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Transcriber: Viviane P. Reviewer: Peter van de Ven I have a confession to make. For years now, I've had this deep, dark secret - my whole life, really - that I've never told anybody. But here and now, I think I'm ready to tell the world. So here goes: My confession is that I am a millennial. I know, it's terrible. That's the worst. What was I thinking when I decided to become a millennial, right? (Laughter) I feel better already just having told you guys that. You know, millennials were a cohort of people born from the early or middle 1980s up until about the early 2000s, but that definition is pretty much the only thing that's agreed upon for our generation. Nevertheless, you guys have probably heard a lot of negative thoughts and stereotypes about us. You might have heard we're narcissistic or entitled, that we're lazy and unfocused,
that we're addicted to our telephones and obsessed with Instagram filters. Now, some of that may be true, but you don't really hear about the positives too much. As we all know, stereotypes don't tell a whole story about a person, let alone a whole generation of millions. So, that being said, allow me to actually introduce myself formally. My name is Dr. Daniel Wozniczka. My patients just call me Dr. Dan. That's what happens when you have a hard-to-pronounce Polish last name. I'm 29 years old, and in a few days, I'll be finishing my internal medicine residency. I'm also finishing two master's degrees, one in business, my MBA, and one in public health, my MPH. I'm also a medical researcher. I've published in some peer-reviewed journals. And outside of medicine, I do a little bit as an entrepreneur. I'm either the founder or expert advisor for a couple different healthcare start-ups. Last but not least, I've worked as a congressional lobbyist, which is pretty much exactly what you think it is,
on behalf of ACP, the American College of Physicians. They've sent me down to Washington, DC, and I've chatted with congressmen or senators about different healthcare issues. I bring all this up because some of what I'm doing, it really brings to light the positives of our generation as a whole. For example, the millennials are the most educated generation we've ever had in America. We're also the most diverse that this nation's ever seen. Unsurprisingly, we're the most tech-savvy, also. But there's one particular positive attribute that no one really talks about. It pertains to the workforce. You can ask millennials a very simple question: "What do you want to accomplish in your career?" They'll give you an answer that may seem simple, but it's profound. They'll all tell you how they want to make an impact. They want to change the world, they want to innovate. And what a beautiful mentality that is when you start your career. So as we go forward, this impact will drive forward the millennials.
People always ask me, "What's it like to be a doctor?" I always give them the same exact answer: I love medicine! Couldn't do anything else. I was that guy in kindergarten who knew he was going to be a doctor. I want to tell you guys a story about why I love medicine so much. A few weeks ago, a patient comes into my hospital, really sick. He's got an infection in both of his lungs. That infection has spread to his bloodstream, so he's sick all over. He has something called septic shock. His breathing is so bad that the only way he can get oxygen is if we put a tube down his mouth, through his throat, into his lungs so a machine can breathe for him. His blood pressure starts to plummet. A healthy blood pressure is like 120/80; this guy is 50/30 and dropping further. I have to put a medicine called a vasopressor to bring his pressure back up. For that, I've got to put a catheter into his jugular vein,
push it further into his subclavian and even further towards the edge of his heart. Doesn't work that well, though; his pressure keeps on dropping. Before my very eyes, his heart stops beating. He passes away. We don't stop, though. One of my nurses literally jumps on top of the guy and starts pressing onto his chest. We get a crash cart, we take these two paddles, charge them up to 600 volts of electricity, put it on his chest, and just like you see on television, we shock him. It works. His heart starts to beat again. We literally brought him back from the dead. A few weeks after that, this same guy? His youngest daughter is getting married, and he's able to walk her down the aisle on her wedding day. I love medicine for things like that. I've only been a doctor for three years, but I've got hundreds of those stories already. But even though I love medicine, I don't really love my job.
I know that sounds like a contradiction, but it's not. No one really talks about what really goes into the day-to-day work of a doctor and how much of it has absolutely nothing to do with medicine. For example, I spend hours a day, any given day, filling out paperwork and forms. For every hour I'll take care of a patient, I'll spend two hours filling out forms. The reason for that is pretty simple: those forms get submitted to an insurance company, and it's based on those forms that the insurance company will reimburse the hospital, will pay them. And it doesn't really matter how great of a job you did on that patient; if that form isn't filled out meticulously, with all the details needed, the hospital gets reimbursed less, if at all. Hours of my day on forms. But then there's that last part of my job that's probably the worst. After I've diagnosed my patient, after I treat them, then I have to navigate insurance companies
to make sure that my patients get the medicine they need. As we all know, patients that can't afford their medicine, that's a patient that's not going to take his medicine. It breaks my heart, guys. I've got patients coming to me in the hospital for a second, third, fourth, fifth, sixth time for the same exact thing simply because they can't get their pills. And it's not just pills, too; I have to spend hours figuring out which surgeon I can send my patient to, or which dialysis center, which nursing home. Hours of my day. That's what it's really like to be a doctor these days, guys. On the national level, things get even more complicated, though. All these slides we're about to see are from the Kaiser Family Foundation. The amount that we as a nation pay per GDP for all healthcare is astronomical, higher than any other country. And what we get from it, not only is it not better, it's sometimes worse. You might be saying to yourself that this has always been this way, right? That's the American system. No, not really.
