Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Prescription for Business: Medical Mindsets in Corporate America
Dr. Mary Mason takes us on her remarkable journey from practicing physician to Chief Medical Officer of Centene Corporation in this illuminating conversation about the intersection of medicine and business leadership.
What happens when a physician's analytical mindset meets the corporate boardroom? Dr. Mason discovered her interest in healthcare administration during medical school, choosing to pursue an MBA while maintaining her clinical practice. This dual approach defined her career trajectory as she moved from managing complex cases for 86,000 patients to overseeing Centene's explosive growth from 800,000 to 24 million patients.
Throughout our discussion, Dr. Mason articulates the fundamental differences between medical and business decision-making cultures. Where medicine has clear hierarchies and protocols, business environments often feature ambiguous authority structures and group decision processes that can bewilder clinicians. Yet physicians bring invaluable perspectives to corporate settings - a calm, solution-focused approach captured in her memorable phrase: "Look, nobody died, okay? We can fix this."
The conversation pivots to healthcare's pressing challenges, including the corporate employment of physicians (now 75%), creating scenarios where business executives without clinical backgrounds make decisions affecting patient care. Additional concerns include hospital financial struggles, the technological complexity of modern healthcare, and the worrying trend of physician burnout leading to early retirement.
Dr. Mason's insights crystallize in her book "Think Like a Doctor, Lead Like a CEO," which encourages physicians to recognize their transferable leadership skills while helping business executives understand the value of clinical thinking in corporate environments. Her journey demonstrates how medical training provides an exceptional foundation for leadership roles where clear thinking and decisive action matter most.
Want to discover how clinical thinking can transform business leadership? Dr. Mason's book "Think Like a Doctor, Lead Like a CEO" is available now on Amazon and Barnes & Noble's website.
Welcome to Doc Discussions. I'm Dr Jason Edwards and this is the world's best medical podcast where we have discussions with physicians to discover who they are and what they do. I'm joined today by a true renaissance woman. She's an engineer, a physician, businesswoman, community leader, teacher, wife of my friend Dr John Mason, mother of three children and an author of a new book entitled Think Like a Doctor and Lead Like a CEO. Welcome, dr Mary Mason.
Speaker 2:Happy to be here.
Speaker 1:Mary, let's start off with your background. Can you tell me about your journey from being a medical professional to becoming a chief medical officer of Centene?
Speaker 2:Yes. So when I went to med school I kind of caught the bug of a student government and I was introduced to it in college and when I got to Washington University got very involved with the leadership of American Medical Association for medical students really started to get involved with policy and even did six, eight weeks in Washington DC with Senator Danforth, really focusing on health policy and especially about trying to recruit people to primary care. So after that I came back, started my internal medicine residency at Barnes Jewish and I was starting to realize that when I was looking around there was so many I was almost. I loved medicine but I was almost more interested in some of the business cases and how to make care more efficient and higher quality and more cost effective.
Speaker 2:And I was offered a chief year internal medicine but you were supposed to take off a year before you started your chief year to give a little distance from the residents. So I was thinking of doing a nephrology fellowship and I was kind of playing around with that and then I said you know what I'm going to go do my MBA. And so started my MBA and did that for a year and did hospitalists at night. And then when I did my chief year, I flipped and finished my MBA at night and ended up graduating. And I was doing my grand rounds for internal medicine as part of my chief year and I had Dr Jim Crane, who was the executive vice chancellor for the medical group, came to me and said how would you like to work in managed care? And that was my first managed care job.
Speaker 1:And so you worked for Washington University.
Speaker 2:I did. My first job was between WashU Physician Network and Health Management Partners and I was still practicing two days a week and then I would do the business side three days a week and that was really about complex case management in a managed service organization. Bjc and Coventry had a group of 86,000 patients at risk and we were using some of the early algorithms for case management and complex you know that complex case management, that you know those high utilizers of care, and it was really, it was really interesting, you know, you know, trying to take that internal medicine knowledge and apply it in that business sense. But it ended up the whole experiment ended up blowing up in arbitration two years into it, which is not great for your first job. But Coventry then came to me and said how would you like to be the chief medical director for our largest Medicaid plan, which happened to be in downtown St Louis?
