gonna essentially say, hey, Dr. So-and-so, we've got this fabulous position that only you can fill in such and such a place, and would you be willing to fly out there and take a look at this position? Now, if that recruiter succeeds in placing you in that position, he or she is gonna make about $40,000 to $50,000. That's about the going fee right now for successfully placing a physician in a new position. Well, one of these physician recruiters, Ira Cohen was his name, he convinced me to fly. Now, get this, I mean, I was living in Maine, four houses up from the Atlantic Ocean. I could work in my study over the garage on my, in those days, Nordic track machine. While I was doing my Nordic track machine, I could look out my window and watch the lobster boats pulling their plots and their pots and taking lobsters out of the Casco Bay as I was exercising that day. Picture that view to Buffalo, New York. Well, I flew to Buffalo, New York to look at the opportunity. It was a private, for-profit facility called the Breiland Hospitals. I don't know if any of you are from Buffalo. If you are, you know what they're all about. And I was ultimately recruited to become the corporate medical director and the chief operating officer. And at the same time, I became the CEO and president of the Western New York Institute for the Psychotherapies. Now, all of these administrative positions did not occur immediately. As I mentioned earlier, I had already received my master's in medical management from Tulane. And while I was in Buffalo, I also received a MBA, worked for the MBA at Medi College in Buffalo. And you might be sitting there saying, what on earth would you spend time getting two masters in management? Well, the MBA, I believe, par excellence, is the management degree that has the most positive notoriety. If your name and MD after your name has an MBA following the MD, I personally believe it's worth more than a triple M or an MPA or a variety of other master degrees because it's the language of finance. And the world of psychiatry and psychiatric administration is the world of clinical work interfacing with finance. Everyone will tell you if your institution, if your system doesn't either break even as a not-for-profit or make money as a for-profit, you're not gonna last. You're gonna close your doors. So you've really gotta be expert in delivering mental health care, substance abuse care, while at the same time, figuring out how the dollars are gonna come in and they're gonna cover your rent, your staff, your malpractice and every other thing. So essentially, your revenues are going to have to exceed expenses or you're not really gonna make it. And so I believe personally that the conversation and the pros and cons of advanced degrees are many. And I think the MBA is the degree par excellence for all of you to consider achieving. Now, MBAs can be achieved in a variety of ways. You can attain an MBA never having set foot on a campus. There are online MBAs that are available. There are executive MBAs called EMBA. Personally, I think a straight MBA has the most currency. It has the most value in terms of positions and moving up in corporate medicine in the United States. That's just one person's opinion. Most MBAs, true MBAs, you're gonna have to spend some time on the campus where the degree-granting institution is gonna have an opportunity to see you, get a feel for your skillset, that type of thing. But oftentimes, it's very abbreviated. You can take a lot of the stuff online and then show up for a week period of time here and there. Sometimes there may be a two-week block in the middle of the summer where, again, you may have to use a lot of your vacation time. But they're not impossible to obtain. I will say that going the MBA route versus other master's degrees essentially requires you to be a little bit better in math because you're gonna be essentially working on spreadsheets. You're gonna be working on accounting issues, micro and macro economics. But you wanna be able to talk with the CFO of your organization on the same plane. And as soon as you're able to do that, you obtain an incredible amount of credibility because they know you know what you're talking about. And that's a big advantage for an MD. Now, there are certain institutions, unfortunately, over the years, have decided that doctors don't know how to run organizations. And so there has been this huge middle echelon of non-physician leaders, CEOs of organizations. There are still many organizations in the United States that pride themselves on having physician, MD, or DO leadership at the very, very top. Cleveland Clinic is one of them. I happen to be on the faculty of both the University of Florida in Vero Beach, Florida. And the Cleveland Clinic took over our regional hospital, the Indian River Hospital, and now they're an affiliate of the Cleveland Clinic. I'm on their faculty also. Their folks at the top are all MDs. There are no non-MDs in the entire Cleveland Clinic system. So again, depending on where you might wanna migrate over your careers, that's another serious consideration. So again, the bottom line is any physician seeking an advanced degree with an emphasis on leadership development should consider enrolling in a master's program. Ultimately, the physician leader needs to focus on their goals and motivations to pursue an