Because, you see, as late as the 1980s, what we were paying was on par with Canada, with the UK, with Europe. It's only recently that these man-made systems have changed it. The future, sadly, as you can see here - even more bleak. In the decades to come, what our nation will pay for Medicare expenditures is going to skyrocket. It could virtually bankrupt the entire nation. Now, all of these things, all of these pressures, both on the day-to-day, personal-level doctor as well as on the national, they make things more stressful for doctors in a job that's already stressful - you're literally doing life-and-death decisions. So these new pressures, whether it be new quality metrics or doctors being told to see more patients in less time, spending more time to fill out forms - surgeons are being told, "Hey buddy, you've got to hurry up those operations, squeeze in a few more cases." All these things come at a cost, and I don't mean financial.
Right now, we have an epidemic of physicians committing suicide. Every single year in America, we lose between 300 to 400 doctors who take their own life. That's a doctor a day, on average. That's an entire graduating medical school class gone, every year. No one talks about this, though. Who's most at risk? It's the female doctor. A female doctor is 2.3 times more likely to commit suicide than a female in the general population. That's medicine these days, guys. There was a great, great study published in Medscape in 2012. They asked 24,000 doctors a simple question: "If you could go back in time and change careers, knowing then what you know now, would you still choose medicine? Or would you do something else?" You guys know the results?
Fifty-four percent of doctors said they would stick with medicine. Half of us either can't or don't want to do this anymore. That's the sad truth that no one talks about. So, where do we go from here? What are the millennials, what's a 29-year-old doctor in Chicago, just starting out, going to do? The answer I have for you is both incredibly simple and very complex. We fight the system. We fight the system for ourselves, for our families, for our patients, for the generations yet to come. And I want to tell you guys exactly how we're going to be doing this. We here in this room, we probably wouldn't think of a hospital as a business, right? Well, rest assured, in our capitalistic society, there's a lot of people who do just that. Every business needs a boss, needs a CEO. What would you guys think of a basketball coach that never took a jump shot in his life? What about a principal that never taught a classroom? What about an automobile CEO that doesn't know how to drive a car?
I mean, I'd have low expectations for all of these people, right? But that's what we've been doing for decades. The people who are running our hospitals know nothing about medicine. They run it as an old-fashioned business, looking at Excel spreadsheets, maximizing profits. There was a study that compared this, published in the journal Social Science & Medicine, 2011. They compared all the hospitals that were run by a normal businessman as opposed to the couple that were actually run by doctors who had some business training. The hospitals that were run by doctors, in almost every single quality metric we had, whether it be cost of care, medical errors, length of stay, what have you, in almost all the metrics, they outperformed the other hospital by 25 percent or more. Shocking, right? No, not really, but that's what we've been doing for decades. On the national level, it gets even worse. The people writing our healthcare laws, our policy, they're not doctors either. We've got 435 people in the House of Representatives,
and we've got 100 in the Senate. 535 total. Would you believe me if I told you that only 3% of our elected officials are doctors or scientists? But these are the people making our laws, despite the fact that we know how contentious a thing healthcare is, the past few decades. That impact that I mentioned the millennials making, that aspiration to change the world? It's not going to be coming with medicine itself. It's going to be coming in the system that we have. Right now, we have the revolution of the business-trained doctor, the rise of the MD/MBA. Fifteen years ago, we had 30 medical schools who offered a joint MD/MBA degree. Nowadays? It's doubled to 65. The reason is obvious: medical schools know that we don't have to just train new soldiers to be in the trenches; we have to train brand-new generals.
Going forward, that impact the millennials will be making will be to take over hospital administration, to run hospitals, to go into medical entrepreneurship, to go into politics and make laws that actually make sense for our country and don't bankrupt us. That is how the upcoming generation of doctors will change healthcare. They'll be saving lives and saving healthcare itself. I want to end by talking to some of the younger millennials directly because yeah, I'm a millennial, I'm 29, but I'm on the older side. And, you know, I'm finishing residency in a few days and I'm finishing my MBA and my MPH. A lot of the millennials that might be watching this, they're probably 18, 19, 20 still. And if you're that young and you want to be a doctor, you've still got a lot of years of training and education ahead of you. Four years of college, four years of medical school, and at least three years of residency. I want to speak directly to you for a second. Because you're going to hear the older generation tell you,
"Medicine's not worth it. Don't become a doctor. Medicine's changed, guys." You're going to hear that. I'm here to tell you the opposite. Medicine is freaking awesome, alright? Nobody has a better gig than the guy who devotes his life to saving the life of his fellow man, I promise you. I don't care if you're climbing to the top of mountains or diving to the bottom of the ocean, I don't care if you're a rockstar selling out concerts coast to coast. I don't even care if you're an astronaut going to outer space. Nobody has a better job than the person devoted to saving lives. We need young, talented, inspired, creative minds to come into medicine, not to be dissuaded away from it. And what a beautiful time it is to come in, because we will be that generation that changes it, that improves the system. The problems we have in medicine are not intrinsic to patient care; they're man-made systems from past generations. Don't let anyone dissuade you away from your dream of becoming a doctor.
I want to end with this quote. This is a quote that's inspired me through a lot of all-nighters in med school. It's inspired me through a lot of 24-hour shifts in my residency, and I hope it'll continue to inspire me as I strive to make that impact that my generation so hopes to make. The quote is this: "Those of us that are crazy enough to think we can change the world, we're the only ones that stand a chance of actually doing it." Thanks so much, guys. (Applause)
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