Speaker 2:And so that's how I got into managed Medicaid.
Speaker 1:And then, how long did you do that before you started working with Centene?
Speaker 2:So I was five years I was working on we had, oh gosh, about 180,000 patients and a lot of pregnancy asthma really started to learn the nuts and bolts of managed Medicaid plasma really started to learn the nuts and bolts of managed Medicaid. And I happened to run into one of my old attendings from WashU who worked for Michael Neidorf, the CEO for Centene, and next thing I know I was in Michael's office and he wouldn't take no for an answer. That's how it works. So I started there January of 2006.
Speaker 1:And really since that time, I mean, they've had a meteoric rise. Yes and the company has grown dramatically.
Speaker 2:When I started, we had about 800,000 patients. When I left Centene in July of 2022, we had 24 million patients.
Speaker 1:That's incredible.
Speaker 2:It was unbelievable the growth, but the mission was so strong and the initial strategic plan that Michael drew up that it really allowed us to grow and to keep to our core values.
Speaker 1:Yeah, now what problems did you experience or kind of unique situations did you come across at your time at Cent?
Speaker 2:and I'm going to step back and say people always tell physicians they're not good at business, which I, you know, it's kind of the old joke, but I think many physicians really, when you start to talk business, they kind of cringe. And I even found that, you know, even though you know I had a mathematics background from undergrad, I had an MBA sometimes I felt like when people saw the MD, they're like, oh, do you need help reading this financial statement? Or you know, and I'm like, I think, it's like, I think I got it, but you know, thanks for asking. But you know, I think that it's, you know, so much of being a physician is being accountable for your patients and you know who's in charge. It's like when you're you know, like when my husband goes in the operating room, he's the king. He knows, you know he's the one who's the buck stops here yeah the clear hierarchy.
Speaker 2:Yeah, absolutely. Whereas with business it is very interesting because it's almost gets to be this group thing sometimes and you go into a room and there's 20 people sitting at the table and a lot, and then you're trying to figure out well, why is this person here and what is this person's role? And sometimes you find out that people got invited because someone didn't want to hurt their feelings and and so then you all of a sudden get to this point where you're not even sure who's in charge and who's making the decision yeah and I think that was one of the.
Speaker 2:Really that was what I thought was very hard in the beginning. Um, and because you know the other thing, over the years I always kept my practice. Um, you know, I did actually, especially when I got into centene, start either teaching with the residents down at wasU and the residency clinic or at Casa de Salud or another you know volunteer offices. But it was always kind of funny switching back and forth, because I like being in charge of my internal medicine patients, I mean. But then to have to come in and say, ok, who do I have to talk to? You know, if I'm going to do this, who do I have to talk to? You know, if I'm going to do this, who else do I need to get their approval from? And that's what I think is always very was very hard in the business world and still is.
Speaker 1:So I mean, to me that sounds like there's less BS in medicine than there is in business, but maybe that's me paraphrasing in medicine than there is in business, but maybe that's me paraphrasing.
Speaker 2:No well, I do think you know to its core in medicine. When you think about how you approach a patient one. You have a fund of knowledge and you know. If I'm an internist and I'm board certified, you know what my skill set is. Now, if I have somebody in marketing or in operations at a business, I don't necessarily know what their skill set is. You're not board certified in marketing or in supply chain.
Speaker 2:So, I think that's one thing. And then in medicine we tend to be we go by the data. I mean, think about when you run a code, you're watching the monitor, you're looking at the vitals, you're, you know, getting all that information in order to make the decision, whereas business that doesn't always happen.
Speaker 1:And I guess in business too, you may face some more unique situations. I mean medicine. You face unique situations a lot. But it's kind of within a like a semi rigid framework.
Speaker 2:So, yeah.
Speaker 1:So the path forward is you know either this or that and you're making a judgment call, whereas in business you may have more options.