advanced management degree because they take both time and money. Now, the time is something that you're just gonna have to figure out how you're gonna allocate it. The money, some MBA programs are $100,000 at the University of Pennsylvania. I was very fortunate in terms of the owner of my hospital in Buffalo, New York, actually ended up paying most of my triple M from Tulane, and he paid all of my MBA from Medi because he knew I was such an asset to the hospital, recruiting and providing leadership to the medical staff. So that's something you can always try to negotiate that if you're gonna do a master's program somewhere, the time is something you're gonna have to squeeze out on your own, but the money is something that try to negotiate with the leadership of the hospital to see if they'll be willing to help subsidize and pay for that experience. So key reasons to seek an advanced degree include doctors are looking to develop programs and truly affect the delivery of healthcare through a high level administrative role, or you're looking for an economic impact with the potential for salary raises and a greater influence in the organization. Physicians also may wanna administer in areas outside the clinical realm and wanna increase their stature and influence with non-physicians. And you know yourself, I mean, whether you're out there in the world or you're a resident looking to get out there after your residency, today, I mean, the going rate for psychiatrists in the United States of America, the day you graduate from your residency is the next day in many areas of the country, you can start a position at $300,000 a year plus, plus some kind of bonus system. Unfortunately, the academic route is not the same as the private practice route and the ability to kind of run your own show. Most academic salaries are less than what you'd make in private practice because the institution feels that by putting their name behind your name is worth a certain amount of money. For example, and don't quote me, although this will be recorded and probably played on the screen tomorrow, but Jerry Rosenbaum, the former chairman of psychiatry at Mass General Harvard, he and I grew up together. I was a Catholic kid, he was a Jewish kid. I went to the Catholic school, he went to the Jewish school. He became famous, I went to the University of Florida. But Jerry always said to me, you know, Wayne, if you're on the Harvard faculty, you're gonna make between 60 and $80,000 less than you're gonna make anywhere else because Harvard behind your name is worth $60,000. So it's called the intangible dimension. I mean, Tobias here has Yale behind his name. I don't know what Yale considers that extra. Yeah, yeah. If it's an Ivy League institution and you can put it behind your name, you know, it really is kind of an intangible piece, but it also opens doors for you. People see that Yale Harvard and they go, whoa, this guy must know something, this gal must know something. And all of a sudden, you know, you're being recruited, you're being looked at for a leadership position. I have to tell you one last anecdote about my Buffalo residency. I had a senior healthcare administrator who had really been around the block at several healthcare institutions. Name was David Carlini, he was one of my vice presidents. Very enjoyable person to work with and I'll never forget a meeting I had with him one day when we were both struggling whether or not to hire an individual that let's just say had not a squeaky clean record. We'll just leave it at that. David looked me in the eye and he said, Wayne, no hands are better than bad hands. No hands are better than bad hands because once you hire someone and they screw up, it's a disaster in healthcare. It's usually money, it's usually attorneys and it's time consuming. So look, I'm the last guy that won't give someone a second chance or a break but when someone clearly has a history of just not making it in several scenarios, stay away. No hands are better than bad hands. Keep looking, don't settle. It won't be worth it in the long run. I'll never forget that administrative gem. It's guided me many times with regard to settling in the hiring process for a candidate who had proven incompetencies in their past and I have to tell you, as my wife often kidded me, best view of Buffalo was in our car's rear view mirror as we left the city on our next step to Grand Rapids, Michigan. There I was able to take over the medical leadership of a large 450 bed. Yes, inpatient psychiatric and substance abuse facility. We had 21 outpatient centers spanning the states of Michigan and Iowa. Having so many centers of clinical care, 22 in total, 450 beds in Cutlerville, Michigan and we had another Alden facility on the river which had 52 substance abuse beds. The importance of having on-site talented managerial staff was paramount to not only delivering excellent clinical care but meeting the bottom line of revenues exceeding expenses. Thankfully, my training in the MBA program allowed me to quickly assess financial statements at the end of the month in order to make managerial decisions about the allocation of resources in order to maintain and improve the success of the institution financially. One last thing about financial statements. Understanding the language of financial concepts and their application is really