Q&A with Stephen Toadvine, MD President of Baptist Health Medical Group

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LOUISVILLE Stephen Toadvine, MD, was named president of Baptist Health Medical Group, effective April 4, 2016.

As a longtime Baptist Health family medicine physician and leader, Toadvine has served as chief medical officer for Baptist Health Lexington, chief medical officer and vice president for Hardin Memorial Health, and chief medical officer for Baptist Health Corbin.

MD-UPDATE Editor-in-Chief Jennifer Newton sat down with Toadvine to learn more about him and his plans for the future.

MD-UPDATE: What led you to specialize in family medicine?

TOADVINE: While in medical school at Northwestern in Chicago, for me it was family practice that offered general breadth of knowledge, with a demand to have some expertise in all the disciplines at a broad level. I was also attracted to continuity of care and longer-term relationships with patients across all spectrums of ages, so it appealed to me very much.

The other influence on me was the physicians my family and I had when I was growing up in Florence, Ky. It was the group of Booth, Baird and Poore. They were tremendous examples of the ideal primary care doctor.

How long did you practice family medicine?

Sixteen years altogether. The first few years of that were in Barbourville, Ky. It was really perfect for what I wanted to do. My partners had come from out-of-state with a strong sense of service for an area of high need and also an area that needed the skills that we had. We did lots of obstetrics, including needing to do our own C-sections and epidurals, and care for the infants, including some very critical premature neonates. We did general medicine, critical care, and rounded in the area nursing homes. The practice really matched the interests I had when I had decided during medical school to pursue family practice.

When did you first become involved in healthcare administration?

I had practiced for three years in Barbourville and then I went to Pittsburgh to do a fellowship in academic family medicine. After that fellowship, I went to Chicago and joined a hospital-owned practice and then began teaching in a residency program. I would describe that as administrative, as I was the associate program director for a family practice residency that we founded and opened at Rush-Copley Hospital in Aurora, Ill., which was affiliated with Rush University Medical School.

I returned to Corbin in 1999 to help open a rural track residency in conjunction with UK at Baptist Health in Corbin. That’s why I left Chicago and returned to Kentucky. We ran that for a few years, but for various reasons decided to close the program. I returned to full-time practice, and we had a total of 10 physicians at the time. My transition to full-time administrative work came in the fall of 2006, when John Henson, the hospital’s CEO, asked me to assume the chief medical officer position at Baptist Health Corbin.

What led you to pursue roles in physician leadership?

I really enjoy direct patient care, and it’s really impossible to beat that in terms of professional satisfaction. But I also had interest in broader issues in healthcare, and in system and policy issues, and I think that interest was what led me to do the fellowship in Pittsburgh, which was in association with a master’s in public health. While I was practicing in Barbourville and Corbin, I was quite active on medical staff committees, and due to that, I believe, I was asked to take the CMO job. I struggled with that decision, but the CMO who was retiring, Dr. Ross Halbleib, was very encouraging to me. He didn’t see the transition as a move out of the practice of clinical medicine, but really a continuation of it, still carrying out the function, the philosophy, and the ideals of a physician, just in a different role.

I went into the CMO position on a trial basis, but what happened quickly was that I began learning so many new things in terms of developments in national healthcare policy, expectations on hospitals and providers from various governmental agencies, and the mechanics of healthcare funding and reimbursement. The new position challenged me with continual learning, which was fun and exciting, and still continues.

What achievements would you like to highlight from your most recent role as CMO for baptist Health?

I think we’ve made really good progress in bringing the doctors together around the state, beginning to work system-wide in terms of advances in clinical policies and care delivery. I think we have made a lot of progress as well in what we need to do in becoming a physician-led organization. By that I mean, not any one physician in particular as a leader, but the physicians as an entire group, where our nearly 500 doctors, as partners, help drive strategy for our health system. We have much work to do, but over the last year we’ve made a lot of progress.

What’s happened in Kentucky, if you go back 15 years where most doctors were in a private practice setting, the physicians were clearly customers of the hospitals and health systems. That’s shifted now that we have 500 doctors in an “employment” arrangement. In my view, they have ceased being customers of the health system and are now co-owners and partners in the health system. Functionally, the medical group physicians are really key in driving Baptist Health.

What challenges or opportunities do you see as you take on this new role?

The challenges for all of us, especially physicians in healthcare, are to continually be advancing what we’ve been doing, which is delivering care that’s safe, effective, and as cost efficient as possible, with great outcomes, delivering a great patient experience, all while adapting to new technologies that are emerging incredibly rapidly, from diagnostic capabilities to genetic testing to telehealth, and in light of rapidly changing reimbursement models.

What are your main goals as president?

We want to continue to grow. We want to improve patient access. We want to meet patient demand. We want to continue to promote physician leadership across the system. What we really need to work on in terms of safety in all our practices and hospitals is information management and closing any and all open loops in that. Second, is a striving for perfection and speed in diagnostic accuracy. And third is to pay meticulous attention to appropriate utilization and medical necessity.

What’s your take on the family practice shortage and what can be done about it?

We need to keep painting the vision of what can be accomplished through primary care to improve the health of our communities, and the professional meaningfulness and satisfaction that comes through that. Second, is to still be looking at models of appropriate compensation for primary care doctors. Third, is to look for new models to make primary care more effective and efficient, such as the use of telemedicine. A large percentage of primary care visits could be done through telehealth application, more efficiently, quickly, with good results and good patient satisfaction. The other is the use of nurse practitioners and physician assistants more appropriately. We’re recruiting primary care everywhere across Baptist Health.

What else should we know about you?

My wife, Ann, and I will have been married for 34 years this summer, and we have six children. I’ve been involved with some international work with several trips to Honduras, and assisting in opening a charity hospital in Iraq.