Speaker 2:You may, absolutely. But I also think too, with you know, and I know my business team I think I was always, you know, I got quoted quite a bit. It's always like look, nobody died, okay, so something happens, okay, we can fix this. You know bit it's always like look, nobody died, okay, so something happens, okay, we can fix this. You know it's like, and don't panic, let's not start pointing fingers at everybody.
Speaker 2:let's figure out what we need to do to right the ship and figure out how to correct this yeah and whereas you know that's, I think, your doctor coming through it's like okay, let's just cut through it, let's not get emotional.
Speaker 1:Yeah, be as objective as possible.
Speaker 2:And I think that sometimes you know you don't want a stereotype but I think and it depends there's some business cultures that are fantastic and you know you see all sorts of different organizations in business, but it does feel like that. With medicine it's much more. Let's cut to the chase and let's let's do what's right by the patient and let's fix it, and we'll worry about who's to blame and whose fault and what we could have done differently. Yeah after we fix the acute problem.
Speaker 1:Yeah, sure, and so the.
Speaker 1:so you kind of you took this jump from medicine, but you still continued your practice which is I think, a very smart thing to do worked with Centene, had this kind of meteoric rise with the company and saw a huge growth, and then you decided to write a book, and I think To me that's art. There's different types of art, but it takes a lot of courage to do something like that, because you risk being exposed as a fool. You don't know how it will be accepted, and so I think that's one of the main challenges in creating something is you have to say, okay, I'm going to take that risk, I'm going to write this and people may look at it and say it's great, but they may look at it and say it's less than great.
Speaker 2:And did you have any of those fears or not, really, I think over the years I kind of had that running book of running list of lessons and it was funny because along the way I had a lot of people tell me you should write this down, you really should get this out here. And in fact I, you know, I was always adjunct teaching between WashU at the School of Business and between the Social Work School and now the law school. So you know I had people say you should make a course out of this, because it's usually the opposite way it's how can doctors learn from the business world how to be that business?
Speaker 2:that position, executive, whereas I kind of thought it was more interesting to go the other way. But I also think, while I'm hoping in all of this, these lessons, you know, can be very useful for people in business to kind of see how a doctor thinks I'm also kind of hoping, on the flip side, that physicians and other clinicians see that you know, I'm actually better at, I have more skills and to be better at business than I actually think I am and give them that confidence to be able to make the decisions that you know. Clinicians are faced with more and more business decisions every day, and so I think that's also very important for clinicians to be confident in their skill set.
Speaker 1:Yeah, you know the. You know you're talking about. You know whether businessmen understand, you know the medical way of thinking or where physicians understand the business way.
Speaker 1:I think actually it was not my idea. Charlie Munger talked about this, but he talked about forming a lattice, having kind of multiple fields of you know some, maybe not expertise, but some knowledge, whether it's physics or mathematics or psychology, and you find out that, if you can, you know the more of those fields you can line up, the more accurate and objectively you can judge something and make decisions. And you kind of reach this Lollapalooza where you have some synergy and I think it helps you be better at whatever you're doing to have some understanding of multiple different disciplines yes, absolutely.
Speaker 1:To have some understanding of multiple different disciplines yes, absolutely so. In your opinion, what are the most pressing challenges facing health care today, or the health care industry today? I know that's a big question.
Speaker 2:How long do we have, I think, the dramatic change that we've seen, and it's you know, it's been gradual over the last couple decades, but I think, physicians being employed and when you've gone to an industry where physicians were independent, they were running their own practices and just because of the complexity of managed care and payers and all the paperwork and documentation and quality you name it that comes with it and now the need for economy of scale in order to support a practice, doctors have found that they really do need to be part of a larger organization, and I believe that one of the studies I was looking at recently was quoting that 75% of physicians are now employed by a corporate entity, a hospital or another health care organization.
Speaker 2:And when that happens, you have business executives often making decisions about what products to use, what processes to use, and the physicians almost become, you know, making the widgets in the background. They're the ones who are really doing the. They're focusing on taking care of patients and not necessarily involved with vetting all the clinical products and all the different processes that affect patient care. And you know, there's some business executives, I think, who are fantastic, who are able to, you know, bring in that expertise and know when to ask the questions. But you also, you know, often see business executives who don't understand the complexities of seeing patients and don't really understand that front lines of where doctors are seeing patients, and they can miss a step, and so that worries me a lot.