critical to the success of physician leaders. Understanding financial statements will demystify the language, they'll become your tools and ability to apply financial principles and help prepare you to apply them to the successful goals of the organization. So comprehensive financial management skills are really fundamental, and they provide a solid base of key concepts and strategies for effective financial decision-making, both in independent practice settings as well as affiliated situations with hospitals and at many times with private equity. Having spent eight years in the Grand Rapids, Michigan area also allowed me to branch out and take additional part-time medical director positions in the managed care industry, including Aurora Behavioral Health and Southfield Behavioral Health based in the suburbs of Detroit. Now these new challenges created a need to develop new skill sets in caring for the behavioral health population of patients that belong to an HMO. This is like a private club. When you belong to an HMO, you know, you got to kind of pay to get in, but once you're in, you're subject to a variety of rules. This stint in my career path allowed for the opportunity to understand and master the evolving world of managed care, as well as the unsavory task of denying payment when undocumented medical necessity was absent. You see, clinical care is never denied by an HMO, only its payment for your services. And this is a very different dimension of a physician's professional lifestyle, as the best clinical care should never be a focus of monetary decision-making, but the necessity to convince the payer system with excellent clinical documentation requires a really new world of being proficient with the requirements of a convincing medical record. So medical records, and now of course electronic medical records, it is critical that an administrative physician is comfortable with electronic health records, core purposes of collecting clinical data regarding a patient's diagnosis, their allergies, lab test results, medications, and a comfort level must be acquired to be able to process and store patient data in a way that can be easily retrieved, analyzed, and transmitted to other caregivers. For an example, when the Cleveland Clinic took over the Indian River Hospital, the Cleveland Clinic decided that the medical, the electronic medical record system that was in place was a disaster. It was not physician-friendly, it was not nursing-friendly, it was archaic, it just simply didn't work. It was hard to e-scribe, control medications. So they brought in Epic. A lot of you are probably familiar with Epic as an electronic medical record, probably the premier medical record in the United States. Cost this one hospital in Burro Beach, Florida, to bring in Epic and get rid of the old system was just over $2 million that was amortized over the last four years. So you never want to make that mistake first. You want to always go with a proven medical record that has been tried and really well-thought-out and used by folks. You get to talk to people. Do you use your EHR every day? Yeah. How do you like it? What works, what doesn't work? Get a good feel before you invest in a medical record. To effectively allow clinicians to provide quality of care, an electronic medical record should allow all providers participating in the care of a patient in different settings to quickly access new and past test results in the EHR system, as this function would include the ability to share results with other providers and the patient in order to both coordinate care and fully engage the patient in his or her care. So for example, when I use Epic for my outpatients, I can also see what's happening with their private practitioners that are using Epic by having the appropriate password to be able to get into their particular area. So I know exactly what meds they're on with everything that they're getting so that the likelihood of adverse med reactions are going to be much less when I can see what the pharmacist sees by using the Epic system. As a further measure to enhance care coordination and to ensure patient safety, as care is provided across multiple settings, the EHR should allow clinicians to enter and store orders for all prescriptions, tests, and other services, as well as the key here, it enhances legibility. It reduces duplication. It improves the speed by which orders are executed, all necessary skills for the physician in leadership positions. Last stop for this particular psychiatrist's administrative career involved two new administrative challenges. The first was assuming the executive medical director's role at the Northeast Florida State Hospital in McClenney, Florida. This is a hospital, it's a state hospital that houses 650 patients who are residing at the facility due to the court determination that they were not guilty of committing a felony by reason of insanity, NGRI. I actually, I was building a house in Gainesville, I actually lived on the facility for about eight months in the superintendent's quarters, so to speak. This was behind a 20-foot wall, barbed wire, and I used to walk my golden retriever with security because a lot of the folks had passes for the 30 acres of the state hospital, and sometimes I made decisions that they weren't favorable to, so it was always good to have security with you. You know, golden retrievers are not going to protect anybody, they'll lick them to death. But it was really a great experience because being the administrator of a forensic facility included my being able to develop an expertise in malpractice, civil commitment, confidentiality, privilege and privacy, legal ethics, the right to treatment, the right to refuse treatment, duty to warn and protect, informed consent, medical board issues, licensure, just to name a few areas of new competencies that are required when you get into the world of forensics. Now you can also do a forensic fellowship for two years and acquire some of those facilities, but you can also acquire them by the seat of your pants, and there were many administrators at Northeast Florida State Hospital, we called it NEFISH, you know, were really continuing to be my mentors, and this was about 18 years ago. And then, lastly, facilitating a startup of an outpatient center for excellence. Now I'm not aware of any textbook, including the one that Sy Syed wrote with a lot of you guys has offered, John Wakaitis is here, and Tobias, and Dr. Ruckall there, all contributed chapters to a fabulous textbook that you can purchase at this convention, I'm not trying to put a plug in, I don't get any finder's fee, but it is available in the APA bookstore, it's really the state of the art about administrative psychiatry, and when the bookstore opens you want to take a good look at it, if you see these guys around they may even give you their autographs for their chapters. So there isn't a real textbook, though, that gives you an outline regarding the opening of an outpatient psychiatric and substance abuse treatment center, starting when you're just looking outside at the shell of a building. The need to work with the building's ownership, renovation crews, state requirements for establishing a laboratory, utilizing transcranial magnetic stimulation machines, obtaining bodily specimens for drug testing, all are necessary in the successful opening and maintaining of a large outpatient psychiatric and substance abuse practice. All of this can be done successfully with collaboration with other experts, demonstrating a respect for the regulatory knowledge of others, and a little bit of humility to not come across as a know-it-all, doctors can come across as know-it-alls, and recognizing those above caveats, success can and was achieved in Vero Beach, Florida, we've had a very thriving practice for 15 years with a waiting list. So this journey takes us to this morning's bright and early lecture for the administrative psychiatry award block of this year's APA annual meeting. Having been a 30-year member of the American Association of Psychiatric Administration and Leadership has truly been a godsend in acquiring skills in all of my previous career challenges that I've addressed regarding mentorship, networking, contracts, labor law, reading financial statements, acquiring expertise in creating medical records, navigating electronical medical records, addressing forensic challenges, facilitating healthcare laws, as well as mastering the requirements of successfully managing a startup of an outpatient clinical facility. There are certainly other administrative dimensions to the life of a psychiatrist, again, read that textbook that Sai Saeed has written with all of the chapters essentially written by AAPAL members, it'll fill you in on the depth of talent required to become a successful psychiatric administrator and leader. As a last thought that I would like to address in this lecture, this is, don't forget this, it's the importance of never ever losing your clinical edge in terms of caring for patients. Whether it's consulting on difficult cases, maintaining a direct care hands-on clinic one morning a week, I believe that the success or failure as an administrator will always rest on one's ability to deliver excellent patient care while at the same time judging administrative responsibilities. Medical staffs are cleanly aware when a physician stops being a clinician and trades in his or her white coat for civilian clothing, don't make that mistake. So thank you very much for your attention this morning, I'm happy to address any comments or questions regarding my presentation. Who has a question? You can use that microphone or speak from anywhere, I think this room is loud enough so we can hear you. Anybody have a question? Please. Can I use the microphone? Sure, I hope it works. Can you hear me? All right. My name is Nahida, I'm coming from United Arab Emirates, Abu Dhabi. So I was recently appointed the chief medical officer of one of the biggest mental health network in the region, so it's the biggest when it comes to mental health from hospitals to psychiatry in integrated clinics to hubs, et cetera. I've done the same route as you, CPE, after my training, I've done a lead at SEHA which is a Harvard Business School based leadership course. I feel I'm really young into the leadership track, but what I'm finding it challenging is that there's no room for personal growth or improvement beyond here because you're so inundated, so much work, like from meetings to getting, moving things forward and managing the whole. So how do you keep up with self-improvement and growth when you're a leader? Excellent, excellent question. Everyone hear that? What happens