Speaker 1:Yeah, I mean. In many senses a hospital is a business, but it's not the same as other businesses in the sense that you can't just focus on profits. Like a lot of businesses, you have to take care of the patients too.
Speaker 1:You have to do what's right and many times that involves losing money and you still do the right thing. And you know in the long termterm scheme a hospital has to do that if they want to stay in business is to take good care of patients. But you know plenty of hospitals over the last you know five years have lost a lot of money.
Speaker 1:Yes, and I think you know that's another challenge. You know of trying to figure out how to pay people and kind of keep the doors open, especially for smaller hospitals and plenty of which I think have shut down.
Speaker 2:Right, and then also it's gotten to a point where you look at the complexity of medicine. You really do need IT dashboards. You need so much data to be able to make thoughtful and strategic decisions, and, especially if you're a smaller hospital or if you're a smaller physician group or you're a solo practice doctor, you don't have that type of information, and so IT solutions can be very expensive, but they can also be very helpful with understanding your revenue cycle and understanding gap closure and how to maximize quality bonuses and value-based contracting and keeping track of the 30 different managed care contracts you may have. So you know, that's, I think, the one of the other big issues that you know we're seeing it now, especially with AI now coming in, you know, with all these artificial intelligence driven technologies is that once again, we're adding all this complexity and it's but, but because the system has gotten so you know, so many people are involved in so many regulations and oversight that you almost have to have that IT support in order to be successful.
Speaker 1:Yeah, it makes it hard for those small guys and I don't know I think the term may be regulatory capture, but where you know only the bigger systems kind of survive, and it seems like the amount of private practice groups will only continue to dwindle and hospitals will likely continue to merge, and to a point where you have, you know, several huge systems is one theory.
Speaker 2:And that kind of leads into. You know, one of the other areas of concern for me is to this physician burnout and because doctors feel that they aren't necessarily a part of of all the decisions and they're not always now in control of their destiny you know, they're just supposed to be doing. This is what you're supposed to do, because this is what my employer told me to do. Yeah, it's. I think we are seeing early retirement of fabulous physicians and not enough physicians coming through the pipeline, especially in primary care.
Speaker 1:Yeah, sure.
Speaker 2:To to replace that. So that's something I think, as an industry, we really need to address head on.
Speaker 1:Yeah, it seems like manpower in many ways is going to be an issue and hopefully AI can kind of help with that to some degree, Hopefully as long as that opens up another can of worms. It's not like the advent of computers in hospitals it just led to more employees, because you need people to take care of the computers, so I guess we'll see which way that goes.
Speaker 1:I want to know about you personally Are there any things that you do for your own personal health I'd like to talk about? I think doctors are great at diagnosing disease and stuff like that, but I think it's important to also just talk about health, like staying in good shape as far as like exercise or diet or stretching. Are there any specific things that you say hey, this has really helped me a lot personally?
Speaker 2:Yeah, we, uh. I think one of the things my um husband who we mentioned earlier, who's been on this podcast decided when we got married 30 years ago was you know, each of us, each week, we decide, you know, we make sure we each get our time to work out and schedule it together.
Speaker 1:You know.
Speaker 2:I think that is critical, and especially as we get older. You know, making sure it's not just. You know I love to spin. In fact, when I used to travel, I used to pick my hotel sometimes by what was closest to a soul cycle.
Speaker 2:You know, because if I wanted to get that 6am spin in so I could work all day and just, you know, get out, you know just really and it really helped me to focus. But you know weight now, weight training I think is critical and you know just moderation, you know it's, you know just trying to figure out how to to balance. You know, you know eating healthy but you know it's okay to to, you know you have to, you know you want to go to the ballpark and have, you know your burger and fries.
Speaker 1:That's okay too.
Speaker 2:And we try to, you know, really teach that to our kids as well. It's it's really about balance. It's work hard but also, you know, have time to enjoy and really take back and find that stress out. You know, way to de-stress because, you're right, medicine is a very stressful career and it's you have to have ways to to balance that because you don't want to take, you don't want to take that stress to the workplace with you, because that, just that, never goes well for anybody.