when you're overwhelmed with stuff? By the way, just to remark, about a year ago I actually drove through all of the United Arab Emirates, all of them right from the airport to Muscat where I spent a week in Oman. We had to get out to Salalah to the frankincense forest for a day to actually scrape frankincense from the trees. So wonderful, beautiful, beautiful area. There is a wonderful article in the Harvard Business Review called Getting the Monkey Off Your Back. Look it up. It's dated somewhat, but Getting the Monkey Off Your Back, Harvard Business Review. And it's a wonderful article about how to shed stuff to other people, basically how to let others do what you're being asked to do. Because she's right, you can become overwhelmed. And if you're trying to balance your life, your leisure time, your responsibility as a spouse and a parent, as well as working as a clinician administrator, I mean you can just be so overwhelmed that the burnout system happens much earlier in life than later in life. So I mean the obvious thing is in order to give over some of those responsibilities to others, I mean you simply have to trust others' judgment. And that's where you then become their mentor. But it's a lot easier for you to mentor them than to take on the role yourself. It's like supervision. I mean you can bill essentially for your resident's work if you supervise their work, which is an advantage to you and an advantage to the resident, but you don't have to spend the double amount of time in terms of seeing the patient for the entire time that they're with you for the session that's billed. So it's the same sort of thing. Getting the Monkey Off Your Back, I think you'll pick up a lot of gems on how to job shed some of those requirements that can just cause way earlier burnout. Thank you. Other? Thank you, Wayne, for a great talk. It's clear as you've had a variety of experiences during your long career, but I noted that the last one has clearly been of the longest duration, so I'm curious what kept you in this role for your last stint, what's brought you joy or satisfaction, and maybe to reflect on as you talked a little bit about it, but maybe what led you to pursue different things at different times in your career. When I got married 47 years ago, my wife made me promise her that you would end up in Florida. So when an opportunity arose, when Dr. Goodman was chairman of the Department of Psychiatry at Florida about 20 years ago, I called him up and I said, Wayne, I said, you know, I'm kind of finishing up in Grand Rapids, my wife wants me to move to Florida, do you need a psychopharm guy? Absolutely, come on down. So he hired me to actually teach psychopharmacology at the medical school at University of Florida, and that was during the time that the Northeast Florida State Hospital in McClenney, Florida, needed a medical executive director, so they contracted me actually to run the state facility for the NGRI population for a two-year block of time. Then when the opportunity arose in Vero Beach, I was able to basically take on an endowed chair of the McKay professorship and run that system for the last 15 years. So we live, this may be the true answer, we live in a house on the island called Orchid Island where if I walk out my front door, I can surf in the Atlantic Ocean, and if I walk out my back door, I can boat up and down the intercoastal waterway out the Sebastian Inlet or the Fort Pierce Inlet for deep sea fishing. So, you know, location I think is always going to be, you know, a factor in terms of where you end up. I've been with Florida now for 20 years, it's been the longest I've ever been anywhere. I tell everyone when they say, well, you've been to five major medical centers in 45 years, why'd you move so often? I first tell them, well, I can't handle a job. But the truth is, you know, you get to a point in your life, in your career where, you know, the hospital is really humming, it's running smoothly, everything's going well. I get a little bored. It's time to kind of move on. And so I've always had new challenges along the way on the faculty of the University of Florida, whether it's been research, whether it's been teaching. Just put out my sixth book, Don't Take Away My Adderall, you can get it on Amazon, it's all about the crisis of Adderall that's basically going on in the United States right now, which I think is a crisis for the wrong reason, by the way. You know, it's a crisis, no one can get their Adderall, you can't make it fast enough. That's because 90% of the people that are on it shouldn't be on it. That's the premise of the book, Amazon 2195. So is that, I mean, that's really a fair response, I think, to your question. Although having said that, I've enjoyed everywhere I've been. I mean, I really, you know, seriously, I would never look back and say I wish I had not gone there. Just been, it's been a piece, it's been another chapter of my life, and I've enjoyed all of it immensely. There's a question back there, maybe? All right, well, listen, we've satisfied the requirements, go off, heal the world, become great administrators, and thank you for coming.

Administrative Psychiatry Award

Dr. Wayne Creelman

psychiatric administration

psychopharmacology consultation

leadership roles

MBA

mentorship

networking

healthcare laws

electronic health records

patient care