Speaker 1:Yeah, you know, when I first started working here, I realized that, you know, energy was an issue for me personally. I said I need to do some things to make sure my energy level is higher and you can't do things you know it's the basics, everybody knows them.
Speaker 2:Well, and I, you know of course we have, because our youngest loves dogs and pets. We've got two dogs and a cat now. But I will tell you, I used to always tell my patients walking is one of the best exercises you can do. But I got to tell you when you can do that evening, like walk after dinner or early in the morning, to get that in, that makes such a difference in your day. And even if it's just, you know, 20 minute walk, just getting outside walking the dog, it just there's something I think that is very therapeutic about it.
Speaker 1:A hundred percent. It's meditative. There's research looking into like what the light does to your retina and seeing things kind of pass at a certain pace and how good that is for your mind to kind of center you for the day. But I think walking is really good for your mental health.
Speaker 1:I agree, I think it's like okay for the body, but the mental health is huge and so it's a really important thing to do. And then, yeah, as we get older, as far as bone density and muscle mass, those really start to go and so it's important to do the weight training and stay on top of that. And then my last question for you I, I I'm making an assumption that you may read a lot. I try to yes.
Speaker 2:Are there interesting, any interesting books that?
Speaker 1:you've read a lot.
Speaker 2:I try to yes.
Speaker 1:Are there any interesting books that you've read in the past few years that you'd recommend?
Speaker 2:Oh gosh. Well, one of our favorites in our house is Boys in the Boat. Okay, I actually was rooked into rowing in Head of the hooch in chattanooga in a mixed double and, uh, probably the most terrifying experience of my life, but um, but you know it was. It was um, I learned that I didn't like rowing. So no, but it's no, I think. I think that's a. I really love those type of stories of that, those you know, you know, you know. Granted, the movie maybe took a little liberty.
Speaker 2:But you know just that, you know that human experience and really hearing the struggles and and how people overcome to succeed and to really, you know, become a better person. I love stories like that.
Speaker 1:Yeah, it's the story of life, I think.
Speaker 2:I have to say, the other thing I've been really enjoying recently is masterclass. Okay sure Our oldest daughter gave us a subscription to the family for the holidays.
Speaker 2:And I have to say I I've been listening to it when I, if I go work out or swim and I really enjoy it I mean there's so many great. I mean not only just you know there's the business and finance, but just even how to you know work your way through a wine list at a restaurant, or just you know decorating tips, whatever. Yeah, there's just, it's a lot. I really enjoy it.
Speaker 1:Did you listen to the Howard Schultz one?
Speaker 2:I have not yet.
Speaker 1:I thought that was that and the Bob Iger one. No, I have a whole list I'm dying to get to.
Speaker 2:Yeah, you'll never get, yeah, but I think it's the one thing when you're busy, I think, trying to use time wisely, and I think that's a you know, I know you know books on tape, but you know podcasts, but but I think too that I mean the masterclass, when, even where it's come in, I mean five years, it's pretty amazing.
Speaker 1:Yeah. Yeah, I think I let my subscription cancel, but I thought it was really good.
Speaker 2:I remember when it first started. It was just a few on there and I was really pleasantly surprised when I started browsing through it a couple months ago.
Speaker 1:Yeah, it's excellent. Well, Mary, thank you so much for your insights and experience with us today. For our listeners who want to learn more, Dr Mason's book is Think Like a Doctor, Lead Like a CEO. It's on Amazon. I checked last night. It had all five star reviews, which is not surprising, and then I assume is available at bookstores bookstores.
Speaker 2:Yes, we're on barnesandnoblecom. It's mainly on the websites right now, but we're working through all of that. I was really excited. It was the first week it came out. It was number one new release on Amazon for quality management.
Speaker 1:Very cool.
Speaker 2:And communications and business.
Speaker 1:Yeah, that's exciting.
Speaker 2:Yeah, it was fun.
Speaker 1:Thanks so much for joining us. Thank you.